Mental Health and Illness - Bipolar Disorder

Bipolar disorder, also known as manic depression, is characterized by alternating periods of persistently elevated, expansive, or irritable mood—called mania—and periods of depression. During a manic episode, a person may feel inflated self-esteem, decreased need for sleep, unusually talkative or pressure to keep talking, and easily distracted. He or she may also have flights of ideas, racing thoughts, increased goal-directed activity such as shopping, and excessive involvement in high-risk activities. (See Table 8.3 for symptoms of bipolar disorder.) According to the NIMH, bipolar disorder strikes about 2.3 million adult Americans, about 1.2% of the population, and it affects males and females equally.

In the early stages of the illness, patients may experience few symptoms or even symptom-free periods between relatively mild episodes of mania and depression. As the illness progresses, however, manic and depressive episodes become more serious and more frequent. Patients are less likely to experience intermissions, manic euphoria is increasingly replaced by irritability, and depressions deepen. Some individuals suffer psychotic episodes during periods of mania or depression. Bipolar disorder is one of the most lethal illnesses. According to Frederick K. Goodwin and Kay Redfield Jamison in their Manic-Depressive Illness (New York: Oxford University Press, 1990):

Patients with depressive and manic-depressive illnesses are far more likely to commit suicide than individuals in any other psychiatric or medical risk group. The mortality rate for untreated manic-depressive patients is higher than it is for most types of heart disease and many types of cancer.

The onset of bipolar illness is usually a depressive episode during adolescence. Manic episodes may not appear for months or even years. During manic episodes adolescents are tireless, overly confident, and tend to have rapid-fire or pressured speech. They may perform tasks and schoolwork quickly and energetically but in a wildly disorganized manner. Manic adolescents may seriously overestimate their capabilities, and the combination of bravado and loosened inhibitions may prompt them to participate in high-risk behaviors, such as vandalism, drug abuse, or unsafe sex.

Treatments for Bipolar Disorder

Lithium has been widely used to treat bipolar disorder since the 1960s, and it is still the medication of choice for controlling the illness. In the 1970s psychiatrists also began using anticonvulsant drugs, including valproate, carbamazepine, and clonazepam to treat patients who could not tolerate lithium or for whom the drug did not work. Chlorpromazine and haloperidol, both antipsychotics, are also helpful in some cases. Antimanic and antipsychotic agents are often combined with antidepressants to relieve depressive symptoms and promote better sleep patterns, an important factor in maintaining patients' mood stability. These medication strategies have proven highly effective in treating bipolar disorder; however, many patients still experience a residual pattern of ups and downs

Medications may become less effective over time and have to be changed. Another major concern among practitioners and patients are medication side effects, especially of lithium. Because therapeutic blood levels of the drug are very close to fatal levels, patients taking lithium must consume adequate amounts of water and salt to prevent dehydration, which would cause lithium blood levels to rise to toxic levels. People who take lithium must have their blood levels of the drug checked frequently, and they must also be aware of the signs of lithium poisoning. Long-term usage of the drug has been shown to cause kidney damage; adequate consumption of water and careful dosage monitoring are believed to reduce the risk of kidney disease.