Bipolar Mood Disorder

Bipolar Mood Disorder

Postby Bob » Mon Sep 03, 2007 2:23 pm

Bipolar disorder is the third most common mood disorder after major depression and dysthymic disorder. My father has been diagnosed with Bipolar I, and it's becoming more and more evident that I too, may have a bipolar mood disorder. The characteristic signs of Bipolar Mood Disorder are manic, hypo-manic, major depressive, and mixed mood episodes over short periods of time.

A bipolar person experiences mania, where the person's mood is abnormally and constantly elevated, expansive, or irritable and impulsive or reckless behavior; hypo-mania, the person shows a high level of energy, excessive moodiness or irritability, Hypomania may feel good to the person who experiences it, so even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong; major depressive states, when the person is depressed or has a loss of interest in pleasure; and mixed episodes, often including agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking; all of which can last about a week or as long as years and are sudden. Severe depression or mania may be accompanied by periods of psychosis. Psychotic symptoms include: hallucinations (hearing, seeing, or otherwise sensing things which do not exist) and delusions (false beliefs that are illogically held despite evidence to the contrary). In its early stages, bipolar disorder may be mistaken for a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.

There are 3 main forms of bipolar disorder; Bipolar I, Bipolar II and Cyclothymic. Bipolar I is characterized by manic or mixed states followed by intense depressive states. Bipolar II is the opposite end of the spectrum, differentiated by major depressive states followed by hypo-manic states. Bipolar I and Bipolar II's symptoms occur regularly and they, as the names infer, often go from pole to pole (depressive to manic and vice versa) without a pause in the middle. Milder than Bipolar I and II, Cyclothymic disorder has states of hypomania, and depression.
Cyclothymic's symptoms are often shorter and less severe. They also don't occur with regularity.

There are other bipolar disorders, not otherwise specified, which do not fall under the above labels. The secondary bipolar disorders have many of the above symptoms, but since everyone's experience of bipolar is different, not everyone fits into neat little categories. These secondary bipolar categories can be treated just as the above.

Symptoms:

Mania:

Inflated Self-Esteem or Grandiosity. This symptom can range from extreme self-confidence to delusional grandiosity. People may believe that they can do things that they have no talent or training to do, such as win an Olympic medal, head the United Nations, or compose a symphony. Sometimes people claim to have powerful friends, such as government leaders, that are protecting them. Keep in mind that not everyone who makes claims such as these is manic or delusional; always make sure you know more of a person 's background before dismissing his or her ideas as inflated self-esteem.

Decreased Need for Sleep. This is one of the most common symptoms of a manic episode. People may get only a few hours of sleep a night, or may go for days without sleep and still seem to be (and claim to feel) refreshed and energetic.

Extremely Talkative/Pressured Speech. Speech becomes loud, fast, and difficult to interrupt. Family or friends may notice that a person is talking much more than usual.

Distractibility. People who seem to be easily distracted or have trouble concentrating on any one task may be experiencing this symptom. People with this symptom may be unable to carry on a logical conversation for any length of time.

Racing Thoughts/Flight of Ideas. For many people experiencing this symptom, it seems that thoughts are flying through their minds. Some people compare their thought process to watching two or three TV sets at once. Conversation may switch from topic to topic, with loose connections between topics.

Excessive Involvement in Pleasurable Activities. Involvement in pleasurable activities is considered a symptom of mania when it results in negative consequences. People experiencing this symptom may spend a lot of money on strange and/or excessive purchases. People may spend well beyond their means, sometimes buying many copies of one item or a collection of items that are all related to each other in a peculiar way. This symptom could also appear as sexual behavior that is excessive and unusual for the person. This is sometimes called "hyper-sexuality" and can range from fantasizing excessively and being preoccupied with sex to actual behavioral excess, or acting out in a sexual manner.

Increase in Goal-Directed Activity/Agitation. High levels of activity are often aimed at accomplishing work or social goals. People experiencing this symptom may begin many different projects at one time or try to do more than is realistically possible. For example, in a single morning, a person may decide to mop the floor twice, paint the roof, mow the lawn, fill a pothole near the driveway and write letters to everyone that he or she graduated with from high school. Agitation (or restlessness) is another symptom. People may feel they have too much energy and can 't sit still. Many people find themselves becoming easily irritated.

Hypo-mania: Hypo-mania has the same symptoms as mania, but a hypo-manic episode does not cause significant impairment to a person 's normal functioning, at work or in social situations or require hospitalization and doesn't include any psychotic features, such as hallucinations or delusions.

Depressive Mood: This can include a sad, cranky or irritable mood, excessive physical complaints and apathy.

Loss of Interest in or Pleasure from Most Activities. This may take the form of "not caring anymore" or loss of interest in hobbies. For example, someone who loves golf may suddenly find excuses not to play. This may also show up as a decreased interest in sex. Your physician may call this lack of interest "anhedonia."

Indecisiveness or Diminished Ability to Concentrate. This may take the form of being easily distracted or having memory difficulties. Jobs that require concentration may become almost impossible to perform.

Sleeping Difficulties. Insomnia can mean difficulty falling asleep, waking and restlessness during the night, or waking up earlier than usual and not being able to fall back to sleep. Hyper-somnia, or feeling sleepy and napping all the time, is less common but also occurs.

Feelings of Worthlessness or Excessive Guilt. This symptom includes unrealistic negative self-evaluations, unrealistic self-blame, or very low self-esteem. Sometimes, a sense of guilt can also reach delusional proportions (such as feeling that you are to blame for world poverty).

Fatigue or Loss of Energy. Minor physical activity (such as getting dressed) may feel like a huge exertion and may take much longer than normal.

Mixed Episodes: Mixed Episodes have a combination of the symptoms of depressive and manic states. Again, mixed episodes take place over a short period of time. Symptoms can come and go daily or even hourly.

Treatment:

Most people with manic-depressive illness can be helped with treatment. Almost all people (even those with the most severe forms) can obtain stabilization of their mood swings. Because manic-depressive illness is usually long-term illness, and symptoms often relapse, long-term preventive treatment is highly recommended. A variety of medications are used to treat manic-depressive illness, but even with optimal treatment, many people with manic-depressive illness do not achieve full remission of symptoms.

Lithium has long been used as a first-line treatment for manic-depressive illness. This medication works by altering neurotransmitters, but the specific way lithium alleviates the symptoms of Bipolar disorder is unknown. It may be used in combination with tranquilizers or antidepressants. The single most important use of lithium is in preventing new episodes of mania and depression.

Most common side effects Diarrhea, dizziness, drowsiness, increased thirst and urine volume, increase white blood cells, nausea, tremors, weight gain, abnormal changes in heart rate

Occasional side effects Blurry vision, skin problems, metallic taste, joint pain, ringing in ears, unsteadiness, loss of bladder control, abnormal thyroid
function, low potassium, inhibited erection, edema (excessive fluid accumulation in body tissues)

Least common side effects Parkinsonism, hair loss, abnormal movements, elevated blood calcium or sugar, "blackout" spells, seizures

Carbamazepine, Sodium Divalproex (Depakote), Tegratol and valproate (mood-stabilizing anticonvulsants) are drugs which were originally developed for use in epilepsy, but which have also been found useful in bipolar illness, especially for patients who do not respond to other treatment. Anticonvulsant drugs have been used as alternatives to lithium in many cases, but often these drugs are combined with lithium for the greatest effect. It may be that these drugs work because they prevent the brain from becoming sensitized to stress. This process has been suggested to be important in bipolar disorder, so that eventually the brain shows episodes of abnormal activity even in the absence of an external trigger. It is thought that lithium acts to block the early stages of this process and that carbamazepine and valproate act later.

Depakote's side effects:

Most common side effects Drowsiness, diarrhea, nausea, vomiting, fatigue/weakness, tremor (at high doses), headache, asthenia

Infrequent side effects Indigestion, stomach cramps, slurred speech, insomnia, nervousness, respiratory infection, blurred vision, flu syndrome

Rare side effects/Risks Liver irritation, pancreas problems, weight gain, tinnitus, hallucinations/psychosis

Tegretol's side effects:

Most common side effects dry mouth and throat, constipation, impaired urination, decreased sense of taste, dizziness, drowsiness, unsteadiness, loss of appetite, nausea, vomiting, indigestion, diarrhea

Occasional side effects lowering of white blood cells, fatigue, blurred vision, confusion, male infertility, photosensitivity

Risks agranulocytosis (a severe and potentially fatal acute deficiency of certain blood cells), aplastic anemia, liver irritation, vitamin D deficiency, low thyroid hormones

During a depressive episode, people with manic-depressive illness commonly require treatment with antidepressant medication. For depressive symptoms, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate. Usually, lithium or anticonvulsant mood stabilizers are given together with an antidepressant to protect against a switch into mania or rapid cycling, which can be brought about in some people with manic-depressive illness by the use of antidepressant drugs. Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine maleate) and Celexa (citalopram hydrobromide) are popular examples of anti depressants.

Most common side effects Decreased appetite, weight loss, nausea, altered taste, insomnia, headache

Infrequent side effects Blurred vision, anxiety, nervousness, drowsiness, dizziness, excessive sweating, anorexia, impaired erection

Rare side effects/Risks Hypomania, seizures, tremor

In some cases, the newer, atypical antipsychotic drugs such as clozapine, risperidone or olanzapine may help relieve severe or treatment-resistant symptoms of manic-depressive illness and prevent relapse of mania. Further research is necessary, however, to establish the safety and efficacy of the atypical antipsychotics as long-term treatments for manic-depressive illness. The high potency benzodiazepines clonazepam and lorazepam may be useful when added to other drugs. They may also help to reduce sleep problems.

Clozapine has many side effects but the numbers aren't all in yet. Some of the side effects include, but are not limited to weight loss/gain, headaches, sedation, dizziness, hypo-tension, salivation, constipation, nausea, seizures and Agranulocytosis an acute blood disorder (often caused by radiation or drug therapy) characterized by severe reduction in granulocytes.

Risperidone & olanzapine's side effects

Most common side effects sleepiness, agitation, anxiety, uncontrolled movements, headache, and nasal stuffiness and irritation, insomnia, dizziness

Infrequent side effects dizziness, constipation, nausea, vomiting, upset stomach, abdominal pains, increased saliva, rapid heartbeat, chest pains, fever, skin rash, headache, depression, weight gain

Rare side effects/Risks neuroleptic malignant syndrome (NMS), uncontrolled movements, life-threatening abnormal heart rhythm, abnormal movements, orthostatic hypotension (low heart rate upon standing)

Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications. Psychotherapy, in combination with medication, often can provide additional benefit. As an addition to drug treatment, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family. While used to treat a variety of psychiatric disorders, it is most effective in the treatment of severe depression, and provides the most rapid relief currently available for this illness.

The most common risks associated with ECT are disturbances in heart rhythm and broken or dislocated bones, which occur very rarely. Muscle relaxants and sedatives are used to relax the body during the induced seizures

My father's experience with Bipolar left him at a loss. He didn't like his medication and was on and off many times. He stopped taking his medication very soon after leaving the hospital; he was hospitalized for 8 days for a nervous breakdown related to his mood disorder. One Bipolar patient described Depakote, one of the medications my father was on, as an out of body experience. He felt as though he were maybe a few inches off his physical representation. He went on to say there was an episode in which he was sitting for an hour trying to align himself with his body. He says he ended up on his back, on the floor, after falling out of the chair.

After a traumatic early life, Ms. Andrews, 21, was diagnosed as being Bipolar II. She is quoted as saying she “couldn't tell if [she] was manic, only the depressive states in early life, but now its much easier to see.” She was put into several group homes and hospitalized between the ages of twelve and thirteen. She says her latest episode of depression started September 11th 2001 and has yet to recede. Her highs can be as short as an hour or as long as a couple of weeks. She realizes that the onsets for her mood changes are sudden and anything can make them worse.

She went on to say “I couldn't afford to miss work in order to survive.” She currently holds a job as shift manager at a convenient store. “I do everything.” She says. She does “the paperwork, payroll, stocking, customer service, and ordering.”

She believes that her boss and all the customers are out to get her fired. She has confronted both and not with positive outcomes.

Her most recent depressive state was capped off with suicidal/homicidal thoughts of taking her boss with her out of a 3rd story window. She said she sat in her chair thinking of the possibilities that were available to her to kill her boss. She was written up for some actions she refused to go into and ended up giving her boss a piece of her mind. She ended the confrontation with saying she was going to quit. She recognized it as being a bad decision, because she was behind on rent as things were and had no job as back up, and that drew her deeper into her already depressive state.

During her most rapid change of mood she began the day depressed, called her ex boyfriend, suicidal, he came over to aide her, she talked to him and they ended up kissing. The kiss triggered a manic stage that helped her get through the day. Once she arrived home she called her ex boyfriend again and felt as though he was ignoring her, ending her manic stage. She sat in her room thinking about the meaning of the kiss and if they were going to get back together, and that lead to another suicidal depression. She spent 4 months in the hospital.

She says she has done drastic things while manic that she knows were wrong and or not beneficial to her. From moving in with people 2 weeks after meeting them to the above “suicidal” homicidal thoughts, to extreme spending sprees, she has had it all.

It seems she has a desire to be needed. If she has a project or something to occupy her mind while she is depressed or manic she seems to calm into some form of normalcy. “I do well, like at my old job when they said ‘reset this department to look like this diagram by tomorrow because the big wigs are gonna be here tomorrow,’ I would kill myself to get it done and love it.”

I asked her to describe her mania. “Fast talk, fast thoughts, big plans,” she elaborated to say, “It’s like having all the energy in the world, and nowhere to put it.” She felt as though she had a purpose when manic. “When I was with my ex boyfriend I would sit there in my manic states and dream of the day we would be married. Right down to the color of the brides maid’s dresses.”

In her current state she referred to her bipolarity as though it were a super power. She repeatedly said she used it for good. She now spends time with children, donating her time at charities to help them. She attributed her intense love to help the children to one of her dreams to become a doctor and to her lack of a childhood, which she “lost” due to her bipolar childhood.

Causes of Bipolar Mood Disorder

Bipolar disorder tends to run in families, and is believed to be inherited in many cases. More than two-thirds of people with manic-depressive illness have at least one close relative with the disorder, or with major depression. This suggests that genetic factors are important, and it is likely that susceptibility to the illness is related to several genes. However, the specific genes involved have not yet been conclusively identified. Once this is achieved it is hoped that it will be possible to better treatments and prevention strategies aimed at the underlying illness process.

It may be that the development of bipolar disorder is due to a process of sensitization (kindling). This idea suggests that the first episodes of the illness are triggered by stressful life events, but that each episode of the illness causes changes in the brain, which make the next episode more likely, and eventually episodes occur spontaneously. This process was first described as an explanation for epilepsy, and may explain why certain antiepileptic drugs are also effective in the treatment of bipolar disorder.

Since it is thought that faulty nerve transmission may be one cause of bipolar disorder, it is possible that neurotransmitters are involved. Examples include dopamine, serotonin, acetylcholine, GABA and glutamate.

Unipolar Mood Disorder

Unipolar disorder, also known as major or clinical depression is similar to Bipolar Mood Disorder, characterized by being sad, or in a depressed mood, anhedonia (inability to enjoy activities normally enjoyed), difficulty in sleeping or excessive sleeping, lethargy or agitation, appetite/weight loss or gain, loss of energy, onset of fatigue, low self-esteem, feelings of worthlessness and guilt, difficulty in concentrating and/or recurrent thoughts of suicide.

Unipolar differs in that it doesn’t have the intense highs that Bipolar Mood Disorder does. Although it can have sudden onsets, it fluctuates more smoothly between normalcy and lows.. Unipolar Mood Disorder is most common in people of a lower socioeconomic status and women.

Both Unipolar Mood Disorder and Bipolar Mood Disorder are incurable. People who are diagnosed with either polar disorder will have it for the rest of their lives. For best results preventative medication is required.

Health-Center.com 2000
Janssen-Cilag 2002
Harvard Bipolar Research Program 2001
Bob
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