Understanding Bipolar Disorder and treatment

My sister told me that a well-known signer, Demi Lovato, announced that she has Bipolar Disorder. What is Bipolar Disorder?

Bipolar disorder is a mental health disease where a person’s mood can cycle back and forth between periods of low activity/depression and periods of mania/high activity. These emotional periods can be looked at as two opposite “poles” of emotion,” hence the term “bipolar.”

In the past, the condition was called “manic-depression” and this term is still used, but not as commonly as bipolar disorder. Bipolar disorder is a chronic medical condition. Like other chronic medical conditions, (e.g. high blood pressure) the goal is to manage and control, not cure. Many cases can last years or even a lifetime. Fortunately, there ae excellent treatments for bipolar disorder that dramatically affect the quality of life for those who suffer with bipolar disorder.

Incidence

Bipolar disorder is very common. In fact, over three million cases are diagnosed in the U.S. every year. It can occur at any age, but most commonly it is seen in ages 15 and 60. It often starts in late adolescence.

Diagnosis

The diagnosis must be made by a certified doctor, preferably a psychiatrist, primary care physician or psychologist. There are no lab tests to make the diagnosis. There are also several subtypes of bipolar disorder that will not be delineated in this article.

Depressive episodes

Patients may feel intensely sad, experience a strong sense of hopelessness, and feel extremely sluggish. The patients may feel low energy, low motivation and feel extremely worthless. They may have trouble concentrating and focusing and making decisions.

They may experience significant appetite changes, which may cause dramatic weight changes, and they may have periods of uncontrollable crying. They tend to focus on negative themes and may isolate themselves from others. Depressive phase patents may require more or even less sleep (insomnia). Patients may stay in bed for days and even contemplate death or suicide.

Manic episodes

During this phase patients experience high levels of energy and require very little sleep. They may become quite productive. Patients often describe feeling especially confident, very hopeful, and intensely excited. Often spectacular and unrealistic plans are made.

Patients can develop rapid speech, have an increased sexual drive, and are more prone to abusing drugs and alcohol. Decisions can be made both impulsively and rapidly, but not always with good outcomes causing a hallmark of bipolar disorder: poor judgment.

Bipolar Disorder may cause their mood to be elevated and joyful at one moment but rapidly change to being angry, irritable, aggressive and hostile. Patients with bipolar disorder, during a manic phase, can experience delusions (believe in things that are not true) and hallucinations (see things that are not really there). The term ‘hypomania’ is used for the manic state without hallucinations or delusions.

Cycling between depression and mania

Although most periods of mania or depression can last days to weeks, some periods of depression and mania can last for months and even years. Depressive and manic episodes may not always cycle back and forth. One emotional state may repeat itself several times before cycling to the other polar state. There are often periods of ‘normalcy’ between cycling to either the depressive of manic states.

Treatment

Treatments are designed to alleviate symptoms and include (usually in combination):

• Prescription medications
• Support groups
• Psychotherapy
• Cognitive behavioral therapy
• Family therapy
• Psychoeducational therapy
• Hospitalization

One of the most important items to acknowledge is that some patients with bipolar disorder may become suicidal during the depressive state. If someone has depression (for any reason), it is important to recognize the warning signs of suicidal risk and make sure help is obtained immediately.

Warning signs include:

• Talking about death
• Loss of participating in activities that were normally enjoyed
• Weight change
• Isolation
• Crying spells
• Giving away personal items
• Focusing in on negative or morbid themes
• Acting recklessly
• Increased drug/alcohol use

Demi Lavato was extremely courageous in publically acknowledging the successful treatment of her bipolar disorder. In fact, she is not alone, hundreds of well-known people have bipolar disorder as documented here: https://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder.

Remember, bipolar disorder cannot be cured, but there are many excellent treatments that can dramatically improve the quality of life and alleviate symptoms of both mania and depression. If you suspect that you or a loved one has bipolar disorder, call you primary care doctor today and get help. It could very well save a life.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.