Patients with bipolar I disorder have had at least one episode of mania. Some patients have had previous depressive episodes, and most patients will have subsequent episodes that can be either manic or depressive. Hypomanic and mixed episodes can occur, as well as significant sub-threshold mood lability between episodes. Patients meeting criteria for bipolar II disorder have a history of major depressive episodes and hypomanic episode only.
What Causes Bipolar Disorder?
Evidence from epidemiological and twin studies strongly suggests that bipolar disorder is a heritable illness. First-degree relatives of patients with bipolar disorder have significantly higher rates of mood disorder than do relatives of nonpsychiatrically ill comparison groups. However, the mode of inheritance remains unknown. In clinical practice, a family history of mood disorder, especially of bipolar disorder, provides strong corroborative evidence of the potential for a primary mood disorder in a patient with otherwise predominantly psychotic features. Likewise, the magnitude of the role played by environmental stressors, particularly early in the course of the illness, remains uncertain. However, there is growing evidence that environmental and lifestyle features can have an impact on severity and course of illness. Stressful life events, changes in sleep-wake schedule, and current alcohol or substance abuse may affect the course of illness and lengthen the time to recover.
Key Points About Bipolar Disorder
Bipolar I
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History of manic or mixed episodes
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Major depressive episodes typical but not required for diagnosis
Bipolar II
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One or more episodes of hypomania
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No manic or mixed episodes
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History of Depression
Some types of psychotherapy such as family-focused and cognitive-behavioral therapies are effective in preventing relapses. Although the research clearly demonstrates that bipolar often has an organic origin, psychotherapy has been proven to be an effective treatment.
Medical Treatment for Bipolar Disorder
Medication is commonly used in the treatment of bipolar disorder. Some regularly prescribed medications include:
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Mood stabilizers: These medications stabilize a person’s mood in order to avoid the highs and lows typically associated with bipolar. Lithium is one example of a mood stabilizer. Lithium has potentially serious side effects, though; people taking this medication are encouraged to have their blood monitored regularly.
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Anticonvulsants: These medications are typically used to treat seizures, but have been found to be effective in mood stabilization as well. Potential side effects of these medications include risk of suicidal thoughts and behaviors. People taking these medications should be closely monitored for new or worsening signs of depression.
- Atypical antipsychotics: These medications are often used in the treatment of schizophrenia, but have also been found to be effective for treating bipolar (especially manic symptoms). Examples include Zyprexa (olanzapine), Abilify (aripiprazole), Seroquel (quetiapine), and Risperdal (risperidone).
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Antidepressants: Antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) can be used to treat depressive symptoms of bipolar. However, use of these medications can cause a manic or hypomanic episode. For that reason, these medications are typically used in combination with a mood stabilizer.
Medical treatment of bipolar disorder also includes hospitalization in some cases. Hospitalization for the purpose of stabilization is typically brief. Hospitalization may be necessary if the following symptoms are present:
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Thoughts of hurting self or others
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Hallucinations
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Delusions
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Insomnia that persists for several days
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Inability to care for oneself