• More than 2 million American adults are diagnosed with bipolar disorder.
• Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. (Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40.)
• Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. (Llewellyn A, Stowe ZN, Strader JR Jr. The use of lithium and management of women with bipolar disorder during pregnancy and lactation. Journal of Clinical Psychiatry, 1998; 59(Suppl 6): 57-64; discussion 65.) 
• There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. (Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-50.)
• Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication. (Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 2000; 48(6): 558-72.)

• People with bipolar disorder often have abnormal thyroid gland function.  Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.  People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation. (Goodwin FK, Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990.)

• Like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder. (Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated with St. John's wort. Biological Psychiatry, 1999; 46(12): 1707-8.)

• In a 2005 study, Jules Angst and his colleagues at Zurich University tracked 406 patients with major mood disorders over a 20-year period. Of 309 patients presenting with depression, 121 (39.2 percent) eventually manifested as bipolar (24.3 percent to bipolar I, 14.9 percent to bipolar II). In all, more than 50 percent of the study population turned out to have bipolar disorder.

• In mid-2003, a twin study was published concerning environmental factors and bipolar disorder. The bipolar twin was found to be far more affected by changes in sunlight. Longer nights resulted in mood and sleep-length changes far greater than the healthy twin. Sunny days also did more to improve mood. In fact, natural light in general was found to have a profound positive effect upon the well-being of the bipolar twin. (Hakkarainen R, et al. (2003). Seasonal changes, sleep length and circadian preference among twins with bipolar disorder. BMC Psychiatry 3 (1), 6.)

• In the 2004 publication of a study using Tel Aviv's public psychiatric hospitals, it was found that "Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature". (Shapira A, et al. (2004). Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature. Bipolar Disorder Feb;6 (1), 90–3)

• In order for a person to be properly diagnosed with bipolar disorders, the mood episodes cannot be due to external medication, drugs or treatment for depression.

• There is no cure for bipolar disorder; the emphasis is on management of the symptoms. A variety of medications are used to treat bipolar disorder; many people with bipolar disorder are prescribed multiple medications (sometimes up to five). Some people with bipolar disorder add to or replace their Western medication with herbal or holistic options. Still, even with optimal medication treatment, many people with the illness have some residual symptoms. Cognitive therapy may to lessen the severity of mood swings by recognizing and managing triggering symptoms or events.

• Many psychiatrists continue to prescribe topiramate and gabapentin for bipolar disorder, although this is becoming increasingly controversial.

• A 2000 study reported that bipolar disorder patients had varying degrees of problems with short- and long-term memory, speed of information processing, and mental flexibility. Medications used for bipolar disorder, however, could have been responsible for some of these abnormalities and more research is needed to confirm or refute these findings.

• The economic burden of bipolar disorder is significant. In 1991, the National Institute of Mental Health estimated that the disorder cost the country $45 billion, including direct costs (patient care, suicides, and institutionalization) and indirect costs (lost productivity and involvement of the criminal justice system). In spite of the obvious need for professional help, access to medical therapies is not always available for patients with bipolar disorder. In one major survey, 13% of patients had no insurance and 15% were unable to afford medical treatment.

• A 2002 study reported that 58% of bipolar patients were overweight, with 26% meeting the criteria for obesity. Being overweight is a significant risk factor for diabetes and so it may be the common factor in both diseases. Drugs used to treat bipolar also pose a risk for weight gain and diabetes. Common genetic factors have also been implicated in diabetes and bipolar disorder, including those causing a rare disorder called Wolfram syndrome and those that regulate carbohydrate metabolism

Patterns and severity of symptoms, or episodes, of highs and lows, determine different types of bipolar disorder.

• is characterized by one or more manic episodes or mixed episodes (symptoms of both a mania and a depression occurring nearly every day for at least 1 week) and one or more major depressive episodes. Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes.

• is characterized by one or more depressive episodes accompanied by at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes but are less severe, but must be clearly different from a person’s non-depressed mood. For some, hypomanic episodes are not severe enough to cause notable problems in social activities or work. However, for others, they can be troublesome.

• is characterized by chronic fluctuating moods involving periods of hypomania and depression. The periods of both depressive and hypomanic symptoms are shorter, less severe, and do not occur with regularity as experienced with bipolar II or I. However, these mood swings can impair social interactions and work. Many, but not all, people with cyclothymia develop a more severe form of bipolar illness.

• When the bipolar disorder is not characterized by any of the above mentioned types of bipolar disorder.  The experiences of bipolar disorder vary from person to person. Occasionally someone will experience the symptoms of a manic episode and a major depressive episode, but not fit into the above mentioned types of bipolar disorder. This is known as Bipolar Disorder Not Otherwise Specified. Just like the other types of bipolar disorder, Bipolar Disorder Not Otherwise Specified is a treatable disorder.

• Rapid Cycling:  4 or more episodes of mania and/or depression in a year.  While mood changes with bipolar disorder typically occur gradually, with bipolar rapid cycling, a full cycle can be completed within days (some individuals even complete a cycle in hours). This pattern of rapid cycling is seen in approximately 5 to 15 percent of patients with bipolar disorder and tends to develop late in the disorder.  Because those who rapid-cycle represent a moving target so-to-speak, and because of the instability of their condition, this group of people are notoriously difficult to treat, with high rates of failure. Women are more likely than men to be rapid-cyclers.

The "kindling" theory suggests that persons who are genetically prone toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Then at some point these mood changes occur spontaneously.[1] The person then "becomes bipolar". This might explain why the cause of bipolar disorder is difficult to pinpoint but is somehow related to genetic and/or genetic and enviromental causes. People can also be "prone" to bipolar disorder after substance abuse, or because of a neurological condition or brain damage. However, if drug abuse can be linked to bipolar symptoms, they may not recur. Adderall and other drugs and amphetamines (including meth) have been cited as producing mania, even if the drug is not in the bloodstream. For such a patient, the euphoria of the Adderall might not wear off as quickly as it may for others. They may exhibit manic symptoms while on the drug.

• Increased energy, activity, and restlessness
• Excessively "high," overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can't concentrate well
• Little sleep needed
• Unrealistic beliefs in one's abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

For a diagnosis of a manic episode, these are the signs and symptoms doctors are looking for:

A.  A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

B.  During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity

2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3. more talkative than usual or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying spree, sexual indiscretions, or foolish business investments)

C.  The symptoms do not meet criteria for a mixed episode.

D.  The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Hypomania:

Hypomania is often not especially problematic for the patient, as he or she typically feels very energetic and in a very good mood. As such, hypomania is often unreported and undiagnosed (this is perhaps the biggest cause of incorrect diagnoses between unipolar and bipolar depression.) Some patients experience only hypomania; in others, hypomania progresses into a full manic state in which the patient has more and more trouble retaining control, and the symptoms become more problematic. For some people, hypomania is an acceptable baseline.  Virtually nothing is known about treating hypomania. Conceivably patients in hypomania, if otherwise stable, could be treated with reduced medication doses, various forms of talking therapy, or relaxation exercises, but there are no studies to guide patients and psychiatrists. On one hand, mild hypomania may be a legitimate baseline for some patients. For others, hypomania may signal the beginning of a cycle into more severe mania, necessitating immediate intervention.

For a diagnosis of a hypomanic episode associated with bipolar disorder, these are the signs and symptoms doctors are looking for:

A.  A distinct period of persistently elevated, expansive; or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B.  During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity

2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3. more talkative than usual or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C.  The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D.  The disturbance in mood and the change in functioning are observable by others.

E.  The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

Depression:

Those with Bipolar Disorder generally experience more depressive episodes than those involving mania.

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, a feeling of fatigue or of being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much, or can't sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

For a diagnosis of a major depressive episode, these are the signs and symptoms doctors are looking for:

A.  Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) Note: In children and adolescents, can be irritable mood.

2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gains.

4. insomnia or hypersomnia nearly every day

5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness of being slowed down)

6. fatigue or loss of energy nearly every day

7. feelings of worthlessness or excessive or inappropiate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B.  The symptoms do not meet criteria for a Mixed Episode.

C.  The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E.  The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Mixed Episode:

When symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and negative thinking, some of which may be automatic.  In a mixed state, depressed mood accompanies manic "activation". Also known as dysphoric mania (from Greek dysphoria: dys, difficulty, phorós, bearer); it does not display euphoric characteristics.

For a diagnosis of a mixed episode of bipolar disorder, these are the signs and symptoms doctors are looking for:

A.  The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B.  The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Manic & Depressive Psychosis:

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms include

• hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there)
• delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts).

Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

MEDICATIONS & SIDE EFFECTS:

Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth.

• Lithium

• Depakote (valproate)
  • May increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.
• Tegretol (carbamazepine)
• Lamictal (lamotrigine)
• Neurontin (gabapentin) - See the following sites:
  • Lawsuit: Drug Company Illegally Marketed Neurontin for Bipolar Disorder (http://bipolar.about.com/cs/neurontin/a/neurontin_suit.htm)
  • Neurontin in Bipolar Disorder (http://www.psycheducation.org/depression/meds/neurontin.htm)
  • Neurontin Lawsuit - Art of Deception (http://www.legalnewswatch.com/Neurontin_report.html)
  • Dateline NBC interview: Drug Giant Accused of False Claims (http://www.antidepressantsfacts.com/2003-07-11-Warner-Lambert-whistleblower.htm)
• Topamax (topiramate)

• Clozaril (clozapine)
• Zyprexa (olanzapine)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Geodon (ziprasidone)

• Klonopin (clonazepam)
• Ativan (lorazepam)

• Ambien (zolpidem)

• Electroconvulsive Therapy (ECT)

• Omega-3 Fatty Acids:  Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder. (Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 1999; 56(5): 407-12.).  Omega-3 fatty acids are polyunsaturated fatty acids which can be found in wild salmon, flaxseed and walnuts. To receive a significant dose, however, omega-3 fatty acids must usually be taken in the form of a fish oil supplement. It has been hypothesized that the therapeutic ingredient in omega-3 fatty acid preparations is eicosapentaenoic acid (EPA) and that supplements should be high in this compound to be beneficial.  It has been hypothesized that bipolar disorder may be the result of poor membrane conduction in the brain and that one possible cause may be a deficiency in omega-3 fatty acids. Following an encouraging small-scale study conducted by Andrew Stoll at Harvard University's McLean Hospital, the Stanley Foundation is sponsoring research regarding the beneficial claims, and several large scale trials of treatment using omega-3 fatty acids are under way.
• In 2005 two double blind placebo controlled studies were underway at Harvard University and University of Calgary to determine if the trends noted in several open label trials using a mineral, vitamin and amino acid supplement called E.M. Power would continue to demonstrate effectiveness. In preliminary studies, as many as 70% of patients taking the supplements were free of symptoms after slowly having withdrawn from psychotropic medications.

• Genetics or Biology

  • Oversecretion of cortisol, a stress hormone.

  • Excessive influx of calcium into brain cells.

  • Abnormal hyperactivity in parts of the brain associated with emotion and movement coordination and low activity in parts of the brain associated with concentration, attention, inhibition, and judgment.

  • One interesting theory proposes that people with bipolar disorder have a superfast biologic "clock", which is actually a tiny cluster of nerves called the supra chiasmatic nucleus or SCN. It is located in the hypothalamus (in the center of the brain) and it regulates a person's circadian rhythm, the daily cycle of life, which influences sleeping and waking.

• Environmental Factors such as stressful events.
• The high rate of winter births in those who develop bipolar disorder (as well as schizophrenia) has encouraged researchers to look at infectious agents as a possible cause or trigger of these mental disorders.
  • Borna Virus. The Borna virus is among the infectious agents being intensively studied. This virus is known to cause serious central nervous system injuries in animals, but not in people. A few studies using sensitive blood testing, however, have detected strong evidence of the infection in psychiatric patients. Some researchers believe that the virus may cause subtle changes in human brain (in contrast to the more dramatic inflammation seen in animals) leading to a range of mental illnesses. It should be noted, however, that other research has not supported the association. Some researchers argue that psychiatric illnesses may suppress the immune system, making some individuals more susceptible to infection by the Borna virus or other microbes.
  • Herpes Simplex. Another possible viral link under study is herpes simplex virus 2 (HSV-2). Adult children of mothers with HSV-2 prior to delivery may have a greater risk of developing bipolar disorder and other psychoses, according to research published in 2001.

• Obsessive Compulsive Disorder
• Anxiety Disorder
• Alcohol & Substance Abuse
  • Up to 60% of patients with bipolar disorder abuse other substances (most commonly alcohol, followed by marijuana or cocaine) at some point in the course of their illness.
• Nicotine
  • Nicotine addiction is very common in people with bipolar disorder, and in the view of some, may be an active precursor to mature onset of both bipolar affective disorder and other forms of clinical depression in general.  Cigarette smoking is prevalent among bipolar patients, particularly those who have frequent or severe psychotic symptoms. Some experts speculate that, as in schizophrenia, nicotine use may be a form of self-medication because of its specific effects on the brain; further research is necessary.
• Drugs like Adderall, Ritalin or any stimulant can produce mania, but often times this is not actually bipolar disorder, but a singular manic episode. This is valid according to the DSM.
• Migraine Headaches
  • Migraines are common in patients with a number of mental illnesses, but they are particularly common among bipolar II patients. In one study, 77% of bipolar II patients had migraines while only 14% of bipolar I had this headache, suggesting that difference biologic factors may be involved with each bipolar form.
• Hypothyroidism
  • Hypothyroidism (low thyroid levels) is a common side effect of lithium, the standard bipolar treatment. However, evidence also suggests that bipolar patients, particularly women, may be at higher risk for low thyroid levels regardless of medications. It may in fact be a risk factor for bipolar disorder in some patients.
• Other mental disorders associated with bipolar disorder include: Anorexia Nervosa, Bulimia Nervosa, Panic Disorder, and Social Phobia.

• Another avenue for treatment that has, at times been curative for resolving manic psychosis is by treating an underlying infections such as Lyme disease. Results in these cases suggest that the term bipolar disorder may not accurately represent the actual biological disorders which meet the DSM-IV requirement for a bipolar disorder. For an unknown number of patients, the problem may be a kind of immune mediated disorder provoked by Lyme disease (Toxoplasmosis, Bornea virus), or any or a number of other chronic infections, including something as common as the flu.
• AIDS, a brain tumor or head injury, diabetes, epilepsy, Lupus, Multiple Sclerosis, a salt imbalance or thyroid disorder can produce bipolar-like symptoms.

Sources:

• NIMH: Bipolar Disorder website (http://www.nimh.nih.gov/publicat/bipolar.cfm)
• Bipolar Disorder - Wikipedia, the free encyclopedia website http://en.wikipedia.org/wiki/Bipolar_disorder#endnote_Shap_2004

Disclaimer:  The information posted on this website is for educational purposes only. We are not licensed Medical Doctors & do not intend to substitute the advise of professionals. The information presented is based on our opinions on the benefits of alternative treatment vs. drugging for treatment. Some of our sources include websites of licensed Medical Doctors & websites of others sharing our opinions. Any mention on this site of alternative treatment & healing through natural remedies, organic or herbal, have not been evaluated by the FDA. Again, some  information on this site is based solely on personal experiences & personal opinions & is protected under Free Speech.