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* Bipolar disorder causes big mood swings. You can switch from periods of very high energy (manic phases) to periods of sadness (depression). Medicines can help control mood swings. Counseling is important to help you recognize your mood swings.
* This illness can be very hard to diagnose. The earlier it is identified and treated, the better your chances of getting it under control.
People often have to try several different medicines before finding what works for them. Regular checkups are important so that your doctor can tell if your treatment is working.
* People often stop their daily medicines during a manic phase because they feel good. But this is a mistake. You must take those medicines regularly, even when you feel fine.
* Learning to recognize when a manic phase may be coming on is important so that you can start treatment early with medicine that is especially for manic phases. Charting your moods is one way you can figure out your patterns and symptoms.
* Having this disorder can make you feel helpless and hopeless. But you are not alone. Talking with others who suffer from it may help you learn that there is hope for a better life.
* Family members often feel helpless when a loved one is depressed or manic. If a loved one has bipolar disorder, you may want to get counseling for yourself. Therapy can also help a child who has a bipolar parent.
What is bipolar disorder?
Bipolar disorder is an illness that causes extreme mood changes that switch from manic episodes of very high energy to the extreme lows of depression. It is also called manic-depressive disorder.
This illness can cause behavior so extreme that you cannot function at work, in family or social situations, or in relationships with others. Some people with bipolar disorder become suicidal.
Having this disorder can make you feel helpless and hopeless. But you are not alone. Talking with others who suffer from it may help you learn that there is hope for a better life. And treatment can help you get back in control.
Family members often feel helpless when a loved one is depressed or manic. If your loved one has bipolar disorder, you may want to get counseling for yourself. Therapy can also help a child who has a bipolar parent.
What causes bipolar disorder?
The cause of bipolar disorder is not completely understood. We know that it runs in families. It may also be affected by your living environment or family situation. One possible cause is an imbalance of chemicals in the brain.
What are the symptoms?
The symptoms depend on your mood swings. In a manic episode, you may feel very happy, energetic, or on edge. You may feel like you need very little sleep. You may feel overly self-confident. Some people spend a lot of money or get involved in dangerous activities when they are manic.
After a manic episode, you may return to normal, or your mood may swing in the opposite direction to feelings of sadness, depression, and hopelessness. When you are depressed, you may have trouble thinking and making decisions. You may have memory problems. You may lose interest in things you once enjoyed. You may also have thoughts about killing yourself.
The mood swings of bipolar disorder can be mild or extreme. They may come on slowly over several days or weeks or suddenly over a few minutes or hours. The mood swings may last for a few hours or for several months.
How is bipolar disorder diagnosed?
Bipolar disorder is hard to diagnose. There are no lab tests for it. Instead your doctor or therapist will ask detailed questions about what kind of symptoms you have and how long they last. To be diagnosed as bipolar, you must have had a manic episode lasting at least a week (less if you had to be hospitalized). During this time, you must have had three or more symptoms of mania, such as needing less sleep, being more talkative, behaving wildly or irresponsibly in activities that could have serious outcomes, or feeling as if your thoughts are racing.
Your urine and blood may be tested to rule out other problems that could be causing your symptoms.
How is it treated?
The sooner bipolar disorder is identified and treated, the better your chances of getting it under control. One of the most important parts of dealing with a manic episode is recognizing the early warning signs so that you can start treatment early with medicine that is especially for manic phases.
A variety of medicines are used to treat bipolar disorder. You may need to try several before you find the right combination that works for you.
- Most people with bipolar disorder need to take a medicine called a mood stabilizer every day.
- Medicines called antipsychotics can help get a manic phase under control.
- Antidepressants are used carefully for episodes of depression, because they cause some people to move into a manic phase.
People often have to try several different medicines before finding what works for them. Regular checkups are important so that your doctor can tell if your treatment is working.
Counseling for you and your family is also an important treatment. It can help you cope with some of the work and relationship issues that your illness may cause.
Charting your mood is one way you can start to see your patterns and symptoms. Keep a notebook of your feelings and what brought them on. If you learn what triggers your mood swings, you may be able to avoid them sometimes.
People often stop taking their medicines during a manic phase because they feel good. But this is a mistake. You must take your medicines regularly, even if you are feeling better.
Who is affected by bipolar disorder?
Over 3 million Americans-about 1% of the population, or 1 in every 100 people-have bipolar disorder, with similar rates in other countries. Bipolar disorder occurs equally among males and females. It often begins between the ages of 15 and 24.
What causes it?
The cause of bipolar disorder is not well understood, although evidence suggests that the disorder runs in families.3 Your living environment and family situation may also play a role in the disorder. Episodes of depression and mania may be caused by a problem with certain brain chemicals called neurotransmitters.
Antidepressant medications can trigger a manic episode in a person who has bipolar disorder. This may occur, however, before someone is diagnosed with bipolar disorder, while he or she is seeking treatment for an episode of depression.
Sleep deprivation or substance abuse, including caffeine, can cause a person with bipolar disorder to have a manic episode.
What are the symptoms?
Bipolar disorder causes extreme mood swings, from feeling overly energetic (mania) to feeling very sad or having low energy (depression).
Mania may cause a person to:
*Feel extremely happy or very irritable.
*Have a very high opinion of himself or herself (inflated self-esteem).
*Not need as much sleep as usual (feel rested after 3 hours of sleep).
*Talk more than usual.
*Be more active than usual.
*Have difficulty concentrating because of having too many thoughts at once (racing thoughts).
*Be easily distracted by sights and sounds.
*Act impulsively or do reckless things, such as go on shopping sprees, drive recklessly, get into foolish business ventures, or have frequent, indiscriminate, or unsafe sex.
Depression may cause a person to:
*Feel sad or anxious for a significant time.
*Feel hopeless or pessimistic.
*Have slowed thoughts and speech because of low energy.
*Have difficulty concentrating, remembering, and making decisions.
*Have changes in eating and sleeping habits leading to too much or too little eating or sleeping.
*Have decreased interest in usual activities, including sex.
*Have suicidal thoughts.
*Not enjoy things he or she normally would.
Types of bipolar disorder:
Bipolar I. Considered the classic form of the illness, bipolar I causes recurrent episodes of mania and depression. The depression may last for a short time or for months. You may then go back to feeling normal for a time, or you may go right into a manic episode.
Bipolar II. If you have bipolar II, you will experience depression just as in bipolar I. But the episodes of mania are less severe (hypomania). People with bipolar II have more depressive episodes than hypomanic episodes.
Rapid-cycling bipolar disorder. If you have rapid-cycling bipolar disorder, you will experience at least four episodes of depression, mania, or both within a 12-month period. You may go directly from an episode of depression to an episode of mania, or you may have a short time lapse between the two extreme moods. The mood swings are the same as with other types of bipolar, but the frequency of mood swings distinguishes rapid-cycling bipolar disorder from the other subtypes.
Some people may have bipolar disorder with mixed symptoms, in which episodes of depression and mania occur together. Symptoms include sadness, euphoria, and irritability. Other symptoms can include agitation, lack of sleep, appetite changes, and possibly, thoughts of suicide. This makes the disorder challenging to treat and very frustrating for you and for those around you. It can also lead to hospitalization if your daily functioning becomes impaired.
In addition to changes in mood, some people with bipolar disorder also have symptoms of anxiety, panic attacks, or symptoms of psychosis.
Symptoms of bipolar disorder in children can be very different than those of adults and can be confused with other childhood mental disorders, such as depression or attention deficit hyperactivity disorder (ADHD). Bipolar disorder in children significantly interferes with a child's ability to function in school, with friends, and at home.
Some other conditions with symptoms similar to bipolar disorder include depression, schizophrenia, and attention deficit hyperactivity disorder (ADHD).
People with bipolar disorder-men more often than women-may have substance abuse problems, especially during manic episodes.4 Abusing alcohol or drugs may affect treatment and interfere with taking medications as prescribed. Other disorders that may occur along with bipolar disorder include:
Panic attacks or panic disorder.
These illnesses need to be treated along with the bipolar disorder.
What happens in bipolar disorder?
With bipolar disorder, you alternate between episodes of depression and mania. In between, you may return completely to normal or have some remaining symptoms. The extreme mood changes may come on suddenly or appear more slowly.
During a manic episode, you may be abnormally happy, energetic, or very irritable for a week or more. Initially, you may feel incredibly productive or creative. You may feel powerful and seductive and think there is nothing you can't accomplish. But as a manic episode progresses, you may behave wildly and irresponsibly, spending a lot of money, getting involved in dangerous activities, and sleeping very little. You may also have a hard time functioning in your job and relationships.
After a manic episode, you may return to normal, or your mood may swing in the opposite direction and you may feel useless, hopeless, and extremely sad. When you are depressed, you may have trouble concentrating, remembering, and making decisions; you may have changes in your eating and sleeping habits; and you may lose interest in things you once enjoyed. Some people become suicidal or harm themselves during episodes of depression. Some feel as if they can't move, care, or think.
Men tend to have more manic episodes, while women have more episodes of depression.
Initially, stress may trigger depression or mania. But, as the illness progresses, mood swings may not be caused by any specific event. Without treatment, your bipolar disorder may get worse, causing you to move more often between mania and depression.
Can I Prevent it?
Bipolar disorder cannot be prevented, but often the mood swings can be controlled with medications.
About 1 in 3 people will remain completely free of symptoms of bipolar disorder by taking mood stabilizer medications, such as carbamazepine or lithium, for life.
Other ways to help prevent a depressive or manic mood episode include:
- Eating a balanced diet.
- Exercising daily.
- Avoiding extensive travel into other time zones.
- Getting approximately the same number of hours of sleep every night.
- Avoiding alcohol and illegal drugs.
- Reducing stress at work and at home.
- Seeking treatment as soon as you notice symptoms of a depressive or manic episode coming on.
Changes in your sleep patterns can sometimes trigger a manic or depressive episode. If you plan extensive travel into other time zones, you may want to call your doctor before you leave to discuss whether you should make any changes in your medications and what to do if you have a manic or depressive episode while you are away.
How can I manage my bipolar disorder?
Home treatment is important in bipolar disorder. In addition to taking your medications every day as prescribed, you can help control mood swings by:
* Getting enough exercise. Try moderate activity for at least 30 minutes a day, every day, if possible. Moderate activity is activity equal to a brisk walk. For more information, see the topic Fitness.
* Getting enough sleep. Keep your room dark and quiet, and try to go to bed at the same time every night.
* Eating a healthy, balanced diet. A balanced diet includes foods from different food groups, such as whole grains, dairy, fruits and vegetables, and protein. Eat a variety of foods within each group (for example, eat different fruits from the fruit group instead of only apples). A varied diet helps you get all the nutrients you need, since no single food provides every nutrient. Eat a little of everything but nothing in excess. All foods can fit in a healthy diet if you eat everything in moderation. For more information, see the topic Healthy Eating.
* Control the amount of stress in your life. Manage your time and commitments, establish a strong system of social support and effective coping strategies, and lead a healthy lifestyle. Techniques to relieve stress include physical activity and exercise, breathing exercises, muscle relaxation, and massage. For more information, see the topic Stress Management.
* Avoid alcohol and illegal drugs.
* Learn to recognize the early warning signs of your manic and depressive episodes.
* Ask for help from friends and family when needed. You may need help with daily activities if you are depressed, or you may need support to control high energy levels if you are experiencing mania. For more information, see: Managing a manic episode.
Family members often feel helpless when a loved one is depressed or manic. Family members and friends can help by:
* Encouraging the person to take his or her medications regularly, even when feeling good.
* Learning the warning signs for suicide, which include:
- Drinking alcohol heavily or taking illegal drugs.
- Talking, writing, or drawing about death, including writing suicide notes.
- Talking about things that can cause harm, such as pills, guns, or knives.
- Spending long periods of time alone.
- Giving away possessions.
- Acting aggressive or suddenly appearing calm.
* Recognizing a lapse into a manic or depressive episode and helping the person cope and get treatment.
* Allowing your loved one to take enough time to feel better and get back into daily activities.
* Learning the difference between hypomania and when he or she is just having a good day. Hypomania is an elevated or irritable mood that is clearly different from a regular nondepressed mood and can last for a week or more.
* Encouraging your loved one to go to counseling and to join a support group, and joining one yourself if needed.
To learn more about how you can help your loved one through mood swings, see:
Helping a depressed person.
Helping a person during a manic episode.
Can I manage a manic episode on my own?
The more you know about bipolar disorder, the better you will be able to cope with this lifelong illness. There are many steps that you can take-or help a loved one take-to recognize and better manage manic episodes.
* Learn the warning signs of a manic episode and get early treatment to avoid disruption in your life.
* At the same time each day, record your mood and any symptoms.
* Take medicines as instructed by your doctor to help reduce the number of manic episodes.
* To help prevent a manic episode, avoid triggers such as caffeine, alcohol or drug use, and stress.
* Exercise, eat a balanced diet, get a good night's sleep, and keep a consistent schedule to reduce minor mood swings that can lead to more severe episodes of mania.
* Have an action plan in place so that if you do have a manic episode, those who support you can follow the plan and keep you safe.
What are signs of a manic episode?
One of the most important parts of managing a manic episode is recognizing the early warning signs. You may have unique warning signs, although many will be common among all people with bipolar illness. It is important to know your warning signs so that you can start treatment early, perhaps preventing a more severe manic episode. Charting your mood is one way you can begin to identify your patterns and symptoms.
A journal, where you can record how you feel each day, will help you recognize patterns in your mood and identify early warning signs. At about the same time every day, ask yourself, "How did I feel today?" Use a scale from -5 (depressed) to +5 (manic), with 0 being normal, and give yourself a daily score. If you have any new or different symptoms, write them down. Also note anything stressful or unusual that disrupted your routine. Did you take your medicine properly? Did you sleep well, eat regular meals, exercise, or drink alcohol? You might discover certain things that trigger a change in your mood, which can lead to more severe symptoms, and avoid those things in the future.
As you chart your mood, ask your friends and family to let you know if they notice any signs of a mood change. Record those in your mood journal as well.
Common early warning signs of a manic episode include:
- Needing less sleep.
- Being more active.
- Feeling unusually happy, irritable, or energetic.
- Making unrealistic plans or focusing intensely on a goal.
- Being easily distracted and having racing thoughts.
- Having unrealistic feelings of self-importance.
- Becoming more talkative.
Why do I need to control a manic episode?
Most people who have bipolar disorder take medicine every day, usually a medicine called a mood stabilizer. But, you can still have a manic or depressive episode despite being on these medicines. During a manic episode, you may need another medicine to help manage your symptoms until they pass. It is important to see your doctor when you first notice symptoms so that you can start treatment right away and perhaps avoid a more serious episode.
For many people with bipolar disorder, the early symptoms of a manic episode feel good. It is not uncommon to feel up and energized, confident and creative. These feelings may seduce you into thinking that you don't need your medicine. This is when it is important to have a support system in place. You may need family or friends to help you stick with your treatment plan.
Getting early treatment allows you to proactively manage your illness-you benefit by having fewer disruptions in your life. By avoiding impulsive and often destructive or dangerous manic behaviors, you will have fewer long-term repercussions. Behaviors like spending too much money, having unprotected sex, or driving recklessly can have serious consequences for both you and your loved ones. Learning the early signs of a manic episode may help you avoid these problems.
How do I manage a manic episode?
The best way to manage bipolar disorder is to prevent manic episodes. Although that is not always possible, you can identify and attempt to avoid the triggers that may lead to a mood swing. One of the most important aspects of managing your illness is to stick to a routine, particularly keeping a stable sleep pattern.
* Maintain a stable sleep pattern. Go to bed about the same time each night and wake up around the same time each morning. Too much or too little sleep or changes in your normal sleep patterns can alter the chemicals in your body, which can trigger mood changes or make your symptoms worse.
* Stick to a daily routine. Plan your day around a fairly predictable routine. For example, eat meals at regular times, make exercise or other physical activity a part of your daily schedule, and perhaps practice meditation or another relaxation technique each night before bed.
* Set realistic goals. Having unrealistic goals can set you up for disappointment and frustration, which can trigger a manic episode. Do the best you can to manage your illness, but expect and be prepared for occasional setbacks.
* Do not use alcohol or illegal drugs. It may be tempting to use alcohol or drugs to help you get through a manic episode. But this can make symptoms worse. Even one drink can interfere with sleep, mood, or medicines used to treat bipolar disorder.
* Get help from family and friends. You may need help from your family or friends during a manic episode, especially if you have trouble telling the difference between what is real and what is not real (psychosis). Having a plan in place before any mood changes occur will assist your support network in helping you to make good decisions.
* Reduce stress at home and at work. Try to keep regular hours at work or at school. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. If stress at work, school, or home is a problem, counseling may help improve the situation and decrease stress.
* Learn to recognize your early warning signs. One of the most important ways to avoid a manic episode is to identify early signs and seek treatment.
* Monitor your mood every day. Once you know your early warning signs, check your mood daily to see whether you may be heading for a mood swing. Write down your symptoms in a journal, or record them on a chart or a calendar. When you see a pattern or warning signs of a mood swing, seek treatment.
* Continue treatment. It can be tempting to stop treatment during a manic episode because the symptoms feel good. However, it is important to continue treatment as prescribed to avoid taking risks or having unpleasant consequences associated with a manic episode. If you have concerns about treatment or the side effects of medicines, talk with your health professional; do not adjust the medicines on your own.
Where to go from here
Learning how to manage your bipolar disorder can help you live a healthy and productive life.
Talk with your health professional
If you have questions about this information, take it along with your mood journal or symptom chart when you visit the doctor. You may want to use a highlighter to mark areas or make notes in the margins of the pages where you have questions.
Be sure to let your doctor know when you notice changes in your behavior. Talk with your doctor about what might be triggers for you and discuss ways to avoid them.