American Medical Association Family Medical Guide - American Medical Association [455]
Effective treatment for bipolar disorder is available but, during the manic phase, many people with the disorder feel so elated that they may fail to seek treatment or refuse to follow the doctor’s treatment recommendations. A mild level of mania, known as hypomania, may even improve a person’s productivity and performance. However, when the upbeat mood inevitably subsides, the person is left feeling lower than normal and may be more responsive to medical help. Family members and friends should strongly encourage the person to seek treatment, taking him or her to the doctor or to a hospital emergency department for evaluation if necessary.
Symptoms
During the manic phase of bipolar disorder, a person has an elevated mood, unrealistically inflated self-esteem, a decreased need for sleep, rapid speech, racing thoughts, and poor impulse control. He or she can be easily distracted, may have exaggerated beliefs about his or her abilities, and may say or do things simply to shock others. Mania also can compel people to go on unrestrained spending sprees, to have impulsive and promiscuous sexual encounters to fulfill an increased sex drive, or to enthusiastically start (but rarely finish) new projects. Extreme mania can progress to delirium (profound mental confusion) or paranoia (extreme or irrational suspicion).
The depressed phase produces the characteristic symptoms of depression (see page 709), including persistent sadness, anxiety, and feelings of emptiness and despair. The person may feel hopeless, helpless, pessimistic, guilty, and worthless. Loss of interest in activities that were once enjoyable, including sex, is common. Decreased energy and difficulty concentrating are accompanied by irritability and restlessness. When depressed, a person may sleep too much or be unable to sleep enough.
He or she may have chronic pain or other uncomfortable sensations that are not caused by physical illness or injury. He or she may think about death or suicide.
Some people with bipolar disorder have a mixed state in which symptoms of mania and depression occur at the same time. In this state, a person may feel sad and hopeless while at the same time feeling full of energy. In a state called rapid cycling (see next page), a person can experience four or more episodes of mania or depression in a year.
Diagnosis
Like other mental disorders, bipolar disorder cannot be diagnosed by a specific medical test. But your doctor will perform a physical examination to rule out any physical disorder that could be causing the symptoms. If no physical conditions are detected, the doctor will probably refer you to a psychiatrist or other mental health professional, who can diagnose bipolar disorder based on your health history and a description of your feelings and behavior.
Treatment
Although bipolar disorder is a condition that occurs in episodes, treatment must be continuous to prevent the severe mood swings that are characteristic of the disorder. A regimen that combines medication and psychotherapy (see page 710) is usually the most effective. Affected people who are experiencing a severe episode of mania or depression may need to be hospitalized for treatment. If they are a danger to themselves or others or if they are unable to care for themselves, they may need to be hospitalized against their will.
Doctors usually prescribe drugs called mood stabilizers (see page 713) to treat bipolar disorder. The drugs may need to be taken indefinitely to control a person’s mood. The most common mood stabilizer prescribed for bipolar disorder is lithium, a naturally occurring mineral, which seems to act