Definition
Bipolar disorder, which is also known as manic-depressive illness and will be called by both names throughout this publication—is a mental illness involving episodes of serious mania and depression. The person’s mood usually swings from overly “high” and irritable to sad and hopeless and then back again, with periods of normal mood in between. Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people who have it may suffer needlessly for years or even decades. Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These include marital break-ups, job loss, alcohol and drug abuse, and suicide.
Articles
- Bipolar Disorder Basics
- Employees with Bipolar Disorder
- A Story of Bipolar Disorder (manic depressive illness)
- What About Clinical Studies for Bipolar Disorder?
- How Can Individuals and Families Get Help for Bipolar Disorder
- Do Other Illnesses Co-occur with Bipolar Disorder?
- How Is Bipolar Disorder Treated?
- What Causes Bipolar Disorder?
- Can Children and Adolescents Have Bipolar Disorder?
- What Is the Course of Bipolar Disorder?
- What Are the Symptoms of Bipolar Disorder?
- Child and Adolescent Bipolar Disorder: An Update from the National Institute of Mental Health
- Fear Circuit Flares as Bipolar Youth Misread Faces
Article Summaries
Bipolar Disorder BasicsBipolar disorder, which is also known as manic-depressive illness and will be called by both names throughout this publication—is a mental illness involving episodes of serious mania and depression. The person’s mood usually swings from overly “high” and irritable to sad and hopeless and then back again, with periods of normal mood in between. Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people who have it may suffer needlessly for years or even decades. Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These include marital break-ups, job loss, alcohol and drug abuse, and suicide.
Employees with Bipolar Disorder
According to National Institute of Mental Health, “more than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder” (NIMH, 2002). The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with bipolar disorder will have a disability under the ADA and some will not. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.
A Story of Bipolar Disorder (manic depressive illness)
“I’ve had times of feeling “down” and sad most of my life. I used to skip school a lot when I felt like this because I just couldn’t get out of bed. At first I didn’t take these feelings very seriously. “I also had times when I felt really terrific, like I could do anything. I felt really “wound up” and I didn’t need much sleep. Sometimes friends would tell me I was talking too fast. But everyone around me seemed to be going too slow. “My job was getting more stressful each week, and the “up” and “down” times were coming more often. My wife and friends said that I was acting very different from my usual self. I kept telling them that everything was fine, there was no problem, and to leave me alone.
What About Clinical Studies for Bipolar Disorder?
Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.
How Can Individuals and Families Get Help for Bipolar Disorder
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.
Do Other Illnesses Co-occur with Bipolar Disorder?
Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan. Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time. In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness. Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic “building blocks” of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person’s chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.
Can Children and Adolescents Have Bipolar Disorder?
Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness. Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment. The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Child and Adolescent Bipolar Disorder: An Update from the National Institute of Mental Health
A fact sheet that describes the symptoms and treatments of bipolar disorder in children and adolescents. (2000) Research findings, clinical experience, and family accounts provide substantial evidence that bipolar disorder, also called manic-depressive illness, can occur in children and adolescents. Bipolar disorder is difficult to recognize and diagnose in youth, however, because it does not fit precisely the symptom criteria established for adults, and because its symptoms can resemble or co-occur with those of other common childhood-onset mental disorders. In addition, symptoms of bipolar disorder may be initially mistaken for normal emotions and behaviors of children and adolescents. But unlike normal mood changes, bipolar disorder significantly impairs functioning in school, with peers, and at home with family. Better understanding of the diagnosis and treatment of bipolar disorder in youth is urgently needed. In pursuit of this goal, the National Institute of Mental Health (NIMH) is conducting and supporting research on child and adolescent bipolar disorder.
Fear Circuit Flares as Bipolar Youth Misread Faces
Youth with bipolar disorder misread facial expressions as hostile and show heightened neural reactions when they focus on emotional aspects of neutral faces, researchers at the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) have discovered. The study provides some of the first clues to the underlying workings of the episodes of mania and depression that disrupt friendships, school, and family life in up to one percent of children. Brain scans showed that the left amygdala, a fear hub, and related structures, activated more in youth with the disorder than in healthy youth when asked to rate the hostility of an emotionally neutral face, as opposed to a non-emotional feature, such as nose width. The more patients misinterpreted the faces as hostile, the more their amygdala flared. Such a face-processing deficit could help account for the poor social skills, aggression, and irritability that characterizes the disorder in children, suggest Drs. Ellen Leibenluft, Brendan Rich, Daniel Pine, NIMH Mood and Anxiety Disorders Program, and colleagues, who report on their findings May 29, 2006 in the Proceedings of the National Academy of Sciences.