What is unipolar illness? When the mood is just depressed. This is far more common than bipolar illness.
What is bipolar disease? Bipolar disorders (manic-depressive illness) are marked by periods of manic, greatly elated moods or excited states as well as by periods of depression. Although the manic-depressive psychosis may alternate from one of its phases to the other, one or the other phase is usually dominant for a while. Depression is more often dominant than mania. Manic-depressive patients often recover spontaneously for periods of time, but relapses are fairly common. Most often this disease is genetic. Bipolar is a severe mental disorder. There are 2 types of the bipolar diseases: Bipolar 1 & bipolar 2.
Bipolar 1- person experiences at least one, and usually many more, manic episodes, alternating with episodes of major depression
Bipolar 2- the individual experiences periods of hypomania alternating with episodes of major depression.
What is cyclothymia? Similar to bipolar disorder since it is characterized by mood swings from mania to depression. However, there are several important differences between the two. A person with cyclothymia experiences symptoms of hypomania but never a full-blown hypomanic episode. A person with cyclothymia is never symptom-free for longer than two months.
The Affective Spectrum- Some people who have bipolar disorder (manic depression) or unipolar disorder (depression-only) have co-existing conditions such as migraines, attention deficit disorder, fibromyalgia, eating disorders, etc
The following have been identified (so far) as part of the medical spectrum, which may accompany affective disorders:
· attention deficit disorder (ADD & ADHD)
· body dysmorphic disorder
· eating disorders (bulimia, anorexia, binging)
· fibromyalgia (includes chronic fatigue)
· impulse-control disorders
· irritable bowel syndrome
· migraine/severe headache
· intermittent explosive disorder
· pathological gambling
· personality disorders
· post traumatic stress disorder
· substance abuse and addiction (includes alcoholism)
· obsessive-compulsive disorder
· panic disorder
· Tourette's disorder
· anxiety disorders
Increased energy- Decreased Sleep, Little Fatigue, an Increase in Activities, and Restlessness.
Speech disruptions- Rapid Speech and Incoherent Speech
Impaired judgment- Lack of Insight, Inappropriate Humor and Behavior, Impulsive Behavior, Financial Extravagance, and Grandiose Thinking.
Changes in thought patterns- Irritability, Excitability, Hostility, and Feelings of Exhilaration
Changes in Perception- Inflated Self-Esteem, Hallucinations, Paranoia, and Increased Religious Activities
Depression- Changes in Activity- Decreased Energy, Fatigue, Lethargy, Diminished Activity, Insomnia or Hypersomnia, Loss of Interest in Pleasurable Activities, and Social Withdrawal
Physical Changes- Unexplained Aches and Pains, Weight Loss or Gain, Decreased or Increased Appetite, and Psychomotor Agitation or Retardation
Emotional Pain- Prolonged Sadness, Unexplained, Uncontrollable Crying, Feelings of Guilt, Feelings of Worthlessness, Loss of Self-Esteem, Despair, Hopelessness, and Helplessness
Difficult Moods- Irritability, Anger, Worry/Anxiety, Pessimism, Indifference, and Self-Critical Changes in Thought Patterns- Inability to Concentrate, Indecision, Problems with Memory, Disorganized
Preoccupation with Death- Thoughts of Death, Suicidal Ideation, Feeling Dead or Detached
Psychotherapy- psychotherapy is indicated to help the person deal with the effects of the illness in his or her life, to work on coping with the stresses that can trigger episodes, or to help individuals who have psychological difficulties when their moods are stable. Family therapy can help all family members learn about the illness and deal with it better as a family.
For Acute Mania- This may require hospitalization to protect the individual or others from impulsiveness. Lithium is generally the drug used to stabilize the person. The response to lithium usually takes a few days. If the individual is experiencing psychotic symptoms, antipsychotics (e.g. haloperidol) are usually given. Anticonvulsant drugs such as Carbamazepine (Tegretol) can also be used.
For Acute Depression- Lithium can be given and is very effective. Antidepressants may also be prescribed to the patient.
Cyclothymia- Therapy is used in most cases. In severe cyclothymia, lithium will be prescribed.
In general- Lithium is given and really decreases the manic and depressive attacks in about 70% the patients. The person must be tested to monitor potential side effects and to be certain the person is taking the medication.
To treat acute episodes of mania and depression and to prevent relapse, doctors often use medications.
Lamotrigine (Lamictal)- Mood Stabilizer / Anticonvulsant
Lithium- Mood Stabilizer
Oxycarbazepine (Trileptal)- Mood Stabilizer / Anticonvulsant
Topiramate (Topamax)- Mood Stabilizer / Anticonvulsant
Venlafaxine (Effexor)- Antidepressant
Side Effects of the Medication:
Lithium- increased urination, Nausea, increased thirst, muscle twitching, and weight gain.
Carbamazepine- clumsiness or unsteadiness, dizziness, drowsiness, lightheadedness, and nausea or vomiting.
Haloperidol- Blurred vision, changes in menstrual period, constipation, dryness of mouth, swelling or pain in breasts (in females), unusual secretion of milk, and weight gain.
Lamotrigine- Blurred or double vision or other changes in vision; clumsiness or unsteadiness.
Oxycarbazepine- Mild sleepiness or fatigue; nausea, vomiting, or stomach pain; tremor; dizziness; rash; diarrhea, constipation, or decreased appetite; headache; or dry mouth
Topiramate- Breast pain in women; nausea; tremors
Venlafaxine- Abnormal dreams; anxiety or nervousness; chills; constipation; diarrhea; dizziness; drowsiness; dryness of mouth; heartburn; increased sweating; loss of appetite; nausea; stuffy or runny nose; stomach pain or gas; tingling, burning, or prickly sensations; trembling or shaking; trouble in sleeping; unusual tiredness or weakness; vomiting; weight loss
Sertraline (Zoloft)- Decreased appetite or weight loss; diarrhea or loose stools; dizziness; drowsiness; dryness of mouth; headache; increased sweating; nausea; stomach or abdominal cramps, gas, or pain; tiredness or weakness; trembling or shaking; trouble in sleeping
Facts About Bipolar Disorder and Suicide
· Approximately twenty percent of all patients with bipolar disorder have their first episode during adolescence. Peak age of onset is between fifteen and nineteen years.
· Most people suffering from bipolar disorder who attempt suicide do so very soon after the onset of the disorder.
· Patients suffering from depression and bipolar disorder are far more likely to take their own lives than individuals in any other psychiatric or medical risk group. Without effective treatment, bipolar disorder leads to suicide in nearly 20 percent of cases.
· The mortality rate for untreated bipolar patients is higher than it is for most types of heart disease and many types of cancer.
· Among all those who die by suicide, more than two thirds suffered from a depressive illness or bipolar disorder.
· Although more men than women complete suicide in the general population (4:1), the gender rates for completed suicide in those suffering from bipolar disorder are equal.
· Studies of bipolar populations indicate that 25-50% of bipolar people attempt suicide at least once.
· Studies indicate that most bipolar patients who die by suicide try and communicate their suicidal ideas to others, most frequently through a direct and specific statement of suicidal intent.
· There is strong scientific evidence linking bipolar disorder, artistic creativity, and suicide. More research is needed to determine which patients are most vulnerable to suicide and which treatments effectively deal with the disorder without hindering a person's artistic performance and creativity.
· Treatments for people with depressive disorder are successful in alleviating symptoms over 80% of the time.
Hypomania- a mild degree of mania; often a precursor to a full manic episode. Often it doesn't require hospitalization because it isn't as severe as a manic episode.
Mania- an excited mood characterized by mental and physical hyperactivity, disorganization of thoughts and behavior.
Manic depression- was and earlier name used for bipolar disease.
Cyclothymia- similar to bipolar disorder since it is characterized by mood swings from mania to depression
Bipolar disorder- Disorder in which an individual alternates between feelings of euphoria and depression.
Manic-type reaction- a psychotic reaction characterized by extreme elation, agitation, confusion, disorientation, and incoherence.
Depressive-type reaction- a response pattern in which a person is overcome by feelings of failure, sinfulness, worthlessness, and despair.
The Medical and Health Encyclopedia
Editor, Rich J. Wagman, M.D.
J.G. Ferguson Publishing Company
Psychology Today May/June 1997
Richard A. Kasschau, PH.D.