Bipolar

What is Bipolar?

       Most people feel anxious at times and have their ups and downs. It is natural for a mood to change or anxiety level to rise when a stressful or difficult event occurs.

       But some people experience feelings of anxiety or depression or suffer mood swings that are so severe and overwhelming that they interfere with personal relationships, job responsibilities, and daily functioning. These people may be suffering from an anxiety disorder, bipolar disorder, or both.

       It is not uncommon for someone with an anxiety disorder to also suffer from bipolar disorder. Many people with bipolar disorder will suffer from at least one anxiety disorder at some point in their lives.

       The good news is that the disorders are treatable separately and together.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function.

       The mood episodes associated with the disorder persist from days to weeks or longer, and can be dramatic, with periods of being overly high and/or irritable to periods of persistent sadness and hopelessness.

       Severe changes in behavior go along with the mood changes. These periods of highs and lows, called episodes of mania and depression, can be distinct episodes often recurring over time, or they may occur together in a so-called mixed state. Often people with bipolar disorder experience periods of normal mood in between mood episodes.

       A manic episode is diagnosed if an elevated mood occurs with three or more primary symptoms most of the day, nearly every day, for at least one week. With an irritable mood, four additional symptoms must be present for a diagnosis.

Types of Bipolar Disorder

       Each type of bipolar disorder includes periods between manic or depressive episodes when symptoms lessen, or people feel stable. The major difference between the types of disorder is how extreme the mood states are and how long they last.

Bipolar I Disorder: having a history of at least one manic episode, but sometimes also having depressed or          hypomanic episodes as well.

Bipolar II Disorder: mood states that vary from an even mood to high to low, but the highs are less extreme        and are called hypomanic states. The depressive episodes may be just as severe as those in                                      Major Depressive Disorder and/or Bipolar I Disorder.

Cyclothymic Disorder: more chronic mood instability (both highs and lows) that are not as long, severe, or frequent as those experienced in bipolar I or II disorder.

Signs and symptoms of Bipolar Disorder:

       When a person has a manic episode, they feel overly excited, productive, and even invincible. On the other hand, when a person has a depressive episode, they feel extremely sad, hopeless, and tired. They may avoid friends, family, and participating in their usual activities. A severe manic or depressive episode may trigger psychotic symptoms, such as delusions (false beliefs) or hallucinations (seeing or hearing things that others do not see or hear). These drastic behavior changes usually cause concern among friends and family. Everyone’s experience with bipolar disorder is different, and the signs and symptoms vary:

A "manic" episode may include:

Intense feelings of euphoria, excitement, or happiness

Appearing abnormally jumpy or wired

Having excessive energy

Insomnia or restlessness (a decreased need for sleep)

Speaking fast or being unusually talkative

Having racing or jumbled thoughts

Distractibility

Inflated self-esteem

Doing impulsive, uncharacteristic, or risky things like having unsafe sex or spending a lot of money

Increased agitation and irritability

Hypomania

A "depressive" episode may include:

Feeling down, sad, worried, worthless, anxious, guilty, empty, or hopeless

Lack of interest, or no interest, in activities

Feeling tired, low energy

Forgetfulness

Indecisiveness

Difficulty concentrating

Changes in sleep, either sleeping too much or too little

Changes in appetite, either eating too much or too little

Thoughts of death and/or suicide

It can be helpful to think of bipolar disorder as a spectrum of moods.

At one end is severe depression, above which is moderate depression, and then mild low mood, which may be called the blues when it is short-lived and dysthymia when it is chronic.

        Next is normal or balanced mood, then hypomania (mild mania that may feel good and be relatively brief and less severe), and then severe mania, which can include hallucinations, delusions, or other symptoms of psychosis.

        Some people may experience symptoms of mania and depression together in what is called a mixed bipolar state. Symptoms often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad hopeless mood even while feeling extremely energized.

Co-Occurring Anxiety Disorder and Bipolar Disorder

       According to Naomi M. Simon, MD, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, making a diagnosis of an anxiety disorder plus bipolar disorder can be confusing, and it is best to seek help from a mental health professional.

A few clues may suggest the presence of both an anxiety disorder and bipolar disorder:

       The presence of panic attacks, significant anxiety, nervousness, worry, or fearful avoidance of activities in addition to periods of depression and mania or hypomania.
       The development of symptoms as a child or young adult, which people with both disorders are more likely to report.
       Significant problems with sleep and persistent anxiety even when not in a manic state, and lack of response to initial treatment.
       Increased sensitivity to initial side effects of medication, and sometimes a longer time frame for finding the right medication combination and dosing.
       Suffering from an anxiety disorder and bipolar disorder has been associated with decreased functioning and quality of life and an increased likelihood of substance abuse and suicide attempts. Insomnia, a common anxiety disorder symptom, is a significant trigger for manic episodes.

       Many children with bipolar disorder also suffer from at least one co-occurring anxiety disorder. The age of onset for an anxiety disorder often precedes the age of onset for bipolar disorder. The co-occurrence of an anxiety disorder with bipolar disorder can worsen the symptoms and course of each disorder, so it’s essential that both are treated.

       Sometimes severe mood episodes, extreme irritability, and other pronounced symptoms of bipolar disorder mask underlying obsessive thoughts, compulsions, worries, or other anxiety symptoms. It’s recommended that children with bipolar disorder are also assessed for an anxiety disorder.