Department of Psychiatry at Far Eastern Memorial Hospital

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes mood swings affecting ones energy and ability to function. Symptoms of bipolar disorder are severe and different from the normal ups and downs that everyone goes through. They can result in damaged relationships, poor job or school performance, and even suicide. But the good news is bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life.

The periods of highs and lows are called episodes of mania and depression.

(a) Signs and symptoms of mania/manic episode include:

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

(b) Signs and symptoms of depression/depressive episode include:

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or of being “slowed down”
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much or can’t sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts

Depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

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.

(a) Medications: mood stabilizers (e.g. lithium, valproate sodium, carbamazepine, lamotrigine) are the mainstay of treatment. However, during the acute stage of either manic or depressive episodes, other medications may be prescribed, typically for short periods of time, to help stabilize the condition (e.g. antipsychotics, benzodiazepines or anxiolytics, antidepressants).

Any untoward reactions to the medications prescribed should be brought up and discussed with the prescribing physician. Medications should not be stopped abruptly as this might cause withdrawal symptoms and even relapse of illness.

(b) Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area.

(c) Psychosocial Treatments: Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy.

(d) Other Treatments:

1. Electroconvulsive therapy (ECT). ECT may be considered in the following conditions: where medication, psychosocial treatment, and the combination of these interventions prove ineffective; work too slowly to relieve severe symptoms such as psychosis or suicidality; to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.

2. Herbal or natural supplements. Discuss them with your doctor before using. There is evidence that St. John’s wort can reduce the effectiveness of certain medications. In addition, like prescription antidepressants, St. John’s wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.

3. Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.

A. Encourage them to have a regular medication intake in order to prevent relapse.

B. If your family/friend with bipolar disorder is in the manic state, avoid getting into arguments with him/her, try to be patient and understanding. If they are in the depressive state, you may be more expressive with your concern to them, encourage them to talk and try to listen to what their trying to say.

C. During the manic state, because of the increase energy and easy distractibility, they may have poor self care (e.g. personal hygiene, nutrition) and are prone to danger (e.g. conflicts with the law, easily gets into fight, etc). Therefore, it is advised that any instruments that might be used as a weapon should be kept out of reach.

D. During the depressed state, suicide is always a probability. Hence, patient’s every suicidal expressions or actions relating to it should be taken seriously and should insure that the patient is never left alone for considerable amount of time. Medications should also be monitored since this might be taken in amounts to cause overdose and harm.

E. If necessary, hospitalization should be considered to guard the safety of the patient and those around them.

Reference:
National Institute of Mental Health “Health Information on Bipolar Disorder”