Bipolar Disorder/Manic Depression

Bipolar disorder is characterized by a “cycling” of moods from extreme depression to an extreme elated feeling known as “mania”. Those going through a “manic” phase may seem unusually productive and/or happy, but rest assured this is not usually the case, and it is in this phase that risk of suicide of highest. Delusional thinking, impulsive decision-making and extreme excitement or energy increases the likelihood of a bad decision to occur. Hallucinations and psychosis can also occur with bipolar disorder. A less severe form of bipolar disorder, cyclothymic disorder, is characterized by less extreme swings between mania and depression, but more rapid cycling between the two moods.

There does seem to be a genetic link, as an individual who has family members with bipolar disorder is more likely to suffer from bipolar disorder. Polymorphisms in BDNF, DRD4, DAO and TPH1 genes have been implicated in the development of bipolar disorder. Environmental stressors such as abuse and long-term stress may trigger abnormalities in these genes as well. CRH, cardiac β-adrenergic, Phospholipase C, glutamate receptor, cardiac hypertrophy, Wnt, Notch, and endothelin 1 signalling pathways have have also been implicated in the development of bipolar disorder.

Due to the extreme low moods, it is not unusual for a bipolar sufferer to be misdiagnosed with unipolar depression. In the past, bipolar disorder was often referred to as “manic depression”. Although there are some similarities between the two conditions, there are also many key differences. Indeed, during a manic phase, antidepressants are contraindicated for bipolar disorder, which shows that there is definitely a difference between the two conditions and how they should be treated.

Bipolar disorder affects approximately 1%-3% of the global population, with approximately 2.6% of US citizens (5.7 million) suffering from bipolar disorder. Benzodiazepines, anticonvulsants, mood stabilizers (e.g. lithium) and antipsychotics are often prescribed to a person with bipolar disorder. Antidepressants may be prescribed during low moods, but doses must be monitored carefully and stopped should signs of a manic phase start to appear. There are two main types of bipolar disorder:

  1. Bipolar I disorder – at least one manic episode, with or without depressive episodes.
  2. Bipolar II disorder – at least one hypomanic episode and one major depressive episode, but not any manic episode.

Cyclothymic disorder is often considered a third type of bipolar disorder. Those suffering from schizophrenia, multiple sclerosis, a personality disorder or Alzheimer’s may present similar symptoms to those suffering from bipolar disorder, but the conditions are markedly different in many respects.

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