The primary symptoms of bipolar disorder are dramatic and unpredictable mood swings. The illness has two (BI) strongly contrasting phases (polar).

1) bipolar mania or hypo-mania

• euphoria or irritability

• *excessive talk; racing thoughts

• inflated self-esteem

• unusual energy; less need for sleep

• impulsiveness, a reckless pursuit of gratification (shopping sprees, impetuous travel, more and sometimes promiscuous sex, high-risk business investments, fast driving)

2) bipolar depression/major depression

• depressed mood and low self-esteem

• low energy levels and apathy

• sadness, loneliness, helplessness, guilt

• slow speech, fatigue, and poor coordination

• insomnia or oversleeping

• suicidal thoughts and feelings

• poor concentration

• lack of interest or pleasure in usual activities

Call Your Doctor if:

• You notice some of these symptoms in a family member. Note: Persons with bipolar disorder often deny anything is wrong, especially in the manic phase. If you are worried about a family member or close friend, a doctor can offer advice on how to handle the situation.

• You notice some of these symptoms in yourself.

Clinical experience suggests that mania may be more devastating to the family in a very short time; excessive spending can pile up huge debts, reckless driving and/or substance abuse can create legal problems, and impulsive hypersexuality/extra-marital affairs may break down a marriage or relationship. The earliest signs of emerging mania can be progressive loss of sleep and extra energy. It can be a matter of hours in which such cases become manic psychosis. Very early intervention in such cases can be rewarding and prevent a hospital admission.

Because of the stigma still attached to bipolar disorder (and to many other mental diseases), patients are frequently reluctant to acknowledge that anything is wrong, and doctors often fail to recognize the disorder. In addition, the symptoms may sometimes seem to be merely exaggerated versions of normal moods. In any event, research suggests that almost 75% of cases go untreated or are treated inappropriately.

The American Psychiatric Association has established a long list of specific criteria for recognizing the disorder. Evaluation involves investigating the patient’s history and any family history of mood swings or suicide. Other disorders must be ruled out — particularly such childhood problems as school phobia and attention deficit disorder; aging problems of dementia, schizophrenia, schizoaffective disorder, and other psychotic states induced solely by alcohol or drugs. Drug or alcohol abuse is common in persons with bipolar disorder and can mask the symptoms, thus complicating diagnosis and treatment. Recognizing and treating any drug abuse is a priority, since it is a strong predictor of suicide, especially in men.

Before treatment begins, the patient receives a careful physical exam, and blood and urine are tested to detect conditions that could put medical constraints on the choice of treatment. A thyroid analysis is particularly important both because hyperthyroidism can look like mania and because lithium — the principal drug treatment for bipolar disorder — is known to lower thyroid function and/or impair kidney function. During treatment, frequent blood tests are necessary to see that adequate drug levels have been reached and to detect adverse reactions at an early stage.
webmd.com

Because of increased awareness and diagnosis, more people than ever before have a basic understanding of bipolar disorder, the condition formally known as manic depression.

Yet myths persist about this mental disorder that causes mood shifts from depression to mania and affects a person’s energy and ability to function.

WebMD asked five bipolar disorder experts to help unravel what’s myth and what’s fact. Read on for the eight common myths about bipolar they often hear from patients and the public.

(What myths have you had to deal with while living with bipolar disorder? Talk with others on WebMD’s Bipolar Disorder: Support Group board.)

Bipolar Myth No. 1: Bipolar disorder is a rare condition.

Not so, according to statistics and research. In a given year, bipolar disorder affects about 5.7 million American adults, or about 2.6% of the U.S. population 18 and older, according to the National Institute of Mental Health.

Estimates for children and teens vary widely, partly because there is debate about the criteria for diagnosis, say Thomas E. Smith, MD, a research scientist at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York.

But the Child and Adolescent Bipolar Foundation estimates that at least three quarters of a million American children and teens may suffer from bipolar disorder, although many are not diagnosed. A recent study by researchers from Columbia University and elsewhere showed the diagnosis of bipolar disorder is up dramatically in children and teens and is also on the rise in adults.

When the researchers looked at the number of office visits with a bipolar disorder diagnosis in 1994-1995 and 2002-2003 in the U.S., they found that the number of office-based visits increased 40-fold for children and nearly doubled for adults from the first time period to the second.

Bipolar Myth No. 2: Bipolar disorder is just another name for mood swings.

Not so. The mood swings associated with bipolar disorder are very different than those of people without the condition, says Matthew Rudorfer, MD, associate director of treatment research in the division of services and intervention research at the National Institute of Mental Health in Bethesda, Md.

“The mood swings of bipolar [disorder] are more severe, longer lasting, and maybe most significant of all, they interfere with some important aspect of functioning, such as ability to work at one’s job, or manage one’s home, or be a successful student,” he says.

The mood swings of a person with bipolar disorder, experts agree, are far more severe than, say, a person without bipolar disorder being bummed out because rain spoiled the weekend plans or weight loss efforts aren’t showing the desired results.

Bipolar Myth No. 3: People with bipolar disorder shift back and forth from depression to mania very often.

The Jekyll-Hyde personality, the type that can turn on a dime from sad to euphoric, is a myth about bipolar, says Gary Sachs, MD, director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston and associate professor of psychiatry at Harvard Medical School. ”The average bipolar patient will be depressed more often [than manic],” he says.

There are people with bipolar who will shift back and forth more quickly than others, Sachs says. But that’s not the typical pattern, he says. “For the most part what is typical is to have an abnormal mood state colored by a predominance of high or low.”

What’s an abnormal mood state? Something intense or unexpected in relation to a situation, such as giggling instead of crying when you find out your home will be foreclosed, Sachs says.

Bipolar Myth No. 4: When they’re in the manic phase, people with bipolar disorder are often very happy.

True for some, experts tell WebMD, but not for others. And a person with bipolar disorder may enter the manic phase happy but not stay that way. “The hallmark of mania is a euphoric or elevated mood,” Smith says.

But, he says, “a significant number of people become edgy and irritable as the mania progresses.”

“Many people are actually frightened when they go into mania,” says Sue Bergeson, CEO of the Depression and Bipolar Support Alliance in Chicago, a patient-run mental health organization. “When you are moving into mania, you are losing control of your actions and thoughts,” she says. Patients often complain they can’t sleep, too.

A person in a manic phase may go on spending sprees, use poor judgment, abuse drugs or alcohol, and have difficulty concentrating. Sexual drive can be increased and behavior can be “off” or out of character for what is normal for them.

It’s crucial, Smith says, to treat a manic phase (typically with mood-stabilizing drugs). If untreated, it can progress from an elevated mood to euphoria to extreme disorganization and other common signs of mania — lack of sleep, increased energy, and disorganized behavior that interferes with relationships, he says.

“I don’t think people look forward to manic episodes,” Smith says. “When you are not manic, you can look back and see how disruptive your life became.”

Smith advises bipolar disorder patients to know their early signs of a manic or depressive episode so they can get additional treatment promptly.

Bipolar Myth No. 5: There is a bipolar test.

Not true. In early 2008, an at-home bipolar test, sold over the Internet, made headlines. But the test only tells users whether their genetic makeup puts them at higher risk of having or getting bipolar disorder.

The bipolar test evaluates saliva samples for two mutations in a gene called GRK3, associated with the disorder. But it can’t tell users for sure.

Today, a diagnosis of bipolar disorder depends on a doctor taking a careful patient history, asking about symptoms over time. A family history of the disorder increases a person’s chances of getting it.

Bipolar Myth No. 6: Bipolar disorder can’t be diagnosed until age 18.

Not true, says Sachs. But it is true that it’s more difficult to diagnose it in some people than in others, because of varying patterns of the disorder.

And typical childhood behavior — such as having a tantrum and recovering quickly to go to a birthday party — can also make it difficult to diagnose the condition in children.

“There are clearly cases of children who have classic presentation in the early childhood years,” he says. But if a child does not have a classic pattern, it’s usually more difficult to make the diagnosis.

Even so, the disorder may be present but not diagnosed until later, he says. According to the National Institute of Mental Health, the median age of onset for bipolar disorder is 25 years old (half are older, half are younger).

But Sachs says many adult patients report having symptoms before age 18, whether they were officially diagnosed or not.

Bipolar Myth No. 7: People with bipolar disorder should not take antidepressants.

Not true, says Smith, who explains where the myth originated. “There’s a concern, and it’s valid, that some people who are depressed and bipolar, if they take antidepressants … could flip into a mania.”

The thinking, however skewed, is that the mood will be elevated too much and mania will result. Although the concern has some validity, Smith says, “that does not mean you should always avoid antidepressants.” Sometimes, he says, people need the drugs, especially if the depression persists.

In a study published in The New England Journal of Medicine, Sachs and his colleagues randomly assigned 366 patients with bipolar disorder to a treatment of mood stabilizer drugs and placebo or to mood stabilizer drugs and an antidepressant, following them for up to 26 weeks.

They found no differences in adverse effects, including a shift from depression to mania, between the two groups.

Bipolar Myth No. 8: Aside from taking medication and engaging in psychotherapy or “talk therapy,” a person with bipolar disorder has few options for controlling the condition.

Not true. “Medication and therapy are important,” says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness. But paying attention to lifestyle can help, too, he says.

“Active” strategies, such as getting regular aerobic exercise, keeping a regular bedtime, eating a healthful diet, and paying attention to personal warning signs that a shift to depression or mania is coming can all help a person manage bipolar disorder, he tells WebMD.

“If people know their warning signs, they can stave off disaster,” Duckworth says. For instance: If a person with bipolar knows he starts to wake up at 4 a.m. when he is shifting to mania, he can pay attention to that pattern, Duckworth says, and promptly seek medical help.
webmd.com

Picking up the pieces after mood swings can be hard. The people whom you need most — especially your friends and family — may be angry with you or reluctant to help.

The best way to avoid these mood swings is to get treatment for bipolar disorder. But unfortunately, periods of hypomania, mania, or depression aren’t completely preventable. Even people who always take their medication and are careful with their health can still have mood swings from time to time.

So that’s why it’s important to catch changes in your mood early before they develop into something serious.

Mood Swing Triggers in Bipolar Disorder

At first, mood swings may take you by surprise if you have bipolar disorder. But over time, you might start to see patterns or signs that you’re entering a period of mania or depression. Aside from a shift in your mood, look for changes in your:

* Sleep patterns
* Energy level
* Alcohol or drug use
* Sex drive
* Self-esteem
* Concentration

You may also discover particular “triggers” — situations or events that can provoke a period of mania or depression. Some people find they’re more likely to become depressed or manic during stressful times at work or during holidays. Many people see seasonal patterns to their mood changes. Of course, not everyone can identify triggers. Also, some triggers can’t be anticipated or avoided, like a serious illness or a traumatic event.

One good way to see patterns or triggers in your bipolar disorder is to keep a journal. Make note of big events, stresses, your medication dosage, and the amount of sleep you’re getting. Over time, you might see some patterns emerge.

If you know what your triggers are, you can prepare for times when you might be most vulnerable. Ask for more help from coworkers. Have your family and friends check in more often so you get extra support.

If you see the signs of potential trouble, get help. Don’t wait for the mood swing to pass on its own. With quick intervention, you might be able to stop a very minor mood swing from becoming a serious problem.

The Appeal of Mania in Bipolar Disorder

When people with bipolar disorder are depressed, they almost always know that something is wrong. Nobody likes feeling that way.

But it’s different for people who are hypomanic or manic. Often, they don’t think anything is wrong. Or if they notice a difference in their mood and personality, they think it’s an improvement.

Mania and hypomania can be seductive. You might feel more energized, creative, and interesting. You might be able to get extraordinary amounts of work done. So what’s the problem?

The fact is that manic phases often turn destructive. Some consequences of a manic episode can’t be undone. You can wipe out your savings account. You can have affairs that ruin your marriage. You can lose your job. Most dangerous of all, mania can make you do things that risk your life or the lives of others.

Although hypomania or mania can feel good at the moment, in the long run, you’ll be happier, healthier, more productive, and more successful if you can maintain a stable mood.
WebMD

Many alternative remedies and natural dietary supplements are easy to access, whether on the Internet or at your local pharmacy. Yet before you begin treating bipolar disorder with natural dietary supplements or an alternative remedy, it’s important to do your homework and know what you’re putting into your body. In addition, always discuss any alternative remedy or dietary supplement with your doctor to avoid an herb/drug interaction, which can be quite serious.

What is a dietary supplement?

According to the FDA, in order for an ingredient of a dietary supplement to be a “dietary ingredient,” it must be one or any combination of the following substances:

* Vitamin
* Mineral
* Herb or other botanical
* Amino acid
* Dietary substance to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or
* Concentrate, metabolite, constituent, or extract

Can supplementing with 5-HTP help bipolar depression and/or mania?

5-hydroxytryptophan (5-HTP) may be used to treat mild depression based on the theory that as a precursor to serotonin, the brain chemical (neurotransmitter) that has a calming effect, 5-HTP can increase serotonin levels and influence mood, sleep patterns, and pain control. When serotonin levels are low, the result can be high anxiety, irritability, insomnia, impatience, and depression.

Although the studies are few, some findings show that 5-HTP supplements may help regulate mood and emotions, even comparable to some antidepressants. For instance, a small study of volunteers with anxiety disorders reported that taking supplements of 5-HTP greatly reduced levels of anxiety.

Should you take 5-HTP supplements? Talk to your doctor first because of possible adverse effects, including drug interactions with medications taken for bipolar disorder.

5HTP alone is not an acceptable alternative to your bipolar medications.

What is DHEA and can it help bipolar disorder?

The body naturally produces the hormone dehydroepiandosterone (DHEA) until the mid-20s, at which point the production of DHEA declines. Advertisers claim that supplementing with DHEA may have anti-aging benefits, boost mood, and improve symptoms of depression.

In one study of patients with HIV/AIDS, DHEA supplementation was found to be better than placebo in reducing depression symptoms. In another study of patients with Addison’s disease, researchers reported improvements in both mood and fatigue after supplementation with DHEA. But, because DHEA affects hormone levels in the body, experts believe more studies are necessary before recommending DHEA for use by the public.

Most studies on DHEA supplementation in healthy individuals show few side effects if the supplements are taken orally in recommended doses. DHEA is not recommended for people with abnormal heart rhythms, blood clots, or a history of liver disease. Also, do not take DHEA if you are pregnant or breastfeeding. The long-term effects of regular DHEA use are not known.

DHEA alone is not an acceptable alternative to your bipolar medications.
Can fish oil supplements boost mood with bipolar disorder?

Fish oil contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are crucial for the production of hormones and nerve tissue. Results from one study showed positive effects of omega-3 fatty acids in treating depression but not for mania. Supplementing the diet with fish oil is less understood with bipolar disorder, because of the mood swings to mania. If you are using fish oils, you must use a product that contains both EPA and DHA for this to be an effective addition to your medications.

Because there is evidence that omega-3 fatty acids can benefit cardiovascular health, some experts believe taking 1 gram per day of omega-3 fatty acid supplements may be beneficial.

Omega 3 Fatty acids may help, when used with your other medications, in treating your bipolar disorder.

What about St. John’s wort and bipolar disorder?

St. John’s wort (Hypericum perforatum), an herbal therapy that’s been shown in studies to lift symptoms of minor to moderate depression, has been used in Europe for centuries. Minor to moderate depression is a common disorder that’s under diagnosed and undertreated. Not only can minor to moderate depression affect your daily functioning and quality of life, it’s also a serious risk factor for major depression.

Studies show that St. John’s wort may affect various brain chemicals (neurotransmitters), including serotonin, epinephrine, and dopamine. These are the same chemicals affected by the prescription Prozac, a selective serotonin reuptake inhibitor (SSRI). St. John’s wort may also improve sleep because hypericum extract increases the brain’s output of melatonin at night. Melatonin is a hormone produced by the body that influences the circadian rhythm and sleep.

But St. John’s wort is not recommended for the treatment of bipolar disorder. Mood stabilizers such as lithium and Lamictal are the drugs of choice for treating bipolar depression. Because of the risk of triggering a manic episode, doctors warn against using any antidepressant, including St. John’s wort, for treatment of bipolar depression. In addition, St. John’s wort may cause serious herb-drug reactions if taken with other SSRI medications such as Prozac.

Are natural therapies safe and effective?

No matter what the advertising flyer claims at the natural food store, even the most popular medicinal herbs with pharmaceutical compounds have ingredients that have not been tested and are not scrutinized by FDA. Unlike products that have FDA approval, many herbal products have not gone through clinical trials to show that they are safe and effective before going onto the market.

As we learn more about natural remedies, some alternative therapies may emerge as the best strategies for treating health conditions, while others may lead to severe side effects. That said, this does not mean that natural supplements do not work — and there are many natural supplements that are safe and effective. Treatment works differently for some people than for others. You need to pay attention to what works for you.

One of the most common mistakes people make when using alternative therapies is to stop the conventional medical treatment altogether. In most cases, supplements are not an adequate alternative to medication for treating bipolar disorder, but may help in addition to your medicine.

Also, keep in mind that supplements — as natural as they may be — can still interact with your medication. That’s why it’s important to discuss all medications and supplements with your doctor. If your doctor isn’t familiar with any potential interactions, your pharmacist is another good source of information.

And as a rule of thumb, just because something is natural doesn’t mean that it is always safe. Even supplements have side effects.

Herbal therapies are not recommended without medical supervision for pregnant women, children, the elderly, people with ongoing disease processes (basically anyone taking a prescribed medicine regularly) or those with compromised immune systems. In addition, some herbs have sedative or blood-thinning qualities, which may dangerously interact with NSAIDs or other pain medications. Others may cause gastrointestinal upset if taken in large doses.

WebMD
Reviewed by David C. Leopold, MD