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Everyone has ups and downs in mood. Feeling happy, sad and angry is normal. Bipolar disorder, or manic-depressive illness, is a serious medical condition that causes people to have extreme mood swings. These swings affect how people think, behave and function.
Bipolar disorder typically consists of three states:
a high state, called mania
a low state, called depression
a well state, during which the person feels normal and functions well.
One to two per cent of adults have bipolar disorder. In adolescents and young adults, the symptoms may be less typical and may be mistaken for teenage distress or rebellion. Men and women are affected equally. In some women, bipolar disorder may appear during pregnancy or shortly after it. In this case, symptoms of depression are more common than symptoms of mania.
Sometimes, a person may seem abnormally and continuously high, happy, expansive and euphoric, or irritable, angry, disruptive and aggressive, for at least one week. If this change in mood is accompanied by at least three of the following symptoms, the person may be in a manic phase of bipolar disorder:
The symptoms of hypomania are less severe than those of mania: the person may feel happy and have a lot of energy, but his or her life usually is not seriously disrupted. Hypomania may progress to a full-blown manic episode or a severe depression, and therefore needs treatment.
Symptoms of depression in bipolar disorder include at least five of the following, which must be present for at least two weeks and must be present most days all day:
marked loss of interest or pleasure in activities that used to be enjoyable
weight loss or gain
insomnia or hypersomnia (oversleeping)
apathy or agitation
loss of energy
feelings of worthlessness and guilt
inability to concentrate or make decisions
thoughts of suicide (which should always be taken seriously).
People with bipolar disorder may experience psychotic symptoms, such as losing touch with reality, hearing voices or having ideas that are not based in reality. Psychotic symptoms can be very frightening for the person having them and for others. Up to 25 per cent of people experiencing episodes of depression or mania also have problems with movement, called catatonic symptoms. These may include extreme physical agitation or slowness and odd movements or postures.
People with bipolar disorder who have psychotic or catatonic symptoms are sometimes incorrectly diagnosed as having schizophrenia [link to “Schizophrenia az], another severe mental illness.
We do not know the precise cause of bipolar disorder. However, research shows that genes play a strong role. Stress or difficult family relationships do not cause the illness. However, these factors may trigger an episode in someone who already has the illness.
Treatment for bipolar disorder includes pharmacotherapy (medications) and psychosocial treatments (psychotherapy, rehabilitation).
Often both types of treatment are needed, but usually biological treatment is needed first to bring symptoms under control.
Recommendations for maintenance, or longer-term treatment, depend on the type of illness.
Like chronic disorders such as hypertension or diabetes, bipolar disorder can be managed and controlled by combining treatment and a healthy lifestyle. The goal in treating bipolar disorder is to help the person get well again. This includes:
treating symptoms until they no longer cause distress or problems
improving work and social functioning
reducing risk of relapse.
Adapted from Bipolar Disorder: An Information Guide © 2000 Centre for Addiction and Mental Health