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Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of bipolar disorder

Causes of depression/bipolar disorder
Because the symptoms, course of illness, and response to treatment vary so much among people with depression, doctors believe that depression may have a number of complex and interacting causes.

Some factors include another medical illness, losing a loved one, stressful life events, and drug or alcohol abuse. Any of these factors also may contribute to recurrent major depressive episodes.

Modern brain imaging technologies are revealing that neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly in people with depression. Imaging studies also indicate that critical neurotransmitters--chemicals used by nerve cells to communicate--are out of balance.

Moreover, genetics research suggests that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. The hormonal system that regulates the body's response to stress also is overactive in many depressed people.

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. However, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional environmental factors, possibly stresses at home, work, or school, are involved in its onset. A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a bipolar/depressive episode.

Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder, including bipolar disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

The mania of Bipolar I is characterized by euphoria and extravagance, while the mania of Bipolar II more typically includes negative thoughts, irritability and agitation. A growing body of research recognizes a "bipolar spectrum," that is, symptoms of bipolarity occuring along a continuum.

Treatment for bipolar disorder
Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder. Other medications have been found to be of benefit in controlling mood swings, including some mood-stabilizing anticonvulsants.

Most people who have bipolar disorder take more than one medication including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Many forms of psychotherapy can help individuals with bipolar disorder. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist.

"Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their disorder. Psychotherapy can help people with bipolar disorder, and their families, identify early warning signs and manage emotional stress, which may help prevent a bipolar episode.

Treatment choice will depend on the outcome of the evaluation. There are a variety of medications and psychotherapies that can be used to treat depressive disorders, including bipolar disorder. Some people with milder forms may do well with psychotherapy alone. Most people with bipolar disorder do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression.

When people are unresponsive to psychotherapy and medications, or cannot take antidepressant medication or the combination of the two works too slowly to relieve severe symptoms, such as psychosis or recurring thoughts of suicide, electroconvulsive therapy (ECT) may be considered. Electrodes are placed at precise locations on the head to deliver electrical impulses ECT is believed to affect the chemical balance of the brain's neurotransmitters.

NIH is funding the largest and most comprehensive studies to date on depression and bipolar disorder. These studies aim to better understand how different treatment options affect people in real-world settings and how to best tailor treatment for improving individualized medical care.

Years of basic research are now promising the first new generation of antidepressant medications in two decades, with a goal of relieving depression in hours, rather than weeks. Such fast acting medications could potentially treat patients at risk for suicide, the most severe consequence of depression, which continues to claim 30,000 lives each year (compared to 18,000 deaths from homicide).

For more information:
Depression and Bipolar Support Alliance
National Alliance on Mental Illness
The National Mental Health Association

Sources:
The National Institute of Mental Health (NIMH)
National Institutes of Health (NIH)
Food and Drug Administration

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