Stress & Wellness Consulting • Occupational & Clinical Psychology
Bipolar disorder, also known as bipolar affective disorder and
manic-depressive illness, is a mental disorder characterized by periods
of elevated mood and periods of depression. The elevated mood is
significant and is known as mania or hypomania depending on the severity
or whether there is psychosis. During mania an individual feels or acts
abnormally happy, energetic, or irritable. They often make poorly
thought out decisions with little regard to the consequences. The need
for sleep is usually reduced. During periods of depression there may be
crying, poor eye contact with others, and a negative outlook on life.
The risk of suicide among those with the disorder is high at greater
than 6% over 20 years, while self harm occurs in 30–40%. Other mental
health issues such as anxiety disorder and substance use disorder are
commonly associated.
The cause is not clearly understood, but both genetic and environmental
factors play a role. Many genes of small effect contribute to risk.
Environmental factors include long term stress and a history of
childhood abuse. It is divided into bipolar I disorder if there is at
least one manic episode and bipolar II disorder if there are at least
one hypomanic episode and one major depressive episode. In those with
less severe symptoms of a prolonged duration the condition cyclothymic
disorder may be present. If due to drugs or medical problems it is
classified separately. Other conditions that may present in a similar
manner include substance use disorder, personality disorders, attention
deficit hyperactivity disorder, and schizophrenia as well as a number of
medical conditions.
Treatment commonly includes psychotherapy and medications such as mood
stabilizers or antipsychotics. Examples of mood stabilizers that are
commonly used include lithium and anticonvulsants. Treatment in hospital
against a person’s wishes may be required at times as people may be a
risk to themselves or others yet refuse treatment. Severe behavioural
problems may be managed with short term benzodiazepines or
antipsychotics. In periods of mania it is recommended that
antidepressants be stopped. If antidepressants are used for periods of
depression they should be used with a mood stabilizer. Electroconvulsive
therapy may be helpful in those who do not respond to other treatments.
If treatments are stopped it is recommended that this be done slowly.
Most people have social, financial, or work-related problems due to the
disorder. These difficulties occur a quarter to a third of the time on
average. The risk of death from natural causes such as heart disease is
twice that of the general population. This is due to poor lifestyle
choices and the side effects from medications.
About 3% of people in the United States have bipolar disorder at some
point in their life. Lower rates of around 1% are found in other
countries. The most common age at which symptoms begin is 25. Rates
appear to be similar in males as females. The economic costs of the
disorder has been estimated at $45 billion for the United States in
1991. A large proportion of this was related to a higher number of
missed work days estimated at 50 per year. People with bipolar disorder
often face problems with social stigma.