FREE ESSAY ON BIPOLAR DISORDER

BIPOLAR DISORDER

Bipolar affective disorder has been a mystery since the 16th century. History has shown
that this disorder can appear in almost anyone. Even the great painter Vincent Van Gogh
is believed to have had bipolar disorder. It is clear that in our society many people
live with bipolar disorder; however, despite the amount of people suffering from it, we
are still waiting for explanations for the causes and cure. The one fact of which we are
aware is that bipolar disorder severely undermines its' victims ability to obtain and
maintain social and occupational success. Because bipolar disorder has such debilitating
symptoms, it is important that we keep looking for explanations of its causes and for
more ways to treat this disorder.
Bipolar has a large variety of symptoms, divided in two categories. One is the manic
episodes, the other is depressive. The depressive episodes are characterized by intense
feelings of sadness and despair that can turn into feelings of hopelessness and
helplessness. Some of the symptoms of a depressive episode include disturbances in sleep
and appetite, loss of energy, feelings of worthlessness, guilt, difficulty thinking,
indecision, and reoccurring thoughts of death and suicide. The manic episodes are
characterized by elevated or irritable mood, increased energy, decreased need for sleep,
poor judgment and insight, and often reckless or irresponsible behavior. These episodes
may alternate with profound depressions characterized by a deep sadness, almost inability
to move, hopelessness, and disturbances in appetite, sleep, problems with concentrations
and driving.
Bipolar affective disorder affects approximately one percent of the population
(approximately three million people) in the United States. It occurs in both males and
females. Bipolar disorder is diagnosed if an episode of mania occurs whether depression
has been diagnosed or not. Most commonly, individuals with manic episodes do experience a
period of depression. Symptoms include elated, excited, or irritable mood, hyperactivity,
pressure of speech, flight of ideas, inflated self-esteem, decreased need for sleep,
distractibility, and excessive involvement in reckless activities.
As the National Depressive and Manic Depressive Association (MDMDA) has found out in
their research, bipolar disorder can create marital and family disruptions, occupational
setbacks, and financial disasters. 
Many times, bipolar patients report that the depressions are longer and increase in
frequency as the person ages. Many times's bipolar states and psychotic states are
misdiagnosed as schizophrenia.
The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age,
with a second peak in the mid-forties for women. A typical bipolar patient may experience
eight to ten episodes in their lifetime. However, those who have rapid cycling may
experience more episodes of mania and depression that follow each other without a period
of remission.
The three stages of mania begin with hypomania, in which patients report that they are
energetic, extroverted and assertive. Hypomania progresses into mania and the transition
is marked by extreme loss of judgment. Often, euphoric grandiose characteristics are
displayed, and paranoid or irritable characteristics begin. The third stage of mania is
evident when the patient experiences paranoid delusions. Speech is generally rapid and
hyperactive behavior sometimes turns into violence.
Sometimes both manic and depressive symptoms occur at the same time. This is called a
mixed episode. Those affected are at special risk because there is a combination of
hopelessness, agitation, and anxiety that make them feel like they could jump out of
their skin. Up to 50% of all patients with mania have a mixture of depressed moods.
Patients report feeling dysphoric, depressed, and unhappy; yet, they have the energy
associated with mania. Rapid cycling mania is another form of bipolar disorder. Mania may
be present with four or more episodes within a 12 month period. This form of the disease
has more episodes of mania and depression than bipolar disorder, although this is
believed to be a branch of actual bipolar disorder.
Lithium has been the primary treatment of bipolar disorder since its introduction in the
1960's. Its main function is to stabilize the cycling characteristic of bipolar disorder.
In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate
for bipolar subjects treated with Lithium was 78% (1990). Lithium is also the primary
drug used for long- term maintenance of bipolar disorder. In a majority of bipolar
patients, it lessens the duration, frequency, and severity of the episodes of both mania
and depression.
Unfortunately, as many as 40% of bipolar patients are either unresponsive to lithium or
can not handle the side effects. Some of the side effects include thirst, weight gain,
nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often
those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder.
One of the problems associated with lithium is the fact the long-term lithium treatment
has been associated with decreased thyroid functioning in patients with bipolar disorder.
Evidence also suggests that hypothyroidism may actually lead to rapid-cycling. Pregnant
women experience another problem associated with the use of lithium. Its use during
pregnancy has been associated with birth defects.
There are other effective treatments for bipolar disorder that are used in cases where
the patients cannot tolerate lithium or have been unresponsive to it in the past. The
American Psychiatric Association's guidelines suggest the next best treatment to be
Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful as
antimanic drugs, especially in those patients with mixed states. Both of these
medications can be used in combination with lithium or in combination with each other.
Valproate is especially helpful for patients who do not wish to take lithium, experience
rapid cycling, or abuse drugs or alcohol.
Neuroleptics such as Haldol or Thorazine have also been used to help stabilize manic
patients who are highly agitated or psychotic. Use of these drugs is often necessary
because the responses to them are rapid, but there are risks involved in their use.
Because of the often severe side effects, Benzodiazepines are often used in their place.
Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms
of rapid control of agitation and excitement, without the severe side effects.
Some doctors as treatment for bipolar disorder have also used antidepressants such as the
selective serotonin reuptake inhibitors (SSRI's) Luvox and Elavil. There are studies that
say these help, but these are controversial however, because conflicting research shows
that SSRI's and other antidepressants can actually cause manic episodes. Most doctors can
see the usefulness of antidepressants when used with mood stabilizing medications such as
Lithium.
In addition to the mentioned medical treatments of bipolar disorder, there are several
other options available to bipolar patients, most, of which are used in conjunction with
medicine. One such treatment is electro-convulsive shock therapy. ECT is the preferred
treatment for severely manic patients and patients who are homicidal, psychotic,
catatonic, or severely suicidal. In one study, researchers found improvement in 78% of
patients treated with ECT, compared to 62% of patients treated only with lithium and 37%
of patients who received neither ECT or lithium.
A final type of therapy that I found is outpatient group psychotherapy. According to Dr.
John Graves, spokesperson for The National Depressive and Manic Depressive Association
has called attention to the value of support groups, and challenged mental health
professionals to take a more serious look at group therapy for the bipolar population.
Research shows that group participation may help increase medication compliance, insight
regarding the illness, and awareness of stress factors leading to manic and depressive
episodes. Group therapy for patients with bipolar disorders responds to the need for
support and reinforcement of medication management, and the need for education and
support for the difficulties that arise during the course of the disorder.
References
Bauer, M.S., Whybrow, P.C. and Winokur, A. (1990). Rapid Cycling Bipolar Affective
Disorder: I. Association with grade I hypothyroidism. Archives of General Psychiatry. 47:
427-432.
Black, D.W., Winokur, G., and Nasrallah, A. (1987). Treatment of Mania: A naturalistic
study of electroconvulsive therapy versus lithium in 438 patients. Journal of Clinical
Psychiatry. 48: 132-139.
Gasperini, M., Gatti, F., Bellini, L., Anniverno, R., Smeralsi, E., (1992). Perspectives
in clinical psychopharmacology of amitriptyline and fluvoxamine. Pharmacopsychiatry.
26:186-192.
Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive Illness. New York: Oxford
University Press.
Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric Diagnosis. Fourth Ed. Oxford
University. p.7.
Hirschfeld, R.M. (1995). Recent Developments in Clinical Aspects of Bipolar Disorder. The
Decade of the Brain. National Alliance for the Mentally Ill. Winter. Vol. VI. Issue II.
Hollandsworth, James G. (1990). The Physiology of Psychological Disorders. Plenem Press.
New York and London. P.111.
Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We
Come? Psychopharmacology Bulletin. 30 (1): 27-38.
Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D., Donnerfeld, A.E., Rieder, M.,
Santelli, R., Smythe, J., Patuszuk, A., Einarson, T., and Koren, G., (1992). Prospective
multicenter study of pregnancy outcome after lithium exposure during the first trimester.
Laricet. 339: 530-533.
Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and Hirschfeld, R.M. (1994). The
National Depressive and Manic Depressive Association (DMDA) Survey of Bipolar Members.
Affective Disorders. 31: pp.281-294.
Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P., Holzer, C. (1991). Psychiatric
Disorders in America. Affective Disorders. Free Press.
Bibliography
References
Bauer, M.S., Whybrow, P.C. and Winokur, A. (1990). Rapid Cycling Bipolar Affective
Disorder: I. Association with grade I hypothyroidism. Archives of General Psychiatry. 47:
427-432.
Black, D.W., Winokur, G., and Nasrallah, A. (1987). Treatment of Mania: A naturalistic
study of electroconvulsive therapy versus lithium in 438 patients. Journal of Clinical
Psychiatry. 48: 132-139.
Gasperini, M., Gatti, F., Bellini, L., Anniverno, R., Smeralsi, E., (1992). Perspectives
in clinical psychopharmacology of amitriptyline and fluvoxamine. Pharmacopsychiatry.
26:186-192.
Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive Illness. New York: Oxford
University Press.
Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric Diagnosis. Fourth Ed. Oxford
University. p.7.
Hirschfeld, R.M. (1995). Recent Developments in Clinical Aspects of Bipolar Disorder. The
Decade of the Brain. National Alliance for the Mentally Ill. Winter. Vol. VI. Issue II.
Hollandsworth, James G. (1990). The Physiology of Psychological Disorders. Plenem Press.
New York and London. P.111.
Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We
Come? Psychopharmacology Bulletin. 30 (1): 27-38.
Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D., Donnerfeld, A.E., Rieder, M.,
Santelli, R., Smythe, J., Patuszuk, A., Einarson, T., and Koren, G., (1992). Prospective
multicenter study of pregnancy outcome after lithium exposure during the first trimester.
Laricet. 339: 530-533.
Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and Hirschfeld, R.M. (1994). The
National Depressive and Manic Depressive Association (DMDA) Survey of Bipolar Members.
Affective Disorders. 31: pp.281-294.
Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P., Holzer, C. (1991). Psychiatric
Disorders in America. Affective Disorders. Free Press.