Bipolar Disorder is characterized by significant mood shifts alternating among a normal, a depressed, and a manic mood (a manic mood presents with a significantly elevated or irritable mood along with markedly increased physical activity).
In order to be diagnosed with a Bipolar Disorder, the individual must have had at least one episode of mania or hypomania (mild version of full-blown mania).
If someone has had at least one episode of mania, they are said to have Bipolar I Disorder. If they have only ever had hypomania, their diagnosis is Bipolar II Disorder.
Bipolar II Disorder is a less severe form of Bipolar Disorder and less problems usually result from the disorder.
About 4.4% of Americans have a Bipolar Disorder. It usually begins during adolescence or young adulthood. Most commonly, the first mood episode is depression so Bipolar Disorder cannot be diagnosed in them until they have a manic or hypomanic episode.
It takes an average of 9 years after onset before a diagnosis is made. Unfortunately, a patient’s life may have been disrupted prior to the correct diagnosis being made. Also, Bipolar Disorder is easier to treat during earlier episodes.
In addition to disrupted relationships, problems in school or at work, and legal problems, patients with Bipolar Disorder have a serious risk of suicide (about 30 to 60 times higher than the general population).
Other co-occurring psychiatric disorders are common in these patients (about 65%). These psychiatric disorders include anxiety disorders, substance use disorders, personality disorders, and ADHD.
A number of general medical disorders are also more common. They include heart disease, diabetes, dementia, high blood pressure, and elevated cholesterol. The reasons for the increased incidence of these illness is likely due to multiple causes.
One important cause is the fact that a greater percentage of these patients smoke tobacco (45%) than the general population. Additional factors include medication side-effects, poor diet, obesity, and inadequate physical activity. Lifestyle interventions have been shown to reduce the risk of cardiac disease.
Fortunately, there are a number of medications that have been shown to treat Bipolar Disorder. It may take some trial and error to find the optimal medication or medications to treat an individual patient.
In addition to medications, severe cases may require ECT, which can often resolve a depressive or manic episode that does not respond adequately to medications.
Psychotherapy has also been shown to benefit patients with Bipolar Disorder. Among other factors, patients in therapy tend to be more consistent in taking their medications.
The data reported in this blog are taken from an excellent review paper on this topic by Nierenberg and colleagues published in JAMA Volume 330, Number 14, on October 10, 2023.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
