Bipolar Disorder

Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. A person with bipolar disorder can go from feeling very, very high (called mania) to feeling very, very low (depression). The average age-of-onset is about 25 years old, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.8% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe. With a proper treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule and early identification of symptoms, many people live well with the condition. While the rate of bipolar disorder is the same among all Americans, Black, Indigenous and other people of color are least likely to receive a diagnosis and, therefore, treatment for this illness.

What are the signs of bipolar disorder?

Mania: Excessive energy, restlessness, racing thoughts and rapid talking; Denial that anything is wrong; Extremely happy feelings; Easily irritated; Needing little sleep; Unrealistic belief in one’s ability; Poor judgment; Sustained, unusual behavior; increased sex drive; substance abuse; aggressive behavior ; paranoia
Depression: Poor appetite or eating too much; Trouble sleeping or sleeping too much; Nervousness and worry; Loss of interest in and withdrawal from usual activities; Feeling of sadness that don’t go away; Irritability or restlessness; Lack of energy; Feelings sadness, worthlessness or guilt; Inability to think or concentrate; Repeated thoughts of death or suicide; Chronic pain or other physical problems that don’t respond to treatment; Increased risk-taking behavior, including reckless driving or substance abuse.

What causes bipolar disorder?

The exact cause of bipolar disorder is not yet known, but its causes may include: imbalances in brain chemistry; genetics; stressful or disturbing events; drug and alcohol abuse.

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, a doctor has to perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses (or medicines) as a cause. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing. To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.

What are the different types of bipolar disorder?

Bipolar I Disorder- manic episodes must last at least seven days or be so severe that hospitalization is required
Bipolar II Disorder- the depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.
Cyclothymic Disorder or cyclothymia- a chronically unstable mood state which people experience hypomania and mild depression for at least two years
Bipolar Disorder, “other specified” and “unspecified” – person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation

What are some treatment strategies for bipolar disorder?

Psychotherapy, Medication, Self-management strategies, Exercise, Stress reduction classes, Religious faith

What medications are used in the treatment of bipolar disorder?

Mood Stabilizers- Lithium, Anticonvulsants (Valproic Acid, Lamotrigine, Carbamazepine, Oxcarbazepine)
Antipsychotics- First Generation, Second Generation
Adjunctive Agents- Antidepressants (SSRIs, Bupropion), Benzodiazepines (Lorazepam, Clonazepam)

Written by:
Kalu Kalu
PharmD Candidate 2021
Temple University School of Pharmacy