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Bipolar Disorder (Manic Depression)

The hallmark of Bipolar Disorder (BPD), also called Manic Depression, is that the patient has manic episodes. They usually also have episodes of depression but not necessarily. Manic episodes are defined as periods of time where the person has an excessive amount of energy which may be described as euphoric, irritable, or both. Commonly the person has racing thoughts, rapid speech, lack of need for much sleep and they still feel well, over indulgence in pleasurable activities that have a high chance for adverse results (i.e., extremes of buying items or investments, using drugs, promiscuity, or even psychotic behavior like directing traffic half naked). The person will usually also eventually have depressive episodes. Some persons even have both manic (rapid speech, racing thoughts, lack of need for sleep, etc) and depressed symptoms (lack of energy, tearfulness, hopelessness, etc.) at the same time (this is called a mixed state).

If the manic symptoms are not severe the person may be said to have hypomania. Persons with hypomania may be very productive, creative and charismatic. The down side is that they may eventually burn-out into exhaustion or full mania, or drop to depression. Others may not be able to keep up with their energy level, they may have a level of irritability and aggression, and they may go to excess in pleasurable activities (i.e., dangerous sports, substance abuse, promiscuity, etc.)

BPD affects 1% of the population, with an equal ration of men and women. The average age of onset is around 20 years-old. Depression, hypomania, and Bipolar Disorder are much more common in first-degree relatives of persons with BPD suggesting a genetic component. The concordance rate for monozygotic twins with bipolar disorder is about 70%. If you put “genetics and bipolar disorder”, or “biology and bipolar disorder”, or “brain scans and bipolar disorder in the Pub Med web site of the U.S. National Library of Medicine, you can get a feel of the biologic findings and nature of BPD.

Many persons with bipolar disorder are talented and creative. Some have made volumes of great artistic or scientific work in relatively short periods of time. This does not mean it is favorable to have this illness as these persons eventually suffer exhaustion, depression, and alienation of their social circle. In addition, persons with some degree of mania often deny they have any problem, enjoy the energy they have, and do not want to admit any personal weakness. If they have an aggressive mania they will blame others. These factors make it extremely common for persons with bipolar disorder to refuse to accept their illness or treatment.

The Diagnostic and Statistical Manual of Mental Disorders-IV details three major categories of bipolar disorder, bipolar I, bipolar II, and cyclothymia. Bipolar I requires one or more manic or mixed episodes. A depressive episode is not required for the diagnosis of bipolar I disorder but it frequently occurs. Bipolar II, which occurs more frequently, is usually characterized by at least one episode of hypomania and at least one major depression. Cyclothymic disorder requires the presence of numerous hypomanic episodes, mixed with mild depressive episodes that do not meet criteria for major depression. Some psychiatrists will also include medication-induced mania, as well as a family history of mania as subtypes of bipolar disorder.

For completeness we will also note that clinical depression may be seen in the context of post-partum depression, seasonal depression, or as premenstrual dysphoric disorder.

After reading about all these mood disorders it may become evident that there are a multitude of variations of depression and mania that one can experience. There is evidence that unipolar depression and bipolar depression may be separate disorders, however many patients often fall into a grey area.

Go to depression page four.

Summary of Depression Links:

DepressionPersonality DisorderPsychodynamic PsychotherapyCore Issue-DefenseCognitive TherapyAnxietyUnipolar DepressionDysthymiaRationalizationDenialManiaPub MedHypothalamic-Pituitary-Adrenal AxisCytokinesNeurotrophic FactorsSerotonin Transporter AlleleMolecular Biology StudiesRecurrent Brief DepressionCircadian RhythmsProjectionAtypical Depressionbipolar disorder (Manic Depression)Mixed StateDiagnostic and Statistical Manual of Mental Disorders-IVBipolar IICyclothymiaHypomaniaMedication-Induced ManiaPost-Partum DepressionSeasonal DepressionPremenstrual Dysphoric DisorderAntidepressantsDepression Treatment

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