Bipolar Disorder

A person with bipolar disorder, which has traditionally been called manic-depressive psychosis, typically experiences discrete episodes of depression and then of mania lasting for a few weeks or months, with intervening periods of complete normality.

The sequence of depression and mania can vary extremely from patient to patient and within one individual, with either mood abnormality predominating in duration and intensity.

Depressive mood swings typically occur more often and last longer than manic ones, though there are patients who have episodes only of mania.

Patients with bipolar disorder frequently also show such psychotic symptoms as delusions, hallucinations, paranoia, or grossly bizarre behavior.

The lifetime risk for developing bipolar disorder is about 0.7 percent and is about the same for men and women.

The onset of the illness often occurs around the age of 30, and the illness persists over the long term.

The predisposition to develop bipolar disorder is partly genetically inherited.

Antipsychotic drugs such as chlorpromazine or haloperidol are used for the treatment of acute mania. Lithium carbonate has proved effective in both treating and preventing recurrent attacks of mania.

Severe and long-lasting depression without the presence of mania is classified by the DSM-III as major depression.

Depression is a much more common illness than mania, and there are indeed many sufferers from depression who have never experienced mania.

Major depression may occur as a single episode or it may be recurrent. It may also exist with or without melancholia and with or without psychotic features.

Melancholia implies the so-called biological symptoms of depression: early-morning waking; daily variations of mood with depression most severe in the morning; loss of appetite and weight; constipation; and loss of interest in love and sex.

Melancholia is a particular depressive syndrome that is relatively more responsive to physical methods of treatment, such as drugs and electroconvulsive therapy.

It is estimated that the annual incidence of major depression is about 140 for men and 4,000 for women per 100,000 population. While the rates for major depression in men increase with age, the peak for women is between the ages of 35 and 45.

There is a serious risk of suicide with the illness; of those who have a severe depressive disorder, about one-sixth eventually kill themselves.

The loss of one's parents or other childhood traumas or deprivations can increase a person's vulnerability to depression later in life, and stressful life events, especially where some type of loss is involved, are in general potent precipitating causes of the illness.

It seems that both psychosocial and biochemical mechanisms are important in causing depression.

Of the latter factor, the best-supported hypotheses suggest that the faulty regulation of the release of one or more naturally occurring amines at sites in the brain where the transmission of nerve impulses takes place is the basic cause, with a deficiency of the amines resulting in depression and an excess causing mania.

The most likely candidates for the suspect amines are the biological monoamines (norepinephrine, dopamine, and 5-hydroxytryptamine).

The treatment of major depressive episodes usually requires antidepressant drugs; electroconvulsive therapy may also be helpful, as may cognitive psychotherapy.