Bipolar depression, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.
Bipolar depression causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Like other mental illnesses, bipolar depression cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar depression is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar depression are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar depression are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
Both children and adolescents can develop bipolar depression. It is more likely to affect the children of parents who have the illness.
Scientists are learning about the possible causes of bipolar depression through several kinds of studies. Most scientists now agree that there is no single cause for bipolar depression-rather, many factors act together to produce the illness.
Most people with bipolar depression even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar depression is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
Medications for bipolar depression are prescribed by psychiatrists-medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.
Research has shown that people with bipolar depression are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication. Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.
Alcohol and drug abuse are very common among people with bipolar depression. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar depression and substance use disorders. Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.
Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar depression. Co-occurring anxiety disorders may respond to the treatments used for bipolar depression, or they may require separate treatment.
Anyone with bipolar depression should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.
Source: National Institute of Mental Health
