FAQ: Bipolar I

Bipolar I disorder (pronounced “bipolar one” and also known as manic-depressive disorder or manic depression) is a form of mental illness. A person affected by bipolar I disorder has had at least one manic episode in his or her life.

Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. This is where the term “manic depression” comes from. In between episodes of mania and depression, many people with bipolar I disorder can live normal lives.

Virtually anyone can develop bipolar I disorder. Most people are in their teens or early 20s when symptoms of bipolar disorder first appear. Nearly everyone with bipolar I disorder develops it before age 50. People with an immediate family member who has bipolar are at higher risk.

During a manic episode in someone with bipolar disorder, elevated mood can manifest itself as either euphoria (feeling “high”) or as irritability. People in manic episodes may spend money far beyond their means, have sex with people they wouldn’t otherwise, or pursue grandiose, unrealistic plans. In severe manic episodes, a person loses touch with reality. They may become delusional and behave bizarrely.

Abnormal behaviors during manic episodes include:

• Flying suddenly from one idea to the next
• Rapid, “pressured,” and loud speech
• Increased energy, with hyperactivity and a decreased need for sleep
• Inflated self-image
• Excessive spending
• Hypersexuality
• Substance abuse

Untreated, an episode of mania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months. Depression may follow shortly after, or not appear for weeks or months.

Many people with bipolar I disorder experience long periods without symptoms in between episodes. A minority has rapid-cycling symptoms of mania and depression, in which they may have distinct periods of mania or depression four or more times within a year. People can also have mood episodes with “mixed features,” in which manic and depressive symptoms occur simultaneously, or may alternate from one pole to the other within the same day.

Depressive episodes in bipolar disorder are similar to “regular” clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks or months, but rarely longer than one year.

Mood stabilizers are medicines that treat and prevent highs (manic or hypomanic episodes) and lows (depressive episodes).

Lithium is one of the oldest, least expensive, and most commonly used mood-stabilizers for Bipolar Disorder. Lithium as a salt, is available as: lithium carbonate and lithium citrate. In capsule, tablet, or liquid form: Lithobid, Lithane, Lithonate, Lithotabs, Cibalith-S, and others.
Findings show it effective in reducing symptoms/episode frequency with a response rate of 70% to 80% for the initial manic phase of Bipolar Disorder. Studies show that lithium effectively reduces the risk of suicide at least six fold. If you take lithium, you will need regular blood tests and monitoring of your kidney and thyroid function for drug toxicity levels.

The general classes of Mood Stabilizing medications used in the treatment of Bipolar Disorder are Anticonvulsants, Antipsychotics, and Benzodiazepines:

• Anticonvulsants:
  May be helpful for bipolar depression and treating manic episodes. Common Anticonvulsants include:
  Lamictal (lamotrigine), Depakote (valproic acid), Tegretol (carbamazepine), Trileptal (oxcarbazepine), Neurontin (gabapentin), and Topamax (topiramate)
• Antipsychotics:
  Improve manic episodes in combination with other medicines. Common Antipsychotics include:
  Haldol (haloperidol), Adasuve or Loxitane (loxapine), Risperdal (risperidone), (aripiprazole), Geodon (ziprasidone), Saphris (asenapine), Seroquel (quetiapine fumarate), and Zyprexa (olanzapine)
• Benzodiazepines:
  May be used instead of antipsychotics or as an additional medicine during a manic phase. Common Benzodiazepines include:
  Klonopin (clonazepam), Ativan (lorazepam), Xanax (alprazolam), and Valium (diazepam)