Disease Description (Causes and Symptoms)
Bipolar disorder (manic-depressive illness) is a mood disorder in which manic (or hypomanic) episodes and depressive episodes recur. Causes discussed include a combination of genetic predisposition, biochemical and hormonal regulatory changes in the central nervous system, and biological and psychosocial factors. Pathophysiologically, abnormalities in neurotransmitters (e.g., serotonin and dopamine), the hypothalamic-pituitary-adrenal (HPA) axis and circadian rhythms, and changes in brain structure and function are involved.
Main symptoms
- Mania (or hypomania): elevated mood and grandiosity (increased self-esteem), flight of ideas (racing thoughts/flight of ideas), increased talking (pressured speech), decreased need for sleep (sleeping only a few hours), excessive goal-directed activity and impulsive risky behavior (excessive spending, reckless driving, excessive sexual behavior, etc.), distractibility, and impaired judgment. In severe cases, delusions and psychotic features may occur.
- Depressive episode: depressed mood, lethargy and reduced energy, changes in sleep (hypersomnia or insomnia), changes in appetite, and increased risk of suicidal thoughts and suicide attempts.
- Episodes of bipolar disorder recur, and manic and depressive symptoms may also occur simultaneously.
Epidemiology (Reference)
- Lifetime prevalence: Bipolar I disorder 0.4–1.6%, Bipolar II disorder approximately 0.5%. The mean age at first onset is often before 30 years of age.
Treatment Methods
Standard treatment combines pharmacotherapy and psychosocial treatment, adjusted according to the symptoms and type of episode.
Pharmacotherapy
- Mood stabilizers: lithium (the standard for preventive maintenance therapy), valproate, carbamazepine, and lamotrigine (particularly helpful in preventing depressive tendencies).
- Antipsychotics (atypical antipsychotics): olanzapine, risperidone, aripiprazole, quetiapine, etc. (used to treat mania and mixed states).
- Antidepressants: May be used for depressive episodes, but because monotherapy carries a risk of inducing mania (switching), they are usually combined with a mood stabilizer.
- Other: Electroconvulsive therapy (ECT) may be considered in cases of severe treatment resistance or clinical emergencies (suicide risk, pregnancy-related complications, etc.).
Psychosocial Treatment and Nonpharmacological Management
- Psychoeducation (understanding the disorder and improving medication adherence), cognitive behavioral therapy (CBT), family therapy, and interpersonal and social rhythm therapy (IPSRT), etc.
- Indications for hospitalization: risk of self-harm or harm to others, severe psychotic symptoms, and severe functional impairment.
Monitoring and Adverse-Reaction Management
- Lithium: Blood concentration monitoring (to confirm the normal maintenance range), as well as kidney and thyroid function tests, is necessary.
- Valproate and carbamazepine: Liver function and blood cell tests; with valproate, caution is needed regarding the risk of birth defects in women of childbearing age (consider an alternative during pregnancy).
- Antipsychotics: Monitor weight, blood glucose, and lipids (metabolic adverse effects).
Precautions
- Do not stop medication without consulting the treating physician, as discontinuation increases the risk of relapse.
- Alcohol and drug abuse can worsen the course.
- If planning pregnancy or breastfeeding, consult a doctor in advance (risks differ by medication).
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
Items to Bring (Recommended)
- A list of all currently used medications and supplements (including doses and times of administration)
- Previous medical certificates, hospitalization records, and test results (if available), as well as a history of medication treatment
- A recent record of mood changes (daily records of emotions, sleep, activities, and impulsive behavior — a mood diary)
- A note on suicidal thoughts, risk of self-harm, or recent impulsive or risky behavior
- Family history (bipolar disorder, depression, schizophrenia, suicide, etc.)
- Information on the possibility of pregnancy or contraception and breastfeeding status
Key Items to Show the Doctor During the Visit
- The onset and course of recent mood fluctuations (manic/depressive symptoms separately)
- Sleep patterns (how many hours you sleep and changes in the need for sleep)
- Experiences with medication effects and adverse effects
- Whether alcohol or drugs are used
- Life stressors and the status of social support
Examples of General Questions to Ask the Doctor
- What are the expected effects and common adverse effects of this medication (formulation)?
- How often should blood levels or blood tests be checked?
- How long is the treatment expected to last, and when can I stop taking the medication?
- What symptoms indicate that hospitalization or emergency treatment is needed?
- How will medication choices change if I am planning a pregnancy?
Examples of Disease-Specific Questions
- Are the symptoms I have recently shown (e.g., reduced sleep time and excessive activity) early signs of mania, and is immediate medication adjustment needed?
- I was previously treated for depression, and having a family history may indicate a risk of conversion to bipolar disorder. In this case, are long-term preventive (maintenance) medications recommended?