Disease Description (Causes and Symptoms)
- Definition: Bipolar disorder is a mood disorder characterized by recurrent manic (or hypomanic) episodes and depressive episodes. Episodes persist for a certain period and then improve.
- Main causes and pathophysiology: Genetic predisposition, neurochemical imbalances in the central nervous system (abnormalities in neurotransmitters and signal transmission), changes in hormonal regulation, and psychosocial stress interact to cause the disorder. The exact mechanism has not been fully identified.
- Main symptoms
- Mania/hypomania: Elevated mood (euphoria or irritability), flight of ideas (increased speed of thought and continuous shifts in topics), inflated self-esteem (increased self-esteem and excessive confidence), decreased need for sleep, increased amount and speed of speech (pressured speech), impulsive and risky behavior (excessive spending, reckless investments, sexual impulsivity), psychomotor agitation, and sometimes delusions or psychotic symptoms.
- Depressive episode: Depressed mood, lethargy, decreased interest and activity, changes in appetite and sleep, reduced concentration, suicidal thoughts, and so on. Bipolar depression is similar to typical depression, but there is a tendency to complain more of lethargy and reduced energy.
- Types and epidemiology: Type I (a form with prominent mania) and Type II (recurrent hypomania and depression). The lifetime prevalence is approximately 1% overall (0.4–1.6% for Type I and approximately 0.5% for Type II). The average age of onset is relatively young (for example, the average age for Type I is around 30).
Treatment Methods
- Medication treatment (standard)
- Mood stabilizers: Lithium (evidence related to preventive efficacy and reduced suicide risk), valproate (valproic acid), carbamazepine, and lamotrigine (particularly helpful in preventing depression).
- Antipsychotics (particularly during the acute phase of mania and for maintenance treatment): Olanzapine, risperidone, aripiprazole, quetiapine, and others (used alone or in combination with a mood stabilizer).
- Antidepressants: Used cautiously during depressive episodes (when used alone, there is a risk of switching to mania → combination with a mood stabilizer is recommended).
- Others: Some medications, such as gabapentin and topiramate, may be used as adjunctive treatments, but evidence is limited.
- Nonpharmacological treatment
- Psychosocial treatment: Psychoeducation, cognitive behavioral therapy (CBT), family-focused therapy, and interpersonal and social rhythm therapy (maintaining daily routines) are useful for preventing relapse and restoring functioning.
- Inpatient treatment: When there is severe mania (dangerous behavior, concern about harm to others, or severe functional impairment) or a high risk of self-harm or suicide during severe depression.
- Electroconvulsive therapy (ECT): Considered when there is no response to medication treatment or in acute, severe conditions (severe psychosis, serious conditions during pregnancy, or life-threatening depression or mania).
- Monitoring and safety management
- Lithium: Regular testing of blood levels (therapeutic range), kidney function, and thyroid function is required.
- Valproate: Liver function and platelet testing; explain the high risk of birth defects in women who become pregnant (particularly the risk of fetal malformations).
- Antipsychotics: Monitor weight, blood glucose, lipids (metabolic abnormalities), and movement-related side effects.
- Lamotrigine: Monitor for rash (especially during the initial period); discontinue immediately if a severe rash develops.
- Lifestyle management
- Maintain regular sleep, meals, and exercise; avoid alcohol, caffeine, and substance abuse; manage stress; adhere to medication regimens; record early warning signs of symptoms (reduced sleep and mood fluctuations) and discuss them with your primary doctor.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items and records to prepare
- A list of currently taken medications (including prescription drugs, over-the-counter drugs, and herbal medicines) and the times they are taken
- Previous diagnostic certificates, hospitalization records, and test results (especially recent electrolyte, liver, kidney, and thyroid tests and drug-level tests)
- Family history (bipolar disorder, schizophrenia, suicide, alcohol-related problems, and substance-related problems)
- A symptom diary (daily records of mood fluctuations, hours of sleep, activity level, and when impulsive behaviors occurred)
- Information about thoughts of or recent behaviors involving self-harm or suicide
- Possibility of pregnancy/whether breastfeeding (for women)
- History of alcohol and substance use
- Key information to convey to the doctor during an outpatient visit (example questions)
- How many hours have you slept recently, over the past several days or week, and how has your energy changed?
- How long did the period of elevated mood last, and how did your behavior change during that time (spending, impulsivity, driving, and so on)?
- Have you recently had thoughts or plans involving self-harm or suicide?
- Are you experiencing severe side effects from your current medications?
Examples of General Questions to Ask the Doctor
- What are the main side effects of this medication, and how often should monitoring be performed?
- Is lithium (or valproate) appropriate for me? What are its advantages and disadvantages?
- Is there a risk of switching to mania when taking an antidepressant? How can this be prevented?
- What short-term and long-term prognosis can be expected from treatment? What should I do to reduce the risk of relapse?
- How should medications be managed if I am planning pregnancy or breastfeeding?
- How should I respond if an emergency occurs (an urge to self-harm or severe confusion)?
Examples of Customized Questions by Disease
- Recently, my sleep has decreased to a few hours, I am speaking faster, and I am more impulsive than usual. How can I determine whether these are signs of mania and whether immediate treatment is needed?
- I am currently taking an antidepressant and my mood has suddenly become elevated (or I have started being excessively active). Should I continue the medication, or should it be changed to or combined with a mood stabilizer?
- In the long term, which is more suitable for preventing relapse, lithium or valproate? How should the choice be made considering my individual risk factors (kidneys, liver, fertility, and so on)?
Urgent warning: If you have thoughts of self-harm or suicide, may harm others, or have severely impaired judgment (such as not eating or sleeping at all), contact an emergency room or treatment facility immediately.