WHAT IS IT?
We all have highs and lows-we feel lively and happy one day, a bit blue the next. But for some people, mood swings can get out of control. The result is bipolar disorder (also known as manic depression): sudden swings in mood from wild elation to the deepest gloom.
These mood shifts can happen fast, though sometimes an “up” or “down” can last for weeks. A person with bipolar disorder may also enjoy long stretches of normal moods between the highs and lows.Bipolar disorder is different from simple depression-the normal “down in the dumps” we all feel sometimes-and is often more serious.
The highs of bipolar disorder, called manias, can vary from mild to extreme. During a mild high, people with bipolar disorder may be very creative and productive. Experts think the writers Lord Byron and Henry James and the painter Vincent van Gogh probably had bipolar disorder. During their highs, they produced some of our greatest literature and art.
But intense manias can cause problems. Some people become dangerous to themselves or others during this time and can’t work or control their actions. The depressions that can follow the highs are often so profound that they approach complete despair.
People with bipolar disorder are not “crazy.” They have a chronic illness. And like any other chronic illness, such as diabetes or asthma, bipolar disorder can be managed and treated.
WHAT IS HAPPENING?
The nervous system and its command station, the brain, are a complex network of billions of nerve cells called neurons. Each neuron is separated from the others by a microscopic gap called a synapse. Experts think that things sometimes go wrong in these gaps to cause bipolar disorder.
Chemicals called neurotransmitters carry messages from cell to cell across the gaps, making it possible for us to move, think, and feel. Our brains have many kinds of neurotransmitters; each plays a defined role. Bipolar disorder may be the result of high or low levels of several, including dopamine, norepinephrine, serotonin, and acetylcholine. Too much or too little of these chemicals may affect the movement of messages across synapses. The result is the racing thoughts and highs of mania and the low moods of depression.
WHAT CAUSES IT?
Though researchers know changes in brain chemistry play a role in bipolar disorder, they’re not sure why these changes happen. Nor do they know whether everyone with the illness has these changes. Scientists are unsure whether these brain chemical changes result from stress or illness or are inherited from one’s family. Also, other illnesses such as stroke or infection, or a head injury, can produce symptoms like those of bipolar disorder.
Your age and your family history do seem to affect your chances of having bipolar disorder. You can’t control those risk factors. But you can control some others that make the illness worse.
THINGS YOU CAN’T CHANGE
Age
It was once thought that most people with bipolar disorder had their first episode in their late teens or twenties. Research now suggests that the disorder affects many children as well.
Family history
Bipolar disorder seems to run in families. If one parent has bipolar disorder, his or her children have a 30 percent risk of getting this disorder. If both parents have bipolar disorder, their children have a 75 percent risk.
Studies of identical twins point to a genetic cause. If one twin suffers from depression or mania, the other has a 70 to 80 percent chance of having the same illness.
Research suggests that many genes make people prone to bipolar disorder. The more of these genes a person inherits, the more likely he or she is to get the illness. But scientists have yet to identify the specific genes involved.
THINGS YOU CAN CHANGE
Medicines
Some drugs for depression may bring on manias in people who have bipolar disorder.
Alcohol or drug use
Alcohol and illegal drugs make symptoms of bipolar disorder worse.
Stress
Extreme stress or a sad event such as a death in the family may trigger a high or low in someone who is prone to mood swings. But these instances are rare. Often there is no single cause for bipolar disorder. Whether life events contribute to most cases of bipolar disorder is unknown.
WHAT YOU CAN DO FOR YOURSELF
You can’t prevent bipolar disorder, but if you have it, you can do a lot with your doctor’s help to ease the problems the illness may cause. Treatment can help with marriage troubles and money problems. Also, it can cut the risk of substance abuse.
Seek help
First, ask your family doctor to check your symptoms and help you decide on a treatment plan.
Take your medicines
This is vital if you have bipolar disorder. Medicines such as lithium, valproic acid, and carbamazepine keep the problem under control and prevent repeat episodes. Take these drugs exactly as your doctor instructs.
Reach out for support
When you feel low, do what you can to stay in touch with friends. Tell them how you feel. Just talking will help, and your friends may offer advice or other help that can ease the lows. Another option: Try a support group for people with bipolar disorder, such as one of those run by the National Depressive and Manic Depressive Association. These groups give you the chance to talk with others who know how you feel.
Take care of your health
Eat balanced meals and get enough sleep when you’re going through stressful times. Also, exercise often. It eases stress and depression. Work up a sweat for 20 to 30 minutes three to five days a week, or whenever you feel depressed. Pick something to do that gets your heart rate up. Walking, running, bicycling, and swimming are all ideal. Exercise outdoors as much as you can. Some people find they feel better just being outside in the sunlight.
Ease stress
There are many ways to relieve stress. Any of them can help keep bipolar disorder under control.
Take time out each day to do things you enjoy, such as reading or taking a walk. Plan outings with friends.
Take breaks during a hectic day to calm down. Try for 20-minute time-outs at least a couple of times a day-any change of pace.
Make sure you eat healthy meals and sleep well. Stay away from caffeine; too much of it can make you tense and nervous.
If you’re feeling frustrated about problems in your life, write about them in a journal or share them with a therapist. Getting your feelings out in the open can help.
Change your medicine
If you’re taking a medicine you think may be causing mood swings, talk to your doctor about switching to another. But never stop taking your medicine without first checking with your doctor.
Avoid drugs and alcohol
Stay away from illegal drugs and don’t drink alcohol.
WHAT YOUR DOCTOR CAN DO FOR YOU
Bipolar disorder seems to be closely linked to changes in brain chemistry. That’s why the main treatment often involves drugs to control these changes. But psychotherapy may also help. Your doctor will work with you to devise the best treatment plan.
Finally, if medicines and psychotherapy don’t help enough, your doctor may suggest that you have electroconvulsive therapy (ECT).