Bipolar illness, or manic-depression

Bipolar disorder is a mental health condition characterized by alternating periods of extreme mood swings.  Also called manic depressive disorder, it affects both men and women and can present at any age, although the peak is between ages 15 and 30.  Approximately 1% of patients have bipolar disorder, with the condition having a tendency to run in families.Patients will manifest one of the two behavior patterns in alternating time periods; mania and depression.  When the behavior pattern appears, it is persistent for 2 weeks or more, and not simply a transient, off and on phenomenon.  Signs of mania include:-thinking and talking so fast that others can’t follow your thoughts-not sleeping at all-feeling unrealistically powerful and important-spending too much money-abusing alcohol and drugs-sexual promiscuity Signs of depression include:-feeling sad or depressed-no interest in activities you used to enjoy-appetite and/or sleep changes-feelings of guilt There is no blood or radiologic test that can diagnose bipolar disorder; a careful history and physical examination by a physician is required. A primary care physician will often focus on whether other conditions such as thyroid dysfunction are present; a psychiatrist is usually the diagnosing and treating specialist.Treatment is aimed at keeping the patients behavior under control and preventing harmful (medical, behavioral and/or financial) actions. Medications are usually the cornerstone of therapy, but require a clinician who is experienced and skilled. Probably the best known is a “mood stabilizer” called lithium, which has been used for decades to treat mania; it is now commonly used to treat the depressed component of bipolar illness as well. Monitored through both clinical response and blood tests, lithium has a number of side effects (weight gain, frequent urination, and kidney and thyroid problems). Often patients may need to take lithium plus another medication. Psychotherapy and counseling are important adjuncts to medical therapy.The diagnosis of bipolar illness in children and adolescents is particularly challenging because of some overlap between normal behavior in this age group and early symptoms of bipolar illness. In particular, the following may point to the need for careful evaluation:§  Increased activity and/or silliness above and beyond what is expected for the developmental age of the child and not accounted by the situation or the presence of other disorders§  Lack of need of sleep, especially if the child is not tired or sleepy the day after having slept only three to four hours during the night §  Inappropriate sexual behaviors without history of being exposed to sexual activity (eg, abuse, videos)  For more information, the Depression and Bipolar Support Alliance (www.DBSAlliance.org ) is a good resource.