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Bipolar Disorder

Bipolar or manic-depressive disorder is a mood disorder that causes intense emotional changes and mood swings from manic “high” to “low” depressive. The majority of bipolar patients experience alternating episodes of mania and depression. In the U.S., more than two million people have been diagnosed with bipolar disorder. This is the sixth in a series of cause of disability worldwide. The average age of onset is from puberty until the middle of the third decade. But because of the complexity of the disorder the correct diagnosis can be delayed for many years.

Bipolar disorder type 1 is characterised by the presence of manic episodes in human life. A person with manic episode often has feelings of overestimation of oneself and euphoria, becomes intensely talkative, characterized by a strong social disinhibition and extroversion with simultaneously inadequate monitoring of impulsions, parallel jobs with multiple activities simultaneously with irritability, impatience, decreased need for sleep. In severe cases, the person can have hallucinations and delusional psychotic thoughts that most commonly confer a sense of grandeur. Usually, the manic phase is followed by a period of depression. Mixed situations where manic and depressive symptoms occur simultaneously, are met relatively frequently in bipolar patients.

Η Bipolar disorder type 2is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania.

Η Bipolar depression may be difficult to distinguish from a plain (unipolar) depressive episode. Patients with bipolar depression typically show extremely decreased energy, feelings of hopelessness, slowed emotional and physical activity and very intense feeling of fatigue, usually more than that happening when plainly depressed.

Η Cyclothymiarefers to swap of hypomanic episodes with depression but not enough to get the dimensions of a major depressive disorder. One-third of patients with cyclothymia will develop bipolar disorder type 1 or type 2 later in life.

The cause of bipolar disorder has not been entirely elucidated. Because two-thirds of bipolar patients have a family history of affective disorders, researchers have been searching for possible genetic correlation with the predisposition for bipolar disorder. Hypotheses have been formulated for unfinished construction of myelin (a substance that surrounds the axons of nerve cells with the purpose of protection and insulation), the presence of large quantities of calcium in nerve brain cells, dopamine and other chemicals-neurotransmitters through which nerve cells communicate. Drug abuse, other organic pathologies such as thyroid disease, medication for other diseases such as cortisone, may cause manic episodes.

The treatment of bipolar disorder most commonly is achieved with medication. Mood stabilisers combined with antidepressants , and antipsychotics  are used to control manic and depressive episodes.

Mood stabilizers used in the “highs” and “lows” of bipolar disorder are lithium, carbamazepine, valproate and lamotrigine.

  • Lithium (Milithin, Lithiofor) is one of the oldest and perhaps the most effective medicine. It regulates bipolar mania and depression but is not suitable for mixed manic episode. Also it is not advisable to the episodes Mania-depression alternating with great speed. Possible lithium side effects are weight gain, thirst, nausea, and trembling of the hands. Prolonged treatment with lithium can lead to hyperthyroidism (thyroid disorder with palpitations, nervousness, sweats etc.
  • Η Carbamazepine (Tegretol) belongs to antiepileptic drugs and has mood stabilizing properties. Blurred vision and skin diseases are two of the most annoying side effects.
  • Το Valproate-Depakine is one of the few medicines that has proved capable to improve the rapidly alternating bipolar disorder as well as the one with mixed manic episodes. Stomach cramps, indigestion, diarrhea, nausea, unusual increase of weight are some of the relatively common side effects.
  • Η Lamotrigine (Lamictal) is a newer antiepileptic, effective especially in depressive episodes of bipolar disorder. It can be co-administered with the previous mood stabilizers but also can be given alone. Dizziness, nausea, headache, skin rashes are some of the side effects.

Apart from the purely mood stabilizing drugs, antipsychotic (neuroleptic) medications can also be widely used, because it appears to help regulate the two poles of mania and depression. The treatment of depression associated with bipolar disorder has several difficulties in relation to the plain (unipolar) depression. This is due to the fact that the depressive episodes within a bipolar disorder is more intense and resistant in pharmaceutical intervention.

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In addition, the uncontrolled prescription of antidepressant drugs can reverse the pole of the disease and trigger a manic episode.

The electroconvulsive therapy (ECT) has been very successful in the treatment of unipolar and bipolar depression. But because of the convenience they offer medications and the stigma that accompanies the implementation of ECT (known as electroshock), ECT is applied when all previous remedies have been exhausted. The ECT is performed under full anesthesia and after the administration of muscle relaxants medicines to prevent spasms. The treatment involves administration of electrical impulses in the brain via implanted electrodes. Although the exact mechanism is not known it is believed that the electrical current alters the electro-chemical environment in the brain resulting in improving depression. Headache, nausea, confusion and temporary loss of memory are referred to as side-effects of the method.

Because bipolar disorder is considered to be organic in nature, psychotherapy is recommended as complementary without substituting medication. Forms of psychotherapy, such as cognitive behavioral therapy and psychoeducation can be a useful tool to help patients and their families to adapt to illness, to encourage compliance to medication and to reduce the risk of suicide.

The ongoing medical monitoring of patients with bipolar disorder is critical for preventing relapse of manic or depressive episodes. Education of patients and their families in the form of psychotherapy is important for recognizing signs and symptoms of the two poles of bipolar disorder.

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