Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a brain disorder that causes extreme shifts in mood, energy, and functioning. Approximately 12 million Indians are affected by this disorder. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar disorder is a chronic condition with recurring episodes that often begin in adolescence or early adulthood. It generally requires ongoing treatment.

What are the symptoms of mania?

Mania is the word that describes the active phase of bipolar disorder. The symptoms of mania may include:

• Either an elated, happy mood or an irritable, angry, unpleasant mood
• Increased activity or energy
• More thoughts and faster thinking than normal
• Increased talking, more rapid speech than normal
• Ambitious, often grandiose plans
• Increased sexual interest and activity
• Decreased sleep and decreased need for sleep

What are the symptoms of depression?

Depression is the other phase of bipolar disorder. The symptoms of depression may include:

• Depressed or apathetic mood
• Decreased activity and energy
• Restlessness and irritability
• Fewer thoughts than usual and slowed thinking
• Less talking and slowed speech
• Less interest or participation in, and less enjoyment of activities normally enjoyed
• Decreased sexual interest and activity
• Hopeless and helpless feelings
• Feelings of guilt and worthlessness
• Pessimistic outlook
• Thoughts of suicide
• Change in appetite
• Decreased need for sleep

What is a "mixed" state?

when symptoms of mania and depression occur at the same time than patient may present mixed feature. During a mixed state depressed mood accompanies manic phase. The symptoms during a mixed state often include agitation, trouble sleeping, and significant change in appetite, increased talkativeness, rapidly shifting mood from crying to laughing, and suicidal thinking.

What is rapid cycling?

Sometimes individuals may experience regularly alternating periods of mania and depression. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women and times difficult to treat.

What are the causes of bipolar disorder?

While the exact cause of bipolar disorder is not known, researchers believe it is the result of a chemical imbalance in the certain parts of the brain. Scientists have also found evidence of a genetic predisposition to the illness. Bipolar disorder tends to run in families, and close relatives of someone with bipolar disorder are more likely to be affected by the disorder. Sometimes serious life events such as a serious loss, chronic illness, or financial problem, can trigger an episode in some individuals who are predisposed to develop the illness. There are other possible precipitating factors for development of bipolar illness: the treatment of depression with an antidepressant medication may precipitate a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. Hence regular supervised treatment is very important to maintain the patient illness free. It is important to note that bipolar episodes can also occur without an obvious trigger.

How is bipolar disorder treated?

Bipolar disorder is a highly treatable and manageable illness. After an accurate diagnosis, most people can be successfully treated. Medication is an essential part of treatment for people with bipolar disorder. Maintenance treatment with a mood stabilizer substantially reduces the number and severity of episodes for most people. Commonly used mood stabilizers are: Desval ER (Tablet Desval ER is extended release divalproex manufactured by Solus Pharmaceuticals) Sodium valproate, Lithium and  carbamazepine. To control acute agitation in bipolar illness antipsychotic e.g .Oleanz (tablet Oleanz is olanzapine manufactured by SUN Pharmaceuticals. Available in the strength of 2.5mg, 5mg,10mg,15mg and 20 mg), Haloperidol, Risperidone are also used). for depression associated with bipolar disorder commonly used drugs are: Sertraline, Censpram (Censpram is escitalopram, one of the safest antidepressant. This is available in the strength of 5mg, 10mg, and 20 mg tablets) (Escitalopram), Mirnite (mirtazepine), Bupropion. In addition, psychosocial therapies including, cognitive-behavioral therapy and psycho-education are important to help people understand the illness and cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.

What are the side effects of the medications used to treat bipolar disorder?

Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.

Side effects of medications used to treat mania.

• Lithium: hand tremors, excessive thirst, excessive urination, and forgetfulness may result from lithium overdose. In very few people, long-term lithium treatment can interfere with kidney function and thyroid function.
• The other mood stabilizers Desval ER (Tablet Desval ER is extended release divalproex manufactured by Solus Pharmaceuticals) (sodium valproate) , carbamazepine) tend to have fewer side effects than lithium.Some newer antipsychotic (Quel SR) are also being used as mood stabilizer with lesser side effects.  Common side effects of medications include: nausea, drowsiness, dizziness, and tremors. Some people taking anticonvulsant mood stabilizers may develop liver problems, hence regular monitoring with doctor is important Therefore, blood tests to monitor liver function may be an important part of treatment with some of these medications.( Quel SR is quitiapine sustained release tablets manufactured by Innova pharmaceuticals.
• The newer antidepressants (Censpram, sertraline) (Censpram is escitalopram, one of the safest antidepressant. This is available in the strength of 5mg, 10mg, and 20 mg tablets) tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual problems.
• Common side effects of tricyclic antidepressants (imipramine) include dry mouth, constipation, urine retention, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.

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