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Bi Polar Disorder (psychological Disorders - Manic Depression)

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The severe mood fluctuations of bipolar or manic-depressive disorders have been around since the 16-century and affect little more than 2% of the population in both sexes, all races, and all parts of the world (Harmon 3). Researchers think that the cause is genetic, but it is still unknown. The one fact of which we are painfully aware of is that bipolar disorder severely undermines its' victims ability to obtain and maintain social and occupational success. Because the symptoms of bipolar disorder are so debilitation, it is crucial that we search for possible treatments and cures.

The characteristics of bipolar disorder are significant shifts in mood that go from manic episodes to deep depressive episodes in a up and down trip that seemingly never ends. There are actually three types of bipolar disorder. In bipolar III disorder there is a family history of mania or hypomania in addition to the client experiencing depressive episodes. This category is not highly used but is worth noting. Bipolar II disorder is marked by hypomanic episodes that have not required hospitalization. Bipolar I disorder is the full-blown illness and is defined by the presence of manic episodes which require treatment, and usually hospitalization (Wilner 44).

Bipolar disorder can strike at any age but most commonly strikes at age 18 in bipolar I; for bipolar II disorder, the age is 22 (Durand and Barlow 189). It has also been found that children can be seen with bipolar disorder early on. This is not very prevalent, and is only one in every 200 cases. This is thought to occur because many children with manic depression might

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have been misdiagnosed or just thought of as hyperactive and disruptive. The early symptoms of childhood bipolar disorder, distractibility, irritability, and hyperactivity are also the signs of attention deficit hyperactivity disorder (ADHD)(Harvard Mental Health Letter, March 1997). It is mainly for this reason that many cases might be misdiagnosed as ADHD and the prevalence of bipolar disorder in children could be much higher.

A person suffering from bipolar disorder alternates from manic states to those of depression. These emotional states can alternate cyclically or one mood may dominate over the other. It is also possible for the two to be mixed or combined with each other.

When the sufferer is in a manic phase of the disorder they may exhibit many unusual behaviors that are not normally present in their everyday life. Elation is probably the most obvious component, and it is often misplaced and without any real reason for being in this mood. Manic episodes bring with them extreme self-confidence and energy to meet people and engage in all sorts of activities and adventures. It is not uncommon to be unable to understand what a person in a manic state is saying because they are talking loud and fast, and can jump from one subject to the next without any provocation or knowing why. Irritability and lack of attention span are also trademarks of this state. In its most extreme, mania can also bring about violence and rage from the individual. During this period the sufferer often enrolls themselves in many activities or responsibilities that they cannot fulfill after the mania subsides, lending to further problems even after the episode has subsided (Encyclopedia Britannica, 23:847).

The depressive state is the darker side of this disorder. There are two types of the depressive state, the agitated state and the retarded state. In the agitated state one may have sustained tension, over-activity, despair and possibly have apprehensive delusions. For the retarded state the stage becomes darker still as their activity is slowed and can almost become

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catatonic. The patient is dejected and sad, and beats himself down with self-degrading talk. Suicide is most likely to happen in the depressive side of bipolar disorder and the patient must be closely watched for suicidal tendencies. Estimates of suicide in bipolar disorder range from 9% to as high as 60%, with an average of 19% (Nathan, 205)

It is often impossible to predict the number of episodes that a person with bipolar disorder can expect to have over the course of a year and is often dependent on each individual case. There is a problem when one experiences too many episodes in one year, it is called rapid-cycling pattern. "An individual with bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to be experiencing a rapid cycling pattern."(Durand and Barlow 192) This group of manic-depressives makes up about 20% of the total number of that are afflicted with bipolar disorder (Harmon 32). In most cases, rapid cycling tends to increase in frequency as time passes and can reach severe states in which there may be no break between manic and depressive stated at all.

Over the years many different medications to treat bipolar have been introduced, but lithium carbonate has been the primary treatment of bipolar disorder since its introduction in the 1960's. Its main function is to stabilize cycling characteristics of bipolar disorder. However, there were drawbacks to using lithium. Some people being treated for bipolar disorder were not able to tolerate the side effects of lithium. Lithium has been linked to causing kidney and thyroid problems. Many people have found the adverse side effects of the medication too difficult to endure, interfering with their jobs and daily living (Burns 103).

For years, Lithium has been the standard treatment for bipolar disorder. By chance, scientists found other effective antimanic drugs are the anticonvulsant medications Tegretol and Depakote, which have been used to treat temporal lobe epilepsy (Harvard Mental Health Letter,

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June 1997). In 1995, Depakote was approved by the FDA for the treatment of bipolar disorder and is slowing becoming the most widely prescribed drug for the use on mania. Depakote hasn't totally replaced lithium; however, it is being used on patients that were not previously treatable with lithium. Compared with lithium, Depakote doesn't have all the bad side effects when properly administered. Patients taking Depakote find their thinking is clearer and don't seems to have the kidney and thyroid problems (Burns 104-106). The antipsychotic drug Clozaril also has been used to stabilize the moods of bipolar disorders, especially those that have not responded to lithium and the anticonvulsants. One major side effect of Clozaril is that is suppresses the production of white blood cells on about 1% of patients (Harvard Mental Health Letter, June 1997). Because of this side effect, doctors have to be extremely careful when



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