DescriptionAn in-depth report on the causes, diagnosis, and treatment of manic depression.
Alternative NamesManic Depression
According to a long-term 2002 study, bipolar patients had higher mortality rates from suicide, heart problems, and death from all causes than those in the general population. Patients who obtained treatment, however, experienced significant improvement in survival rates, including deaths from suicide and heart disease. (There is a known connection between heart disease and major depression. In this study, patients treated for major depression did not have a lower mortality rate from heart disease.)
The risk for suicide is very high in patients who suffer from bipolar disorder and who do not receive medical attention. Between 10% and 15% of patients with bipolar disorder I commit suicide, with the risks being highest during episodes of depression or mixed mania (simultaneous depression and mania). Some studies have suggested that the risk for suicide in bipolar disorder II patients is even higher than it is for those with bipolar disorder I or major depressive disorder. Patients who also suffer from an anxiety disorder, also are at greater risk for suicide. (Rapid cycling, although a more severe bipolar disorder variation, does not appear to increase the suicide risk in patients with bipolar disorder.)
Many pre- and early adolescent children with bipolar disorder are more severely ill than are adults with the disease. According to a 2001 study, 25% of children with bipolar disorder are seriously suicidal. They have a higher risk for mixed mania, multiple and frequent cycles, and a long duration of illness without well periods.
Thinking and Memory Problems
Studies suggest that patients with bipolar disorder may have varying degrees of problems with short- and long-term memory, speed of information processing, and mental flexibility. Such problems persist even between episodes. They tend to be more severe when a person has more manic episodes. Medications used for bipolar disorder could be responsible for some of these abnormalities, although some evidence suggests that such traits may have a biologic basis. These mental difficulties may make it harder for these patients to comply with medications or to participate in complex psychotherapies.
Behavioral and Emotional Effects of Manic Phases on the Patient
A small percentage of bipolar disorder patients demonstrate heightened productivity or creativity during manic phases. More often, however, the distorted thinking and impaired judgment that are characteristic of manic episodes can lead to dangerous behavior, including the following:
Often such behaviors are followed by low self-esteem and guilt, which are experienced during the depressed phases. During all stages of the illness, patients need to be reminded that the mood disturbance will pass and that its severity can be diminished by treatment.
Cigarette smoking is prevalent among bipolar patients, particularly those who have frequent or severe psychotic symptoms. Some experts speculate that, as in schizophrenia, nicotine use may be a form of self-medication because of its specific effects on the brain; further research is necessary.
Up to 60% of patients with bipolar disorder abuse other substances (most commonly alcohol, followed by marijuana or cocaine) at some point in the course of their illness.
The following are risk factors for alcoholism and substance abuse in bipolar patients:
Effects on Loved Ones
Patients do not manifest their negative behaviors (e.g., spending sprees or even becoming verbally or physically aggressive) in a vacuum. They have a direct effect on others around them. It is very difficult for even the most loving of families or caregivers to be objective and consistently sympathetic with an individual who periodically and unexpectedly creates chaos around them.
Many patients and their families, therefore, cannot admit that these episodes are part of an illness and not simply extreme, but normal, characteristics. Such denial is often strengthened by patients who are highly articulate and deliberate and can intelligently justify their destructive behavior, not only to others, but also to themselves.
Often family members feel socially alienated by the fact of having a relative with mental illness, and they conceal this information from acquaintances. (This is particularly true if the patient is female and lives away from home.) People with more education are more likely to feel ostracized by their acquaintances than are those with less education.
The economic burden of bipolar disorder is significant. In 1991, the National Institute of Mental Health estimated that the disorder cost the country $45 billion, including direct costs (patient care, suicides, and institutionalization) and indirect costs (lost productivity and involvement of the criminal justice system). In spite of the obvious need for professional help, access to medical therapies is not always available for patients with bipolar disorder. In one major survey, 13% of patients had no insurance and 15% were unable to afford medical treatment.
Association with Physical Illnesses
People with mental illness have a higher incidence of many medical conditions, including heart disease, asthma and other lung problems, gastrointestinal disorders, skin infections, diabetes, hypertension, migraine headaches, hypothyroidism, and cancer. Bipolar patients are also less likely to receive medical care than people without mental disorders. Substance abuse, including smoking, alcoholism, and drug abuse, also contributes to many of these problems as well as reduced access to care. Medications used for bipolar disorder can also increase the risk for medical problems.
However, people with bipolar disorder and other mental illness have a higher risk for a number of these conditions independent of these factors.
Diabetes. Diabetes is diagnosed almost three times more often in people with bipolar disorder than it is in the general population. A 2002 study reported that 58% of bipolar patients were overweight, with 26% meeting the criteria for obesity. Being overweight is a significant risk factor for diabetes and so it may be the common factor in both diseases. Drugs used to treat bipolar also pose a risk for weight gain and diabetes. Common genetic factors have also been implicated in diabetes and bipolar disorder, including those causing a rare disorder called Wolfram syndrome and those that regulate carbohydrate metabolism.
Migraine Headaches. Migraines are common in patients with a number of mental illnesses, but they are particularly common among bipolar II patients. In one study, 77% of bipolar II patients had migraines while only 14% of bipolar I patients had this headache, suggesting that different biologic factors may be involved with each bipolar form.
Hypothyroidism. Hypothyroidism (low thyroid levels) is a common side effect of lithium, standard treatment for bipolar. However, evidence also suggests that bipolar patients, particularly women, may be at higher risk for low thyroid levels regardless of which medications they use. It may in fact be a risk factor for bipolar disorder in some patients.