Bipolar disorder

Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of depression and abnormally elevated mood, lasting days to weeks, and in some cases months. If the elevated mood is severe or associated with psychosis, it is called mania; if it does not significantly affect functioning, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and often makes impulsive decisions with little regard for the consequences. There is usually sleep disturbance during manic phases. During periods of depression, the individual may experience crying, have a negative outlook, and demonstrate poor eye contact. An estimated 15–20% of those with BD die by suicide. Approximately 30–60% attempt suicide during their lifetime. Among those with BD, 40–50% overall and 78% of adolescents engaged in self-harm.

While the causes of this mood disorder are not clearly understood, genetic and environmental factors are thought to play a role. Genetic factors may account for up to 70–90% of the risk of developing BD. Environmental risks include a history of child abuse and long-term stress. The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode. It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes. If these symptoms are due to drugs or medical problems, they are not diagnosed as BD.

Mood stabilizers, particularly lithium, and anticonvulsants, such as lamotrigine and valproate, as well as atypical antipsychotics are used for treatment. Atypical antipsychotics are used for acute manic episodes or when mood stabilizers are ineffective or not tolerated, with long-acting injectables available for patients with adherence issues. There is evidence that psychotherapy improves the course of BD. Use of antidepressants in depressive episodes is controversial: they can be effective, but certain classes of antidepressants increase the risk of mania. The treatment of depressive episodes, therefore, is often difficult. Electroconvulsive therapy (ECT) is effective in acute manic and depressive episodes, especially with psychosis or catatonia. Admission to a psychiatric hospital may be required if someone is a risk to themselves or others; involuntary treatment is sometimes necessary if someone refuses treatment.

Bipolar I and bipolar II occur in approximately 2% of the population, while bipolar spectrum disorder has been estimated to affect as much as 6% of the population. Symptoms most commonly begin between 20–25 years old; an earlier onset is associated with a worse prognosis. Around 30% of people with BD have financial, social or work-related problems due to the condition. Bipolar disorder is the 6th leading cause of disability worldwide and leads to substantial societal costs. Due to lifestyle consequences and medication side effects, risk of death from natural causes, such as coronary artery disease, in people with BD is twice the average.