BIPOLAR DISORDER

Bipolar disorder is a chronic psychiatric illness characterized by recurrent episodes of mania and depression. It is a mood disorder and is also referred to as manic-depressive disorder. It typically begins in the twenties, but it can also start after the age of 60. The first episode is usually a depressive episode; however, for a diagnosis of bipolar disorder, at least one manic episode must have occurred.

Manic Episode:

A sudden display of emotions, attitudes, and behaviors that are markedly different from the person’s usual state—and are easily noticed by others—is very characteristic of a manic episode. These differences often include:

Irritability, low tolerance, mood swings, excessive happiness, inappropriate joking, increased energy and activity, increased sexual interest and desire, excessive spending, reduced need for sleep, feeling very energetic despite little sleep, inflated self-confidence, generating numerous unrealistic projects, increased talkativeness, increased self-care, exaggerated makeup, grandiosity… At times, paranoid thoughts (delusions) with political, economic, religious, or sexual content may occur.

Depressive Episode:

Symptoms generally include social withdrawal, unhappiness, pessimism, lack of interest, low motivation, sleep and appetite disturbances, and thoughts of death. Delusions may also occur during this period.

Manic and depressive episodes usually subside within approximately 4–6 weeks with treatment. Apart from these episodes, there are intermediate periods of recovery called remission or euthymia, during which the individual largely returns to their pre-illness state.

Treatment

The most important aspect of treatment is educating both the patient and their family about the illness. If the individual learns about the disorder and the early warning signs of episodes (such as increased irritability and activity, reduced need for sleep, excessive spending), it becomes easier to manage the illness and improves quality of life.

Since the disorder progresses with episodes (mania and depression) and remission periods, the treatments for these phases differ:

1. Mood Stabilizers: These include medications such as lithium, valproate, and carbamazepine. They are used both during episodes and in remission periods. Even after recovering from a manic or depressive episode, individuals must continue taking these medications to prevent recurrence.
   
   The most commonly used mood stabilizer is lithium. Although it is popularly believed that bipolar disorder is caused by a deficiency of lithium, this is incorrect. This misconception arises because blood levels of lithium must be monitored regularly during treatment. The medication needs to be maintained within a certain range in the blood—levels below this range are ineffective, while levels above it can be toxic.
2. Antipsychotics: These are especially used during manic episodes, and the dose is reduced as the mania subsides. However, they may also be used during depressive and remission periods.
3. Antidepressants: These are used only during depressive episodes and should be gradually discontinued under medical supervision afterward, as they may otherwise trigger mania.
4. Electroconvulsive Therapy (ECT): This may be applied in hospitalized patients, particularly in severe mania or severe depression (especially when there is a risk of suicide).
5. Psychotherapy: This is mainly provided in the form of psychoeducation for the patient and their family. During remission periods, therapy focusing on life challenges and coping skills can be beneficial.

Psychiatrist Dr. Arzu Dalmış