What is Bipolar Disorder, Anyway?

From the Wall Street Journal – Bipolar Disorder is one of the most misunderstood problems in mental health treatment. Take a look at this useful summary.

What is Bipolar Disorder, Anyway?:



We’ll admit it up front: we’re writing about bipolar disorder today because — as you may know unless you’ve been too busy paying attention to things like the deficit debate or the latest from the Middle Easta rep for Catherine Zeta-Jones says the actress has sought help for the problem.

But bear with us. While most people associate bipolar disorder with episodes of severely high highs and equally low lows, that just describes bipolar 1. About half of the 2% or so of the population with bipolar — and Zeta-Jones — have another form of the condition, bipolar 2.

That’s also characterized by episodes of severe depression, but sufferers also have a milder form of the high, called hypomania. “They may have an elated mood, grandiose thoughts and energy,” David Miklowitz, professor of psychiatry and director of the UCLA Child and Adolescent Mood Disorders Program, tells the Health Blog. But the lessened mania isn’t as disruptive, he says. “People probably won’t lose their job over it and they probably won’t have to be in the hospital.”

Because the depressive periods tend to be severe and longer than the hypomanic ones, bipolar 2 is often misdiagnosed as pure depression, says Miklowitz. That’s significant because the antidepressants that may help depression aren’t appropriate for bipolar disorder; they may aggravate the mania. Standard treatment is mood stabilizers like lithium and anticonvulsants. (Here’s what the NIH has to say about bipolar treatment, including information on risks and side effects.)

Miklowitz says there is some evidence that adding psychotherapy to medication can improve bipolar disorder. His research focuses on the effectiveness of family interventions, which help parents, spouses and siblings recognized their loved one’s symptoms and improve how they communicate.

Between the mid-1990s and 2003, the number of kids diagnosed with bipolar disorder increased from 25 per 100,000 kids to 1,003 per 100,000. It’s unclear whether it was previously underdiagnosed, is now overdiagnosed, or something in between.

Miklowitz says there’s controversy over “the boundaries” of what constitutes bipolar disorder in a kid. For example, many kids may have “very frequent, but short” episodes. “Is it the same thing as bipolar disorder in adults? Do they grow out of it? There are diagnostic quandaries,” he says.

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