Beating Bipolar Depression

Bipolar depression, also called manic-depressive illness, is not as common as major depression or dysthymia. It is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression).

It is a brain disorder that also causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms are severe. They can result in damaged relationships, poor job or school performance, and even suicide . But there is good news: bipolar depression can be treated, and people with this illness can lead full and productive lives.

Typically developing in late adolescence or early adulthood, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar depression is a long-term illness that must be carefully managed throughout a person’s life.

The exact cause has not been discovered, but many experts believe that multiple factors are involved which act together to cause the disease. It may result from a chemical imbalance within the brain. The brain's functions are controlled by chemicals called neurotransmitters. An imbalance in the levels of one of these neurotransmitters may cause bipolar depression. When levels of this chemical are too high, mania occurs. When levels of norepinephrine drop below normal levels, a person may experience depression.

There is a significant genetic component to this disease. If one family member has it, other family members may be at risk.

However, stress of some kind often is needed to trigger the onset of the disease. The disease does not occur just because of one gene, and the cause of the disease is likely a combination of multiple genetic and environmental factors.

Sometimes a period of emotional stress, drug use, an illness, or another event seems to trigger the onset of the disease. Stresses can also trigger a manic or depressive episode in people who are known to have the condition.

Not everyone with severe mood swings or a change in personality has bipolar depression. Mood swings can be caused by other medical conditions such as a low or "sluggish" thyroid gland that need to be diagnosed and treated properly. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are checked before a diagnosis is made.

Most people with bipolar depression — even those with the most severe forms — can get substantial stabilization of their mood swings and related symptoms with proper treatment.

Because it is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated.

A strategy that combines medication and psychosocial treatment is often the best way for managing the problem over time. In most cases, it is much better controlled if treatment is continuous than if it is on and off.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar depression and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications For Bipolar Depression

• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.

• Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat cases. Valproate was FDA-approved in 1995 for treatment of mania.

Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.

Before starting any medication, always talk with your doctor about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth.

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