Bipolar Mood Disorder (BMD)

Bipolar Mood Disorder (BMD) is classified under Bipolar and Related

Disorders in the DSM-5 (Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition). Bipolar Mood Disorder, formerly called manic
depression, is a mental health condition that causes extreme mood swings
that include emotional highs (mania or hypomania) and lows
(depression).

When we become depressed, we may feel sad or hopeless and lose

interest or pleasure in most activities. When our mood shifts to mania or
hypomania (less extreme than mania), we may feel euphoric (feeling
intense excitement and happiness , full of energy or unusually irritable.
These mood swings can affect sleep, energy, activity, judgment, behavior
and the ability to think clearly.

Types:

There are several types of bipolar and related disorders. They may
include mania or hypomania and depression. Symptoms can cause
unpredictable changes in mood and behavior, resulting in significant
distress and difficulty in life.

1. Bipolar I Disorder:

 Defined by the occurrence of at least one manic episode lasting at

least 7 days (or requiring hospitalization).
 Depressive episodes are common but not required for diagnosis.

2. Bipolar II Disorder:

 Characterized by at least one hypomanic episode (lasting at least 4

days) and one major depressive episode.
 No full manic episodes (presence of mania would change the
diagnosis to Bipolar I).

3. Cyclothymic Disorder:

 Chronic fluctuating mood disturbances involving periods of

hypomanic and depressive symptoms that don’t meet the full
criteria for hypomania or major depression.
  Symptoms persist for at least 2 years (1 year in
children/adolescents).

4. Other Specified and Unspecified Bipolar and Related Disorders:

 Used when symptoms characteristic of bipolar disorder are present

but do not meet the full criteria for any specific bipolar disorder.

Key Diagnostic Features:

1. Manic Episode (Bipolar I):

 Elevated, expansive, or irritable mood, and increased
energy or activity, lasting at least 1 week.
 At least three or more symptoms (four if mood is only
irritable):
 Inflated self-esteem or grandiosity.
 Decreased need for sleep.
 More talkative than usual or pressured speech.
 Flight of ideas or racing thoughts.
 Distractibility.
 Increased goal-directed activity or psychomotor
agitation.
 Excessive involvement in activities with high potential
for painful consequences (e.g., reckless spending,
sexual indiscretions).
2. Hypomanic Episode (Bipolar II):
 Similar symptoms to mania but less severe, lasting at least 4
days.
 No psychotic features or need for hospitalization.
3. Major Depressive Episode:
 Depressed mood or loss of interest/pleasure (anhedonia) for
at least 2 weeks.
 Five or more symptoms:
 Depressed mood most of the day.
 Markedly diminished interest or pleasure in almost all
activities.
 Significant weight loss/gain or appetite change.
 Insomnia or hypersomnia.
  Psychomotor agitation or retardation.
 Fatigue or loss of energy.
 Feelings of worthlessness or excessive guilt.
 Diminished ability to think or concentrate.
 Recurrent thoughts of death or suicidal ideation.

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include

other features, such as anxious, distress, melancholy (sad, depressed),
psychosis or others. The timing of symptoms may include diagnostic
labels such as mixed or rapid cycling. In addition, bipolar symptoms may
occur during pregnancy or change with the seasons.

Causes

The exact cause of bipolar disorder is unknown, but several factors may
be involved, such as:

 Biological differences. People with bipolar disorder appear to

have physical changes in their brains. The significance of these
changes is still uncertain but may eventually help pinpoint causes.
 Genetics. Bipolar disorder is more common in people who have a
first-degree relative, such as a sibling or parent, with the condition.
Researchers are trying to find genes that may be involved in
causing bipolar disorder.
Risk factors

Factors that may increase the risk of developing bipolar disorder or act as
a trigger for the first episode include:

 Having a first-degree relative, such as a parent or sibling, with

bipolar disorder
 Periods of high stress, such as the death of a loved one or other
traumatic event
 Drug or alcohol abuse
Complications

Left untreated, bipolar disorder can result in serious problems that affect
every area of our life, such as:

 Problems related to drug and alcohol use

 Suicide or suicide attempts
 Legal or financial problems
 Damaged relationships
 Poor work or school performance
Prevention

There's no sure way to prevent bipolar disorder. However, getting

treatment at the earliest sign of a mental health disorder can help prevent
bipolar disorder or other mental health conditions from worsening.

If we've been diagnosed with bipolar disorder, some strategies can help
prevent minor symptoms from becoming full-blown episodes of mania or
depression:

 Pay attention to warning signs. Addressing symptoms early can

prevent episodes from getting worse.
 Avoid drugs and alcohol. Using alcohol or recreational drugs can
worsen our symptoms and make them more likely to come back.
 Take our medications exactly as directed. We may be tempted to
stop treatment — but don't. Stopping our medication or reducing
our dose on our own may cause withdrawal effects or our
symptoms may worsen or return.
Diagnosis

To determine if we have bipolar disorder, our evaluation may include:

 Physical exam. Our doctor may do a physical exam and lab tests
to identify any medical problems that could be causing our
symptoms.
 Psychiatric assessment. Our doctor may refer us to a psychiatrist,
who will talk to us about our thoughts, feelings and behavior
patterns. We may also fill out a psychological self-assessment or
 questionnaire. With our permission, family members or close
friends may be asked to provide information about our symptoms.
 Mood charting. We may be asked to keep a daily record of our
moods, sleep patterns or other factors that could help with
diagnosis and finding the right treatment.
 Criteria for bipolar disorder. Our psychiatrist may compare our
symptoms with the criteria for bipolar and related disorders in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
published by the American Psychiatric Association.
Treatment

Bipolar disorder is a lifelong condition. Treatment is directed at

managing symptoms. Depending on our needs, treatment may include:

 Medications. Often, we'll need to start taking medications to

balance our moods right away.
 Continued treatment. Bipolar disorder requires lifelong treatment
with medications, even during periods when we feel better. People
who skip maintenance treatment are at high risk of a relapse of
symptoms or having minor mood changes turn into full-blown
mania or depression.
 Day treatment programs. Our doctor may recommend a day
treatment program. These programs provide the support and
counseling we need while get symptoms under control.
 Substance abuse treatment. If we have problems with alcohol or
drugs, we'll also need substance abuse treatment. Otherwise, it can
be very difficult to manage bipolar disorder.
 Hospitalization. Our doctor may recommend hospitalization if
we're behaving dangerously, we feel suicidal or we become
detached from reality (psychotic). Getting psychiatric treatment at
a hospital can help keep us calm and safe and stabilize our mood,
whether we're having a manic or major depressive episode.
Medications

A number of medications are used to treat bipolar disorder. The types and
doses of medications prescribed are based on our particular symptoms.

Medications may include:

1. Mood Stabilizers

These are the cornerstone of BMD treatment and help prevent mood
swings.

 Lithium
o Effective for both mania and depression prevention.
o Requires regular monitoring of blood levels due to potential
toxicity.
 Valproate (Valproic Acid, Divalproex Sodium)
o Particularly effective for acute mania.
o Requires liver function and blood count monitoring.
 Carbamazepine
o Often used for treatment-resistant cases.
o Requires regular blood monitoring for side effects.
 Lamotrigine
o More effective for bipolar depression than mania.
o Risk of skin rash (Stevens-Johnson syndrome).

2. Antipsychotics

Used in acute mania or for maintenance therapy, especially if psychotic

symptoms are present.

 Second-Generation (Atypical) Antipsychotics:

 Olanzapine
 Risperidone
 Quetiapine
 Aripiprazole
 Lurasidone (particularly effective for bipolar depression).
 Ziprasidone
3. Antidepressants

 Typically used cautiously in bipolar depression, as they can trigger

mania.
 Often combined with a mood stabilizer to mitigate the risk.
 Selective Serotonin Reuptake Inhibitors (SSRIs): E.g.,
Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil),
Citalopram (Celexa), Escitalopram (Lexapro).
 Bupropion: Considered less likely to induce mania.

4. Benzodiazepines

 Used short-term for agitation or insomnia during acute mania.

 Examples: Lorazepam, Clonazepam.

5. Adjunctive Treatments

 Electroconvulsive Therapy (ECT): For severe cases, especially

when medications fail.
 Omega-3 Fatty Acids: Potentially beneficial as an adjunct to
medication.

Monitoring:

 Regular blood tests (e.g., lithium levels, liver function tests for
valproate).
 Monitoring for side effects, such as weight gain, sedation, or
metabolic syndrom

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be

provided in individual, family or group settings. Several types of therapy
may be helpful. These include:

 Interpersonal and social rhythm therapy (IPSRT). IPSRT

focuses on the stabilization of daily rhythms, such as sleeping,
waking and mealtimes. A consistent routine allows for better mood
management. People with bipolar disorder may benefit from
establishing a daily routine for sleep, diet and exercise.
  Cognitive behavioral therapy (CBT). The focus is identifying
unhealthy, negative beliefs and behaviors and replacing them with
healthy, positive ones. CBT can help identify what triggers our
bipolar episodes. We also learn effective strategies to manage
stress and to cope with upsetting situations.
 Psychoeducation. Learning about bipolar disorder
(psychoeducation) can help us and our loved ones understand the
condition. Knowing what's going on can help us get the best
support, identify issues, make a plan to prevent relapse and fix
with treatment.
 Family-focused therapy. Family support and communication can
help us stick with our treatment plan and help us and our loved
ones recognize and manage warning signs of mood swings.
Other treatment options

Depending on our needs, other treatments may be added to our depression

therapy.

 During electroconvulsive therapy (ECT), electrical currents are

passed through the brain, intentionally triggering a brief seizure.
ECT seems to cause changes in brain chemistry that can reverse
symptoms of certain mental illnesses. ECT may be an option for
bipolar treatment if we don't get better with medications, can't take
antidepressants for health reasons such as pregnancy or are at high
risk of suicide.

 Transcranial magnetic stimulation (TMS) is being investigated

as an option for those who haven't responded to antidepressants.

Lifestyle and home remedies

We'll probably need to make lifestyle changes to stop cycles of behavior

that worsen our bipolar disorder. Here are some steps to take:

 Quit drinking or using recreational drugs. One of the biggest

concerns with bipolar disorder is the negative consequences of
risk-taking behavior and drug or alcohol abuse. Get help if we have
trouble quitting on our own.
  Form healthy relationships. Surround ourself with people who
are a positive influence. Friends and family members can provide
support and help us watch for warning signs of mood shifts.
 Create a healthy routine. Having a regular routine for sleeping,
eating and physical activity can help balance our moods. Check
with our doctor before starting any exercise program. Eat a healthy
diet. If we take lithium, talk with our doctor about appropriate fluid
and salt intake. If we have trouble sleeping, talk to our doctor or
mental health professional about what we can do.
 Check first before taking other medications. Call the doctor
who's treating for bipolar disorder before we take medications
prescribed by another doctor or any over-the-counter supplements
or medications. Sometimes other medications trigger episodes of
depression or mania or may interfere with medications we're taking
for bipolar disorder.
 Consider keeping a mood chart. Keeping a record of our daily
moods, treatments, sleep, activities and feelings may help identify
triggers, effective treatment options and when treatment needs to
be adjusted.
Alternative medicine

If we choose to use alternative or complementary medicine in addition to

our physician-recommended treatment, take some precautions first:

 Don't stop taking our prescribed medications or skip therapy

sessions. Alternative or complementary medicine is not a
substitute for regular medical care when it comes to treating
bipolar disorder.
 Be honest with our doctors and mental health
professionals. Tell them exactly which alternative or
complementary treatments we use or would like to try .
 Be aware of potential dangers. Alternative and complementary
products aren't regulated the way prescription drugs are. Just
because it's natural doesn't mean it's safe. Before using alternative
or complementary medicine, talk to our doctor about the risks,
including possible serious interactions with medications.
Coping and support

Coping with bipolar disorder can be challenging. Here are some strategies
that can help:

 Learn about bipolar disorder. Education about our condition can

empower us and motivate us to stick to our treatment plan and
recognize mood changes. Help educate our family and friends
about what we're going through.
 Stay focused on our goals. Learning to manage bipolar disorder
can take time. Stay motivated by keeping our goals in mind and
reminding ourself that we can work to repair damaged
relationships and other problems caused by our mood swings.
 Join a support group. Support groups for people with bipolar
disorder can help us connect to others facing similar challenges
and share experiences.
 Find healthy outlets. Explore healthy ways to channel our energy,
such as hobbies, exercise and recreational activities.
 Learn ways to relax and manage stress. Yoga, massage,
meditation or other relaxation techniques can be helpful.