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Manic depression – bipolar
disorder
Manic depression - Bipolar disorder, also known as manic-depressive
illness, is a brain disorder that 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 of bipolar disorder are severe. They can result
in damaged relationships, poor job or school performance,
and even suicide. But there is good news: bipolar disorder
can be treated, and people with this illness can lead full
and productive lives.
More than 2 million American adults,1 or about 1 percent
of the population age 18 and older in any given year,2 have
bipolar disorder. Bipolar disorder typically develops in late
adolescence or early adulthood. However, 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 disorder
is a long-term illness that must be carefully managed throughout
a person's life.
What Are the Symptoms of Manic depression- Bipolar Disorder?
Manic depression - Bipolar disorder causes dramatic mood
swings—from overly "high" and/or irritable
to sad and hopeless, and then back again, often with periods
of normal mood in between. Severe changes in energy and behavior
go along with these changes in mood. The periods of highs
and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
• Increased energy, activity, and restlessness
• Excessively "high," overly good, euphoric
mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from
one idea to another
• Distractibility, can't concentrate well
• Little sleep needed
• Unrealistic beliefs in one's abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behavior that is different from
usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and
sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with
three or more of the other symptoms most of the day, nearly
every day, for 1 week or longer. If the mood is irritable,
four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode)
include:
• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed,
including sex
• Decreased energy, a feeling of fatigue or of being
"slowed down"
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much, or can't sleep
• Change in appetite and/or unintended weight loss or
gain
• Chronic pain or other persistent bodily symptoms that
are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these
symptoms last most of the day, nearly every day, for a period
of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania
may feel good to the person who experiences it and may even
be associated with good functioning and enhanced productivity.
Thus even when family and friends learn to recognize the mood
swings as possible bipolar disorder, the person may deny that
anything is wrong. Without proper treatment, however, hypomania
can become severe mania in some people or can switch into
depression.
Sometimes, severe episodes of mania or depression include
symptoms of psychosis (or psychotic symptoms). Common psychotic
symptoms are hallucinations (hearing, seeing, or otherwise
sensing the presence of things not actually there) and delusions
(false, strongly held beliefs not influenced by logical reasoning
or explained by a person's usual cultural concepts). Psychotic
symptoms in bipolar disorder tend to reflect the extreme mood
state at the time. For example, delusions of grandiosity,
such as believing one is the President or has special powers
or wealth, may occur during mania; delusions of guilt or worthlessness,
such as believing that one is ruined and penniless or has
committed some terrible crime, may appear during depression.
People with bipolar disorder who have these symptoms are sometimes
incorrectly diagnosed as having schizophrenia, another severe
mental illness.
It may be helpful to think of the various mood states in
manic depression - bipolar disorder as a spectrum or continuous
range. At one end is severe depression, above which is moderate
depression and then mild low mood, which many people call
"the blues" when it is short-lived but is termed
"dysthymia" when it is chronic. Then there is normal
or balanced mood, above which comes hypomania (mild to moderate
mania), and then severe mania.
In some people, however, symptoms of mania and depression
may occur together in what is called a mixed bipolar state.
Symptoms of a mixed state often include agitation, trouble
sleeping, significant change in appetite, psychosis, and suicidal
thinking. A person may have a very sad, hopeless mood while
at the same time feeling extremely energized.
Manic depression - Bipolar disorder may appear to be a problem
other than mental illness—for instance, alcohol or drug
abuse, poor school or work performance, or strained interpersonal
relationships. Such problems in fact may be signs of an underlying
mood disorder.
Diagnosis of manic depression - Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet
be identified physiologically—for example, through a
blood test or a brain scan. Therefore, a diagnosis of bipolar
disorder is made on the basis of symptoms, course of illness,
and, when available, family history. The diagnostic criteria
for bipolar disorder are described in the Diagnostic and Statistical
Manual for Mental Disorders, fourth edition (DSM-IV).3
Descriptions offered by people with bipolar disorder give
valuable insights into the various mood states associated
with the illness:
Depression: I doubt completely my ability to do anything
well. It seems as though my mind has slowed down and burned
out to the point of being virtually useless…. [I am]
haunt[ed]… with the total, the desperate hopelessness
of it all…. Others say, "It's only temporary, it
will pass, you will get over it," but of course they
haven't any idea of how I feel, although they are certain
they do. If I can't feel, move, think or care, then what on
earth is the point?
Hypomania: At first when I'm high, it's tremendous…
ideas are fast… like shooting stars you follow until
brighter ones appear…. All shyness disappears, the right
words and gestures are suddenly there… uninteresting
people, things become intensely interesting. Sensuality is
pervasive, the desire to seduce and be seduced is irresistible.
Your marrow is infused with unbelievable feelings of ease,
power, well-being, omnipotence, euphoria… you can do
anything… but, somewhere this changes.
Mania: The fast ideas become too fast and there are far
too many… overwhelming confusion replaces clarity…
you stop keeping up with it—memory goes. Infectious
humor ceases to amuse. Your friends become frightened….
everything is now against the grain… you are irritable,
angry, frightened, uncontrollable, and trapped.
Suicide
Some people with bipolar disorder become suicidal. Anyone
who is thinking about committing suicide needs immediate attention,
preferably from a mental health professional or a physician.
Anyone who talks about suicide should be taken seriously.
Risk for suicide appears to be higher earlier in the course
of the illness. Therefore, recognizing bipolar disorder early
and learning how best to manage it may decrease the risk of
death by suicide.
Signs and symptoms that may accompany suicidal feelings
include:
• talking about feeling suicidal or wanting to die
• feeling hopeless, that nothing will ever change or
get better
• feeling helpless, that nothing one does makes any
difference
• feeling like a burden to family and friends
• abusing alcohol or drugs
• putting affairs in order (e.g., organizing finances
or giving away possessions to prepare for one's death)
• writing a suicide note
• putting oneself in harm's way, or in situations where
there is a danger of being killed
If you are feeling suicidal or know someone who is:
• call a doctor, emergency room, or 911 right away to
get immediate help
• make sure you, or the suicidal person, are not left
alone
• make sure that access is prevented to large amounts
of medication, weapons, or other items that could be used
for self-harm
While some suicide attempts are carefully planned over time,
others are impulsive acts that have not been well thought
out; thus, the final point in the box above may be a valuable
long-term strategy for people with bipolar disorder. Either
way, it is important to understand that suicidal feelings
and actions are symptoms of an illness that can be treated.
With proper treatment, suicidal feelings can be overcome.
What Is the Course of manic depression - Bipolar Disorder?
Episodes of mania and depression typically recur across
the life span. Between episodes, most people with bipolar
disorder are free of symptoms, but as many as one-third of
people have some residual symptoms. A small percentage of
people experience chronic unremitting symptoms despite treatment.4
The classic form of the illness, which involves recurrent
episodes of mania and depression, is called bipolar I disorder.
Some people, however, never develop severe mania but instead
experience milder episodes of hypomania that alternate with
depression; this form of the illness is called bipolar II
disorder. When four or more episodes of illness occur within
a 12-month period, a person is said to have rapid-cycling
bipolar disorder. Some people experience multiple episodes
within a single week, or even within a single day. Rapid cycling
tends to develop later in the course of illness and is more
common among women than among men.
People with bipolar disorder can lead healthy and productive
lives when the illness is effectively treated (see below—"How
Is Bipolar Disorder Treated?"). Without treatment, however,
the natural course of bipolar disorder tends to worsen. Over
time a person may suffer more frequent (more rapid-cycling)
and more severe manic and depressive episodes than those experienced
when the illness first appeared.5 But in most cases, proper
treatment can help reduce the frequency and severity of episodes
and can help people with bipolar disorder maintain good quality
of life.
Can Children and Adolescents Have manic depression - Bipolar
Disorder?
Both children and adolescents can develop bipolar disorder.
It is more likely to affect the children of parents who have
the illness.
Unlike many adults with bipolar disorder, whose episodes
tend to be more clearly defined, children and young adolescents
with the illness often experience very fast mood swings between
depression and mania many times within a day.6 Children with
mania are more likely to be irritable and prone to destructive
tantrums than to be overly happy and elated. Mixed symptoms
also are common in youths with bipolar disorder. Older adolescents
who develop the illness may have more classic, adult-type
episodes and symptoms.
Bipolar disorder in children and adolescents can be hard
to tell apart from other problems that may occur in these
age groups. For example, while irritability and aggressiveness
can indicate bipolar disorder, they also can be symptoms of
attention deficit hyperactivity disorder, conduct disorder,
oppositional defiant disorder, or other types of mental disorders
more common among adults such as major depression or schizophrenia.
Drug abuse also may lead to such symptoms.
For any illness, however, effective treatment depends on
appropriate diagnosis. Children or adolescents with emotional
and behavioral symptoms should be carefully evaluated by a
mental health professional. Any child or adolescent who has
suicidal feelings, talks about suicide, or attempts suicide
should be taken seriously and should receive immediate help
from a mental health specialist.
What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar
disorder through several kinds of studies. Most scientists
now agree that there is no single cause for bipolar disorder—rather,
many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers
have been searching for specific genes—the microscopic
"building blocks" of DNA inside all cells that influence
how the body and mind work and grow—passed down through
generations that may increase a person's chance of developing
the illness. But genes are not the whole story. Studies of
identical twins, who share all the same genes, indicate that
both genes and other factors play a role in bipolar disorder.
If bipolar disorder were caused entirely by genes, then the
identical twin of someone with the illness would always develop
the illness, and research has shown that this is not the case.
But if one twin has bipolar disorder, the other twin is more
likely to develop the illness than is another sibling.7
In addition, findings from gene research suggest that bipolar
disorder, like other mental illnesses, does not occur because
of a single gene.8 It appears likely that many different genes
act together, and in combination with other factors of the
person or the person's environment, to cause bipolar disorder.
Finding these genes, each of which contributes only a small
amount toward the vulnerability to bipolar disorder, has been
extremely difficult. But scientists expect that the advanced
research tools now being used will lead to these discoveries
and to new and better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what
goes wrong in the brain to produce bipolar disorder and other
mental illnesses.9,10 New brain-imaging techniques allow researchers
to take pictures of the living brain at work, to examine its
structure and activity, without the need for surgery or other
invasive procedures. These techniques include magnetic resonance
imaging (MRI), positron emission tomography (PET), and functional
magnetic resonance imaging (fMRI). There is evidence from
imaging studies that the brains of people with bipolar disorder
may differ from the brains of healthy individuals. As the
differences are more clearly identified and defined through
research, scientists will gain a better understanding of the
underlying causes of the illness, and eventually may be able
to predict which types of treatment will work most effectively.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with
the most severe forms—can achieve substantial stabilization
of their mood swings and related symptoms with proper treatment.11,12,13
Because bipolar disorder is a recurrent illness, long-term
preventive treatment is strongly recommended and almost always
indicated. A strategy that combines medication and psychosocial
treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled
if treatment is continuous than if it is on and off. But even
when there are no breaks in treatment, mood changes can occur
and should be reported immediately to your doctor. The doctor
may be able to prevent a full-blown episode by making adjustments
to the treatment plan. Working closely with the doctor and
communicating openly about treatment concerns and options
can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments,
sleep patterns, and life events may help people with bipolar
disorder and their families to better understand the illness.
This chart also can help the doctor track and treat the illness
most effectively.
Medications
Medications for bipolar disorder are prescribed by psychiatrists—medical
doctors (M.D.) with expertise in the diagnosis and treatment
of mental disorders. While primary care physicians who do
not specialize in psychiatry also may prescribe these medications,
it is recommended that people with bipolar disorder see a
psychiatrist for treatment.
Medications known as "mood stabilizers" usually
are prescribed to help control bipolar disorder.11 Several
different types of mood stabilizers are available. In general,
people with bipolar disorder continue treatment with mood
stabilizers for extended periods of time (years). Other medications
are added when necessary, typically for shorter periods, to
treat episodes of mania or depression that break through despite
the mood stabilizer.
• 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
bipolar episodes. Valproate was FDA-approved in 1995 for treatment
of mania.
• Newer anticonvulsant medications, including lamotrigine
(Lamictal®), gabapentin (Neurontin®), and topiramate
(Topamax®), are being studied to determine how well they
work in stabilizing mood cycles.
• Anticonvulsant medications may be combined with lithium,
or with each other, for maximum effect.
• Children and adolescents with bipolar disorder generally
are treated with lithium, but valproate and carbamazepine
also are used. Researchers are evaluating the safety and efficacy
of these and other psychotropic medications in children and
adolescents. There is some evidence that valproate may lead
to adverse hormone changes in teenage girls and polycystic
ovary syndrome in women who began taking the medication before
age 20.14 Therefore, young female patients taking valproate
should be monitored carefully by a physician.
• Women with bipolar disorder who wish to conceive,
or who become pregnant, face special challenges due to the
possible harmful effects of existing mood stabilizing medications
on the developing fetus and the nursing infant.15 Therefore,
the benefits and risks of all available treatment options
should be discussed with a clinician skilled in this area.
New treatments with reduced risks during pregnancy and lactation
are under study.
Treatment of Bipolar Depression
Research has shown that people with bipolar disorder are
at risk of switching into mania or hypomania, or of developing
rapid cycling, during treatment with antidepressant medication.16
Therefore, "mood-stabilizing" medications generally
are required, alone or in combination with antidepressants,
to protect people with bipolar disorder from this switch.
Lithium and valproate are the most commonly used mood-stabilizing
drugs today. However, research studies continue to evaluate
the potential mood-stabilizing effects of newer medications.
• Atypical antipsychotic medications, including clozapine
(Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®),
quetiapine (Seroquel®), and ziprasidone (Geodon®),
are being studied as possible treatments for bipolar disorder.
Evidence suggests clozapine may be helpful as a mood stabilizer
for people who do not respond to lithium or anticonvulsants.17
Other research has supported the efficacy of olanzapine for
acute mania, an indication that has recently received FDA
approval.18 Olanzapine may also help relieve psychotic depression.19
• If insomnia is a problem, a high-potency benzodiazepine
medication such as clonazepam (Klonopin®) or lorazepam
(Ativan®) may be helpful to promote better sleep. However,
since these medications may be habit-forming, they are best
prescribed on a short-term basis. Other types of sedative
medications, such as zolpidem (Ambien®), are sometimes
used instead.
• Changes to the treatment plan may be needed at various
times during the course of bipolar disorder to manage the
illness most effectively. A psychiatrist should guide any
changes in type or dose of medication.
• Be sure to tell the psychiatrist about all other prescription
drugs, over-the-counter medications, or natural supplements
you may be taking. This is important because certain medications
and supplements taken together may cause adverse reactions.
• To reduce the chance of relapse or of developing a
new episode, it is important to stick to the treatment plan.
Talk to your doctor if you have any concerns about the medications.
Thyroid Function
People with bipolar disorder often have abnormal thyroid
gland function.5 Because too much or too little thyroid hormone
alone can lead to mood and energy changes, it is important
that thyroid levels are carefully monitored by a physician.
People with rapid cycling tend to have co-occurring thyroid
problems and may need to take thyroid pills in addition to
their medications for bipolar disorder. Also, lithium treatment
may cause low thyroid levels in some people, resulting in
the need for thyroid supplementation.
Medication Side Effects
Before starting a new medication for bipolar disorder, always
talk with your psychiatrist and/or pharmacist 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. Be sure to tell the doctor about all side effects
you notice during treatment. He or she may be able to change
the dose or offer a different medication to relieve them.
Your medication should not be changed or stopped without the
psychiatrist's guidance.
Psychosocial Treatments
As an addition to medication, psychosocial treatments—including
certain forms of psychotherapy (or "talk" therapy)—are
helpful in providing support, education, and guidance to people
with bipolar disorder and their families. Studies have shown
that psychosocial interventions can lead to increased mood
stability, fewer hospitalizations, and improved functioning
in several areas.13 A licensed psychologist, social worker,
or counselor typically provides these therapies and often
works together with the psychiatrist to monitor a patient's
progress. The number, frequency, and type of sessions should
be based on the treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder
are cognitive behavioral therapy, psychoeducation, family
therapy, and a newer technique, interpersonal and social rhythm
therapy. NIMH researchers are studying how these interventions
compare to one another when added to medication treatment
for bipolar disorder.
• Cognitive behavioral therapy helps people with bipolar
disorder learn to change inappropriate or negative thought
patterns and behaviors associated with the illness.
• Psychoeducation involves teaching people with bipolar
disorder about the illness and its treatment, and how to recognize
signs of relapse so that early intervention can be sought
before a full-blown illness episode occurs. Psychoeducation
also may be helpful for family members.
• Family therapy uses strategies to reduce the level
of distress within the family that may either contribute to
or result from the ill person's symptoms.
• Interpersonal and social rhythm therapy helps people
with bipolar disorder both to improve interpersonal relationships
and to regularize their daily routines. Regular daily routines
and sleep schedules may help protect against manic episodes.
• As with medication, it is important to follow the
treatment plan for any psychosocial intervention to achieve
the greatest benefit.
Other Treatments
• In situations where medication, psychosocial treatment,
and the combination of these interventions prove ineffective,
or work too slowly to relieve severe symptoms such as psychosis
or suicidality, electroconvulsive therapy (ECT) may be considered.
ECT may also be considered to treat acute episodes when medical
conditions, including pregnancy, make the use of medications
too risky. ECT is a highly effective treatment for severe
depressive, manic, and/or mixed episodes. The possibility
of long-lasting memory problems, although a concern in the
past, has been significantly reduced with modern ECT techniques.
However, the potential benefits and risks of ECT, and of available
alternative interventions, should be carefully reviewed and
discussed with individuals considering this treatment and,
where appropriate, with family or friends.20
• Herbal or natural supplements, such as St. John's
wort (Hypericum perforatum), have not been well studied, and
little is known about their effects on bipolar disorder. Because
the FDA does not regulate their production, different brands
of these supplements can contain different amounts of active
ingredient. Before trying herbal or natural supplements, it
is important to discuss them with your doctor. There is evidence
that St. John's wort can reduce the effectiveness of certain
medications.21 In addition, like prescription antidepressants,
St. John's wort may cause a switch into mania in some individuals
with bipolar disorder, especially if no mood stabilizer is
being taken.22
• Omega-3 fatty acids found in fish oil are being studied
to determine their usefulness, alone and when added to conventional
medications, for long-term treatment of bipolar disorder.23
A Long-Term Illness That Can Be Effectively Treated
Even though episodes of mania and depression naturally come
and go, it is important to understand that bipolar disorder
is a long-term illness that currently has no cure. Staying
on treatment, even during well times, can help keep the disease
under control and reduce the chance of having recurrent, worsening
episodes.
Do Other Illnesses Co-occur with Bipolar Disorder?
Alcohol and drug abuse are very common among people with
bipolar disorder. Research findings suggest that many factors
may contribute to these substance abuse problems, including
self-medication of symptoms, mood symptoms either brought
on or perpetuated by substance abuse, and risk factors that
may influence the occurrence of both bipolar disorder and
substance use disorders.24 Treatment for co-occurring substance
abuse, when present, is an important part of the overall treatment
plan.
Anxiety disorders, such as post-traumatic stress disorder
and obsessive-compulsive disorder, also may be common in people
with bipolar disorder.25,26 Co-occurring anxiety disorders
may respond to the treatments used for bipolar disorder, or
they may require separate treatment. For more information
on anxiety disorders, contact NIMH (see below).
How Can Individuals and Families Get Help for Bipolar Disorder?
Anyone with bipolar disorder should be under the care of
a psychiatrist skilled in the diagnosis and treatment of this
disease. Other mental health professionals, such as psychologists,
psychiatric social workers, and psychiatric nurses, can assist
in providing the person and family with additional approaches
to treatment.
Help can be found at:
• University—or medical school—affiliated
programs
• Hospital departments of psychiatry
• Private psychiatric offices and clinics
• Offices of family physicians, internists, and pediatricians
• Public community mental health centers
People with bipolar disorder may need help to get help.
• Often people with bipolar disorder do not realize
how impaired they are, or they blame their problems on some
cause other than mental illness.
• A person with bipolar disorder may need strong encouragement
from family and friends to seek treatment. Family physicians
can play an important role in providing referral to a mental
health professional.
• Sometimes a family member or friend may need to take
the person with bipolar disorder for proper mental health
evaluation and treatment.
• A person who is in the midst of a severe episode may
need to be hospitalized for his or her own protection and
for much-needed treatment. There may be times when the person
must be hospitalized against his or her wishes.
• Ongoing encouragement and support are needed after
a person obtains treatment, because it may take a while to
find the best treatment plan for each individual.
• In some cases, individuals with bipolar disorder may
agree, when the disorder is under good control, to a preferred
course of action in the event of a future manic or depressive
relapse.
• Like other serious illnesses, bipolar disorder is
also hard on spouses, family members, friends, and employers.
• Family members of someone with bipolar disorder often
have to cope with the person's serious behavioral problems,
such as wild spending sprees during mania or extreme withdrawal
from others during depression, and the lasting consequences
of these behaviors.
What About Clinical Studies for Bipolar Disorder?
Some people with bipolar disorder receive medication and/or
psychosocial therapy by volunteering to participate in clinical
studies (clinical trials). Clinical studies involve the scientific
investigation of illness and treatment of illness in humans.
Clinical studies in mental health can yield information about
the efficacy of a medication or a combination of treatments,
the usefulness of a behavioral intervention or type of psychotherapy,
the reliability of a diagnostic procedure, or the success
of a prevention method. Clinical studies also guide scientists
in learning how illness develops, progresses, lessens, and
affects both mind and body. Millions of Americans diagnosed
with mental illness lead healthy, productive lives because
of information discovered through clinical studies. These
studies are not always right for everyone, however. It is
important for each individual to consider carefully the possible
risks and benefits of a clinical study before making a decision
to participate.
In recent years, NIMH has introduced a new generation of
"real-world" clinical studies. They are called "real-world"
studies for several reasons. Unlike traditional clinical trials,
they offer multiple different treatments and treatment combinations.
In addition, they aim to include large numbers of people with
mental disorders living in communities throughout the U.S.
and receiving treatment across a wide variety of settings.
Individuals with more than one mental disorder, as well as
those with co-occurring physical illnesses, are encouraged
to consider participating in these new studies. The main goal
of the real-world studies is to improve treatment strategies
and outcomes for all people with these disorders. In addition
to measuring improvement in illness symptoms, the studies
will evaluate how treatments influence other important, real-world
issues such as quality of life, ability to work, and social
functioning. They also will assess the cost-effectiveness
of different treatments and factors that affect how well people
stay on their treatment plans.
References
1Narrow WE. One-year prevalence of depressive disorders
among adults 18 and over in the U.S.: NIMH ECA prospective
data. Population estimates based on U.S. Census estimated
residential population age 18 and over on July 1, 1998. Unpublished.
2Regier DA, Narrow WE, Rae DS, et al. The de facto mental
and addictive disorders service system. Epidemiologic Catchment
Area prospective 1-year prevalence rates of disorders and
services. Archives of General Psychiatry, 1993; 50(2): 85-94.
3American Psychiatric Association. Diagnostic and Statistical
Manual for Mental Disorders, fourth edition (DSM-IV). Washington,
DC: American Psychiatric Press, 1994.
4Hyman SE, Rudorfer MV. Depressive and bipolar mood disorders.
In: Dale DC, Federman DD, eds. Scientific American®; Medicine.
Vol. 3. New York: Healtheon/WebMD Corp., 2000; Sect. 13, Subsect.
II, p. 1.
5Goodwin FK, Jamison KR. Manic-depressive illness. New York:
Oxford University Press, 1990.
6Geller B, Luby J. Child and adolescent bipolar disorder:
a review of the past 10 years. Journal of the American Academy
of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76.
7NIMH Genetics Workgroup. Genetics and mental disorders.
NIH Publication No. 98-4268. Rockville, MD: National Institute
of Mental Health, 1998.
8Hyman SE. Introduction to the complex genetics of mental
disorders. Biological Psychiatry, 1999; 45(5): 518-21.
9Soares JC, Mann JJ. The anatomy of mood disorders—review
of structural neuroimaging studies. Biological Psychiatry,
1997; 41(1): 86-106.
10Soares JC, Mann JJ. The functional neuroanatomy of mood
disorders. Journal of Psychiatric Research, 1997; 31(4): 393-432.
11Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP.
The expert consensus guideline series: medication treatment
of bipolar disorder 2000. Postgraduate Medicine, 2000; Spec
No:1-104.
12Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance
treatment. Biological Psychiatry, 2000; 48(6): 573-81.
13Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of
psychosocial treatments in bipolar disorder: state of the
evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40.
14Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen
AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced
hyperandrogenism during pubertal maturation in girls with
epilepsy. Annals of Neurology, 1999; 45(4): 444-50.
15Llewellyn A, Stowe ZN, Strader JR Jr. The use of lithium
and management of women with bipolar disorder during pregnancy
and lactation. Journal of Clinical Psychiatry, 1998; 59(Suppl
6): 57-64; discussion 65.
16Thase ME, Sachs GS. Bipolar depression: pharmacotherapy
and related therapeutic strategies. Biological Psychiatry,
2000; 48(6): 558-72.
17Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush AJ.
Clinical outcome in a randomized 1-year trial of clozapine
versus treatment as usual for patients with treatment-resistant
illness and a history of mania. American Journal of Psychiatry,
1999; 156(8): 1164-9.
18Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa
KN, Daniel DG, Petty F, Centorrino F, Wang R, Grundy SL, Greaney
MG, Jacobs TG, David SR, Toma V. Olanzapine versus placebo
in the treatment of acute mania. Olanzapine HGEH Study Group.
American Journal of Psychiatry, 1999; 156(5): 702-9.
19Rothschild AJ, Bates KS, Boehringer KL, Syed A. Olanzapine
response in psychotic depression. Journal of Clinical Psychiatry,
1999; 60(2): 116-8.
20U.S. Department of Health and Human Services. Mental health:
a report of the Surgeon General. Rockville, MD: U.S. Department
of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Mental Health Services,
National Institutes of Health, National Institute of Mental
Health, 1999.
21Henney JE. Risk of drug interactions with St. John's wort.
From the Food and Drug Administration. Journal of the American
Medical Association, 2000; 283(13): 1679.
22Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated
with St. John's wort. Biological Psychiatry, 1999; 46(12):
1707-8.
23Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA,
Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in
bipolar disorder: a preliminary double-blind, placebo-controlled
trial. Archives of General Psychiatry, 1999; 56(5): 407-12.
24Strakowski SM, DelBello MP. The co-occurrence of bipolar
and substance use disorders. Clinical Psychology Review, 2000;
20(2): 191-206.
25Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher
FC, Vidaver R, Auciello P, Foy DW. Trauma and posttraumatic
stress disorder in severe mental illness. Journal of Consulting
and Clinical Psychology, 1998; 66(3): 493-9.
26Strakowski SM, Sax KW, McElroy SL, Keck PE Jr, Hawkins
JM, West SA. Course of psychiatric and substance abuse syndromes
co-occurring with bipolar disorder after a first psychiatric
hospitalization. Journal of Clinical Psychiatry, 1998; 59(9):
465-71.
This publication, written by Melissa Spearing of NIMH, is
a revision and update of an earlier version by Mary Lynn Hendrix.
Scientific information and review were provided by NIMH Director
Steven E. Hyman, M.D., and NIMH staff members Matthew V. Rudorfer,
M.D., and Jane L. Pearson, Ph.D. Editorial assistance was
provided by Clarissa K. Wittenberg, Margaret Strock, and Lisa
D. Alberts of NIMH.
ll material in this publication is in the public domain and
may be copied or reproduced without permission of the Institute.
Citation of the source is appreciated.
NIH Publication No. 3679
Printed 2002
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