Bipolar Disorder

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Will Winter, MD, FAAP

Bipolar Disorder is a type of mood disorder. The term "bipolar" refers to extremes in mood- "mania" and "depression". Mania, a clinical term, includes a constellation of symptoms, i.e. grandiosity and being in a fantastic mood. But there are also other aspects of mania which generally include decreased sleep or need for it, rapidity of thoughts and possible poor judgment- putting one's self in dangerous situations because he feels so good that he feels invincible.

Depression is a diagnosis made when one meets criteria in the DSM IV for this as well. It often includes feeling very sad, lack of pleasure in anything, and can affect appetite, sleep and concentration.

It is also important to note that irritability can be a symptom of either depression or mania and can be a presenting symptom in children and adolescents.

Each episode, mania or depression, extends for days to weeks- or longer.

Sometimes, within a few hours, I can go from feeling really great to feeling really awful. Does that mean that I am bipolar?
This is a description of emotional reactivity. This alone does not qualify for a diagnosis of bipolar disorder. However, if you are concerned, a psychiatric evaluation can provide clarity on this question. Also, if your ups and downs are making it difficult to function, that is a good enough reason to seek help.

My 16 year old is constantly irritable and she is behaving erratically. Sometimes I just don't know where she is and she just shows up a few days later. I'm really worried and overwhelmed. Can she be bipolar?
Given this useful but limited amount of information, bipolar disorder is a possibility. However, diagnostically speaking, there are also many other possibilities. A psychiatric evaluation is important to clarify what the diagnosis might be, and therefore, the appropriate treatment.

My 5 year old is beating up the other children in school. He is very irritable and it takes a long time to soothe him. He has never been a good sleeper. Is he manic?
Generally, bipolar disorder presents itself in the late teens/ early 20's. It can present earlier than that but it is unusual. It is even more unusual to present at such a young age.
Regardless of what his diagnosis may be found to be, the problems that you are talking about are concerning and it is recommended that you obtain help.

What is the treatment for bipolar disorder?
Talk therapy is useful on an individual basis. Family therapy is also useful in learning how to handle the ups and downs of a loved one. As bipolar disorder is considered a chemical imbalance, medication is essential in controlling these episodes.

Bipolar disorder is difficult on loved ones because when someone is manic, he can place himself in harm's way and everyone around who cares will feel helpless. Also, when someone is manic, he doesn't feel like he has a problem. He will feel great. He will not realize that he is not functioning. Therefore, more often than not, medication compliance is a big challenge.