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Does your child have trouble paying attention? Does he or she talk nonstop or have trouble staying still? Does your child have a hard time controlling his or her behavior?

For some children, these may be symptoms of attention deficit/hyperactivity disorder, or ADHD.

    What is attention deficit/hyperactivity disorder, or ADHD?

    ADHD is a common childhood disorder, and it may affect children differently. It makes it hard for a child to focus and pay attention. Some kids may be hyperactive or have trouble being patient. ADHD can make it hard for a child to do well in school or behave at home.

    ADHD can be treated. Doctors and specialists can help.

    Who can develop ADHD?

    Children of all backgrounds can have ADHD. Teens and adults can have ADHD too.

    What causes ADHD?

    No one knows for sure. ADHD probably comes from a combination of things. Some possibilities are:

    • Genes, because the disorder sometimes runs in families
    • Lead in old paint in and plumbing parts
    • Smoking and drinking alcohol during pregnancy
    • Certain brain injuries
    • Food additives like artificial coloring, which might make hyperactivity worse.

    Some people think refined sugar causes ADHD. But most research does not support the idea that sugar causes ADHD.

    What are the symptoms of ADHD?

    ADHD has many symptoms. Some symptoms at first may look like normal behaviors for a child, but ADHD makes them much worse and occur more often. Children with ADHD have at least six symptoms that start in the first five or six years of their lives.

    Children with ADHD may:

    • Get distracted easily and forget things often
    • Switch too quickly from one activity to the next
    • Have trouble with directions
    • Daydream too much
    • Have trouble finishing tasks like homework or chores
    • Lose toys, books, and school supplies often
    • Fidget and squirm a lot
    • Talk nonstop and interrupt people
    • Run around a lot
    • Touch and play with everything they see
    • Be very impatient
    • Blurt out inappropriate comments
    • Have trouble controlling their emotions.

    How do I know if my child has ADHD?

    Your child’s doctor may make a diagnosis. Or sometimes the doctor may refer you to a mental health specialist who is more experienced with ADHD to make a diagnosis. There is no single test that can tell if your child has ADHD.

    It can take months for a doctor or specialist to know if your child has ADHD. He or she needs time to watch your child and check for other problems. The specialist may want to talk to you, your family, your child’s teachers, and others.

    Sometimes it can be hard to diagnose a child with ADHD because symptoms may look like other problems. For example, a child may seem quiet and well-behaved, but in fact he or she is having a hard time paying attention and is often distracted. Or, a child may act badly in school, but teachers don’t realize that the child has ADHD.

    If your child is having trouble at school or at home and has been for a long time, ask his or her doctor about ADHD.

    How do children with ADHD get better?

    Children with ADHD can get better with treatment, but there is no cure. There are three basic types of treatment:

    1. Medication. Several medications can help. The most common types are called stimulants. Medications help children focus, learn, and stay calm.Sometimes medications cause side effects, such as sleep problems or stomachaches. Your child may need to try a few medications to see which one works best. It’s important that you and your doctor watch your child closely while he or she is taking medicine.
    2. Therapy. There are different kinds of therapy. Behavioral therapy can help teach children to control their behavior so they can do better at school and at home.
    3. Medication and therapy combined. Many children do well with both medication and therapy.

    How can I help my child?

    Give your child guidance and understanding. A specialist can show you how to help your child make positive changes. Supporting your child helps everyone in your family. Also, talk to your child’s teachers. Some children with ADHD can get special education services.

    How does ADHD affect teens?

    Being a teenager isn’t always easy. Teens with ADHD can have a tough time. School may be a struggle, and some teens take too many risks or break rules. But like children with ADHD, teens can get better with treatment.

    What can I do for my teen with ADHD?

    Support your teen. Set clear rules for him or her to follow. Try not to punish your teen every time he or she breaks the rules. Let your teen know you can help.

    Can adults have ADHD too?

    Many adults have ADHD and don’t know they have it. Like ADHD in children and teens, ADHD in adults can make life challenging. ADHD can make it hard for adults to feel organized, stick with a job, or get to work on time. Adults with ADHD may have trouble in relationships. The disorder can also make adults feel restless.

    ADHD in adults can be diagnosed and treated. For some adults, finding out they have ADHD can be a big relief. Being able to connect ADHD to longtime problems helps adults understand that they can get better. If you’re an adult and think you may have ADHD symptoms, call your doctor.

    More Information

    ADHD Survival Guides (Books)
    ADHD Help (DVD)

    Contact information find out more about ADHD.

    National Institute of Mental Health
    Science Writing, Press & Dissemination Branch
    6001 Executive Boulevard
    Room 8184, MSC 9663
    Bethesda, MD 20892-9663
    Toll-free: 1-866-615-NIMH (6464)
    TTY Toll-free: 1-866-415-8051
    E-mail: nimhinfo@nih.gov
    Web site: www.nimh.nih.gov

    U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
    National Institutes of Health
    NIH Publication No. TR-08-3572

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    To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.18-20 This is also true for people with the most severe forms of the illness.

    Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.21

    Medications

    Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state’s licensing agency to find out more.

    Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

    Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person’s symptoms change or if side effects become serious, the doctor may switch or add medications.

    Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA).

    1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:
    • Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
    • Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.23, 24 Also see the section in this booklet, “Should young women take valproic acid?”
    • More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
    • Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

    Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

    Lithium and Thyroid Function

    People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people.22 Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.

    Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

    Should young women take valproic acid?

    Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20.25, 26 PCOS causes a woman’s eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid.27 Young girls and women taking valproic acid should be monitored carefully by a doctor.

    1. Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called “atypical” to set them apart from earlier medications, which are called “conventional” or “first-generation” antipsychotics.
    • Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.28 Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
    • Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
    • Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
    • Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.
    1. Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person’s risk of switching to mania or hypomania, or of developing rapid cycling symptoms.29 To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.

    Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.30

    • Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

    Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.

    What are the side effects of these medications?

    Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.

    The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.

    If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound,” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

    FDA Warning on Antidepressants

    Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.

    The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.

    1. Mood Stabilizers

    In some cases, lithium can cause side effects such as:

    • Restlessness
    • Dry mouth
    • Bloating or indigestion
    • Acne
    • Unusual discomfort to cold temperatures
    • Joint or muscle pain
    • Brittle nails or hair.31

    Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.

    If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person’s blood, as well as kidney and thyroid function.

    These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you’re taking.

    Common side effects of other mood stabilizing medications include:

    • Drowsiness
    • Dizziness
    • Headache
    • Diarrhea
    • Constipation
    • Heartburn
    • Mood swings
    • Stuffed or runny nose, or other cold-like symptoms.32-37

    2. Atypical Antipsychotics

    Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

    • Drowsiness
    • Dizziness when changing positions
    • Blurred vision
    • Rapid heartbeat
    • Sensitivity to the sun
    • Skin rashes
    • Menstrual problems for women.

    Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.38 A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.

    In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.

    3. Antidepressants

    The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:

    • Headache, which usually goes away within a few days.
    • Nausea (feeling sick to your stomach), which usually goes away within a few days.
    • Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
    • Agitation (feeling jittery).
    • Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.

    Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.

    For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.

    Should women who are pregnant or may become pregnant take medication for bipolar disorder?

    Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant.39 But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.40

    Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder.40, 41 However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk.41 Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.

    Psychotherapy

    In addition to medication, psychotherapy, or “talk” therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

    1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
    2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
    3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
    4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

    A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor’s instructions for any psychotherapy will provide the greatest benefit.

    For more information, see the Substance Abuse and Mental Health Services Administration web page on choosing a mental health therapist.

    Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.42 They were also more likely to get well faster and stay well longer.

    NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.

    Visit the NIMH Web site for more information on psychotherapy.

    Other treatments

    1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.44
    2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.

    People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

    Herbal Supplements

    In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John’s wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.45 St. John’s wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.46 Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder.47 Study results have been mixed.48 It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.

    What can people with bipolar disorder expect from treatment?

    Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year’s time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.

    However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state.49 If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse.49 Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.42

    Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person’s response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.

    How can I help a friend or relative who has bipolar disorder?

    If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.

    To help a friend or relative, you can:

    • Offer emotional support, understanding, patience, and encouragement
    • Learn about bipolar disorder so you can understand what your friend or relative is experiencing
    • Talk to your friend or relative and listen carefully
    • Listen to feelings your friend or relative expresses-be understanding about situations that may trigger bipolar symptoms
    • Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
    • Remind your friend or relative that, with time and treatment, he or she can get better.

    Never ignore comments about your friend or relative harming himself or herself. Always report such comments to his or her therapist or doctor.

    Support for caregivers

    Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, poor work or school performance. These behaviors can have lasting consequences.

    Caregivers usually take care of the medical needs of their loved ones. The caregivers have to deal with how this affects their own health. The stress that caregivers are under may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.

    Stress from caregiving can make it hard to cope with a loved one’s bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode.50 It is important that people caring for those with bipolar disorder also take care of themselves.

    How can I help myself if I have bipolar disorder?

    It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment.

    To help yourself:

    • Talk to your doctor about treatment options and progress
    • Keep a regular routine, such as eating meals at the same time every day and going to sleep at the same time every night
    • Try to get enough sleep
    • Stay on your medication
    • Learn about warning signs signaling a shift into depression or mania
    • Expect your symptoms to improve gradually, not immediately.

    Where can I go for help?

    If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.

    • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
    • Health maintenance organizations
    • Community mental health centers
    • Hospital psychiatry departments and outpatient clinics
    • Mental health programs at universities or medical schools
    • State hospital outpatient clinics
    • Family services, social agencies, or clergy
    • Peer support groups
    • Private clinics and facilities
    • Employee assistance programs
    • Local medical and/or psychiatric societies.

    You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

    What if I or someone I know is in crisis?

    If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.

    • Call your doctor.
    • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
    • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.

    Make sure you or the suicidal person is not left alone.

    reprinted with permission NIMH

    More Information

    Bipolar Disorder Help (Books)

    Bipolar Disorder Information (DVD)

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    People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

    Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

    A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

    Symptoms of bipolar disorder are described below.

    Symptoms of mania or a manic episode include: Symptoms of depression or a depressive episode include:
    Mood Changes

    • A long period of feeling “high,” or an overly happy or outgoing mood
    • Extremely irritable mood, agitation, feeling “jumpy” or “wired.”

    Behavioral Changes

    • Talking very fast, jumping from one idea to another, having racing thoughts
    • Being easily distracted
    • Increasing goal-directed activities, such as taking on new projects
    • Being restless
    • Sleeping little
    • Having an unrealistic belief in one’s abilities
    • Behaving impulsively and taking part in a lot of pleasurable,
      high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
    Mood Changes

    • A long period of feeling worried or empty
    • Loss of interest in activities once enjoyed, including sex.

    Behavioral Changes

    • Feeling tired or “slowed down”
    • Having problems concentrating, remembering, and making decisions
    • Being restless or irritable
    • Changing eating, sleeping, or other habits
    • Thinking of death or suicide, or attempting suicide.

    In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.

    Scale of Severe Depression, Moderate Depression, and Mild Low Mood

    One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.

    At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.

    During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.

    Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person’s extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.

    People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it’s not easy to recognize these problems as signs of a major mental illness.

    What are the risk factors for bipolar disorder?

    Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

    Genetics

    Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person’s chance of developing the illness. Genes are the “building blocks” of heredity. They help control how the body and brain work and grow. Genes are contained inside a person’s cells that are passed down from parents to children.

    Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder.12 However, most children with a family history of bipolar disorder will not develop the illness.

    Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:13

    • Missed work because of their illness
    • Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders
    • Been treated or hospitalized for bipolar disorder.

    The researchers also identified certain traits that appeared to run in families, including:

    • History of psychiatric hospitalization
    • Co-occurring obsessive-compulsive disorder (OCD)
    • Age at first manic episode
    • Number and frequency of manic episodes.

    Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.

    But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person’s environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

    Brain structure and functioning

    Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.14, 15 Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain’s structure and activity.

    Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with “multi-dimensional impairment,” a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.16 This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

    Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

    reprinted with permission NIMH

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