Lithium toxicity leads to drowsiness

Bipolar disorder

In bipolar disorder (formerly known as manic-depressive illness), depression and mania (or a less severe form of mania called hypomania) alternate in phases. Mania is characterized by excessive physical activity and extreme elation that is out of proportion to a previous positive event.
  • Family predisposition plays a role in bipolar disorder.

  • Depression and mania can occur separately or together.

  • People have one or more periods of excessive sadness and lack of interest in life, and one or more periods of elation, excessive energy, and often irritability, with periods of relatively normal mood in between.

  • Doctors make the diagnosis based on the symptom pattern.

  • Mood-stabilizing medicines, such as lithium, and certain anti-seizure medicines, as well as sometimes psychotherapy, may be helpful.

Bipolar disorder is so named because it encompasses the two opposite poles of mood disorders - depression and mania. Approximately 4 percent of the US population is affected to some extent. Men and women are equally affected by bipolar disorder. Bipolar disorder usually begins in adolescence, between the ages of 20 and 40. Bipolar disorder is rare in children.

Most bipolar disorder can be classified as follows

  • Bipolar I Disorder: Those affected have had at least one pronounced manic episode (which makes normal everyday life almost impossible or is accompanied by delusions) and usually periods of depression.

  • Bipolar II Disorder: Those affected had severe depressive phases, at least a less severe manic (hypomanic) phase, but no pronounced manic phases.

However, some people have phases that are similar to those of bipolar disorder, but are milder and do not meet the specific criteria for bipolar I or II disorder. Such phases can be classified as nonspecific bipolar disorder or cyclothymia.

Did you know ...

  • Certain physical disorders and medications can cause symptoms of bipolar disorder.

  • People who experience mania often think they are in the best of shape.


The exact cause of bipolar disorder is unknown. Family predisposition probably plays a role in the development of bipolar disorder. It may also work to regulate certain substances made by the body, such as: B. the neurotransmitters norepinephrine or serotonin, are not correct. (Neurotransmitters are substances that are needed for nerve cells to communicate.)

Bipolar disorder sometimes begins or starts a new phase after a stressful event. However, no cause-effect relationship has been established.

The manic symptoms of bipolar disorder can occur with certain other diseases, such as high thyroid hormone levels (hyperthyroidism). The manic phases can also be triggered by drugs such as cocaine and amphetamines.

Some causes of mania


In bipolar disorders, symptomatic phases alternate with practically symptom-free phases (remissions). The phases last from a few weeks to 3 to 6 months. The cycles - d. H. the time from the beginning of one phase to the beginning of the next phase - vary in length. Some people have fewer phases, perhaps only a few in their lifetime, while others experience four or more phases per year (called rapid cycling). Despite these large deviations, the cycle duration is relatively constant for the individual.

The phases consist of depression, mania or the less severe hypomania. Very few people fluctuate between mania and depression on each cycle. For most of them, one of the two prevails in some way.

People with bipolar disorder can commit or try suicide. In a lifetime, they are at least 15 times more likely to commit suicide than the general population.


Depression in bipolar disorder is similar to depression that occurs on its own. Those affected feel deeply sad and lose interest in their activities. Their thinking and movements are slowed and some sleep more than usual. Appetite may be increased or decreased, and people may gain or lose weight. Some feel overwhelmed with feelings of hopelessness and guilt. They may not be able to focus or make decisions.

Psychotic symptoms (such as hallucinations and delusions) are more common in depression associated with bipolar disorder than in depression alone.


The phases of mania end more abruptly than the phases of depression and are typically shorter, usually a week or longer.

Those affected are exuberant, energetic and excited or irritable. Some are overly confident, behave or dress extravagantly, sleep little, and talk more than usual. Your mind racing. They are easily distracted and keep changing from one topic or company to another. You pursue one activity (e.g. risky business venture, gambling, or dangerous sexual behavior) after another without thinking about the consequences (e.g. loss of money or injury). However, those affected often think they are in the best of mental health.

They themselves have no insight into their constitution. This lack of insight plus the great potential for activity can make them impatient, intrusive, intrusive and easily excitable when contradicted. As a result, they can experience social issues and feel like they are being treated unfairly or persecuted.

Some people have hallucinations and hear and see things that are not there.

A manic psychosis is an extreme form of mania. Those affected have symptoms of psychosis, such as those found in schizophrenia. They can be megalomaniac and believe, for example, that they are Jesus. Others feel persecuted, for example by the FBI. The activity increases significantly. People may run around, yell, curse, or sing. The physical and mental activity can be so feverish that coherent thinking and behavior can be completely lost (delirious mania), which leads to extreme exhaustion. Those affected this way need immediate treatment.


Hypomania is not as severe as mania. Those affected feel cheerful, do not need much sleep and are mentally and physically active.

For some people, hypomania is a very productive phase. They have a lot of energy, feel creative and confident, and often function well in social situations. You may want to remain in this comfortable state. Other people with hypomania, on the other hand, are easily distracted and excitable, which occasionally leads to outbursts of anger. They often make commitments that they can't keep or start projects that they don't finish. Your mood changes very quickly. You may be able to recognize such effects and feel annoyed by them, as well as the people around you.

Mixed phases

When depression and mania or hypomania coexist, people may cry while in the middle of a high, or their thoughts may start racing in the middle of depression. Often those affected go to bed with depression in the evening and feel excited and energetic when they wake up.

The risk of suicide is particularly high in mixed phases.


  • Examination by the doctor

  • Occasionally blood and urine tests to rule out other conditions

The diagnosis of bipolar disorder is based on the respective list of symptoms (criteria). However, people with mania may not be able to describe their symptoms because they believe they are all right. Therefore, doctors often have to interview other family members. People and their family members can use a short questionnaire to help them assess their risk of developing bipolar disorder (see Affective Disorder Questionnaire).

Patients are also asked if they have any thoughts of suicide.

Doctors will check the medications you are taking to see if any of them could be contributing to the symptoms. It will also look for signs of other disorders that may be contributing to the symptoms. For example, blood tests for suspected overactive thyroid gland (hyperthyroidism) and blood and urine tests to check for drug or drug abuse can be performed.

Doctors determine whether people are in a phase of mania or depression so that the correct treatment can be given.


  • Education and support

Severe mania or depression often requires inpatient treatment. Even if the mania is less severe, people need to be admitted to a clinic if they are suicidal, have tried to harm themselves or others, cannot care for themselves, or have other serious problems (e.g. Alcohol consumption or other substance use disorders). Most patients with hypomania can be treated on an outpatient basis. Treating people with rapid cycling is more difficult. Without treatment, bipolar disorder recurs in most people.

Treatment can include:

  • Mood stabilizers such as lithium and some anti-epileptic drugs

  • Education and support

  • Electroconvulsive therapy, sometimes used when phase prophylactic drugs do not relieve depression