[100세시대 건강]Repeated depression and happiness ‘bipolar disorder’

Most require long-term treatment

# A month ago, I couldn’t sleep at night. Even late at night, I am not sleepy and my head is clear. A lot of ideas come to my mind, but if I run a business with them, I think I will definitely succeed. Even though I only slept for two hours, I am not tired at all and my body is light. I keep calling my acquaintances because I think I need to discuss business items in a hurry, but people don’t seem to understand. After giving birth two years ago, I was depressed and lethargic, so I spent almost six months in bed, but now I am more energetic and happy than ever.

Bipolar disorder is a mood disorder in which high moods or hypomania and depressed states are repeated, that is, mood swings often appear. In fact, most patients experience depression for a longer period of time due to frequent periods of depression, but bipolar I disorder is diagnosed if mania occurs at any time, and bipolar II disorder if hypomania occurs. As mentioned above, the representative symptom is mood instability, which is mostly repetitive depression, often accompanied by mania or hypomania. Hypomania is diagnosed when the mood is excessively high or excitement lasts for more than 4 days, and mania is diagnosed when symptoms last for more than 1 week or are severe enough to require hospitalization. At this time, the mood and behavior are different from usual, such as being excited or elated, full of energy, talking a lot, and thinking quickly. In addition, they become more active, act proactively, or show impulsive tendencies such as excessive consumption or reckless investment. In severe cases, it is accompanied by psychotic symptoms such as grandiose delusions, hallucinations, and hallucinations. Conversely, during the period of depression, emotions and behaviors show a slowdown or slowdown, and interpersonal relationships are also reduced due to lethargy, fatigue, and decreased motivation and concentration. Suicidal thoughts are common in severe cases. Manic episodes in bipolar disorder last for an average of 2 months, and depressive episodes last for an average of 2 to 5 months. The lifetime prevalence rate is about 0.5~2.5%, and it often develops in the 20s, a little earlier than ‘major depressive disorder’.

The onset of bipolar disorder is caused by a combination of biological and psychosocial factors, including genetic influences. It is known to be caused by an imbalance of neurotransmitters that control mood or energy in the brain, such as serotonin, dopamine, and norepinephrine, and dysfunction of the limbic system and frontal lobe related to mood control. In addition, changes in female hormones and stress also affect it.

Bipolar disorder often requires long-term treatment because of recurrent mood episodes. In particular, it is often accompanied by other psychiatric disorders such as anxiety disorder or substance use disorder, and in this case, the course is more complicated. For acute treatment such as mania, drug treatment is the primary treatment, and hospitalization is often required. Mood regulators such as ‘lithium’ or ‘valproate’ and antipsychotic drugs are mainly used, and anticonvulsants such as ‘lamotrigine’ or ‘carbamazepine’ are also used. Since the depression of bipolar disorder is different from the depression of major depressive disorder that we are commonly aware of, the use of antidepressants is ineffective or rather causes conversion to mania, so it is not recommended in most cases. Therefore, use mood stabilizers or antipsychotics rather than antidepressants. Non-pharmacological ‘electroconvulsive therapy’ or ‘transcranial magnetic stimulation’ is used, and psychological therapy for stress or conflict can also increase the therapeutic effect.

Bipolar disorder is a disease with a high probability of developing into a chronic disease and recurrence is common. In particular, depressive episodes are frequent and long lasting, but the response to treatment is slow. In addition, there are many cases in which patients or guardians stop treatment because of the high resistance to long-term drug treatment. In this case, the probability of recurrence of the disease is high, and if this is repeated, treatment becomes more difficult and the risk of suicide increases. Therefore, it is necessary to maintain treatment for at least 1 to 2 years, sufficient period of time.

Hyeyeon Park, Professor, Department of Psychiatry, Seoul National University Bundang Hospital