Bipolar disorder is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood episodes can affect energy levels, activity levels, behavior, and the ability to function in daily life.
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings. These include emotional highs, also known as mania or hypomania, and lows, also known as depression. Hypomania is less extreme than mania.
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania, you may feel very excited and happy (euphoric), full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Episodes of mood swings from depression to mania may occur rarely or multiple times a year. Each bout usually lasts several days. Between episodes, some people have long periods of emotional stability. Others may frequently have mood swings from depression to mania or both depression and mania at the same time.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, healthcare professionals use medicines and talk therapy, also known as psychotherapy, to treat bipolar disorder.
Gabapentin, originally developed as an anticonvulsant and used primarily for neuropathic pain, has also been studied for off-label use in managing bipolar disorder. While it is not a first-line treatment, it may help in specific situations due to its effects on the brain’s excitatory and inhibitory systems.
Here’s why it can be considered for bipolar disorder:
Mechanism of Action in Bipolar Disorder
- Modulation of Neurotransmitters:
- Gabapentin affects calcium channels in the nervous system, reducing the release of excitatory neurotransmitters like glutamate.
- This modulation can help stabilize mood by preventing excessive neuronal excitation, which is thought to play a role in mood swings, especially in mania.
- Calming Overactive Neural Pathways:
- Bipolar disorder involves dysregulation of neural circuits controlling mood and emotion.
- Gabapentin may help by reducing hyperactivity in these pathways, particularly during manic or mixed episodes.
- Anxiolytic Effects:
- Gabapentin has anxiety-reducing properties, which can be beneficial for individuals with bipolar disorder who experience comorbid anxiety.
- Sleep Regulation:
- It promotes relaxation and improves sleep quality, addressing common issues like insomnia in bipolar patients, which can worsen mood instability.
When Gabapentin Might Be Used
- Adjunctive Therapy:
- Gabapentin is not a primary mood stabilizer like lithium or valproate but may be used alongside other medications to manage specific symptoms.
- Treatment-Resistant Cases:
- In some cases, it is used when patients do not respond well to standard treatments.
- Comorbid Conditions:
- For individuals with bipolar disorder and conditions like chronic pain or generalized anxiety disorder, gabapentin can address multiple issues simultaneously.
Bipolar disorder Symptoms
There are several types of bipolar and related disorders:
- Bipolar I disorder. You’ve had at least one manic episode that may come before or after hypomanic or major depressive episodes. In some cases, mania may cause a break from reality. This is called psychosis.
- Bipolar II disorder. You’ve had at least one major depressive episode and at least one hypomanic episode. But you’ve never had a manic episode.
- Cyclothymia. You’ve had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms. These symptoms are less severe than major depression.
- Other types. These types include bipolar and related disorders caused by certain drugs or alcohol, or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.
These types may include mania, or hypomania, which is less extreme than mania, and depression. Symptoms can cause changes in mood and behavior that can’t be predicted. This can lead to a lot of distress and cause you to have a hard time in life.
Bipolar II disorder is not a milder form of bipolar I disorder. It’s a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, people with bipolar II disorder can be depressed for longer periods of time.
Bipolar disorder can start at any age, but usually it’s diagnosed in the teenage years or early 20s. Symptoms can differ from person to person, and symptoms may vary over time.
Mania and hypomania
Mania and hypomania are different, but they have the same symptoms. Mania is more severe than hypomania. It causes more noticeable problems at work, school and social activities, as well as getting along with others. Mania also may cause a break from reality, known as psychosis. You many need to stay in a hospital for treatment.
Manic and hypomanic episodes include three or more of these symptoms:
- Being much more active, energetic or agitated than usual.
- Feeling a distorted sense of well-being or too self-confident.
- Needing much less sleep than usual.
- Being unusually talkative and talking fast.
- Having racing thoughts or jumping quickly from one topic to another.
- Being easy to distract.
- Making poor decisions. For example, you may go on buying sprees, take sexual risks or make foolish investments.
Major depressive episode
A major depressive episode includes symptoms that are severe enough to cause you to have a hard time doing day-to-day activities. These activities include going to work or school, as well as taking part in social activities and getting along with others.
An episode includes five or more of these symptoms:
- Having a depressed mood. You may feel sad, empty, hopeless or tearful. Children and teens who are depressed can seem irritable, angry or hostile.
- Having a marked loss of interest or feeling no pleasure in all or most activities.
- Losing a lot of weight when not dieting or overeating and gaining weight. When children don’t gain weight as expected, this can be a sign of depression.
- Sleeping too little or too much.
- Feeling restless or acting slower than usual.
- Being very tired or losing energy.
- Feeling worthless, feeling too guilty or feeling guilty when it’s not necessary.
- Having a hard time thinking or concentrating, or not being able to make decisions.
- Thinking about, planning or attempting suicide.
Other features of bipolar disorder
Symptoms of bipolar disorders, including depressive episodes, may include other features, such as:
- Anxious distress, when you’re feeling symptoms of anxiety and fear that you’re losing control.
- Melancholy, when you feel very sad and have a deep loss of pleasure.
- Psychosis, when your thoughts or emotions disconnect from reality.
The timing of symptoms may be described as:
- Mixed, when you have symptoms of depression and mania or hypomania at the same time.
- Rapid cycling, when you have four mood episodes in the past year where you switch between mania and hypomania and major depression.
Also, bipolar symptoms may happen when you’re pregnant. Or symptoms can change with the seasons.
Symptoms in children and teens
Symptoms of bipolar disorder can be hard to identify in children and teens. It’s often hard to tell whether these symptoms are the usual ups and downs or due to stress or trauma, or if they’re signs of a mental health problem other than bipolar disorder.
Children and teens may have distinct major depressive or manic or hypomanic episodes. But the pattern can vary from adults with bipolar disorder. Moods can shift fast during episodes. Some children may have periods without mood symptoms between episodes.
The most noticeable signs of bipolar disorder in children and teenagers may be severe mood swings that aren’t like their usual mood swings.