Bipolar Disorder

Bipolar disorder includes elements of both depression and mania (uninhibited abnormal mood and behavior). In the past, bipolar disorder was called manic-depressive disorder. An estimated 2% of the general population have bipolar disorder. Usually, this condition starts at a young age, but older adults can also be diagnosed. An estimated 3 to 9% of adults with HIV have bipolar disorder. It is not clear why bipolar disorder occurs at a higher rate in older adults with HIV. Bipolar disorder is often a life-long problem and often precedes HIV infection.

Bipolar disorder usually begins with a manic episode. Typical symptoms include the need for less sleep, being very talkative and easily distracted, grand feelings, and poor judgment. The latter could lead not only to bad business or financial decisions, but also the potential for physical harm by engaging in high-risk behaviors. Depressive symptoms are discussed in the psychosocial section of the site. Mania and depressive symptoms can alternate or predominately one or the other during various time intervals. This make diagnosing bipolar disorder challenging. Treatment is designed to stabilize the emotions with medications called mood stabilizers. Various medications such as lithium can both calm and prevent emotional swings. Lithium treatment requires specialty consultation and monitoring by a doctor. A treatment goal is preventing deep depression that could lead to suicidal actions. Treatment approaches often combine medicines with psychotherapy, including talk therapy.

What can you and your physician do to address the problem?

Because of the complexities of treating bipolar disorder, the medical team treating your HIV must work closely with the specialist treating your bipolar disorder. This will require added doctor visits, possible additional blood tests, and other medical care. In addition, you will need to be aware of the recurrence of symptoms, such as depressive symptoms, and immediately contact your treating physicians if they occur. Also, you should discuss any nutritional supplements that you are taking with your treatment team. Supplements and foods may be helpful in certain cases, but they could also cause harm and need careful consideration.

What can you do?

Bipolar disorder is often a chronic condition, especially if you have had several episodes. You may need to accept that you will have to take medication for a long time to prevent recurrences. This will require that you adhere to various medications and make periodic visits to your physician. You must also continue to adhere to your HIV treatment. If your treatment regimen for bipolar disorder doesn’t work, there are many other medications that can be successfully used to prevent recurrences. With the correct regimens for both your HIV and bipolar disorder, you should be able to maintain a satisfactory lifestyle.