Bipolar Disorder
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What is bipolar disorder?
Bipolar disorder, formerly called manic depression, is a neurological disorder that causes unusual shifts in mood, energy, thought patterns, and the ability to carry out day-to-day tasks. People with bipolar disorder often experience periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) and very “down,” sad, indifferent, or hopeless periods (known as depressive episodes).
These shifts are different from the normal “ups and downs” that everyone goes through from time to time. Bipolar disorder can significantly impact individuals with autism by intensifying mood swings, emotional regulation difficulties, and impulsiveness. Symptoms can result in damaged relationships, poor job or school performance, and other psychosocial concerns.
How common is bipolar disorder?
Evidence suggests autistic people have increased rates of bipolar disorder compared to the general population (2.8%). The overlapping symptoms between autism and bipolar disorder can make diagnosis and treatment more complex.
Signs of bipolar disorder in autism
The symptoms of bipolar disorder in someone with autism are likely to look different than they would in others. They commonly include “pressured speech” (rapid, loud and virtually nonstop talking), constant pacing, an abrupt decrease in sleep and increased impulsivity leading to aggression.
One way clinicians differentiate bipolar disorder symptoms from autistic traits is by looking at when they appeared and how long they lasted. For example, a 10-year-old with autism has been observed as high-energy and socially intrusive since toddler-aged. Because these traits developed and remained consistent during childhood, they are likely due to autism, not a symptom of a manic mood swing.
Treatment options for bipolar disorder and providers who can help
Medication is a common treatment for bipolar disorder. But some of the medications used to treat bipolar can cause significant side effects and be problematic for some with autism, particularly those who have difficulty recognizing and expressing feelings. For instance, lithium, a mood stabilizer and one of the most common prescribed medications, often produces significant side effects. They can include thirst, excessive drinking and bed wetting, shaky hands and even life-threatening toxicity. This is of particular concern for autistic individuals who have communication difficulties, as they may not be able to alert caregivers to the side effects they’re experiencing.
Anti-seizure mood-stabilizing medications or a combination of a mood-stabilizing medicine and a low dose of an antipsychotic medication may be a safer treatment. It is crucial that a licensed psychiatrist prescribe and medication for bipolar, preferably one with experience with autistic patients.
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