So what really is Bipolar Disorder?
Bipolar Disorder, also known by its older name "manic depression," is a mental disorder that is characterized by serious mood swings. A person with bipolar disorder experiences alternating “highs” (what clinicians call “mania“) and “lows” (also known as depression).
Causes of Bipolar Disorder
Some of the known causes of Bipolar disorder include:
Genetics
Bipolar disorder tends to run in families. People with certain genes are more likely to develop bipolar disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, not all children with a family history of bipolar disorder develop the illness.
Genes however, are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder, despite the fact that identical twins share all of the same genes. Research suggests that factors besides genes are also at work. It is likely that many different genes and environmental factors are involved.
Brain structure and functioning
Studies on the brains have shown that prefrontal cortex in adults with bipolar disorder tends to be smaller and function less well compared to adults who don't have bipolar disorder. The prefrontal cortex is a brain structure involved in "executive" functions such as solving problems and making decisions. This structure and its connections to other parts of the brain mature during adolescence, suggesting that abnormal development of this brain circuit may account for why the disorder tends to emerge during a person's teen years. Pinpointing brain changes in youth may help us detect illness early or offer targets for early intervention.
Some individuals also develop Bipolar disorder as a result of injury to the brain especially those parts of the brain that are responsible for our moods.
Symptoms of Bipolar Disorder
In everyday life, people have a variety of moods and feelings. These feelings include frustration, joy and anger. Usually these moods last one day rather than several days. For people with bipolar disorder, however, moods usually swing from weeks of feeling overly “high” and irritable to weeks of feeling sad and hopeless with normal periods in between.
An important distinction between bipolar disorder and the normal emotions of life is that bipolar disorder results in an inability to handle daily activities. The person cannot work or communicate effectively and may have a distorted sense of reality (for example, unrealistically high or low opinion of one’s skills).
Bipolar disorder often is not recognized by the patient, relatives, friends or even physicians. However, recognizing the mood states that occur is essential. Treatment can help a person with bipolar disorder avoid harmful consequences such as destruction of personal relationships, job loss and suicide.
During a manic phase, symptoms include:
- heightened sense of self-importance
- exaggerated positive outlook
- significantly decreased need for sleep
- poor appetite and weight loss
- racing speech, flight of ideas, impulsiveness
- ideas that move quickly from one subject to the next
- poor concentration, easy distractibility
- increased activity level
- excessive involvement in pleasurable activities
- poor financial choices, rash spending sprees
- excessive irritability, aggressive behavior
During a depressed phase, symptoms include:
- feelings of sadness or hopelessness
- loss of interest in pleasurable or usual activities
- difficulty sleeping; early-morning awakening
- loss of energy and constant lethargy
- sense of guilt or low self-esteem
- difficulty concentrating
- negative thoughts about the future
- weight gain or weight loss
- talk of suicide or death
Bipolar disorder may also be present in a mixed state, in which one might experience both mania and depression at the same time. During a mixed state, one might feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia.
People with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a major mental illness.
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.
Diagnosis
Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from your normal mood or behavior. There are four basic types of bipolar disorder:
- Bipolar I Disorder: This defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
- Bipolar II Disorder: This is defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
- Bipolar Disorder Not Otherwise Specified (BP-NOS): This is diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
- Cyclothymic Disorder, or Cyclothymia: This is a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
A severe form of the disorder is called Rapid-cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year. Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age. One study found that people with rapid cycling had their first episode about 4 years earlier—during the mid to late teen years—than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men. Rapid cycling can come and go.
When getting a diagnosis, a doctor or health care provider should conduct a physical examination, an interview, and lab tests. Currently, bipolar disorder cannot be identified through a blood test or a brain scan, but these tests can help rule out other factors that may contribute to mood problems, such as a stroke, brain tumor, or thyroid condition. If the problems are not caused by other illnesses, your health care provider may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
The doctor or mental health professional should discuss with you any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professional should also talk to your close relatives or spouse about your symptoms and family medical history.
People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania.
Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent or more severe over time without treatment. Also, delays in getting the correct diagnosis and treatment can contribute to personal, social, and work-related problems. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.
Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear. Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs (self- medication). However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.
Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.
People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.
Treatment
Bipolar disorder cannot be cured, but it can be treated effectively over the long-term. Proper treatment helps many people with bipolar disorder—even those with the most severe forms of the illness—gain better control of their mood swings and related symptoms. But because it is a lifelong illness, long-term, continuous treatment is needed to control symptoms. Treatment is more effective if you work closely with a doctor and talk openly about your concerns and choices. An effective maintenance treatment plan usually includes a combination of medication and psychotherapy.
Medication
Different types of medications can help control symptoms of bipolar disorder. Not everyone responds to medications in the same way. You may need to try several different medications before finding ones that work best for you.
Keeping a daily life chart that makes note of your daily mood symptoms, treatments, sleep patterns, and life events can help you and your doctor track and treat your illness most effectively. If your symptoms change or if side effects become intolerable, your doctor may switch or add medications.
The types of medications generally used to treat bipolar disorder include:
- mood stabilizers
- atypical antipsychotics
- antidepressants.
Psychotherapy
When done in combination with medication, psychotherapy can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
- Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
- Family-focused therapy, which involves family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication among family members, as well as problem-solving.
- Interpersonal and social rhythm therapy, which helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
- Psychoeducation, which teaches people with bipolar disorder about the illness and its treatment. Psychoeducation can help you recognize signs of an impending mood swing so you can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.
Other Treatments
- Electroconvulsive Therapy (ECT)—For cases in which medication and psychotherapy do not work, electroconvulsive therapy (ECT) may be useful. Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.
- Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, your doctor may suggest a change in medications. If the problems still continue, your doctor may prescribe sedatives or other sleep medications.
Helping People with Bipolar Disorder
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If you have a friend or relative suffering from Bipolar Disorder, you can:
- Offer emotional support, understanding, patience, and encouragement
- Learn about bipolar disorder so you can understand what your friend or relative is experiencing
- Talk to your friend or relative and listen carefully
- Listen to feelings your friend or relative expresses and be understanding about situations that may trigger bipolar symptoms
- Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
- Remind your friend or relative that, with time and treatment, he or she can get better.
Common Misconceptions about Bipolar Disorder
The prevailing myths about Bipolar Disorder include:
Myth: Individuals cause their disorder.
Fact: Bipolar disorder is caused by a complex interplay of genetic, biological and environmental factors.
Myth: You can will yourself out of mood swings.
Fact: Left untreated, bipolar disorder can wreak havoc on a person’s life. It requires both medical treatment and psychotherapy.
Myth: You’ll never be normal.
Fact: Many patients in the beginning feel like they won’t be able to accomplish their goals, that bipolar will prevent them from getting married or getting the job of their dreams. Though patients’ lives might require certain changes, they can pursue their dreams. For instance, student patients might take fewer classes every semester and take longer to graduate, but they still achieve a college degree.
Bipolar is easy to diagnose.
Fact: According to Elizabeth Brondolo, Ph.D, a clinical psychologist specializing in bipolar disorder and professor at St. John’s University in New York, it’s often very difficult to diagnose bipolar disorder based on an initial visit, even a prolonged one. This typically occurs because our self-awareness changes with mood.
It can be hard to translate the experiences and moods one has into the symptoms for Bipolar Disorder. For instance, what might appear to one as confidence and clever ideas for a new business venture might be a pattern of grandiose thinking and manic behavior.
Medical treatment is worse than the disorder.
Fact: Many people perceive medication as worse than the illness. Although some people can experience a bad reaction to certain medication, you don’t get hooked on medication like you would a street drug, said Monica Ramirez Basco, Ph.D, clinical psychologist at the University of Texas at Arlington and author of The Bipolar Workbook: Tools for Controlling Your Mood Swings.
References
http://psychcentral.com/lib/living-with-bipolar-disorder
http://psychcentral.com/lib/symptoms-of-bipolar-disorder-manic-depression/000911
