Bipolar disorder, also referred to as manic-depression, is a disorder of the brain that results in unusual shifts in:
- Energy levels
- Activity levels
- Abilities to do daily tasks
The symptoms of this condition can be quite severe. They are very different from the typical ups and downs that we all experience from time to time.
Bipolar disorder can cause relationships to become damaged, problems performing in school/job, and even suicide.
However, this condition is not all gloom and doom. Individuals who have this illness truly can lead a very full and productive life.
Causes of Bipolar Disorder
Scientists are in agreement that there really is no single cause for this condition, and they are studying the possible causes.
Most of the scientific world believes that several factors together cause the illness or increase an individual’s risk for developing it.
Research suggests that this condition runs in families and that individuals with specific genes are much more likely to develop this condition than others.
Children who have a parent or a sibling with this condition are much more likely to develop it than those who have no family history of the condition.
On the other hand, most children who do have a family history of the illness will not develop it.
In addition, scientists are looking at other illnesses with similar symptoms in order to find differences in genetics that could increase an individual’s risk for developing bipolar.
If they are able to pinpoint these genetic “hotspots” they could also learn how the environment could increase risk.
Genes are not the only factor that increases a person’s risk of developing this condition.
In fact, identical twin studies have shown that even when one has this condition, that does not mean that the other will develop the condition, even though they share all of the same genes. Research is suggesting that there are other factors at play.
Magnetic Resonance Imaging and Positron Emission Tomography, and other brain imaging tools have allowed researchers to take pictures of the brain at work- which allows the scientists to study the activity and structure of the brain.
Some of these studies have revealed how the brains of those who have bipolar disorder are different from the brains of those who have other mental disorders or are completely healthy.
This offers the conclusion that brain development could be linked to a risk for unstable moods.
In addition to finding the cause for bipolar disorder, these studies will help scientists find treatment options that will work more effectively.
Signs/Symptoms of Bipolar Disorder
Individuals with this condition typically experience extremely intense emotional states that occur in what are referred to as “mood episodes.”
Each of these episodes is a drastic change from an individual’s typical behavior and mood.
When an individual is overly excited or joyful, it is referred to as a manic episode. When an individual is extremely hopeless or sad, it is referred to as a depressive episode.
In some cases, a mood episode could include symptoms of depression and mania, this is referred to as a mixed episode. Individuals with this condition might also be very irritable and explosive during one of their episodes.
In addition, significant changes in activity, behavior, energy, and sleep accompany these mood changes.
Even in cases where the mood swings are not extreme, the individual could still have bipolar disorder.
In some cases, an individual with bipolar disorder experiences a condition known as hypomania, which is a form of mania.
During this period, the individual feels good, functions well, and is highly productive.
They don’t feel that anything is wrong, but their loved ones might consider these moods as potential bipolar disorder.
Without getting the proper treatment, individuals with this condition are likely to develop more severe depression or mania.
This condition could also be present during a mixed state, where the individual experiences both mania and depression at the same time.
During this mixed state, they may feel extreme agitation, have difficulty sleeping, experience major appetite changes, and experience suicidal thoughts.
Individuals in a mixed state usually feel extremely energized, but sad and hopeless at the same time.
In some cases, an individual that has severe episodes of depression and/or mania will also experience psychotic symptoms such as delusions or hallucinations. These psychotic symptoms are reflective of the individual’s extreme mood.
Individuals with this condition are also prone to abusing alcohol and/or other substances, have problems with relationships and poor performances at work/school. It is often difficult to see these issues as a serious mental illness.
Bipolar disorder is a lifetime condition. Between episodes, the individual is often free of symptoms. However, there are some that do have symptoms that linger.
Who is at Risk for Bipolar Disorder?
This is a condition that often develops during late teens or early adult years. Around half of the cases of bipolar disorder start before the individual turns 25.
There are some individuals that do show symptom during childhood and others who start showing symptoms later in life.
Diagnosing Bipolar Disorder
Physicians use the DSM, or Diagnostic and Statistical Manual of Mental Disorders, to diagnose this condition.
In order to be diagnosed, the signs and symptoms must be a significant change from your typical behavior and mood. There are 4 types of bipolar disorder:
Bipolar I- characterized by manic/mixed episodes that last for at least seven days or by a manic episode that is so severe that the individual needs immediate treatment in an inpatient facility. Most of the time, the depressive episodes last for at least two weeks.
Bipolar II- characterized by a pattern of hypomanic and depressive episodes with no full-blow mixed/manic episodes.
BP-NOS- Bipolar Disorder Not Otherwise Specified- characterized when symptoms of this condition exist, but not enough to meet the criteria for being diagnosed with I or II. Still, the symptoms are obviously outside of the individual’s normal behavior.
Cyclothymia- this is a mild form of bipolar. Individuals with this condition exhibit mild depression and episodes of hypomania for at least two years. However, their symptoms do not meet the criteria for being diagnosed with any other type of bipolar.
There is a severe form of this disorder that is known as Rapid-Cycling Bipolar Disorder and is characterized by the individual experiencing four or more episodes of hypomania, depression, mania, or mixed within one year.
This form of bipolar is most common in those who had their first episode at a young age. This form affects women more often than men and can come and go over the years.
In order to reach a diagnosis, your physician is likely to do the following:
- Lab tests
- Medical history
- Family history
- Physical examination
At this time, this condition cannot be diagnosed through a brain scan or blood tests, but these tests can rule out other factors that might contribute to mood disorders such as:
- Thyroid condition
Once these other conditions are ruled out, your physician will likely conduct an evaluation of your mental health or refer you to a trained mental health professional that is experienced in diagnosing and treating this disorder.
Your physician or mental health professional will discuss your family history of bipolar disorder and/or any other mental illnesses as well as collect a history of your symptoms.
They will also speak with your spouse/family about family history and what they have observed in you.
Individuals with this condition are more likely to get help when they are in a depressed state than when they are manic or hypomanic.
Therefore, it is critical that a medical history is conducted to avoid bipolar being mistaken as major depression. Individuals with major depression do not experience manic episodes.
If left undiagnosed and untreated, this condition will worsen. The episodes will become more severe and/or more frequent.
In addition, delays in getting the proper diagnosis and treatment can cause more problems with performance in work/school, relationships, and more.
On the other hand, getting the proper diagnosis and treatment can help those with this condition go on to lead productive, healthy lives.
Most of the time, proper treatment will reduce the severity and the frequency of the episodes.
Treating Bipolar Disorder
This condition is not curable, but there are effective treatments for controlling the symptoms.
If the individual finds the proper treatment, they will get some control of their mood swings and other symptoms.
However, since it is a lifelong condition, there must be continuous treatment in order to keep that control. On the other hand, even with the proper treatment, some mood changes are still likely to occur.
Treatment of this condition is most effective if you’re working with a physician and being honest about your choices and concerns.
An effective treatment plan will encompass both psychotherapy and medication.
Some of the most common treatments are:
- Electroconvulsive Therapy
- Sleep medications
Medication to Treat Bipolar Disorder
There are several different types of medications that can be used to treat this condition and not everyone will respond to them in the same way.
You will most likely need to try out several different ones before you can find the one that is right for you.
One of the best ways to keep track of and treat your condition effectively is to keep a daily chart/journal that includes your sleep patterns, symptoms, life events, and treatments.
This way, if you have some side effects or changes in symptoms that are intolerable, your physician can switch or even add medications.
The types of medications typically used to treat this condition are:
- Mood stabilizers
- Atypical antipsychotics
These are typically the first choice for treating this condition. In most cases, individuals with this condition are able to treat it with mood stabilizers for many years.
Lithium is a very effective treatment and was the first mood stabilizer that the FDA approved for treating depressive and manic episodes.
Also used for mood stabilizers are anticonvulsants. These were developed originally for treating seizures, but also control moods.
These medications are sometimes used to treat this condition. In most cases, these are used with other medications such as antidepressants.
These types of medications are sometimes used to treat depressive symptoms of bipolar disorder.
However, taking only an antidepressant is likely to increase your risk of switching to hypomania or mania- or even developing rapid-cycling bipolar.
To prevent this, physicians typically will prescribe a combination of medications and psychotherapy.
When used in combination with medications, this is an extremely effective treatment for this condition.
Therapy offers education, guidance, and support to those who have the condition as well as their families. Some of the most common psychotherapy treatments include:
Cognitive Behavioral Therapy, or CBT- this form of therapy helps those with this condition to change their negative/harmful thought patterns and behavior.
Family Focused Therapy- this form of therapy involves the whole family, teaching and enhancing coping strategies, such as recognizing the new symptoms/episodes in their loved one. In addition, communication and problem solving are improved.
Interpersonal/Social Rhythm Therapy- this form of therapy helps those with this condition learn to improve their relationships as well as manage daily routines. Regular routines are often helpful for protecting against manic episodes.
Psychoeducation- this teaches individuals with this condition about the illness itself as well as options for treatment.
This will also help the individual to recognize signs of a swing so that treatment can be sought early on. This also may be helpful for caregivers and family members to attend.
ECT, or electroconvulsive therapy, is used in cases where the combination of psychotherapy and medication has proven to be ineffective.
This is what was formerly referred to as shock therapy and was given a bad reputation.
However, in more recent history, it has proven to provide relief for those individuals suffering with severe cases of bipolar where other treatments have not worked.
Before this treatment is used, the individual is given a muscle relaxer and is put under short-term anesthesia.
He/she does not feel the electrical impulses, which last from thirty to ninety seconds. The patient typically recovers after approximately five to fifteen minutes and is able to go back home the same day.
ECT is also used in cases where other medical conditions make taking medication risky. This is a very effective treatment for those who have severe manic, mixed, or depressive episodes and it is typically not used as a first defense against the condition.
Individuals using ECT could have some short term side effects including:
- Memory loss
Individuals who have bipolar disorder and also have trouble sleeping will typically be able to get some sleep once they get their condition under control.
However, if insomnia does not improve, your physician is likely to suggest changing your medication.
If sleep problems continue, he/she is likely to give you a sedative or other sleep medication.
Living with Bipolar Disorder
If you have a loved one that has this condition, it will also have an effect on you. The very first thing you must do is to help him/her to find a physician that will find the right diagnosis and treatment.
Chances are you will need to make the appointment, and even take him/her to see the doctor. You must encourage your loved one to keep treating their condition.
Following are some things you can do to help your loved one:
- Offer emotional support
- Learn more about the condition
- Talk to them/listen to them
- Listen to their feelings and be understanding
- Invite them out for some positive distractions
- Remind them that with proper treatment (and time) he/she will get better
- Never ignore threats/comments from them about hurting themselves
Chances are, if you are experiencing symptoms of bipolar disorder, you are having difficulty asking for help and seeking the necessary treatment.
However, you should know that it will get better- with the proper treatment.
Following are some ways to help yourself:
- Discuss your options and progress with your physician
- Keep a regular routine such as eating meals at the same time and going to bed/getting up at the same time every day
- Do whatever you can to get the sleep you need (but not too much)
- Keep taking your medication even when you think you don’t need it
- Learn about your triggers and warning signs
- Understand that symptoms will not improve overnight, but it will be a gradual process
Where to Get Help
If you are experiencing this condition and you’re not sure where to get the help you need, speak with your physician. He/she will guide you.
Following are some other options for seeking help:
- Mental health professionals
- Local medical/psychiatric societies
- Employee assistance programs
- Health maintenance organizations
- Peer support groups
- Community mental health centers
- Private clinics/facilities
- Hospital psychiatry departments
- Mental health programs at medical schools
- Hospital psychiatry outpatient clinics
If you or a loved one is experiencing this condition, you must be aware that you are not alone.
There are others out there who are having the same difficulties you are. Please seek help immediately if you are experiencing the signs/symptoms of bipolar disorder.