Bipolar disorder

Bipolar disorder (BPD), previously known as manic depression, is a mental disorder that causes periods of depression and periods of abnormally elevated mood. The elevated mood is significant and is known as mania or hypomania, depending on its severity, or whether symptoms of psychosis are present. During mania, an individual behaves or feels abnormally energetic, happy, or irritable. Individuals often make poorly thought out decisions with little regard to the consequences.

The need for sleep is usually reduced during manic phases. During periods of depression, there may be crying, a negative outlook on life, and poor eye contact with others. The risk of suicide among those with the illness is high at greater than 6 percent over 20 years, while self-harm occurs in 30–40 percent. Other mental health issues such as anxiety disorders and substance use disorder are commonly associated with bipolar disorder.

The causes are not clearly understood, but both environmental and genetic factors play a role. Many genes of small effect contribute to risk. Environmental risk factors include a history of childhood abuse and long-term stress. About 85% of the risk is attributed to genetics. The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no manic episodes) and one major depressive episode.

In those with less severe symptoms of a prolonged duration, the condition cyclothymic disorder may be diagnosed. If the symptoms are due to drugs or medical problems, it is classified separately. Other conditions that may present similarly include attention deficit hyperactivity disorder, personality disorders, schizophrenia and substance use disorder as well as a number of medical conditions. Medical testing is not required for a diagnosis, though blood tests or medical imaging can be done to rule out other problems.

Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. Bipolar disorder is also known as bipolar disease or manic depression.

People with bipolar disorder may have trouble managing everyday life tasks at school or work, or maintaining relationships. There’s no cure, but there are many treatment options available that can help to manage the symptoms.

We all have our ups and downs, but with bipolar disorder these peaks and valleys are more severe. The symptoms of bipolar disorder can hurt your job or school performance, damage your relationships, and disrupt your daily life. And although it’s treatable, many people don’t recognize the warning signs and get the help they need to feel well and do well. Since bipolar disorder tends to worsen without treatment, it’s important to learn what the symptoms look like. Recognizing the problem is the first step to feeling better and getting your life back on track.

Bipolar disorder is a medical condition that involves rapid mood swings between periods of good moods and those of irritability and depression. The condition is experienced equally by both men and women and generally manifests itself for the first time when the individual is between the ages of 15 and 25. So far, the cause of bipolar disorder is not known, but those who suffer from the condition are likely to have family members who also have bipolar disorder.

There are three types of bipolar disorder:

• Bipolar disorder type I
• Bipolar disorder type II
• Cyclothymia

Cyclothymia

Bipolar disorder type I was once known as manic-depression. It indicates those sufferers who have experienced any manic period-strong feelings of euphoria-as well as the depressive periods of the disorder at least once in their lifetimes. Bipolar disorder type II is a condition in which the individual doesn’t have fully manic episodes. Instead, the person has periods of hypomania.

Hypomania is defined as a period of extremely high energy levels accompanied by impulsive behavior. Type II sufferers do experience the same depressive episodes as individuals with type I. Cyclothymia is the mildest form of bipolar disorder.

Those with this type of the disorder experience less extreme mood swings, going from mild hypomania to depression. Because the hypomania is less severe, it is often overlooked as a symptom. This often leads those with the condition to be diagnosed as suffering only from depression.

What is bipolar disorder?

Bipolar disorder (once known as manic depression or manic-depressive disorder) causes serious shifts in mood, energy, thinking, and behavior from the highs of mania on one extreme, to the lows of depression on the other.

More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with your ability to function.

During a manic episode, you might impulsively quit your job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.

The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood.

The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed resulting in unnecessary suffering. But with proper treatment, self-help, and support, you can function normally and lead a rich and fulfilling life.

Psychotherapy

Also known as talk therapy or counseling, psychotherapy can provide valuable time for an individual to learn and practice effective strategies for coping with the disorder and managing symptoms. Cognitive behavioral therapy can help an individual challenge negative thinking patterns and the behaviors that follow. Family therapy can help family members learn to communicate calmly and effectively and reduce overall stress in relationship systems. Psychotherapy can also provide valuable psychoeducation for problem-solving, developing self-care habits, and building resilience.

Depression

You may initially be diagnosed with clinical depression before having a future manic episode (sometimes years later), after which you may be diagnosed with bipolar disorder.

During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.

If you’re feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or local mental health emergency services as soon as possible.

If you want to talk to someone confidentially, call the Samaritans, free of charge, on 116 123. You can talk to them 24 hours a day, 7 days a week.

Who is affected?

Bipolar disorder is fairly common and one in every 100 adults will be diagnosed with the condition at some point in their life.

Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely to develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely between people. For example, some people only have a couple of bipolar episodes in their lifetime and are stable in between, while others have many episodes.

Side-effects

These can start in the first few weeks after starting Lithium treatment. They can be irritating and unpleasant, but often disappear or get better with time.

They include:

• feeling thirsty
• passing more urine than usual
• weight gain.

Less common side-effects are:

• blurred vision
• slight muscle weakness
• occasional diarrhoea
• fine trembling of the hands
• a feeling of being mildly ill.

These can usually be improved by lowering the dose of Lithium.

The following signs suggest that your Lithium level is too high. Contact your doctor immediately if you notice:

• you feel very thirsty
• you have bad diarrhoea or vomiting
• obvious shaking of your hands and legs
• twitching of your muscles
• you get muddled or confused.

Signs and Symptoms

Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.

There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

Mania symptoms

In the manic phase of bipolar disorder, it’s common to experience feelings of heightened energy, creativity, and euphoria. If you’re experiencing a manic episode, you may talk a mile a minute, sleep very little, and be hyperactive. You may also feel like you’re all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. You may behave recklessly during a manic episode: gambling away your savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. You may also become angry, irritable, and aggressive—picking fights, lashing out when others don’t go along with your plans, and blaming anyone who criticizes your behavior. Some people even become delusional or start hearing voices.

Common signs and symptoms of mania include:

• Feeling unusually “high” and optimistic OR extremely irritable
• Unrealistic, grandiose beliefs about one’s abilities or powers
• Sleeping very little, but feeling extremely energetic
• Talking so rapidly that others can’t keep up
• Racing thoughts; jumping quickly from one idea to the next
• Highly distractible, unable to concentrate
• Impaired judgment and impulsiveness
• Acting recklessly without thinking about the consequences
• Delusions and hallucinations (in severe cases)

Symptoms of bipolar depression

In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. With bipolar depression, you may move and speak slowly, sleep a lot, and gain weight. In addition, you’re more likely to develop psychotic depression a condition in which you lose contact with reality and to experience major problems in work and social functioning.

Symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Treatment

If you spot the symptoms of bipolar disorder in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. But bipolar disorder is highly treatable, so diagnosing the problem and starting treatment as early as possible can help prevent these complications.

If you’re reluctant to seek treatment because you like the way you feel when you’re manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.

Treatment basics

Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it’s important to continue treatment even when you’re feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.

It’s best to work with an experienced psychiatrist. Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment is often difficult. For safety reasons, medication should be closely monitored. A psychiatrist who is skilled in bipolar disorder treatment can help you navigate these twists and turns.

Treatment of bipolar disorder is aimed at stabilizing the patient’s mood as much as possible. Even when the treatment proves successful, the patient may still experience both manic and depressive phases. With treatment, that the patient may avoid hospital stays, have a lowered desire to self-injure and function better in all of the phases of the condition.

During treatment, a physician will try to determine the triggers of the mood swings and provide the patient with exercises to complete when these triggering events occur. These exercises may help prevent the moods or lower their severity.

The physician will also use mood stabilizers, some of which include:

• Valproate
• Carbamazepine
• Lithium
• Lamotrigine

Along with mood stabilizers, the doctor might also prescribe antianxiety medications or antipsychotics to handle mood issues. Antidepressants are also used to help the patient deal with the depressive phases. The use of antidepressants raises the likelihood of experiencing hypomanic or manic periods, so they are usually used in conjunction with mood stabilizers.

For those patients who do not respond to medicine, electroconvulsive therapy might be used. This therapy consists of electrical currents applied to the patient while under anesthesia and will cause brief seizures when used. After the electroconvulsive therapy application, the physician may also use transcranial magnetic stimulation, which applies magnetic pulses of a high frequency to the patient’s brain.

Those patients experiencing severe symptoms may require hospitalization while the mood is stabilized. This may be necessary for either the manic or depressive stages of the disorder.

Self-help for bipolar disorder

While dealing with bipolar disorder isn’t always easy, it doesn’t have to run your life. But in order to successfully manage bipolar disorder, you have to make smart choices. Your lifestyle and daily habits can have a significant impact on your moods and may even lessen your need for medication..

The keys to bipolar disorder self-help

Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.

Get moving. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise that activates arm and leg movement such as running, walking, swimming, dancing, climbing or drumming may be especially beneficial to your brain and nervous system.

Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.

Seek support. It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend. Reaching out is not a sign of weakness and it won’t mean you’re a burden to others. In fact, most friends will be flattered that you trust them enough to confide in them, and it will only strengthen your relationship.

Stay closely connected to friends and family. Nothing is as calming to the nervous system as face-to-face contact with caring supportive people who can just listen to you talk about what you’re experiencing.

Make healthy choices. Healthy sleeping and eating habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.

Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.

Causes and Trigger.

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause.

Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.

External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

Stress Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes either good or bad such as getting married, going away to college, losing a loved one, getting fired, or moving.

Substance Abuse While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

Medication Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

Seasonal Changes Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.

Sleep Deprivation Loss of sleep even as little as skipping a few hours of rest can trigger an episode of mania.