Bipolar disorder

Bipolar disorder is a mental health condition that can cause intense shifts in mood, energy, and level of activity. Otherwise known as manic depression, symptoms of the illness consist of high and low moods that vary from person to person. 

The emotional highs experienced in the condition are called mania or hypomania. The symptoms of mania in bipolar disorder include increased energy, abnormally elevated mood, exaggerated optimism, increased impulsiveness, as well as shifting from one idea to the next when speaking. 

On the other hand, the low moods experienced by someone suffering from the mental illness are called depressive episodes. The symptoms of depressive episodes in bipolar disorder are continuous low mood, feelings of hopelessness, loss of energy or fatigue, difficulty concentrating, as well as suicidal ideation and attempts. 

Bipolar disorder can profoundly affect different areas of a person’s life. The effects of bipolar disorder can be physical, psychological, or social and may include headaches, memory problems, shrinking of the brain’s hippocampus, brain chemical imbalance, substance abuse, and dysfunctional family relationships. 

The characteristics of bipolar disorder include a manic, hypomanic, and a major depressive episode, changes in sleep patterns, trouble concentrating, and psychotic features.

Treatment for bipolar disorder may include medications, psychotherapy, lifestyle modifications, and social support. Since bipolar disorder is a lifelong illness, continued treatment is crucial in preventing relapse and staying symptom-free.

What are the myths about Bipolar disorder?

The myths about bipolar disorder influence perceptions of people on what the condition really is. The most common myths about bipolar disorder are listed below. 

• Bipolar people are only either manic or depressed: Bipolar disorder is a different experience for everyone. Symptoms vary according to pattern, frequency, and severity. Some people are more likely to experience either mania or depression, while others may equally have patterns of alternating depression and periods of elevated mood.
• People with bipolar disorder cannot hold down jobs or live normal lives: Individuals can live with bipolar disorder and still be able to hold steady jobs or even have successful careers. Living with the condition can be challenging, but with early and consistent treatment, people can lead meaningful, productive lives while managing their symptoms.
• Mania is enjoyable and makes a person more productive: Early periods of mania can initially be productive. However, without treatment, a full-blown mania is hardly productive at all. People can lose control of their thoughts and actions, may become reckless, and overreact over small things.
• Bipolar disorder is a rare mental illness: Bipolar disorder is more common than most people think. 2.8% or about five million adults in the United States have had a bipolar disorder diagnosis in the past year, according to an article on bipolar disorder from the National Institute of Mental Health (NIMH).
• Only one type of bipolar disorder exists: There are a few varied types of the disorder, with basic types including bipolar I, bipolar II, and cyclothymia. Each type of bipolar disorder affects individuals differently.
• Bipolar disorder is only an adult condition: This is a myth, as bipolar disorder can also occur in children. However, diagnosing the disease can be challenging as it can occur alongside other mental health problems such as attention deficit hyperactivity disorder (ADHD). It can also be difficult for parents to discern whether reckless behaviors and feelings of sadness are a natural part of childhood or already a cause for concern.
• Bipolar people are just moody: There is a vast difference between natural mood swings and longer-lasting mood episodes involved in bipolar disorder. While a change in mood that lasts for a few hours or even for one day is normal, mood swing cycles could last days, weeks, or even a few months and are much more intense.   

What are the types of Bipolar disorder?

The types of bipolar disorder include different classifications of the disorder which are experienced at different severities. The main types of bipolar disorder are listed below. 

• Bipolar I disorder: is a diagnosis given to individuals who experience at least one manic episode, which is marked by persistently increased energy or irritability and lasts for at least a week. Manic periods can be so severe that a patient may be sent to the hospital for medical care. People diagnosed with bipolar I disorder can also have depressive periods that last for more than two weeks. 
• Bipolar II disorder: To be diagnosed with bipolar II disorder, someone must have at least one major depressive episode that lasts for at least two weeks and one hypomanic episode, which is less severe than mania and could last for about four days.
• Cyclothymic disorder: features cyclical mood swings and involves numerous periods of hypomanic and depressive symptoms that last for at least two years. The emotional ups and downs in cyclothymic disorder also tend to be milder than those experienced in full-blown hypomanic or depressive episodes. 

Other types of bipolar disorder include:

1. Unspecified bipolar and related disorders
2. Other specified bipolar and related disorders
3. Substance/medication-induced bipolar disorder
4. Bipolar and related disorder due to another medical condition

What are the symptoms of Bipolar disorder?

The symptoms of bipolar disorder in adult men and women include extreme mood shifts ranging from mania, hypomania, and depression, while these signs may be more challenging to identify in children and teens. 

Although bipolar disorder affects men and women at equal rates, the features of the condition and how it impacts males and females can be different. For instance, women tend to receive a bipolar disorder diagnosis later in life and are also more prone to depressive symptoms than men, according to a 2015 study on bipolar disorder in women published in the Indian Journal of Psychiatry.  

Mixed episodes consisting of elevated mood with a few depressive symptoms predominate bipolar disorder symptoms in women. Rapid cycling, which involves having four or more mood episodes within a year, also appears to be more common in females. They may also have an increased risk of having conditions that exist alongside bipolar disorder, such as obesity, thyroid disease, and anxiety disorders. A 2003 review by Lesley M. Arnold published in the Psychiatric Clinics of North America suggests that women have an increased likelihood of being diagnosed with bipolar II than bipolar I.

On the other hand, men generally display bipolar signs earlier than women and are less likely to experience the depressive symptoms in bipolar disorder. Manic states are also less common in men but when they do occur, they tend to be more severe and accompanied with aggression. Additionally, bipolar disorder in males is more likely to be comorbid with substance use disorder.

As with adults, bipolar disorder in children and teens is also marked by mood swings from emotional highs to emotional lows. Unruly behaviors and rough periods also tend to be normal during childhood and teenage years, but if symptoms become severe to the point that they result in significant problems, it should not be dismissed as simply being just a phase. 

Manic symptoms in children may include difficulty focusing, outbursts of anger, reckless behaviors, a decreased need for sleep, and racing speech. On the other hand, depressive episodes in children may include symptoms like significantly decreased energy, lack of interest in activities once enjoyed, frequent crying, and suicidal thoughts. 

In teens, the difficulty of diagnosing bipolar disorder stems from hormonal changes that occur during puberty, which can cause both good and bad mood patterns in teenagers. However, drastic changes in mood may be indicative of a more serious mental health condition. 

The most common signs of mania in teenagers include extreme irritability, trouble concentrating, engaging in risky behaviors such as having casual sex, and displaying socially inappropriate behaviors. Meanwhile, symptoms of a depressive episode in teens may include feelings of hopelessness, social withdrawal, frequent sadness, showing little excitement or interest in usual activities, and suicidal thoughts or behaviors.

What are the causes of Bipolar disorder?

The causes of bipolar disorder include  genetics, stress, structural brain abnormalities, and chemical imbalances in the brain. Although the exact cause of the disorder is still poorly understood to this day, experts believe these factors play a role in the development of the condition.

There is an increased likelihood for a person to develop bipolar disorder if they have parents or siblings who suffer from the disease, according to a 2014 review on the genetics of bipolar disorder published in The Application of Clinical Genetics. Stress is believed to be another contributing factor to the condition. Extreme stress caused by traumatic life events such as death of a loved one, losing a job, or divorce can trigger bipolar symptoms. 

Additionally, structural brain abnormalities can increase one’s risk of developing manic depression. Brain imaging studies suggest that bipolar patients tend to have a diminished size in certain brain regions, which leads to dysregulation of mood, according to a 2004 review by Strakowski et al., published in Molecular Psychiatry. 

Experts also point to chemical imbalances in the brain as a potential cause of bipolar disorder. The three brain chemicals that affect the brain’s functions in the disease are known as neurotransmitters, and include norepinephrine, serotonin, and dopamine.

What are the risk factors for Bipolar disorder?

The risk factors for bipolar disorder may increase the likelihood of certain groups of people to develop the condition. The risk factors for bipolar disorder are listed below. 

• Having a first-degree relative with bipolar disorder: A 2016 study by Özdemir et al., published in the Archives of Neuropsychiatry suggests that first-degree relatives of bipolar patients are at a higher risk of psychological disorder transmission. This means that having parents or siblings with bipolar disorder makes one more susceptible to the condition.
• Recent stressful life events: Experiencing stressful life events prior to the development of bipolar disorder is widely believed to trigger its symptoms, according to a 2018 article on the epidemiology and risk factors for bipolar disorder published in Therapeutic Advances in Psychopharmacology. Traumatic experiences may include unemployment, divorce, or the death of a family member.
• Substance misuse: Manic depression is often comorbid with substance misuse, particularly abuse that involves opioids, cannabis, alcohol, cocaine, and sedatives.
• Medical comorbidities: Bipolar disorder is frequently comorbid with certain medical and psychological conditions, including asthma, migraine, anxiety disorders, conduct disorders, and obesity.
• Physical changes in the brain: Certain physical changes in the brain that studies have observed through brain scans are believed to influence the development of bipolar disorder.
  

Other risk factors for bipolar disorder include:

1. Early parental loss
2. Family dysfunction
3. A history of childhood maltreatment
4. Suffering from traumatic brain injury
5. Nonmedical use of prescription medications

How Is Bipolar disorder diagnosed?

Bipolar disorder is diagnosed by undergoing a physical examination, conducting psychological evaluation, asking detailed questions about the patient’s symptoms, and using the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders of DSM-5. 

A medical professional may carry out a physical exam and order lab tests to rule out other medical conditions, such as hypothyroidism, which is widely reported to be associated with bipolar disorder. Another way to diagnose the condition is through a psychological evaluation. A doctor may refer you to a mental health specialist, who will ask detailed questions about your mood swings, behavior patterns, feelings, and other bipolar symptoms.

Your psychiatrist may specifically talk to you about when the symptoms started, their severity, or how long they lasted. With the help of these methods, the patient’s symptoms are compared with the specific criteria for bipolar disorder in the DSM-5 to make a diagnosis of the disease.

What are the treatments for Bipolar disorder?

Treatments for bipolar disorder often focus on managing the symptoms of the condition. The treatments for bipolar disorder are listed below. 

• Medications: The use of medications can help stabilize mood and control the symptoms of bipolar disorder. Doctors will often recommend a combination of mood stabilizers like lithium, antipsychotic medications, antidepressants, and medications that help with anxiety or sleep.
• Supplements: Some people use supplements such as multivitamin pills, tablets, and fish oil capsules to stabilize their moods and help with bipolar disorder symptoms. It is worth noting, however, that some of these supplements may interact with bipolar medications and exacerbate depressive or manic symptoms. It is best to check with your doctor first before trying alternative remedies.
• Therapy: The most commonly recommended therapy approach for bipolar disorder is cognitive behavioral therapy (CBT), a form of psychotherapy that helps a patient identify and replace destructive habits through positive coping strategies. CBT also teaches a bipolar person to manage stress and reframe negative thoughts.
• Electroconvulsive therapy (ECT): Otherwise known as electroshock therapy, ECT is a short-term, last-resort treatment when individuals with severe manic or depressive symptoms have not responded well to medications and therapy. Mood episodes treated with ECT often involve suicidal or psychotic symptoms. It is done by passing small electric currents through the scalp to set off a small seizure in the brain.
• Psychoeducation: Psychoeducation treatment involves educating the patient and their family members about the clinical features and treatment options for bipolar disorder. This helpful information can help supportive people around the patient recognize an episode’s early symptoms and offer support for better management of the condition.
• Lifestyle modifications: Making a few lifestyle changes can also help with managing bipolar disorder. Some healthy lifestyle modifications that can be used in the condition include getting regular exercise, following a healthy diet, and keeping a sleep schedule.

What are the natural remedies for Bipolar disorder?

Some individuals with bipolar disorder use alternative treatments for relief from symptoms. The natural remedies for bipolar disorder are listed below. 

• Fish oil: Omega-3 fatty acids such as fish oil may affect chemicals in the brain that play a role in mood disorders. Studies suggest it may stabilize mood and could help with depressive episodes in bipolar disorder. However, more research is needed to find out how fish oil can affect mania, which is a common part of bipolar 1 disorder.
• Rhodiola rosea: Believed to be effective in treating mild-to-moderate depression, this medicinal herb may also help with the depression phase of bipolar disorder.
• S-adenosylmethionine (SAMe): SAMe is an amino acid supplement that  may help reduce symptoms in individuals with major depressive disorder and other mood disorders due to its antidepressant properties, according to a 2008 trial of SAMe for treatment-resistant bipolar depression published in ClinicalTrials.gov.
• Inositol: a synthetic vitamin that is reported to have antidepressant effects, especially when taken with mood stabilizers such as lithium or antiepileptics.
• N-acetylcysteine (NAC): Due to its antioxidant and anti-inflammatory properties, the use of N-acetylcysteine for psychiatric disorders has been considered for some time. In a 2018 randomized controlled trial of bipolar people published in the International Journal of Bipolar Disorders, the use of NAC as an add-on treatment for the condition resulted in significant improvement in mania and depression. 

What other conditions can possibly co-occur with Bipolar disorder?

Other conditions that can possibly co-occur with bipolar disorder also require treatment. The conditions that can possibly co-occur with bipolar disorder are listed below. 

• Eating disorder: One in three bipolar patients also meet the diagnostic criteria for binge eating disorder, according to a 2019 study by McAulay et al., published in the Journal of Eating Disorders. The study also found elevated rates of mood disorders in eating disorders and vice versa.
• Attention-deficit/hyperactivity disorder (ADHD): Bipolar disorder is commonly comorbid with ADHD. A combination of genetic and biological factors may explain the association between the two conditions.
• Anxiety disorders: Most people with bipolar disorder also experience some form of anxiety disorder, which can include generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD). Suffering from an anxiety disorder and a mood disorder is associated with psychosocial dysfunction and decreased quality of life.
• Substance use disorders: Substance abuse is common among individuals with manic depression. A study on the impact of substance abuse on the course of bipolar disorder published in the September 2000 issue of Biological Psychiatry suggests that a large percentage of bipolar patients have some history of substance abuse, which can exacerbate bipolar symptoms. The reason behind the connection is still poorly understood, but it appears that bipolar disorder increases a person’s risk of abusing drugs or alcohol.
• Social phobia: is one of the most prevalent forms of anxiety disorder in bipolar patients. Social phobia largely contributes to decreased functioning in people with bipolar disorder and the combination of the two conditions is often associated with adverse outcomes. 

Other conditions that may coexist with bipolar disorder include:

1. Thyroid problems
2. Migraine headaches
3. Heart disease
4. Obesity

How to overcome Bipolar disorder

To overcome bipolar disorder, there are self-management strategies that a patient can do to positively impact their recovery. Some helpful ways to overcome bipolar disorder are listed below. 

• Advance your bipolar disorder education: Take a deeper dive into the condition by learning coping strategies, treatment options, and new research about bipolar disorder. This can help you prepare for dealing with the challenges of living with the disease. Without adequate information about bipolar disorder, recovery could be a rough and slow process.
• Stay active: Bipolar patients can benefit from lifestyle modifications such as frequent exercise, healthy diet, and a strict sleep schedule. Healthy diet and increased physical activity can contribute to good mental health and well-being. Exercise can also be a healthy outlet for when a patient is experiencing stress. Maintaining a consistent sleep schedule is just as important to avoid manic symptoms.
• Keep stress under control: Stress is one of the major risk factors for bipolar disorder. With that said, keeping stress in check is extremely important. One can benefit from discovering healthier ways to manage stress through relaxation techniques. Identifying and if possible, avoiding areas in their life where they often experience stressful situations can also be helpful.
• Reach out to trusted people for support: Having bipolar disorder might make someone retreat from the world. However, reaching out to others for support is crucial for a successful recovery. Maintain open communication with trusted friends and family members so they can also assist you on your journey. Access to a bipolar disorder support group such as The Depression and Bipolar Support Alliance (DBSA) where patients can have a safe place to share experiences also contributes to a strong social support network.
• Recognize early symptoms and common triggers: Keeping a close watch for changes in one’s mood, thoughts, and behavior patterns can make way for a prompt response to prevent a subtle mood change from escalating into a full-blown mood episode. Having trigger awareness is the first step to managing them in healthier ways. 

Other ways to overcome bipolar disorder include:

1. Avoid drug and alcohol abuse
2. Make a list of go-to coping activities that help stabilize your mood
3. Consider going to therapy
4. Stick to your prescribed treatment plan
5. Create a bipolar disorder crisis plan in case symptoms get out of control