Bipolar Disorder

Bipolar disorder (formerly manic depression) is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. The exact cause of of bipolar disorder is unknown, but a combinations of genetics, environment, and altered brain structure and chemistry may play a role. 

Bipolar disorder involves extreme mood swings between emotional highs (manic or hypomania) and extreme lows (depression). Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

The average age-of-onset is about 25, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.6% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe.

  • Types of Bipolar Disorder
  • Signs & Symptoms
  • Risk Factors
  • Treatment
  • Related Conditions/Misdiagnosis
There are four basic types of bipolar disorder, all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extreme highs and extreme lows.  
 
  1. Bipolar I Disorder – defined by manic episodes that last at least 7 days, or by having manic symptoms so severe that the person needs immediate hospital care. Depressive episodes usually occur as well, lasting at least 2 weeks. 
  2. Bipolar II Disorder – defined by a pattern of depressive episodes and hypomanic episodes, but not full-blown manic episodes as described in Bipolar I disorder.
  3. Cyclothymic Disorder (also called cyclothymia) – defined by numerous periods of hypomanic symptoms as well as numerous periods of depressive symptoms lasting for at least 2 years (1 year in children or adolescents). However, symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. 
  4. Other Specified and Unspecified Bipolar and Related Disorders – defined by bipolar disorder symptoms that do not match the three categories listed above.

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These mood episodes are drastically different from the moods and behaviors that are typical for the person.

People having a manic episode:

  • Feel very up, high, or elated
  • Have a lot of energy
  • Have increased activity levels
  • Feel jumpy or weird
  • Have trouble sleeping
  • Become more active than usual
  • Talk really fast about a lot of different things
  • Be agitated, irritable, or touchy
  • Feel like their thoughts are going very fast
  • Think they can do a lot of things at once
  • Do risky things, like spend a lot of money or have reckless sex

People having a depressive episode may:

    • Feel very sad, down, empty, or hopeless
    • Have very little energy
    • Have decreased activity levels
    • Have trouble sleeping, they may sleep too much or too little
    • Feel like they can’t enjoy anything
    • Feel worried and empty
    • Have trouble concentrating
    • Forget things a lot
    • Eat too much or too little
    • Feel tired or “slowed down”
    • Think about death and suicide

Researchers are currently studying possible causes of bipolar disorder. Most agree that there is more than one factor contributing to developing bipolar disorder or an increased risk.

Brian Structure and Functioning – Some studies show how the brains of people with bipolar disorder may differ from the brains of those who don’t have the illness. 

Genetics – Some research suggest that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only factor. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder – despite them sharing the same genes.

Family History – Bipolar disorder tends to run in families. Children of parents or siblings who have bipolar disorder are much more likely to develop the illness, compared to children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the illness. 

Proper diagnosis and treatment help people with bipolar disorder lead  healthy, productive lives. Talking to a doctor or licensed mental health professional is the first step for anyone who thinks they may have bipolar disorder. Treatment is usually lifelong and often involves a combination of medications and psychotherapy.  

There are several ways to manage and treat bipolar disorder. These include:

  • Psychotherapy – such as cognitive behavioral therapy and family-focused therapy
  • Medications – such as mood stabilizers, antipsychotic medications, and to a lesser extent, antidepressants
  • Self-management – including education and recognition of an episode’s early symptoms
  • Complementary health approaches – such as aerobic exercise mediation, faith and prayer can support, but not replace, treatment

People with bipolar disorder tend to also experience other mental health related conditions. These include:

  • Anxiety
  • Attention-deficit hyperactivity disorder (ADHD)
  • Post Traumatic Stress Disorder (PTSD)
  • Substance Abuse Disorders/Dual Diagnosis
  • Eating disorders

Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for doctors to make a diagnosis. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. 

Bipolar disorder can also be misdiagnosed as Borderline Personality Disorder (BPD). Other illnesses and misdiagnoses can make it hard to treat bipolar disorder. For example, the antidepressants used to treat OCD and the stimulants to treat ADHD may worsen symptoms of bipolar disorder and may trigger a manic episode.  

Psychosis: Sometimes, a person with severe episodes of mania or depression may have psychotic symptoms - hallucinations or delusions. The psychotic symptoms tend to match the person's extreme mood. For example:

  • Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special powers.
  • Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has committed a crime.

As a result, people with bipolar disorder and psychotics symptoms can be wrongly diagnosed with schizophrenia. 

Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends, and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.

When to Get Emergency Help

Suicidal thoughts and behaviors are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to the emergency room, or confide in a trusted relative or friend. Or you can call a suicide hotline number – in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
 
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

When to See a Doctor

Despite symptoms, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of the people around them. Because of this, they don’t get the treatment they need. 

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

Source: National Institute of Mental Health 

Resources

Links to various resources on the topics discuss on this page. 

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