Formerly known as manic depression, bipolar disorder is a condition associated with extreme changes in mood. People with this condition have periods of deep sadness (depression) that can last for weeks or months. They also experience periods of an extreme elevation in the mood (mania) that may continue for several months. Bipolar disorder often causes people to have difficulties with school or work, and these struggles may be accompanied by conflicts in a person’s relationships. This disorder is considered a chronic condition that can be managed with proper treatment and support.
Researchers have not yet identified an exact cause for bipolar disorder. However, they believe that a combination of genetics, neurological differences, and stress likely contributes to the development of this disorder and to an individual’s first episode of this disease. Bipolar disorder typically runs in families, and children whose parents have the condition face an elevated risk of developing it themselves as compared to children whose parents do not have the illness. Some studies have suggested that individuals with bipolar disorder may have structural and functional differences in their brains that are unique to this condition. For individuals who are predisposed to developing this disorder, periods of significant stress may make experiencing an episode more likely.
The major symptoms of bipolar disorder are mania, hypomania, and depression. During episodes of mania, people may feel a sense of euphoria, excitement, and energy. They may be unusually talkative, and this may be accompanied by racing thoughts or a decreased need for sleep. Some people may have an exaggerated sense of self-confidence, and they may engage in impulsive or risky behaviors such as substance use, unsafe sex, reckless driving, or expensive spending sprees.
Episodes of hypomania, usually associated with a type of bipolar known as bipolar II, are usually less severe than manic episodes. People who are experiencing an episode of hypomania engage in the same types of impulsive behaviors that are seen in manic episodes but to a lesser degree. People typically feel very excited and notice higher energy levels. They may not need to sleep as much as they otherwise would. Whereas manic episodes often cause severe difficulties in school and with employment, an episode of hypomania may not cause these disruptions, and the individual may be able to continue performing well in these activities.
During periods of depression, bipolar individuals often have symptoms that are also associated with major depressive disorder. Generally, these symptoms are so severe that the person may need to take time off from school or work. Depressive episodes often include extreme fatigue, sleeping too much, feelings of hopelessness or worthlessness, difficulty concentrating, and a drastic loss of interest in nearly all activities. Individuals may neglect personal hygiene, and they may spend days in bed. Some people experience weight loss due to having no appetite whereas others gain weight due to comfort eating. Episodes of depression frequently cause people to have suicidal thoughts, and this may lead to planning or attempting suicide.
While men and women are equally affected by this condition, symptoms in women may differ from those in men. Most women are typically diagnosed in their 20s or 30s, and they experience episodes of mania that are milder than those experienced by men. Women have more depressive episodes than they do manic episodes, and they often have at least four episodes of mania or major depression each year, a process known as rapid cycling.
For women, bipolar disorder often exists alongside other medical conditions such as obesity, anxiety, migraines, and thyroid disease. Women are more likely to experience frequent relapses, and they have a higher risk of developing an alcohol use disorder as a result of this condition.
Men are often diagnosed with bthe ipolar disease earlier in life than women are, and they typically experience more episodes of mania than women might. Their episodes of mania can be especially severe, and they are more likely to engage in risky practices during these episodes, including substance use. Men with bipolar disorder have a higher risk of death from suicide as compared to women with the condition, and men are also less likely to seek medical care than women are.
There are four major types of bipolar disease that are currently recognized. The first type, called bipolar I, is diagnosed if a person has experienced one or more episodes of mania that were either preceded or followed by one or more episodes of hypomania or depression. As a result of their manic episodes, some people may experience an episode of psychosis in which they become detached from reality.
The next type of this condition is known as bipolar II. It is identified in people who have never experienced an episode of mania but who have had at least one episode of depression and one episode of hypomania. Bipolar II is often mistakenly believed to be a milder form of the disease than bipolar I. However, both forms of the disease are equally severe, and people with bipolar II tend to experience prolonged depressive episodes as compared to individuals with bipolar I.
The third type of bipolar disease that has been recognized is a cyclothymic disorder. This is diagnosed in adults who have had at least two years of numerous episodes of hypomania symptoms as well as numerous episodes of depressive symptoms. In the case of cyclothymic disorder, the depressive symptoms that people experience will not approach the severity of a major depressive episode.
In some cases, other types of bipolar disease, officially known as either “other specified” or “unspecified,” may be triggered by substance use and certain medications. They may also be caused by medical conditions such as Cushing’s disease, strokes, or multiple sclerosis.
The symptoms of bipolar disorder may occur with other medical conditions, and some types of bipolar disease may have identifiable medical causes. To fully investigate all possible medical causes for a patient’s symptoms, a clinician will typically gather a health history and perform a physical examination as the first part of any diagnostic assessment.
During the health history portion of the assessment, the doctor will ask the patient about any family history of bipolar disorder or other mental health conditions, and the patient will also be asked about substance use and smoking. To help the clinician, patients should bring along a list of all of their current medications to the appointment.
After conducting the health history, the clinician will begin the physical examination. This exam can provide important information about underlying health conditions and help the physician know whether the patient is healthy enough to safely take certain medications for mental health conditions. A patient will have his or her height, weight, blood pressure, pulse rate, and body temperature recorded. The doctor will listen to the patient’s heart and breathing with a stethoscope, and he or she may also feel the abdominal area for signs of tenderness or masses.
As part of the physical exam, the doctor may conduct a thorough neurological assessment. This will include checking the patient’s alertness, memory, and mental status. The cranial nerves, sensations, and reflexes will all be examined. Blood and urine tests may be performed to check liver and kidney function and to detect any abnormalities that may be contributing to the patient’s symptoms.
If the clinician cannot determine a medical cause for the patient’s symptoms, he or she will likely refer the patient to a mental health professional for an additional assessment. Taking the form of an interview, the mental health professional will ask the patient about his or her well-being, thoughts, behavior, and mood. In particular, he or she will focus on any signs of stress, anxiety, depression, or mania. If necessary, the mental health professional may speak with the patient’s doctor or family members to gather additional information that could aid in making a correct diagnosis. Prior to receiving a definitive diagnosis, patients may be asked to fill out a mood chart for several weeks and to share this list with the mental health professional. The chart is a daily log of the patient’s sleep patterns, emotions, stress, and behaviors.
Many patients with bipolar disease use a combination of medication and psychotherapy to manage their condition. Medications that may be prescribed include antidepressants, mood stabilizers, antipsychotics, and benzodiazepines. Lithium is an example of a mood-stabilizing drug, and commonly prescribed antidepressants include selective serotonin reuptake inhibitors such as fluoxetine, commonly referred to as Prozac or Sarafem.
In some cases, patients may be able to take one pill, such as fluoxetine-olanzapine, which is a combination of both Zyprexa & Prozac which is an antidepressant-antipsychotic medication. Benzodiazepines like alprazolam are used to reduce anxiety in patients with bipolar disorder, but they are generally only used for a short time. Patients who experience insomnia during an episode may be prescribed additional medication to help them sleep.
Some patients may need to use a combination of several types of medications, and they will be monitored closely by their physicians for side effects. In addition to conventional medicine, many patients have found that acupuncture is beneficial for their symptom management.
Forms of psychotherapy that are typically used to treat patients with Bipolar disease include cognitive behavioral therapy, psychoeducation, interpersonal therapy, and social rhythm therapy. Cognitive behavioral therapy teaches patients to understand their thought patterns and to replace negative thoughts with positive ones. A patient learns to reframe his or her thoughts and outlook, and he or she develops healthy coping mechanisms to use in response to stressful events. Therapy also teaches a patient that it is OK to simply observe his or her thoughts without acting on them.
Psychoeducation teaches patients and their families about the intricacies of bipolar disorder and what they might expect with this disease. This type of education empowers patients and their families to support one another more effectively, and it gives them a sense of control over the disease. Through interpersonal and social rhythm therapy sessions, patients learn to develop better regulation of their daily habits, including sleeping, eating, and exercise schedules.
In addition to these treatment options, clinicians may also recommend outpatient day treatment programs at a hospital or mental health facility. These programs can provide more intensive counseling that can benefit patients with more severe forms of the illness.
Patients who have substance use issues along with their bipolar disease will be advised to receive treatment for these, perhaps at a residential facility. In some cases, patients with Bipolar disease may need to be hospitalized if they have become psychotic (detached from reality), if they are suicidal, or if they are otherwise considered a danger to themselves or others. Hospitalization may be particularly necessary during a manic or a major depressive episode. Treatment at the hospital can help patients stay safe while their moods stabilize.
Electroconvulsive therapy (ECT) may be useful in patients who have not responded to other treatments. Patients may also find it helpful to keep a life chart. This chart records daily moods, treatments, life events, and sleeping patterns and is shared with the patient’s mental health provider. This chart can help the provider know when treatment changes may be needed, and it can help lead to informed suggestions for such changes.
Patients with Bipolar disease can live full and happy lives with proper treatment. As a patient, you give yourself the best chance of managing your disease when you learn everything that you can about it.
Understand the potential signs of relapse so that you can get help promptly. In particular, it is crucial to continue to take prescribed medications, even during periods when you may be feeling fine. Keeping a regular schedule for bedtime and waking up and following a nutritious diet may be beneficial as well. Some patients find that meditation and yoga are particularly soothing.
Just remember that these self-care tools are to be used in combination with your medical treatment. Continue to keep all appointments with your doctors and mental health providers, and reach out for support from your family, friends, and community.