Bipolar disorders are brain disorders that cause changes in a person’s mood, energy and ability to function. Bipolar disorder is a category that includes three different conditions — bipolar I, bipolar II and cyclothymic disorder. It known as manic depression is a mental disorder that causes periods of depression and periods of 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.
Types of Bipolar Disorders
- Bipolar I Disorder – defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
- Bipolar II Disorder – defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
- Cyclothymic Disorder (also called cyclothymia) – defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders – defined by bipolar disorder symptoms that do not match the three categories listed above.
Causes of Bipolar Disorders
The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:
- Biological differences – People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
- Genetics – Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
- Brain-chemical imbalances – Neurotransmitter imbalances appear to play a key role in many mood disorders, including bipolar disorder.
- Hormonal problems – Hormonal imbalances might trigger or cause bipolar disorder.
- Environmental factors – Abuse, mental stress, a “significant loss,” or some other traumatic event may contribute to or trigger bipolar disorder.
- Neurological – Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury. Conditions like these and injuries include (but are not limited to) stroke, traumatic brain injury, HIV infection, multiple sclerosis, porphyria, and rarely temporal lobe epilepsy
- Environmental – Environmental factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions. It is probable that recent life events and interpersonal relationships contribute to the onset and recurrence of bipolar mood episodes, just as they do for unipolar depression
Symptoms of Bipolar Disorders
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- A sense of distraction or boredom
- missing work or school, or underperforming
- thinking they can “do anything”
- belief that nothing is wrong
- being extremely forthcoming, sometimes aggressively so
- likelihood of engaging in risky behavior
- a sense of being on top of the world, exhilarated, or euphoric
- excessive self-confidence, an inflated sense of self-esteem and self-importance
- excessive and rapid talking, pressurized speech that may jump from one topic to another
- “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
- Unusual talkativeness
- Racing thoughts
- Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
|People having a manic episode may:||People having a depressive episode may:|
Major depressive episode
A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms
- Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
- Marked loss of interest or feeling no pleasure in all — or almost all — activities
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
- guilt, and a feeling that everything that goes wrong or appears to be wrong is their fault
- changes in eating patterns, whether eating more or eating less
- weight loss or weight gain
- extreme tiredness, fatigue, and listlessness
- an inability to enjoy activities or interests that usually give pleasure
- low attention span and difficulty remembering
- irritation, possibly triggered by noises, smells, tight clothing, and other things that would usually be tolerated or ignored
- an inability to face going to work or school, possibly leading to underperformance
- Either insomnia or sleeping too much
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Thinking about, planning or attempting suicide
Diagnosis of Bipolar Disorders
These may include
- Physical exam – Your doctor will do a full physical exam. They may also order blood or urine tests to rule out other possible causes of your symptoms.
- Mental health evaluation – Your doctor may refer you to a mental health professional such as a psychologist or psychiatrist. These doctors diagnose and treat mental health conditions such as bipolar disorder. During the visit, they will evaluate your mental health and look for signs of bipolar disorder.
- Mood journal – If your doctor suspects your behavior changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. The easiest way to do this is to keep a journal of how you’re feeling and how long these feelings last. Your doctor may also suggest that you record your sleeping and eating patterns.
- Diagnostic criteria – The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an outline of symptoms of various mental health disorders. Doctors can follow this list to confirm a bipolar diagnosis.
Treatment of Bipolar Disorders
Recommended medications may include
- mood stabilizers, such as lithium
- antipsychotics, such as olanzapine
- antidepressant-antipsychotics, such as fluoxetine–olanzapine
Other mood stabilisers for Bipolar Disorders
There are other medications, apart from Lithium, that can be used to help.
- Anti-epileptic medications/anticonvulsants – it is possible that Sodium Valproate, an anti-convulsant, works just as well Lithium, but we don’t yet have enough evidence to be sure. It should not be prescribed to women of child-bearing age.
- Carbamazepine and Lamotrigine – are also effective for some people.
- Antipsychotic medications – Olanzapine or Quetiapine.
Recommended psychotherapy treatments may include
Cognitive behavioral therapy
Cognitive behavioral therapy is a type of talk therapy. You and a therapist talk about ways to manage your bipolar disorder. They will help you understand your thinking patterns. They can also help you come up with positive coping strategies.
Electroconvulsive Therapy (ECT)
ECT can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky.
Psychoeducation is a kind of counseling that helps you and your loved ones understand the disorder. Knowing more about bipolar disorder will help you and others in your life manage it.
Interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics can help you manage your disorder.
Antipsychotic medications are effective for short-term treatment of bipolar manic episodes and appear to be superior to lithium and anticonvulsants for this purpose. Atypical antipsychotics are also indicated for bipolar depression refractory to treatment with mood stabilizers. Olanzapine is effective in preventing relapses, although the supporting evidence is weaker than the evidence for lithium.
Antidepressants are not recommended for use alone in the treatment of bipolar disorder and have not been found to be of any benefit over that found with mood stabilizers.Atypical antipsychotic medications (e.g., aripiprazole) are preferred over antidepressants to augment the effects of mood stabilizers due to the lack of efficacy of antidepressants in bipolar disorder.
- Depression or mania can cause great strain on friends and family – you may have to rebuild some relationships after an episode.
- It’s helpful if you have at least one person that you can rely on and confide in. When you are well, try explaining the illness to people who are important to you. They need to understand what happens to you – and what they can do for you.
Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness.
Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood.
Make sure you regularly do things that you enjoy and that give your life meaning.
Continue with medication
You may want to stop your medication before your doctor thinks it is safe – unfortunately this often leads to another mood swing. Talk it over with your doctor and your family when you are well.
It may have beneficial effects on depressive symptoms, but not manic symptoms. However, only a few small studies of variable quality have been published and there is not enough evidence to draw any firm conclusions.
Keeping a Life Chart
Even with proper treatment, mood changes can occur. Treatment is more effective when a client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track and treat bipolar disorder most effectively.
Other treatment options for Bipolar Disorders
Other treatment options may include
Prevention of Bipolar Disorders
- Pay attention to warning signs – Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
- Avoid drugs and alcohol – Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.
- Take your medications exactly as directed – You may be tempted to stop treatment — but don’t. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.