Bipolar disorders are classified as mood disorders which include characteristics of extreme mood shifts – highs and lows — including depressive symptoms and manic episodes separated by relatively normal periods of mood.
Because of the existence of co-occurring disorders, bipolar disorder is often misdiagnosed or mistreated. According to the National Institute of Mental Health, nearly 6 million adult Americans suffer from bipolar disorders, with the median age of onset being 25 years old, although children and teens do suffer from symptoms as well.
Additionally, more than two-thirds of people diagnosed with bipolar disorders have a relative with similar symptoms and characteristics.
People with bipolar symptoms are at a greater risk of suicide if left untreated.
Overview of Bipolar Disorder
Bipolar Disorder, also called manic-depressive illness, is a serious mental condition characterized by intense and unusual mood swings between emotional highs and lows. The highs and lows experienced by individuals with bipolar disorder are significantly more severe than the emotional highs and lows people without the condition go through on a day-to-day basis. Their mood swings also usually bring about extreme changes in energy, activity, sleep, and behavior. These unusually intense periods of emotional volatility are referred to as “mood episodes”, and they last anywhere from seven to fourteen days. Each mood episode represents a marked change in a person’s usual behavior, and they can inhibit people’s ability to lead normal lives. Bipolar disorder is a lifelong illness, and it cannot be cured. However, through prolonged and closely monitored treatment, those with bipolar disorder can learn to control their mood swings, and lead stable, productive, and successful lives.
Background Information on Bipolar Disorder
According to the Depression and Bipolar Support Alliance, more than five and a half million Americans are affected by bipolar disorder every year. Most individuals that suffer from bipolar disorder develop the condition in their late teens or early twenties, but it can occur at any age. Diagnoses for bipolar disorder are made using the Diagnostic and Statistical Manual of Mental Disorders (DSM), and in order to be diagnosed, a person’s symptoms must represent a major change from their usual mood or behavior.
The fluctuations between the emotionally “high” episodes (manic or hypomanic mood episodes) and emotionally “low” (depressive mood episodes) make it difficult for individuals with bipolar and their families to recognize their symptoms. They may be able to identify singular symptoms, but they are not always able to recognize the larger underlying issue. Consequently, some people with bipolar disorder will suffer for years before being properly diagnosed and treated.
The longer the condition goes untreated, the more severe the symptoms become. Bipolar symptoms can result in damaged relationships with friends and family, poor work or academic performance, and in some cases even suicide. This fact helps emphasize the importance of treatment and the severity of the condition because it shows that bipolar disorder does not get better on its own. Getting the proper treatment is the only way to ensure that bipolar individuals get their symptoms under control.
The underlying cause of bipolar disorder is unknown, but there are a number of risk factors to be aware of. The most prominent risk factors are genetics, brain structure, and brain functioning. Individuals with a first-degree relative, namely a parent or sibling, with the condition are more susceptible to developing the condition. In regards to brain structure and functioning, an MRI study found that adults with bipolar disorder have smaller prefrontal cortices with smaller functional capacities than people without the condition. The prefrontal cortex is a cerebral cortex covering a portion of the brain’s frontal lobe and is responsible for constructing complex cognitive behavior, personality expression, decision making, and moderating social behavior. Interestingly, the prefrontal cortex develops during late adolescence, which may help explain why more than 50% of bipolar diagnoses occur before the age of twenty-five.
Mood Episodes & Symptoms of Bipolar Disorder
Mood episodes are the distinct periods in which individuals experience intense emotional states along with unusual sleep habits, activity levels, thoughts, and/or behavior. Each episode denotes a drastic alteration from a person’s typical mood or behavior. During an episode, people will experience symptoms for the majority of the day and bipolar individuals usually experience multiple episodes. The DSM delineated four particular types of mood episodes: manic episodes, hypomanic episodes, depressive episodes, and mixed episodes.
Mania and hypomania are two different types of mood episodes but manifest the same symptoms. Hypomania is simply a mild form of mania. Mania is noticeably more severe, posits more problems in daily activity, and can even induce psychosis. It is important to note that without proper treatment, hypomanic episodes can develop into severe mania or depression. In order for an individual to experience a manic or hypomanic episode, they must exhibit three or more of the following symptoms:
- Feeling very “up” or “high” for an extended period of time
- Feeling jumpy, wired, or abnormally upbeat
- Extreme irritability
- Difficulty concentrating or having racing thoughts
- Becoming more outgoing and talking faster or more than usual
- Increasing their amount of activity or thinking they can do a myriad of
things at once
- Decreased need for sleep or sleeping less
- Impulsivity in behavior and decision making – engaging in excessive risky behaviors deemed pleasurable like shopping sprees or reckless sex
It’s common for bipolar individuals to enjoy the euphoric feelings and increased productivity attributed to manic and hypomanic episodes, but is important to remember that they’re impermanent. Both hypomanic and manic episodes result in an emotional crash that leaves individuals feeling depressed and worn out.
Major depressive episodes (MDE) are the antithesis of manic episodes. During a depressive episode, individuals become much more reserved and tend to isolate themselves. It’s common for depressive symptoms to become severe enough to disrupt their daily lives, and make the most routine tasks difficult. When someone is going through an MDE, they will experience five or more of the following nine symptoms for two or more weeks:
- Prolonged depressed mood – feeling sad or empty for the majority of the
- Decreased interest or pleasure in almost all activities, even those they
- Significant weight fluctuations or altered appetite
- Insomnia or hypersomnia
- Restlessness or slowed behaviors
- Fatigue or loss of energy
- Feeling excessive/inappropriate guilt or worthlessness
- Inability to think or concentrate
- Suicidal ideation
People with bipolar disorder are more likely to seek out help amidst a depressive episode, which is why bipolar disorder is sometimes misdiagnosed as major depressive disorder. So, it’s extremely important to have your physician conduct a close examination of your previous medical history in order to prevent this from happening.
A mixed mood episode, or mixed state, is a manifestation of manic and depressive symptoms simultaneously. During a mixed state, individuals are likely to be more irritable than normal, have trouble sleeping, and experience a drastically changed appetite. The National Institute of Mental Health noted that “People in a mixed state may feel very sad and hopeless while at the same time feel extremely energized.” Thus, a mixed mood episode can be characterized by emotional uncertainty or conflict.
People with particularly severe mood episodes may develop symptoms of psychosis. Psychosis affects a person’s ability to know what’s real and what is not in addition to their thoughts and emotions. The psychotic symptoms an individual exhibits will reflect their particular mood extremity. When a person is experiencing psychotic symptoms during a manic episode, they may believe that they’re rich and famous or have special powers like invincibility. Conversely, psychotic symptoms during a depressive episode include the belief that they’ve committed a crime, the belief that they’ve lost all of their money, or that their life has been ruined in some way or another. As a result, bipolar individuals with psychotic symptoms can be misdiagnosed with schizophrenia.
Types of Bipolar Disorders
There are four primary types of bipolar disorder, and physicians use the DSM to determine the particular form of the disorder an individual has. In order to be diagnosed, their symptoms must represent a marked change from their usual mood or behavior.
- Bipolar I Disorder: Defined by one or more manic or mixed episodes lasting at least seven days, usually accompanied by major depressive episodes.
- Bipolar II Disorder: Defined by one or more major depressive episodes accompanied by at least one hypomanic episode. This excludes full-blown manic or mixed episodes.
- Bipolar Disorder Not Otherwise Specified (BP-NOS): Diagnosed when symptoms of the illness do not meet the criteria for any of the specific bipolar disorders, but the symptoms are clearly out of the person’s normal range of behavior.
- Cyclothymic Disorder: Defined by at least two years of numerous periods of hypomanic symptoms that do not meet criteria for a manic episode and numerous depressive symptoms that do not meet the criteria for a major depressive episode. This is a mild form of bipolar disorder
There is also a severe form of bipolar disorder called Rapid-Cycling Bipolar Disorder which occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states over the course of a single year. Rapid cycling can occur at any point within the course of the disorder and will come and go depending on the individual’s treatment. This particular form of bipolar disorder is more common in women and those with bipolar II disorder. It has also been documented that rapid cycling occurs in individuals that experience their first mood episodes in their mid to late teens, which is earlier than most diagnoses.
It is also important that bipolar II disorder is not a milder form of bipolar I disorder. They are completely separate diagnoses. The manic episodes of bipolar I disorder can be more severe, but individuals with bipolar II disorder can be depressed for longer periods and are more susceptible to rapid cycling bipolar disorder.
Coexisting Conditions & Complications With Bipolar Disorder
People with bipolar disorder frequently have other mental or behavioral conditions that contribute to their bipolar disorder. Some of the most common cohabitation ailments include:
- Substance abuse problems
- Anxiety Disorders – PTSD and social phobias
- Eating Disorders
- Physical health problems – heart disease, thyroid problems, headaches, and obesity
Substance abuse problems are the most common cohabitation sickness, and they’re also the biggest complication attributed to bipolar individuals’ stability. Some people attempt to treat their disorder by “drowning their sorrows” in alcohol or recreational drugs. But, this often triggers or prolongs their symptoms and the manic behavioral complications lead them to excessive indulgences. Other common complications with bipolar disorder include but are not limited to:
- Damaged Relationships
- Legal or financial problems
- Poor work or academic performance
- Suicide or suicide attempts
Treating Bipolar Disorder
There is no way to prevent the development of bipolar disorder, but seeking out treatment at the onset of symptoms can prevent conditions from worsening. Proper treatment helps all bipolar individuals gain better control of their mood swings and behavioral symptoms.
Bipolar disorder may be treated with medication, psychotherapy, or a combination of medication and psychotherapy. The most effective forms of treatment typically include a steady, prolonged combination of medication and psychotherapy. Additionally, keeping a log of your daily mood symptoms, treatments, sleep patterns, and life events can help individuals and their physicians track and treat their illnesses most effectively.
Medications Used in Treating Bipolar Disorder
Not everyone responds to medications the same way, and there are different medications used to treat different symptoms of bipolar disorder. Individuals may need to try a number of different medications before they find a solution that works best for them. The most commonly prescribed medications for treating bipolar disorder are mood stabilizers, atypical antipsychotics, and antidepressants.
- Mood Stabilizers: These are typically the first option in treating bipolar disorder. Prescriptions for mood stabilizers typically last for years. Lithium was the first FDA-approved mood stabilizer, and it remains the most popular and effective stabilizer.
- Side effects of Mood Stabilizers include:
- Dry Mouth
- Joint or muscle pain
- Brittle nails or hair
- Unusual discomfort to cold temperatures
- Side effects of Mood Stabilizers include:
- Atypical Antipsychotics: These are typically prescribed along with antidepressants for individuals with bipolar I disorder. These are not as commonly prescribed as mood stabilizers and are only prescribed symptomatically.
- Side effects of Atypical Antipsychotics include:
- Dizziness upon standing
- Blurred vision
- Heart palpitations
- Sun sensitivity
- Skin rashes
- Menstrual problems
- Side effects of Atypical Antipsychotics include:
- Antidepressants: These are used to treat all types of bipolar disorder, but are rarely prescribed to exclusively treat the condition. Strictly taking antidepressants increases the likelihood of an individual switching to manic or hypomanic episodes, and/or developing rapid cycling bipolar disorder. Consequently, antidepressants are usually used in conjunction with mood stabilizers
- Side effects of Antidepressants
- Diminished sex drive or difficulty enjoying sex
- Side effects of Antidepressants
Psychotherapies Used in Treating Bipolar Disorder
Psychotherapy is commonly prescribed along with medication. Therapy is particularly effective because it provides individuals with a condition and their families with support, education, and guidance. There is a myriad of psychotherapy methods used in treating bipolar disorder, but the most popular methods include:
- Cognitive Behavioral Therapy (CBT): CBT is an evidence-based form of psychotherapy used to treat numerous behavioral and psychological conditions. CBT helps individuals with bipolar disorder identify and cope with their mood swings. If a person is able to recognize an impending mood swing, they will be able to effectively address it in order to mitigate the symptoms.
- Interpersonal & Social Rhythm Therapy (IPSRT): IPSRT is empirically validated and designed to help individuals improve their moods by understanding and working with their biological and social rhythms. This helps bipolar people structure daily routines and improve their relationships with others. The structural approach of IPSRT is effective in protecting against manic episodes.
- Psychoeducation : The goal of psychoeducation is to provide people with a deeper understanding and coping with mental health conditions. Psychoeducation is typically conducted in a group setting and is helpful for individuals with the condition and their family members.
- Family-Focused Therapy: Family-focused therapy is a hybrid of psychoeducation and family therapy. The goal is to enhance family coping strategies, improve communication among family members, improve problem-solving skills, and be able to recognize incoming mood episodes to help their loved ones.
References and Resources
- Bipolar Disorder in Adults. National Institute of Mental Health, 2014.
- Blumberg HP. The Next wave in neuroimaging research in pediatric bipolar disorder. J Am Acad Child Adolesc
Psychiatry . 2008 May;47(5):483-486.
- Schneck, Christopher D., et al. “The Prospective Course of Rapid-Cycling Bipolar Disorder: Findings From the STEP-BD.” American Journal of Psychiatry, vol. 165, no. 3, Mar. 2008, pp. 370–377., doi:10.1176/appi.ajp.2007.05081484.
- “Bipolar Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, medprofvideos.mayoclinic.org/videos/bipolar-disorder.
- “Bipolar Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
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