Bipolar Disorder

Overview

Bipolar disorder, also called manic depression, is a mental disorder that causes extreme mood swings in individuals. The mood usually varies between extreme highs, known as mania or hypomania and extreme lows, something similar to depression.

Individuals with bipolar disorder can go through a phase of depression that may last for weeks. When they go through extreme lows, they feel hopeless and do not have the energy to do anything. Either they sleep a lot or have trouble sleeping, get thoughts of self-harm, tend to hide away and do not enjoy life.

When the phase of extreme high strikes, they tend to be always hyperactive. They will act silly, speak so fast that one cannot follow their conversation, not feel the need to sleep, do things without even thinking, try to rush through everything, and believe they have superpower abilities. This kind of personality is extremely risky.

Having bipolar disorder can be challenging not only for the patient but also for individuals around them. Because of their confusing personality, it becomes difficult for individuals around them to understand them. Getting along with others, making friends, sticking to goals, and concentrating on work or studies can be tricky.

This disorder affects the individual's decision-making ability, and they often take risks. Suicide, self-harm, and trying to harm others are common among patients with bipolar disorder. They often depend on alcohol or drugs to manage their mood.

The disorder usually affects individuals 25 years or above, but in rare cases, it can occur among teenagers.
Bipolar disorder is a lifelong disease, and there is no cure. But with regular psychological counselling, medicines, assisted living, and a proper treatment plan, bipolar disorder can be managed. The treatment primarily focuses on addressing the mood swings so the patient does not harm themselves.

It is essential to start proper treatment after the disease is diagnosed. Otherwise, the condition worsens.

The causes of the disorder primarily include genetics. If the disorder runs in the family or any siblings or parents, there is a high chance of the individual suffering from bipolar disorder. However, in some cases, the individual may not get it, even if it runs in the family. Another factor is stress or childhood trauma or accident.

Types of Bipolar disorder:

There are different types of bipolar disorder. These affect every individual differently. The type of the disorder also determines the symptoms and period of the episodes.

The difference between the different types of disorders is only sometimes clear as the symptoms may overlap. This is why different doctors use other terms to define the type of the disorder.

The three most common types of bipolar disorder include:

Bipolar I Disorder

This type of disorder is characterised by at least one episode of mania. While most individuals go through depression, it is not rare. The episode mostly lasts up to 7 days; sometimes, they are so severe that the patient needs to be hospitalised.

Bipolar II Disorder

In this type, the mania episodes are slowly replaced by episodes of depression. While mood swings become prominent and shift between mania and depression, depression becomes the dominant mood. Also, the episodes are more frequent than in Bipolar I.

Cyclothymic Disorder or Cyclothymia

This includes both mania and depression, and the mood changes become more or less permanent. Cyclothymia is usually developed when the first two categories of bipolar last for at least two years.

There is also an 'unspecified' category when the symptoms do not fall into either the Bipolar I or Bipolar II category. Individuals falling in this category can also exhibit signs of bipolar disorder. 

Symptoms:

Individuals with bipolar disorder experience extreme episodes of mania and depression.

When they go through mania, a period of extreme high, they experience the following symptoms:

• Feeling energetic all the time

• Feeling distracted all the time

• Not wanting to sleep

• Having hallucinations

• Having the urge to do plenty of things at once

• Speaking very fast

• Feeling excited or thrilled most of the time

• Not paying heed to others

The period of depression makes the individual go through extreme opposite characteristics. The symptoms in the phase include:

• Feeling worthless, sad, or irritable all the time

• Feeling too lethargic to do anything

• Not feeling the urge to do regular activities

• Having self-doubt all the time

• Lack of appetite

• Having difficulty trying to sleep

• Feeling the need to withdraw from everything and everyone 

• Having thoughts of self-harm or suicide

• Having hallucinations or being delusional

Causes:

Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs and lows. The exact cause of bipolar disorder is unknown, but experts believe many factors work together to make a person more likely to develop it. These factors include:

- Genetics: Bipolar disorder often runs in families, and having a first-degree relative with the disorder increases the risk.
- Brain structure and function: People with bipolar disorder may have abnormal brain structure and activity that affect their mood and behaviour.
- Environmental factors: Stressful life events, such as trauma, loss, or abuse, may trigger or worsen bipolar disorder symptoms in some people.
- Substance misuse: Using drugs or alcohol may induce or exacerbate manic or depressive episodes in people with bipolar disorder.

Bipolar disorder is a complex and chronic condition that requires ongoing treatment and management. If you or someone you know is experiencing symptoms of bipolar disorder, please seek professional help as soon as possible. There are effective treatments available that can help you cope with your condition and improve your quality of life. 

Risk factors:

Factors that may raise the risk of developing bipolar disorder or serve as a trigger for the first episode include:

• Having a first-degree relative, such as a parent or sibling with bipolar disorder

• Periods of high stress, such as the death of a loved one or any other traumatic event

• Alcohol or drug abuse

Possible Complications:

If bipolar disorder is left undiagnosed and untreated, it can cause serious problems that can interfere with the individual's social, personal, and work life. The condition worsens over time, and the episodes become more frequent and severe. The individual may consider ending his/her life at one point and attempt suicide.

Problems related to drug or alcohol abuse may also arise. Individuals often think alcohol can help them stabilise their mood. But this will only worsen the condition.

Prevention: 

There is no certain way to prevent bipolar disorder. However, seeking treatment at the first sign of a mental health disorder can help to prevent bipolar disorder or other mental health conditions from worsening.

When to Consult a Doctor?

It is advised to consult a doctor on the onset of the primary symptoms to prevent the condition from progressing further. However, the symptoms may become severe, and individuals have suicidal thoughts or thoughts of self-harm. They become a danger to themselves and others without realising it. Consult a doctor immediately for help.

Diagnosis:

Since bipolar disorder involves changes in mood over time, the doctor usually monitors the patient over a few weeks before diagnosing the disorder. This condition can also overlap with other mental health disorders. So, it is important to identify the right symptoms to diagnose the disease correctly.

The patient must have experienced at least one episode of maniac or depressive symptoms. The challenge here is that patients often overlook mania symptoms as nobody goes to the doctor because they feel elated or overjoyed.

The doctor conducts an interview and asks the patient questions like the different symptoms, the duration of the depression episode, how the mood swings make them behave, how they handle the mood and other similar questions. Before diagnosis, family history and the patient's medical history are considered. The doctor usually asks the patient to maintain a diary to understand their mood swings.

Lab Tests

Lab tests or imaging tests are not used to diagnose bipolar disorder. However, the doctor may recommend some blood tests and urine tests to rule out the possibility of underlying medical conditions causing similar symptoms.

Treatment

Proper treatment can help the patient to live a healthy and everyday life. The exact amount depends on how long the patient has been experiencing the symptoms, the patient's surroundings, and how the patient reacts to the mood phases.

With the help of treatment, the disorder can be stabilised, and the patient can handle things, even when alone. The treatment can be a combination of medications, psychotherapy, and alternative management.

Different treatments available for bipolar disorder include:

• Psychotherapy

Different types of psychotherapy are administered to treat the symptoms of bipolar disorder. Cognitive behavioural therapy (CBT) reduces stress by helping patients change their thinking patterns. This also helps in better mood management.

• Talk Therapy

This allows the patient to discuss their feelings, mood swings, thoughts, and daily activities with a psychologist. This helps them to improve relationships with their loved ones, understand their mental condition and improve daily functioning.

• Home Care

Small lifestyle changes in everyday life can bring about many positive changes for patients with bipolar disorder. Self-management techniques suggested by psychologists can be highly effective for managing the disorder.

Following are some self-management techniques that individuals with bipolar disorder can adopt at home:

• Keeping track of mood and monitoring what triggers the episodes

• Educating oneself about the disease

• Following a disciplined life

• Managing stress and limiting them

• Attending regular counselling with family or alone

• Following a sleep hygiene

• Practicing workouts and meditation

• Carefully thinking and making decisions

• Reaching out for help whenever required

• Taking prescribed medication timely

• Avoiding alcohol and drugs

Medication

Different types of drugs can be used to treat bipolar disorder, depending on the symptoms and the phase of the disorder. Some of the main classes of drugs are:

Mood stabilizers: These drugs help prevent or reduce the severity of mood swings, especially manic episodes. They include lithium, valproic acid, carbamazepine, and lamotrigine.
Antipsychotics: These drugs help reduce symptoms of psychosis, such as delusions, hallucinations, and paranoia, that may occur during manic or depressive episodes. They include aripiprazole, quetiapine, risperidone, olanzapine, and cariprazine.
Antidepressants: These drugs help relieve symptoms of depression, such as low mood, loss of interest, and suicidal thoughts. They include fluoxetine, sertraline, citalopram, venlafaxine, and duloxetine. However, antidepressants may also trigger or worsen manic episodes in some people, so they are usually used with caution and in combination with a mood stabilizer or an antipsychotic.
Benzodiazepines: These drugs help reduce anxiety, agitation, and insomnia that may accompany bipolar disorder. They include lorazepam, clonazepam, diazepam, and alprazolam. They are usually used for short-term relief and not as a long-term treatment, as they can cause dependence and withdrawal symptoms.

The choice of medication for bipolar disorder depends on many factors, such as the type and severity of symptoms, the patient’s medical history, the response and tolerance to previous treatments, and the potential side effects and interactions of the drugs. Therefore, it is important to consult with a doctor before starting, changing, or stopping any medication for bipolar disorder. Medication alone is not enough to treat bipolar disorder; it should be combined with psychotherapy and lifestyle changes to achieve the best outcomes.

Surgical Treatment

There is no surgical treatment for patients with bipolar disorder.

Alternative Management

Since stress can trigger the disorder, alternative management is adopted to manage stress. Different calming techniques are adopted as complementary treatments to manage the symptoms. Individuals benefit from massage therapy or daily yoga or meditation to promote calmness.

Individuals are also encouraged to practice aerobics or sports. This is a helpful addition to the overall treatment as this allows the stress to be released.

There are also different support groups that patients can attend either with family or friends or alone to connect with individuals with a similar condition. These groups provide mental and social support to the patient.