Bipolar Disorder

Bipolar disorder is a mental disorder that was misunderstood and poorly diagnosed for centuries. Previously known as manic depression, bipolar disorder gained scientific awareness in the late 19th century thanks to German psychiatrist Emil Kraepelin, who analyzed the behavior of untreated bipolar patients. However, it wasn’t until the late 1970s that the types of bipolar disorder were established and this condition gained general awareness. Bipolar disorder occurs in 1-3% of the population and is characterized by extreme mood swings between depressive and manic episodes.


Bipolar Disorder Overview & Facts

Bipolar disorder affects the brain, causing unusual, clear and extreme mood changes. Patients experience a sudden surge of energy or elation, causing them to be hyperactive or manic, followed by a down period when they feel sad, hopeless and depressed. In general, these two moods occur one after the other, but there are also cases when they occur at once. Bipolar disorder can range in intensity but even the mildest forms can interfere with daily tasks, affecting their social and professional life and increasing the risk of self-harm and suicide.

Doctors recognize 4 basic types of bipolar disorder:

  1. Bipolar I Disorder: this type of bipolar disorder is defined by episodes of mania that can span across an entire week. These episodes are generally extreme, preventing the patient from doing their job and functioning normally in society, which is why they may require hospitalization during this period. Patients with Bipolar I Disorder also experience depressive episodes that can go on for 14 days, but it is possible for manic and depressive episodes to occur at the same time.
  2. Bipolar II Disorder is more common and mild than Bipolar I Disorder. In this case, the patient struggles mainly with depressive episodes. Manic periods also occur, but they last less and aren’t that severe.
  3. Cyclothymia, or Cyclothymic Disorder, is less common than types I and II and is characterized by shifting episodes that can last for up to two years. However, the shift is not so sudden and even without medication, the patient can manage to function in society. More often than not, Cyclothymia develops into Bipolar I or II Disorder
  4. Other bipolar and related disorders that do not fit in the categories above.


Bipolar Disorder Symptoms & Diagnosis

Bipolar disorder symptoms include extreme mood changes ranging from mania to depression. Although they are referred to as “mood swings” for better understanding, it’s important to point out that these are not the normal mood swings that an average person goes through, but extreme ones that can be noticed even by strangers, but just friends and family. The symptoms of bipolar disorder fall into two categories: manic episodes (the up, elated period) and depressive episodes (the sad, down period).

Manic episode symptoms include a feeling of elation, restlessness, sudden energy surges and increased activity levels. During this episode, the patient often has trouble sleeping because they feel that their thoughts are racing, they talk very fast about many things at once and have the energy to multitask. However, the increased energy makes the irritable, agitated and could push them to do risky things that they later regret, such as get into fights or make large impulse purchases.

Depressive episode symptoms follow the manic episode and they are the complete opposite: once the surge of energy goes away, the patient feels drained of all their energy, sad, hopeless to the point of suicidal thoughts. They no longer have energy and can stay in bed for weeks, unable to sleep or sleeping too much. People who have depressive episodes have minimum productivity levels, lose their appetite, forget to do their daily tasks and experience general apathy.

In general, there is a clear distinction between the two episodes because they occur one after the other, but in some cases, the bipolar patient can have an episode with mixed features, where they feel energetic and depressed at the same time.

Symptoms of bipolar disorder in children are different from symptoms of bipolar disorder in adults, which makes diagnosis more difficult. As children and teenagers already display mood swings as a result of hormonal changes, parents and doctors have to make a distinction between these normal mood swings and the ones caused by bipolar disorder. Teenagers with bipolar disorder may display different episodes patterns and the episodes are more severe. Also, the episodes may succeed faster.

Because the signs of bipolar disorder are often mistaken for normal mood swings or confused with the symptoms of other mental disorders, bipolar disorder is one of the most misdiagnosed disorders. In 2000, people suffering from bipolar disorder lived with their condition for 10 years until getting the correct diagnosis and they had an average of 3 incorrect diagnoses before being classified as bipolar. In 2016, a connection was made between the suicide rate and people with undiagnosed bipolar disorder.

Bipolar disorder diagnosis can be hard to pinpoint when there isn’t a high rate of mental disorder awareness in the patient’s medical system or when the patient postpones seeing a healthcare professional. Blood tests cannot confirm bipolar disorder, but they may be required to exclude certain disorders that give similar symptoms, such as syphilis, thyroid problems or an infection. To diagnose bipolar disorder, specialists use rating scales and conduct a series of clinical interviews to rule out other mental disorders such as ADHD, schizophrenia and substance abuse.


Bipolar Disorder in Women vs. Men

The prevalence of bipolar disorder in women is the same as for men. The condition does not affect one gender more than another. However, it does affect them differently, leading many to believe that women are more at risk of developing bipolar disorder:

  • According to the Journal of Clinical Psychiatry, women experience rapid episode cycling
  • Women experience more depressive and mixed episodes, while men have more manic episodes.

Because of the way in which episodes manifest in men and women, men are often misdiagnosed with schizophrenia and women with depression.


Bipolar Disorder Treatment & Care

Once bipolar disorder is diagnosed, the medical professional may suggest different treatments and therapies depending on the severity of the condition. Modern bipolar treatment options include:

  • Bipolar medication is often recommended as an initial treatment to see if the symptoms can be controlled. From case to case, the doctor may suggest only one drug or a combination of antidepressants, anticonvulsants, mood stabilizers and drugs for anxiety relief. Prescribing the right medicine for bipolar disorder can be a matter of trial and error until the doctor discovers the right combination that causes minimal side effects. It may take up to 2 months for the medication to take effect and changing drugs is done gradually.
  • Behavioral therapy for bipolar disorder is an effective way of treatment that can be used on its own or as a way of complementing medication. The aim of behavioral therapy is to help the patient understand the symptoms of an episode and learn to manage them. The patient has one on one sessions with a trained therapist and learns emotion and stress control techniques. Because behavioral therapy has no side effects, it is recommended for children, pregnant women, and other patient groups that are not eligible for bipolar medication.
  • Electroconvulsive therapy for bipolar disorder is recommended when medication does not provide lasting symptom relief and has been declared as safe and effective by the Food and Drug Administration.


Bipolar Disorder Causes

The causes of bipolar disorder aren’t fully understood, but several risk factors have been identified:

  • Genetic factors: people who have a bipolar first-degree relative are at a higher risk of developing this disorder themselves.
  • Neurological factors: bipolar disorder can occur after an injury to the brain or as a complication of neurological conditions such as multiple sclerosis, strokes, and epilepsy.
  • Environmental factors: although it is not clear if environmental factors alone are enough to cause bipolar disorder, they contribute to an early onset and may aggravate episodes. For example, up to 50% of bipolar adults reported childhood abuse. Moreover, recurring stress and substance abuse can encourage bipolar episodes.


Living with Bipolar Disorder

Following the prescribed treatment is the most effective way of keeping bipolar disorder symptoms under control and maintaining a normal, active lifestyle. Although the episodes can sometimes be severe, living with bipolar disorder is perfectly possible and the patient can function as a normal member of society. Having a pre-established action plan in case of emergencies and a list of tips to follow helps manage the condition:

  • Avoiding stressful settings and situations
  • Maintaining healthy sleeping patterns
  • Avoiding smoking, alcohol and reducing caffeine intake
  • Joining the gym or taking up a sport
  • Seeking therapy sessions with a professional counselor
  • Engagement in creative and artistic activities
  • Maintain a good relationship with close friends and family members who know about the challenges of bipolar disorder. Isolation can aggravate depressive episodes and should be avoided as much as possible.
  • Creating a set daily routine with fixed times for meals, sleeping, work and socializing.
  • Increasing the intake of Omega-3 fatty acids, which have been linked to a decrease in bipolar episodes. Foods that are rich in Omega-3 fatty acids include walnuts, fish and pumpkin seeds.
  • Establishing an emergency contact, preferably a close friend or a relative to provide support during severe episodes
  • Maintaining good communication with the doctor and talking to them about the efficiency and side effects of the bipolar medication
  • Creating a mood chart to spot symptoms of a bipolar episode early
  • Coping techniques for manic or depressive episodes range from patient to patient


Myths about bipolar disorder

Due to the media and mental health awareness campaigns, most people have heard about bipolar disorder and know at least in theory what its symptoms are. However, there are still many myths about bipolar disorder that delay appropriate treatment or prevent patients from activating in society.

  • Bipolar disorder is the same as mood swings

Having mood swings is normal, but it does not make you bipolar. However, extreme mood swings that occur for a long period of time and prevent people from doing their job and interacting with their loved ones could be a warning sign and should be investigated by a medical professional.

  • Very few people suffer from bipolar disorder

As bipolar diagnosis methods have evolved and people became more aware of this condition, it became obvious that bipolar disorder is not as rare as initially thought. In the US, 5.7 million people are diagnosed with bipolar disorder every year, not including children and elderly people.

  • Bipolar people go from one state to another very quickly

The symptoms of manic and depressive episodes are often simplified and many people imagine that patients go from agitated to depressed in a matter of minutes. The truth is that the transition from one state to another can be as long as a few months. Moreover, there is rarely a balance between depression and mania. A two-week manic episode is not automatically followed by a two-week depressive episode. On the contrary, each patient is different and one type of episode is predominant.

  • Manic episodes are periods of happiness

The fact that a bipolar patient experiences a surge of energy and alertness during a manic episode does not mean that he is happy. This episode should not be idealized because it is the one that patients often fear the most, because it makes them feel that they are losing control and could do something crazy. Oftentimes, people with bipolar disorder need the help of a loved one during this manic episode to keep them from getting in trouble.

  • Online tests can diagnose bipolar disorder

Bipolar disorder diagnosis is a complex task that can only be carried out by a professional who has the skills, knowledge and tools for it. It may include blood tests, one-on-one interviews, long term behavioral analysis. Bipolar disorder cannot be diagnosed by an online quiz, no matter how through its questions may be.

  • Bipolar disorder can only be diagnosed in adults

The belief that people can only be diagnosed with bipolar disorder after the age of 18 is one of the longest standing bipolar myths. Although the disorder is harder to recognize in children because they throw tantrums and have mood swings, diagnosis is possible and finding the problem from an early age actually helps with management tremendously.

  • The life of a bipolar patient will quickly spiral out of control

People with bipolar disorder can often feel helpless and feel that they are losing control over their own lives, especially during manic episodes. They could also feel that there’s nothing they can do apart from taking their medicine and going to therapy, but, according to researchers, establishing a daily routine can reinstate control and recognize warning signs before a new episode hits.

Last updated on March 2nd, 2018

Chris Riley

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