Everything You Need to Know About Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorder is a serious and chronic mental illness that is mostly characterized by severe shifts in a person's mood. These “ups” and “downs” — called manic and depressive episodes — represent much more extreme shifts than a healthy person’s good and bad moods, and they can lead to reckless behavior as well as a high suicide risk. According to the National Institute of Mental Health, at least 2.6 percent of adults in the United States live with bipolar disorder at any given time; that is almost six million people.

Four types of Bipolar Disorder

Not everyone who lives with bipolar disorder experiences the same patterns in mood shifts. Depending on the symptoms, and the length of the prevalent polarity, bipolar disorder is divided into four main types.

Bipolar I Disorder

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes bipolar I disorder as causing an abnormally elevated or irritable mood (mania) through the entire day at least for a week. Besides being highly irritable, a person should meet at least three of the following characteristics to be diagnosed with this subtype of bipolar disorder while they are manic:

• Sky-high self-esteem
• Talking too much
• Decreased need for sleep
• Being easily distracted
• Racing thoughts
• Desire to start new projects
• Engaging in risky activities with a potentially bad outcome

In bipolar I disorder, a manic episode is preceded or followed by hypomanic or depressive episode.

Bipolar II Disorder

When it comes to the second type of bipolar disorder, bipolar II disorder, it’s mandatory that a person experiences at least one hypomanic and one depressive episode in order to qualify for the diagnosis. The symptoms are the same as with bipolar I but unlike mania, hypomania is mostly not severe enough to cause serious dysfunctions and impairments to a person’s life.

Regarding the major depressive episode, a person diagnosed with bipolar II disorder must experience five or more symptoms and they must last at least two weeks:

• A depressed mood noticeable to other people
• Lack of desire or interest in any activities that previously were meaningful to them
• Noticeable weight loss for no apparent reason
• Sleeping too little or too much
• Psychomotor agitation noticed by others
• Decreased energy levels (feeling drowsy and tired)
• Feeling of worthlessness or self-hate
• Being unable to concentrate
• Thoughts about suicide, or attempts to commit suicide.

Cyclothymic Disorder

People with cyclothymia or cyclothymic disorder have experienced some symptoms of hypomania as well as depression for at least two years, but have never met criteria for any of the three main episodes – hypomania, mania, or depression. The main feature of cyclothymia is a chronic mood disturbance ranging from periods of hypomanic to depressive symptoms but they are insufficient in number as well as intensity to be classified as (hypo)manic or depressive episodes.

Otherwise specified and unspecified bipolar disorders

Many people, including children and adolescents, experience certain symptoms of bipolar disorder but don’t meet the full diagnostic criteria for any of the three main types. This is where the fourth category, otherwise specific and unspecified bipolar disorder, comes handy for clinicians, who use it as a guideline to be able to offer treatment to these people.

There are various combinations within this group:

• Short hypomanic and long depressive episodes
• Major depressive episodes with hypomanic-like symptoms that don’t meet the criteria to be called hypomanic
• Hypomanic episodes without depressive episodes
• Cyclothymia that lasts less than two years

In cases when a physician chooses not to specify the reason why someone doesn’t meet the criteria or there is insufficient information about a patient so they can’t come up with a specific diagnosis (such as in emergency rooms), the bipolar disorder remains “unspecified”.

What is rapid cycling in bipolar disorder?

When a person with bipolar disorder goes through four or more manic or depressive episodes per year, this pattern is called rapid cycling in bipolar disorder. Rapid cycling doesn’t have to be permanent; it depends how well the patient responds to treatment. According to an Italian study published in European Psychiatry, rapid cycling is more common in females and it’s linked with an increased risk for hospitalization when compared to other types of bipolar disorder.

Causes and risk factors that might influence the development of bipolar disorder

Family studies and twin studies have shown that the heritability of bipolar disorder is quite well established and bipolar disorder can run in families, but many patients are isolated cases as well.

Genetics and family history

Although bipolar disorder is considered a complex genetic disorder, the genes that cause it have yet to be researched and identified. Children of parents with mental disorders have roughly a one-third chance of developing the illness as well, but in addition to genetic risk factors, there are various other factors that affect whether someone gets bipolar disorder or not.

Brain structure

According to scientists from the University of Cambridge and various other studies across the world, the brains of people with bipolar disorder are different than those with no psychiatric disorders. Bipolar disorder may be associated with pathologies in the prefrontal and anterior cingulate cortex, as well as the amygdala and ventral striatum. Of course, bipolar disorder is still diagnosed based on a person’s symptoms and family history rather than brain mapping, but these findings help to better understand the disorder and might be useful in finding the right form of treatment for each patient in the future.

Trauma

Various traumatic and adverse experiences in childhood can increase the risk of bipolar disorder onset sometime in life, and they include things such as parental neglect, violence, physical and/or sexual abuse, death of a parent or sibling, and a few other traumatic experiences.

How is Bipolar Disorder Diagnosed?

Let’s be honest, it’s not easy to diagnose bipolar disorder. In fact, almost 70 percent of patients are initially misdiagnosed, and third of them remain misdiagnosed for a decade on average. Once you decide to get tested for bipolar disorder, your physician will likely do various tests in order to find the exact reason for your symptoms.

Physical examination. Doctors first perform laboratory tests to rule out other, physical, disorders such as thyroid problems that have symptoms similar to those of bipolar disorder. If no physical symptoms are detected, a person is referred to a mental health specialist.

Psych evaluation. If your physician suspects of a mental disorder, they will likely send you to a psychiatrist. At the appointment, they will ask you to extensively discuss how you feel, ask about your mood, as well as your family’s medical history. Several sessions may be recommended to complete the evaluation.

Mood charting. A mood chart helps you and your doctor to gain a better perspective of your bipolar disorder. Logging your symptoms helps detect if there are any patterns in your episodes (some people go through manic or depressive episodes at the similar time each year); to detect the triggers (for some people it’s stress, and for others it’s drug or alcohol abuse). Having this kind of insight can help keep the symptoms under control, sometimes even prevent mania or depression from occurring it the first place.

Bipolar diagnosis and children

When it comes to children, it is important not to confuse bipolar disorder in children with other mental disorders that come with similar symptoms. These include unipolar depression, ADHD, oppositional defiant disorder, and conduct disorder, among others.

It’s often hard to detect mania in children because it can manifest as hostile behavior and agitation rather than typical euphoria that characterizes adult mania, so a lot of children gets misdiagnosed.

Treatments that can help manage bipolar disorder symptoms

Most psychiatrists use a combination of therapies, especially when dealing with acute manic episodes. Many people who have or suspect they could have bipolar disorder refuse to visit a doctor because they’re afraid of being put on drugs. It makes sense, since a review of the effectiveness of the most common drugs used to treat bipolar disorder suggests that for one person who finds them helpful, there are at least seven people who don’t due to side-effects, ineffectiveness, and other reasons.

While it is true that typical treatment for severe bipolar disorder involves a combination of psychotherapy and medications, if a bipolar person doesn’t put themselves and others in danger, a psychiatrist can suggest other forms of treatment.

Medications

Mood stabilizers. Lithium is a common medication for bipolar disorder and among the safest options in its treatment, but it still doesn’t come without side-effects. It decreases the severity of manic episodes, but it can also prevent future episodes of mania, as well as depression. Nirvana’s frontman Kurt Cobain who allegedly also suffered from bipolar disorder even made a song about lithium. According to scientists from the Karolinska Institutet in Sweden and their seven-year-long study, individuals with bipolar disorder treated with lithium have the lowest risk of rehospitalization. A few other common mood stabilizers include valproic acid, divalproex sodium, and carbamazepine.

Antipsychotics. They’re commonly used in severe cases of bipolar disorder, especially in patients with psychotic features. There’s a debate in medical circles whether or not antipsychotics should be replaced with another form of therapy once the severity of symptoms has decreased.

Antidepressants. Recent studies have found that antidepressants alone shouldn’t be used in the treatment of bipolar disorder because they don’t do a good job, but many psychiatrists still prescribe them. According to research, they can make the symptoms (mainly when it comes to rapid-cycling) worse in about a third of the bipolar patients. Bipolar disorder needs something with mood-stabilizing effect, and antidepressants are mood destabilizers.

Anticonvulsants. Antiepileptic drugs commonly used in the treatment of bipolar disorder include valproate, lamotrigine, carbamazepine, gabapentin, oxcarbazepine, topiramate and a few others. While lithium is still the main treatment for the disease, recent studies have proven the utility of a number of anticonvulsants when it comes to bipolar disorder. Medications such as carbamazcpine and valproate cover a broad spectrum of bipolar disorders and offer significant antimanic and prophylactic efficacy – between solid 50 and 60 percent.

Symbiax. The combination of olanzapine (antipsychotic) and fluoxetine (antidepressant from the group of selective serotonin reuptake inhibitors) has been prescribed for a while now as a treatment for depressive episodes but, according to the FDA, it should be used with a psychiatrist supervision and only if a patient hasn’t responded to two other prior treatments because one of Symbiax’s many side-effects is suicidal thoughts. Ironic, right?

Two common procedures are used when severe bipolar patients don’t respond to medications: noninvasive transcranial magnetic stimulation (TMS), and more serious, stigma-surrounded electroconvulsive therapy (ECT).

Psychological counseling or talk therapy

Even though medication is still the first line of action for people with bipolar disorder, there are a few common forms of psychological counseling such as cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), as well as family-focused therapy. Talk-therapies can help to better understand the disease and deal with the consequences of one’s actions, especially for severe cases of manic behavior when people lose possessions, jobs or relationships.

Cognitive behavioral therapy for bipolar disorder. According to the American Psychological Association, CBT should be a go-to therapy because it is able to change thought patterns of a person with bipolar disorder. Therapists use role-playing to prepare a patient for situations and interactions that they avoided in the past, as well to calm the mind and the body.

Interpersonal and social rhythm therapy. With IPSRT, bipolar patients can improve their daily habits, relationships, and learn how to prevent triggers and development of future manic or depressive episodes. The name might sound fancy, but this therapy is basically changing a person’s daily routines for the better.

Family-focused therapy for bipolar disorder. As the name says, FFT sessions are for family members: parents, spouses or anyone you feel should know more about your bipolar disorder. It usually consists of 12 sessions, and during the first few meetings, your family is educated about the condition: symptoms, triggers, what to do to prevent episodes from happening, how to react when they happen, etc. Studies have shown that patients who take FFT sessions after major episodes have lesser symptoms and do better a year to two after the episode.

Support groups

Talking with a therapist is crucial if you have bipolar disorder, and it must be someone that you feel comfortable around because you’ll have to share a lot of information with this person. In most cases, a psychiatrist alone is not enough to have the disease under control. Your loved ones and those in similar situation are almost as important as your doctor. Having a good support system means having someone who understands what you’re going through. Friends and family mean well, but they won’t always understand you and can even be judgmental. This is why joining a support group for bipolar disorder might be a good idea.

Alternative forms of therapy for bipolar disorder

While there’s nothing bad in trying meditation or massage to help ease your symptoms, there’s no actual proof that these work when it comes to treating bipolar disorder. Just be careful if you want to try herbs or supplements because some of them tend to affect the way medications are absorbed. Just to be safe, talk to your physician or therapist before trying any alternative methods of treatment, since most complementary and alternative treatments for bipolar disorder are unproven.

You are much more than your disease

Bipolar disorder is not the average “ups” and “downs” that most people experience. It’s a serious lifelong disease that needs attention, management and above all – support.

With the right medications, therapy, as well as support from the loved ones, a person can still lead a positive and productive life. Winston Churchill who suffered from bipolar disorder called his disease a “Black dog”, but he still managed to write 43 books and to win a Nobel Prize. Pop singer Demi Lovato struggled to accept her diagnosis at first, but she’s now an avid speaker on the condition, and inspires others who are in the similar situation and encourages them to seek help.

You are not your illness. Bipolar disorder can be a beast but it shouldn’t control or define you, rather the opposite; you should be the one controlling the beast.