Introduction. Recollection of facts about bipolar disorder
In the below text we summarize the main facts related to bipolar disorder giving the reader an overview about its symptoms, root causes, diagnosis, and treatment.
Bipolar disorder is a mental disorder that causes changes in a person’s mood, energy, and functioning. People with bipolar disorder alternate between intense and conflicting emotional states. These mood swings are classified as manic or hypomanic (abnormally happy or irritable mood) or depressive (sad mood) with periods of neutral mood in-between. The mood swings called mood episodes can last weeks to months. One of such extremes is depressed mood, also called bipolar depression, the other is mania or hypomania.
Under the condition of a proper diagnosis and professional treatment, people with bipolar disorder can be stabilized on the “baseline” mood level allowing them to live a normal life without limitations.
Who can develop bipolar disorder?
Bipolar disorder can affect people of any age, ethnicity, or gender. However, it typically develops in late adolescence or early adulthood, and is usually diagnosed in late teens or early twenties.
The specific cause of bipolar disorder is unknown. It can be triggered by multiple factors; however, the genetic factor plays much higher role compared to other psychiatric diagnosis. The condition is more common in those with a family history of the illness. 80-90% of people with bipolar disorder have a relative with bipolar disorder or depression. The studies on identical twins proved that if one of the twins develops BD, 50% of the second twins will develop the disorder within their lifetime.
The genetic predisposition doesn’t result by default in the onset of bipolar disorder. Environmental factors such as stress, sleep disturbances, drugs and alcohol can provoke the onset of the illness in at-risk individuals.
Despite high genetic predisposition people can manage to avoid the onset of bipolar disorder by avoiding stressful events, creating proper life-work balance and by avoid drugs and alcohol. On the other side people with no genetic predisposition, but being exposed to traumatizing life circumstances, physical illnesses or to usage of drugs and alcohol are at high risk to develop the illness.
How to recognize the normal mood fluctuation from bipolar episodes?
Even people without bipolar disorder have mood swings. However, these mood swings usually last for hours, maximum few days instead of weeks or months. Moreover, the “normal” mood swings are usually triggered by external circumstances, and they are not accompanied by an extreme degree of behavioral changes. During the mood swings people without bipolar are still fully functional. In contrary a person affected by bipolar disorder exhibits during depressive or manic episodes difficulties in daily living and social interactions. Depressive as well as manic episodes can disrupt relationships, creating severe social and professional consequences.
Are there different disorders causing mood swings?
Bipolar disorder is a category that includes three different diagnoses: Bipolar I, Bipolar II, and cyclothymic disorder.
Bipolar I disorder:
In this type, periods of manic “ups” last at least a week, or they are severe enough, reaching the level of mania and require medical attention. In this type also the depressive periods are more severe and last longer. The risk of suicide is significantly higher in people with bipolar I disorder than in the general population and even higher than in major depressive disorder.
Bipolar II disorder:
This type is characterized by recurring episodes of depression and hypomania. Hypomania is a milder form of mania, with less severe symptoms, but still noticeable changes in mood, and energy levels. People with bipolar II often experience more episodes of depression than hypomania.
Cyclothymic disorder:
Cyclothymic disorder, also known as cyclothymia, is a type of mood disorder characterized by cyclic mood swings over a period of at least two years, including periods of hypomania and periods of mild depression. The symptoms are less severe than those of bipolar I and II.
What is rapid cycling?
Rapid cycling is not a type of bipolar disorder, but is a term used to describe the course of illness in people with bipolar I or II disorder. In rapid cycling the mood episodes occur four or more times in a year. Women are more likely to experience rapid cycling than man.
What are the symptoms of bipolar disorder?
Symptoms of bipolar disorder are characterized by episodes of mania or hypomania and depression.
Mania or hypomania symptoms can include:
- Increased energy and activity levels
- Excessively high or irritable mood
- Impulsive or reckless behaviour
- Racing thoughts or rapid speech
- Decreased need for sleep
- Grandiose thinking or delusions of grandeur
Depression symptoms can include:
- Persistent sad, anxious, or “empty” mood
- Loss of interest or pleasure in activities
- Significant weight loss or gain, or decrease or increase in appetite
- Insomnia or excessive sleeping
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
These episodes can last for several weeks or longer and can occur multiple times in a year.
What is the prevalence of bipolar disorder?
The prevalence of bipolar disorder is estimated to be about 2% of the global population. However, the actual prevalence may be higher due to underdiagnosis and lack of access to mental health resources. It is more commonly diagnosed in high-income countries, but the illness can occur anywhere in the world. Prevalence estimates can vary based on the criteria used for diagnosis and the population studied.
Can bipolar disorder be healed?
Bipolar disorder is a long-term mood disorder. Bipolar disorder does exist in two varieties: Bipolar 1 and Bipolar 2. The difference between those two types is the range of severity of the mood swings. Each of bipolar episodes is time-limited, which means people will typically return to their baseline of functioning. Bipolar disorder can’t be “cured” in proper sense. The treatment objective is to stabilize the patients on their baseline of functioning without switching to one of the extremes. Keeping the symptoms under control, allows the individual a normal life. Without treatment, bipolar disorder tends to become chronic with more frequent and more severe episodes.
The dangerous escalation of undiagnosed, untreated, or not properly treated bipolar disorder can happen in depressive as well as in manic phases. While the severe depressive episodes can end in a suicide, the manic episodes can ruin the patient financially and/or socially.
How to diagnose bipolar disorder?
People with bipolar disorder are often misdiagnosed, changing frequently the therapists along with the medication. Sometimes they are luckier and will get an accurate diagnosis and effective treatment. The diagnose of bipolar disorder can be secured by an experienced psychiatrist. Recognizing bipolar disorder II or cyclothymia is more difficult due to the less pronounced symptoms.
What are the proper treatment approaches in bipolar disorder?
The most effective treatment is the combination of medication, psychotherapy, and lifestyle changes helping individuals managing their symptoms. The key role is patient’s education about the disorder. Establishing the therapeutic alliance with the psychiatrist and psychologist is the prerequisite of an effective treatment. Early recognition of bipolar warning signs can prevent the escalation of the illness which makes it easier to control its dynamics.
The first step in the treatment of bipolar disorder is the correct diagnosis. In the second step the psychiatrist should find a balanced medication keeping the symptoms at bay.
The treatment of bipolar disorder should include one or more of the following:
- Medications to prevent mania and depression are called mood stabilizers and are taken daily for long periods of time, frequently lifelong.
- Medications for main symptoms of depression and mania when they occur.
- Learn to recognize the triggers and signs of a depressive or manic episodes.
- Participating in the psychotherapy. The most effective method is the Cognitive Behavioral Psychotherapy (CBT)
- Lifestyle advice includes motivation for regular exercise, planning activities that are enjoyable and rewarding, improving diet and getting more sleep.