Diseases & Conditions

 

Bipolar Disorder

Diseases & Conditions

What is bipolar disorder?

Bipolar disorder, previously known as manic-depressive illness, is a medical condition that involves changes in brain function that leads to exaggerated mood swings and a shift of energy and activity levels. This long-term illness is characterized by recurring episodes of mania and depression that can last from one day to months. Bipolar disorder symptoms can cause damaged relationships, job-related problems or poor school performance, and even suicide. Bipolar disorder often appears in the late teens or early adult years. However, some people have their first symptoms during childhood.1

 

What causes bipolar disorder?

Most scientists agree that there is no single known cause of bipolar disorder. Many factors act together to produce the illness. Studies show that the main causes are:

  • Genetics:

Bipolar disorder tends to run in families. Some genes inherited from parents are the leading contributor to this illness. It has been shown that approximately 10% of people who have a parent with bipolar disorder will develop the illness themselves.2 However, genes are not the only factor in causing bipolar disorder because in identical twins who share the same genetic make-up, one might develop the disease but not the other.

  • Environmental factors

Other biological, social, and emotional factors also must play a role in the development of the disorder. It has been suggested that trauma or stressful life events can sometimes trigger an episode of bipolar disorder in people who are genetically vulnerable.3

 

What are the signs and symptoms of bipolar disorder?

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called ‘mood episodes’. Each mood episode represents a drastic change from a person’s usual mood and behavior. The illness may have two strongly contrasting phases: mania and depression.4

During manic episodes, symptoms may include:

Mood changes:

  • An elevated, high, or euphoric mood without a clear cause
  • Irritable, angry, or raging mood that is out of proportion to any reasonable cause

Behavioral changes:

  • Racing thoughts or having many thoughts at the same time
  • Speech that is faster, louder than usual, more difficult to interrupt or jumps from one idea to another without clear connections
  • Being unusually distracted
  • Being overly restless
  • Decreased need for sleep
  • Angry behavior that results in destroyed property, physical aggression, yelling, or crying
  • Inappropriate sexual behavior

During depression episodes, symptoms may include:

Mood changes:

  • A period of feeling sad or hopeless
  • Loss of interest or pleasure in activities once enjoyed
  • Feelings of hopelessness or pessimism

Behavioral changes:

  • Irritability thinking
  • Thoughts of suicide or death or a suicide attempt
  • Difficulty concentrating, remembering, and making decisions
  • Sleeping too much or not enough
  • Social isolation

 

How is bipolar disorder diagnosed?

Bipolar disorder is a disease that lasts for a lifetime. Doctors diagnose bipolar disorders using guidelines from the diagnostic and statistical manual of mental disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from the normal mood or behavior.5

There are different types of bipolar disorder which are based on the nature of the mood swings the person experiences. These differences can be important, as they will influence treatment approaches.

  1. In Bipolar I Disorder, the person has manic episodes and usually experiences depression at some stage.
  2. In Bipolar II Disorder, the person has depressive episodes and not full manic episodes.
  3. In Rapid-Cycling Bipolar Disorder, there are at least four episodes per year, in any combination of mania, hypomania or depression. This is seen in 5 to 15% of people with bipolar disorder.6
  4. In Mixed State Bipolar Disorder, symptoms involve both mania and depression occurring at the same time or alternating frequently during the day.
  5. Cyclothymia is a milder form of bipolar disorder. Cycles of hypomania and depression are shorter and less intense. Episodes typically last for days rather than weeks.

How is bipolar disorder treated?

Different types of medications can help control symptoms of bipolar disorder. Not every patient responds to medications in the same way. Medications used to treat bipolar disorder often include: 7

  • Mood stabilizers
  • Antipsychotics
  • Antidepressants
  • Anti-anxiety medications

Psychotherapy and self-care interventions are vital parts in the treatment of bipolar disorder. Most useful psychotherapies generally focus on understanding the illness, learning how to cope and changing ineffective patterns of thinking. Psychotherapy interventions include: 8

  • Cognitive behavioral therapy: The aim of this therapy is to replace negative thoughts and behaviors with positive ones.
  • Psychoeducation: This helps the patient to understand about his condition and to recognize the warning signs of mood changes.
  • Interpersonal and social rhythm therapy: This therapy teaches the patients to adapt a routine in their diet, exercise and sleep cycle allowing them to cope with bipolar disorder.

Other treatments may include;

  • Electroconvulsive therapy (ECT): When other treatments do not work, ECT could be considered as an option. It consists of sending electrical currents to the brain inducing a sudden change in the levels of neurotransmitters offering immediate relief.
  • Transcranial magnetic stimulation (TMS): When other treatments do not work, TMS could be considered as an option as well. It consists of sending magnetic pulses to stimulate nerve cells in the part of the brain responsible for mood regulation and depression.

References:

  1. Bipolar disorder (- Mayo Clinic). http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/definition/con-20027544
  2. 1NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication. No. 98-4268. Rockville, MD: National Institute of Mental Health,1998.
  3. Ogren, Marilee P., and Paul J. Lombroso. "Epigenetics: behavioral influences on gene function, part II: molecular mechanisms." Journal of the American Academy of Child & Adolescent Psychiatry 47.4 (2008): 374-378.
  4. Bipolar Disorder (NIMH RSS). http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  5. http://www.mooddisorderscanada.ca/documents/Consumer%20and%20Family%20Support/Bipolar%20Brochure%20English%20FINAL%20150109.pdf
  6. "What Is Bipolar Disorder?" Mood Disorders Canada. 2009. Web. 1 Dec. 2015. <http://www.mooddisorderscanada.ca/documents/Consumer and Family Support/Bipolar Brochure English FINAL 150109.pdf>.
  7. Price, Amy L., and Gabrielle R. Marzani-Nissen. "Bipolar disorders: a review." Am Fam Physician 85.5 (2012): 483-93.
  8. Bipolar disorder (Treatments and drugs). http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544