Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual changes in mood, energy, activity levels and the ability to perform day-to-day tasks.
Bipolar disorder affects about 4% of people in adulthood. The number of people diagnosed with this condition can reach 6 million people in Brazil.
There are four basic types of bipolar disorder. They all involve clear changes in mood, energy and activity levels. These mood states range from periods of extremely “upward”, exalted and energized behavior (known as manic episodes) to very sad, “low” or hopeless periods (known as depressive episodes). The less severe manic periods are known as hypomanic episodes.
Types of Bipolar Disorder
- Bipolar I Disorder – defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Generally, depressive episodes also occur, typically lasting at least 2 weeks. Episodes of depression with mixed characteristics (with depression and manic symptoms at the same time) are also possible.
- Bipolar II Disorder – defined by a pattern of depressive episodes and hypomanic episodes, but not the manic episodes developed above.
- Cyclothymic disorder (also called cyclothymia) – defined by numerous periods of hypomanic symptoms, as well as numerous periods of depressive symptoms of at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders – defined by symptoms of bipolar disorder that do not correspond to the three categories listed above.
Signs and symptoms
People with bipolar disorder experience unusual periods of intensity, changes in sleep patterns and unusual levels of activity and behavior. These distinct periods are called “mood episodes”. Mood episodes are drastically different from the person’s typical manners and behaviors. The extreme changes in energy, activity, and sleep go along with the mood episodes.
People in manic or depressive episodes may experience the signs in the chart below:
Sometimes a mood episode includes a combination of manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with combined characteristics can feel very sad, empty or hopeless, while feeling extremely energized.
Bipolarity can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual can feel great, be highly productive and function well. The person may not feel that something is wrong, but family and friends may recognize changes in mood and / or changes in activity levels as a possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.
A good diagnosis and treatment helps people with bipolar disorder to lead healthy and productive lives. Talking to a psychiatrist or psychologist is the first step for anyone who is suspicious of bipolar disorder. A psychiatrist can complete a physical exam to rule out other conditions. If the problems are not caused by other illnesses, the doctor may perform a mental health assessment or provide a referral to a psychiatrist or psychologist who is experienced in diagnosing and treating bipolar disorder.
Note for healthcare professionals:
People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is necessary to ensure that it is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have only depression (also called unipolar depression) do not experience mania. They can, however, experience some manic symptoms at the same time, which is also known as major depressive disorder with mixed features.
Bipolar Disorder and Other Diseases
Some symptoms of bipolarity are similar to other illnesses, which can make it difficult for a doctor to make a diagnosis. In addition, many people have bipolar disorder along with another illness, such as anxiety disorder, substance abuse, or an eating disorder. Bipolar people are also at increased risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity and other physical illnesses.
Sometimes a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations or delusions. Psychotic symptoms tend to correspond to the person’s extreme mood. For example:
- Someone with psychotic symptoms during a manic episode may believe that she is famous, has a lot of money, or has special powers.
- Someone who has psychotic symptoms during a depressive episode may believe that he is ruined and penniless, or that he has committed a crime. As a result, people with bipolar disorder who also have psychotic symptoms are sometimes mistakenly diagnosed with schizophrenia .
Anxiety and ADHD
Anxiety disorders and attention deficit hyperactivity disorder (ADHD) are often diagnosed among people with bipolar disorder.
Chemical Substance Abuse
People with bipolar disorder may also use alcohol or drugs, have relationship problems, or perform poorly at school or at work. Family members, friends and people with symptoms may not recognize these problems as signs of a serious mental illness, such as bipolar disorder.
Bipolar disorder does not appear to have a single cause, but it is more likely to result from a number of interacting factors.
Some studies have suggested that there may be a genetic component in bipolar disorder. It is more likely to occur in a person who has a family member with the disease.
Bipolar disorder patients often show physical changes in their brains, but the connection remains uncertain.
Neurotransmitter imbalances appear to play a key role in many mood disorders, including bipolar disorder.
Hormonal imbalances can trigger or cause bipolar disorder.
Abuse, mental stress, a “significant loss” or some other traumatic event can contribute to or trigger bipolar disorder.
One possibility is that some people with a genetic predisposition to bipolar disorder may not experience noticeable symptoms until an environmental factor triggers a severe mood swing.
The scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, many factors are likely to contribute to the onset of the disease or increase the risk.
Brain structure and function
Some studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Learning more about these differences, along with new information from genetic studies, helps scientists better understand bipolar disorder and predict what types of treatment will work most effectively.
Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even though one twin develops the disorder, the other twin does not always develop the disease, despite the fact that identical twins share all the same genes.
Bipolar disorder tends to occur repeatedly in families . Children with a parent or sibling who has bipolar disorder are much more likely to develop the disease, compared to children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the disease.
Treatments and Therapies
Proper treatment can help many people – even those with the most severe forms of bipolar disorder – gain better control of their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of medication and psychotherapy . Bipolar disorder is a lifelong disease. Episodes of mania and depression usually return over time. Between episodes, many people with bipolar disorder may be free from mood swings, but some people may have persistent symptoms. In the long run, continuous treatment helps to control these symptoms.
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Different types of medications can help control the symptoms of bipolar disorder. An individual may need to try several different medications before finding those that work best. Medicines commonly used to treat bipolar disorder include:
- Mood stabilizers
- Atypical antipsychotics
Anyone taking a medication should:
- Have a medical prescription and have the proper guidance from your psychiatrist. It is important to understand all the risks and benefits of the medication.
- Report any concerns about side effects to a doctor immediately. The doctor may need to change the dose or try a different medication.
- Avoid stopping the medication to inform your doctor beforehand. Suddenly stopping a medication can lead to a “rebound” effect or worsen symptoms of bipolar disorder. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
When done in combination with medication, psychotherapy can be a very effective treatment for bipolar disorder. It can provide support, education and guidance for people with the disorder and their families. Some psychotherapy treatments used include:
- Cognitive-behavioral therapy (CBT)
- Family-focused therapy
- Therapy of interpersonal and social rhythms
Other Treatment Options
Electroconvulsive Therapy (ECT)
ECT can provide relief for people with severe bipolar disorder who have not been able to recover from other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make using drugs extremely risky. ECT can cause some short-term side effects, including confusion, disorientation and memory loss. People with bipolarity should discuss possible benefits and risks of ECT with a qualified health professional.
People with bipolar disorder who have trouble sleeping usually find the treatment useful. However, if insomnia does not improve, a doctor may suggest a change in medication. If the problem persists, the doctor may prescribe sedatives or other sleeping medications.
Little research has been conducted on herbs or natural supplements and how they can affect bipolar disorder. It is important for a doctor to know about all prescription drugs, other medications given by his own decision and supplements that a patient is taking. Some medications and supplements taken together can cause unwanted or dangerous effects.
Even with proper treatment, mood swings can occur. Treatment is most effective when a client, a doctor and a psychologist work together and talk openly about concerns and choices. Keeping notes with records of daily mood symptoms, treatments, sleep patterns and life events can help patients and doctors to monitor and treat the disorder more effectively.
How can I help myself if I am diagnosed with bipolar disorder?
You can help yourself by getting treatment and following the guidance of your psychologist and psychiatrist. Recovery takes time, and it is not easy. But treatment is the best way to start feeling better. Here are some tips:
- Talk to your doctor and psychologist about your treatment.
- Do not interrupt your medication.
- Maintain a routine for eating and sleeping.
- Make sure you get enough sleep.
- Learn to recognize your mood swings.
- Ask a friend or relative to help you maintain your treatment.
- Be patient with yourself. Improvement takes time.
How can I help a loved one with bipolar disorder?
Help your friend or relative to see a psychiatrist for the correct diagnosis and treatment. You may need to make an appointment and go to the doctor with him. Here are some useful things you can do:
- Be patient.
- Encourage your friend or relative to speak, and listen carefully.
- Be understanding about mood swings.
- Include your friend or relative in fun activities.
- Remind the person that getting better is possible with the right treatment.
How does bipolar disorder affect friends and family?
When a friend or relative has bipolar disorder, it affects you too. Caring for someone with bipolar disorder can be stressful. You have to deal with mood swings and sometimes other problems, like drinking too much. Sometimes, stress can stretch your relationships with other people. Caregivers can lose their job or lose free time.
If you are taking care of someone with the disorder, take care of yourself as well. Find someone with whom you can talk about your feelings. See a psychologist, do therapy too. Ask for guidance on support groups for caregivers. If you keep your stress level low, you will do a better job, and you can help your loved one maintain their treatment.