Bipolar Disorder

Understanding Bipolar Disorder

Bipolar disorder is a chronic mental health condition defined by fluctuations in mood and energy levels. Previously known as manic depression, it can involve episodes of mania, hypomania, and depression. These mood swings can significantly affect behavior, judgment, daily activities, and overall well-being.

The two most prevalent types of bipolar disorder include:

• Bipolar I, which contains one or more severe mania episodes lasting at least seven days with or without a depressive episode. However, the symptoms of a manic episode may require hospitalization.
• Bipolar II is characterized by shifting between milder hypomanic episodes alternating with depressive episodes.

Mania is a phase of emotional highs in bipolar disorder, characterized by an extremely elevated mood, increased energy, and heightened activity. It often manifests like thoughts of grandiosity, decreased need for sleep, and impulsive behavior. These episodes often require treatment to stabilize mood and prevent negative consequences, as they can impair a person’s daily functioning and lead to risky behaviors.

Bipolar Disorder: Causes, Patterns, and Diagnosis

Bipolar disorder can vary in severity and presentation, and individuals may experience different patterns of mood episodes over time. Some individuals may have rapid-cycling bipolar disorder, characterized by frequent mood swings between mania/hypomania and depression within a short period, while others may experience more stable periods between episodes. The exact cause of bipolar disorder is not fully understood, but it is believed to involve a combination of genetic, biological, and environmental factors. Neurobiological abnormalities, such as dysregulation of neurotransmitters (e.g., dopamine, serotonin), disruptions in circadian rhythms, and alterations in brain structure and function, may contribute to the development of bipolar disorder. Stressful life events, trauma, substance abuse, and disruptions in sleep-wake cycles can also trigger or exacerbate mood episodes in vulnerable individuals. Diagnosis of bipolar disorder is based on a comprehensive psychiatric evaluation, including a thorough assessment of symptoms, medical history, family history, and psychosocial functioning. It is essential to differentiate bipolar disorder from other mood disorders such as major depressive disorder or cyclothymic disorder, as well as medical conditions that may mimic bipolar symptoms.

Navigating the Highs and Lows: Understanding the Impact of Bipolar Disorder

Coping with significant fluctuations in mood can profoundly affect various aspects of one’s life. Experiencing intense highs and deep lows can be exhausting and confusing for an individual and their loved ones. Unpredictable moods may strain relationships, with behavior shifting from sociable to withdrawn, making it difficult for others to understand or keep up. Professionally, mood inconsistencies can hinder a person’s work performance, resulting in periods of high productivity followed by low motivation and .

Prevalence of Bipolar Disorder: Who is Affected?

According to Mental Health America, about 1 in 40 adult Americans and around 1% of the US teenagers live with bipolar disorder, affecting men and women equally. Depression and Bipolar Support Alliance estimates that approximately 2.8% of U.S. adults have been diagnosed with bipolar disorder in any given year. Both men and women from various backgrounds have an equal likelihood of developing bipolar disorder. This rate is consistent among males (2.9%) and females (2.8%)​. Bipolar disorder can develop at any age, but it typically begins during late adolescence or early adulthood, as stated by the National Institute of Mental Health.

Symptoms of Bipolar Disorder

Bipolar disorder is characterized by distinct mood episodes, each with its own set of symptoms. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides clear diagnostic criteria for different types of bipolar disorder:

Bipolar I Disorder

A manic episode is defined by the following:

• A period of at least one week where the individual experiences an abnormally elevated, expansive, or irritable mood, along with increased energy or activity nearly every day.
• At least three (or four if mood is only irritable) of the following:
• Inflated self-esteem or a sense of grandiosity
• Reduced need for sleep
• Excessive talkativeness or compulsion to speak continuously
• Racing thoughts
• Being easily distracted
• Physical restlessness
• Engaging in risky behaviors with potentially painful consequences (e.g., spending sprees, reckless driving, taking sexual risks)

Symptoms must be severe enough to limit activities of daily living or need hospitalization. These episodes may occur before or after hypomanic or severe depressive episodes, although they are not necessary for diagnosis.

Bipolar II Disorder

Hypomanic episode is a less severe form of mania lasting at least four days, characterized by:

• Persistent elevated, expansive, or irritable mood
• Increased activity or energy
• Racing thoughts
• Distractibility
• Increased talkativeness
• Heightened creativity
• Decreased need for sleep
• Increased goal-oriented behavior
• Risky or impulsive behavior
• Excessive cheerfulness and euphoria
• Elevated self-esteem
• Unlike mania, hypomania does not cause significant impairment in social or professional functioning.

Major depressive episodes must be present along with hypomanic episodes for a diagnosis of bipolar II. Symptoms include:

• Depressed mood most of the day
• Persistent feelings of sadness or loss of interest/pleasure in activities for at least two weeks
• Significant changes in weight and appetite
• Insomnia or hypersomnia
• Loss of energy and fatigue
• Reduced ability to think and concentrate
• Indecisiveness
• Excessive guilt or feelings of worthlessness
• Recurrent suicidal ideas or attempts.

Mixed Features

Symptoms of both mania/hypomania and depression occur nearly every day for at least one week and can include experiencing intense sadness or hopelessness alongside high energy levels or restlessness. This can complicate diagnosis and therapy since a person may be very agitated while also severely depressed. They may become extremely edgy, have difficulties concentrating, and be more likely to engage in impulsive or self-destructive behaviors.

Differences Between Mania and Hypomania

Mania and hypomania differ in the severity of symptoms and the impact these symptoms have on a person’s daily life. While both involve elevated or irritable moods and increased activity or energy, manic episodes are:

• more intense
• last at least one week
• significantly impair social or work-related functioning
• often require hospitalization or involve psychosis​.

Bipolar I vs. Bipolar II: What is the Difference?

People with bipolar disorder typically experience at least one manic episode that comes before or after a hypomanic or severe depressive episode. The manic episode is the distinguishing trait of bipolar I disorder, and it can cause considerable impairment or require hospitalization.

People with bipolar II disorder experience at least one hypomanic episode and one major depressive episode without any history of a full manic episode. However, determining whether an individual has bipolar II can be more difficult because hypomania may resemble the symptoms of anxiety, ADHD, or substance use disorders, such as restlessness, racing thoughts, impulsivity, and sleep disturbance.

Depression in Bipolar Disorder

Most people with bipolar disorder have more frequent and prolonged depressive episodes than manic or hypomanic episodes. Depressive episodes frequently dominate the course of the illness and can be debilitating, impairing everyday functioning and quality of life.

Risk Factors: Why People Develop Bipolar Disorder

Genetic Factors

Research shows that bipolar disorder has a strong genetic component. Twin studies indicate that the heritability of bipolar disorder is approximately 60-80%. While Bipolar I disorder shares a genetic correlation with schizophrenia, Bipolar II disorder is genetically linked to major depressive disorder​.

Environmental Factors

Lifestyle and environmental factors, such as smoking, poor diet, physical inactivity, and trauma, are more common among individuals with bipolar disorder and can exacerbate the condition​.

Trauma

Trauma, particularly adverse childhood experiences, is strongly associated with an increased risk of developing bipolar disorder.

Brain Changes Linked to Manic Episodes

Research indicates that mania is linked to changes in the brain, specifically reductions in gray matter, particularly in the prefrontal cortex. Interestingly, if manic episodes are avoided, there may be an increase in specific brain structures, suggesting the brain can recover.

Comorbidities and Risks of Untreated Bipolar Disorder

It is estimated that about 90% of adults with bipolar disorder experience at least one additional psychiatric and medical condition. Nearly 50% have three or more comorbid conditions. According to the National Institutes of Mental Health (NIMH), common psychiatric comorbidities include:

• Anxiety disorders
• Substance use disorders
• Alcohol use disorders
• ADHD
• Personality disorders
• Binge eating disorder

Risks of Untreated Bipolar Disorder

Without treatment, a person may face several risks, including worsening symptoms and increased frequency of episodes. This can result in more severe coexisting conditions, considerable impairment in everyday functioning, and a greater chance of engaging in risky behaviors.

Moreover, untreated bipolar disorder is associated with not only mental health consequences, such as an increased risk of suicide and substance use disorders, but also medical comorbidities. These include a heightened risk of heart disease and premature mortality.

Bipolar Disorder Treatment Options

The management of bipolar disorder focuses on:

• Preventing and treating episodes of hypomania, mania, and depression
• Reducing depressive symptoms between episode
• Improving cognitive function
• Normalizing sleep patterns
• Addressing associated conditions
• Improving the quality of life
• Reducing suicidality

Pharmacotherapy is the primary treatment modality for bipolar disorder, particularly for acute mania. However, cognitive behavioral therapy and psychoeducation are also helpful for improving treatment outcomes.

Pharmacological Options

Bipolar disorder is treated using a combination of medications, including second-generation antipsychotics like olanzapine and quetiapine, which are effective for managing manic or hypomanic episodes, and mood stabilizers (lithium and valproate).

Acute mania is typically treated with antipsychotics, lithium, divalproex, and carbamazepine. Bipolar depression treatments include cariprazine, lurasidone, quetiapine, and the combination of olanzapine-fluoxetine, as well as electroconvulsive therapy.

Maintenance therapy involves the long-term use of medications like lithium, quetiapine, and long-acting injectable antipsychotics, essential for preventing recurrence and maintaining stability.

Therapy

Psychotherapy and lifestyle changes complement these treatments to improve overall management and quality of life.

How We Can Help

Addressing bipolar disorder requires a multifaceted approach and is something you should not tackle alone. Here’s how we can help:

Pharmacological Measures: Offering medications to manage your bipolar disorder and other psychological symptoms.

Therapy: In addition to medications, various forms of psychotherapy can provide support for managing the condition.

Genetic Testing: Conducting tests to identify the most effective medications.

Lab Testing: Performing tests to rule out medical conditions that might contribute to mood symptoms. Additionally, we monitor your lab values throughout treatment with medications like antipsychotics and mood stabilizers during treatment.

Remember—seeking professional help is crucial when experiencing mental health symptoms. Therapists, psychiatrists, counselors, and support groups can offer guidance and support tailored to individual needs. Seeking help is a sign of strength, and prioritizing mental well-being is essential for a healthier and happier future.