The subject of bipolar seems to be getting more attention in recent years. Movie stars confess to their fan base that they have been secretly dealing with bipolar disorder for years. Violent and nonviolent criminal prosecutors cite the disorder as an explanation of an event or use it as an integral (and many times, valid) part of their defense. The fact is, bipolar disorder is not a recently discovered disease. It was in the late 1800’s that Frenchman Jules Bailarger first presented descriptions of the disorder to the Academie de Medicine in Paris.
Most people experience occasional ups and downs in their emotions. But people with bipolar disorder—an illness affecting areas of the brain governing mood, behavior, and judgment—experience extreme shifts (or “episodes”). They may feel overly excited or high (manic) at one end (“pole”) or devastatingly low (depressive) at the other; thus, the illness is sometimes referred to as manic-depressive disorder. The two most common forms of bipolar disorder, based on the pattern and severity of manic and depressive episodes, are bipolar I disorder and bipolar II disorder.
Bipolar Disorder Manic and Depressive Symptoms
In the manic state, a person may have feelings of euphoria and elation, but also confusion or irritability. Common symptoms include restlessness, inability to sleep; poor concentration; fast talking, racing thoughts, jumping between ideas; heightened ego/inflated sense of self; and impulsive or irresponsible behavior such as sexual promiscuity and extravagant spending. People diagnosed with bipolar I disorder experience a more severe manic state, while those diagnosed with bipolar II disorder experience a hypomanic state that is similar to mania in terms of elevated mood and certain other symptoms but does not obviously impair functioning and relationships as manic episodes do. Thus, because the symptoms are more subtle with bipolar II it may be harder to diagnose.
In the depressive state, people may experience deep sadness and emptiness; feelings of worthlessness and helplessness; loss of interest or pleasure in activities they usually enjoy; lack of libido; decreased energy or fatigue; difficulty concentrating, remembering or making decisions; sleeplessness or too much sleep; changes in appetite, either too much or too little; physical symptoms unrelated to illness or injury (psychosomatic); and thoughts of suicide. Between one-quarter and one-half may attempt suicide.
Bipolar disorder can also present in a mixed state in which people experience both mania and depression at the same time. For example, they may feel sad or hopeless while simultaneously charged with energy.
People with bipolar disorder are more likely to have drug or alcohol dependence. And those in severe episodes of either mania or depression may have psychotic symptoms such as hallucinations or delusions.
The symptoms, severity, frequency and duration of mood episodes can vary from person to person and within the same person at different times. Episodes may last anywhere from a couple hours to months, sometimes years. In between, people often return to their usual functioning. Some may maintain a stable mood for years, while others may cycle between extremes almost continuously; the rest experience mood episodes at intervals somewhere in between.
Bipolar Disorder Prevalence
Bipolar disorder usually develops in the late teens/early adulthood, though it can occur earlier in childhood and later in adulthood. The average age of onset is 25. Males and females are equally at risk. More than 5.7 million American adults, or 2.6 percent of the population age 18 or older, have bipolar disorder in any given year.
Bipolar Disorder Risk Factors
Bipolar Disorder is more common in people who have a blood relative with the condition so researchers are looking for genes that may be involved. However, studies of identical twins, one with the disorder and the other without, indicate there’s more at work than just heredity.
Factors like stress and major life traumas (e.g., a death of someone close, job loss, abuse) appear to trigger episodes, possibly in people who have inherited a tendency to develop the disorder.
Through imaging studies, researchers have detected physical aspects of the brains of people with bipolar disorder that differ from the brains of mentally healthy people and even people with other types of mental disorders. The significance has not been determined yet.
Neurotransmitters & Hormones
Imbalances in neurotransmitters, naturally occurring brain chemicals involved in regulating mood, have been identified in people with bipolar disorder as have hormone imbalances.
Diagnosing Bipolar Disorder
Bipolar disorder is difficult to recognize when it starts because symptoms may seem like separate problems. Some people suffer for years before they are properly diagnosed and treated. Currently, it cannot be identified through blood tests or brain scans, but these tests can help rule out other medical factors that may contribute to mood problems, such as a thyroid condition, brain tumor or stroke.
Besides ruling out other possible causes, a professional diagnosis currently is based on the symptoms, family history, and course of illness. Guidelines for diagnosing bipolar disorder are contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which distinguishes between Bipolar I Disorder; Bipolar II Disorder, Bipolar Disorder Not Otherwise Specified (BP-NOS; doesn’t meet the diagnostic criteria of either I or II), and Cyclothymic Disorder or Cyclothymia (in which people experience mild depression and hypomania).
Treatment and Treatment Goals
Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life. The most effective treatment approach may involve several components.
Most individuals can be treated with medication. Mood stabilizers such as lithium are usually the first choice. Anticonvulsant meds (generally used to treat seizure disorders) sometimes offer mood-stabilizing effects as well.
People with bipolar disorder typically start with a depressive episode and spend more time in depressive states than manic ones so they are sometimes incorrectly diagnosed with major depression and treated with antidepressants. This can be counterproductive because antidepressants given without a mood stabilizer can launch a person with bipolar disorder into a manic state.
Psychotherapy can provide support, guidance, and education to people with bipolar disorder and their families. Support and self-help groups are a helpful resource for learning coping skills, feeling acceptance, and avoiding social isolation.
Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent and/or severe over time without treatment. Just having a diagnosis has been enough to start turning things around for some people with the condition. There is no short-term solution; bipolar disorder cannot be “cured,” only managed effectively over the long term. People with the condition cannot seek treatment when feeling bad but stop when feeling good as they would with a cold. However, with appropriate treatment, as well as the support and understanding of those around them, they can lead normal, productive lives.
Bipolar Treatment Services at Carrier Clinic®
Carrier Clinic® is among the top psychiatric facilities in NJ with inpatient bipolar treatment services for adults, older adults, and adolescents. Another option for treating Bipolar Disorder is our inpatient or outpatient ECT treatment program (electroconvulsive therapy).
Bipolar disorder can be difficult to recognize because symptoms may seem like separate problems. Some people suffer for years without being properly diagnosed. The more you know about the disorder, the more likely it is that you or someone you care about will receive the appropriate help. Please contact our Access Center for more information about admissions or to set up an assessment.
If you found this topic interesting or helpful, learn more about our free and informal support group for people with mood disorders (such as bipolar disorder).
Or, if you are experiencing frequent mood swings and are not sure why, learn more by reading this newsletter. The causes of mood swings vary and are not necessarily indicative of a Bipolar disorder.
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