Bipolar disorder, sometimes referred to as manic-depression, is a genetically-based psychiatric disorder, which involves poorly regulated changes in brain chemistry resulting in extreme mood swings. With a proper diagnosis and treatment plan (usually a combination of mood-stabilizing medication and therapy), a person with bipolar can have a long, happy and successful life.
Signs of Bipolar Disorder
Include episodes of mania or hypomania, which can involve euphoric and expansive mood; or dysphonic mood, which is marked by high levels of irritability and agitation. These episodes also typically include grandiose self-image, decreased need of sleep, rapid thoughts, pressured speech, distractibility, increased energy and creative desires, and severe impulsivity that lead to high-risk behaviours.
Mania lasts at least seven days in a row, and can lead to severe consequences to health, finances and relationships. Hypomania has the same symptoms, but usually of shorter duration at least four days and often with fewer consequences per episode.
In bipolar depressive episodes, the mood can become severely reduced, dark, and demoralizing. Often in this mood zone, a person becomes very sad, restless, low on energy, hopeless, and even suicidal. While manic or hypomanic, a person can feel terrific, charged with energy and a sense of great creativity, and a strong desire to get several things done at once. However, bipolar depression will make the same person lose energy and interest in anything important or pleasurable, potentially causing a severe crash in his or her emotional or physical well-being.
Types of Bipolar Disorder
There are three basic types of bipolar disorder, known as bipolar I disorder, bipolar II disorder, and cyclothymic disorder, which some people casually refer to as bipolar III. The distinction among these three types is important when it comes to understanding the overall course of the disorder and the various treatments that can be used.
Bipolar I Disorder
All that is needed to be diagnosed with bipolar I disorder is a history of at least one manic episode in the person’s lifetime. While depression is common in bipolar I disorder, it is not necessary for the diagnosis. A person with bipolar I may have had hypomanic episodes, but a single manic episode forever defines this type of the disorder.
When psychotic features of hallucinations, such as hearing voices that are not actually present, or delusional thinking are evident in bipolar disorder, only the bipolar I diagnosis applies. The seven-day minimum of a manic episode helps define the diagnosis, unless treatment interrupts the episode, as we would see in a psychiatric hospitalization.
People in a manic episode can become very excited, flush with energy and extravagance. They can exhibit rapid thoughts and become accelerated in their speech making it difficult to interrupt them. They also purposely avoid sleep due to the increased energy and need to get many things completed. They often engage in high-risk behaviours, such as spending sprees, sexual indiscretions, alcohol or drug binges, driving too fast, etc.
Not only can these behaviours lead to financial and relationship problems, but legal troubles may also eventually result. In any case, people with bipolar I disorder will often deny the consequences of mania, or justify the need to protect their manic behaviour as a means to maintain creative output in their lives, despite the extensive threat bipolar I can have on their overall health and functioning.
When manic, a person with bipolar I can be mistaken as having another disorder, such as ADHD, OCD, panic disorder, or narcissistic personality disorder. If they have psychotic symptoms, they can be thought of as having schizophrenia. But the intense change in mood drives all the symptoms of this particular psychiatric disorder. When mania subsides, they often return to a more typical, or baseline, mood zone. The confusion now is about whether or not they have any psychiatric disorder at all.
Causes of Bipolar Disorder
The genetic factor is the strongest and most consistent one in the development of bipolar disorder. In other words, bipolar runs in families and is passed through family genes. What is coded in the person’s DNA essentially sets the foundation for the brain’s inability to regulate moods consistently. A person generally must have this genetic predisposition for the true bipolar symptom pattern to eventually emerge during the lifespan.
Catalytic factors can bring out those symptoms. Some common catalysts involve hormonal changes, such as in puberty or in women during or after childbirth, known as per partum bipolar onset. Drug and alcohol abuse or certain medical disorders can also trigger underlying bipolar symptoms.
Traumatic experiences can trigger bipolar symptoms as well, but it’s important to know that trauma alone does not completely cause bipolar disorder. The average age of onset is late adolescence to early adulthood, though accurate recognition and diagnosis may not occur until several years into adult life.
Is It Bipolar Disorder or Depression?
An important study showed about two-thirds of bipolar patients are misdiagnosed and treated as having other psychiatric disorders, while those patients had consulted a mean average of nearly 4 clinicians before receiving appropriate care.2 Among people with bipolar who are misidentified, a significant majority are given a diagnosis of major depression.
Most people with a major depressive disorder unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with psychotherapy along with antidepressant medication, if needed. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.
It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.
Bipolar vs. Other Disorders
While sometimes a history of manic symptoms is not presented right away, it’s also common for those symptoms to be confused with other mental health conditions, such as ADHD, OCD, borderline or narcissistic personality disorders, or schizophrenia. One typical variable that helps clinicians distinguish bipolar mania from anything else is the intermittent nature of bipolar mood swings.
For example, a person with schizophrenia may neither be depressed or energetic to experience hallucinations or delusional thinking. Another example is ADHD. While distractibility is common in both bipolar mania and ADHD, the ability to focus tends to improve in bipolar when the mania subsides.
It’s generally true that symptoms of disorders other than bipolar will be present no matter the mood state. Knowing these important differences between bipolar disorder and other mental health conditions helps reduce the time it takes for people with bipolar to get to the right treatment plan.
Diagnosing Bipolar Disorder
If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.
First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis.
Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life.
There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviours or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.
Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them.
Treatments for Bipolar Disorder
Once bipolar disorder is properly diagnosed, a treatment plan can be accurately developed. This is best achieved in collaboration with the patient, any available and trusted family member, prescribing physician (such as a psychiatrist or psychiatric nurse practitioner), and psychotherapist (unless the physician is also providing psychotherapy).
The standard bipolar treatment plan involves both mood stabilizing medication and psychotherapy, whether it is provided to the individual, a couple, the family as a whole, or any appropriate combination.
Medications for bipolar disorder typically involve mood stabilizers, such as lithium or certain anti-seizure drugs, or antipsychotic medications, or some combination of those drugs. Other medications such as antidepressants and anti-anxiety drugs may also be used along with mood stabilizers. It’s not unusual for the prescribing doctor to add or subtract medications, or increase or decrease dosages to get the right levels of any particular individual.
Achieving mood stabilization with medication can take time and some trials of different combinations to meet an individual’s particular need. Therefore, patience is itself an important bipolar treatment issue. People often have several concerns around medications, including side effects and possible consequences of long-term use. Knowing that bipolar disorder can severely damage a person’s life, including their physical and mental health, a thorough discussion of these concerns should be explored with the treatment team.
As for therapy, it’s important to find a professional who is familiar with bipolar and the various factors unique to the disorder. It’s necessary to be involved in therapy through all phases of bipolar treatment, from assessment in pre-stabilization, through stabilization with medication, to post-stabilization as the person with bipolar becomes more familiar with life away from the former consequences of the disorder.
Some typical therapy issues include working through denial and accepting the reality of bipolar in a person’s life. There are often fears of losing the perceived benefits of mania and hypomania, and that treatment will change a person into a boring and listless character. Therapy can help the person with bipolar through any difficulties in achieving mood stabilization, and begin a process of developing living creativity and productively without depend