What is Bipolar Disorder?
Bipolar disorder, formerly known as
manic-depressive illness, is a mental health condition characterized by extreme
mood swings that include emotional highs (mania or hypomania) and lows
(depression).
Types Of Bipolar Disorder
There are several types of bipolar
disorder.
Bipolar I Disorder
This type is characterized by at
least one manic episode, with or without a depressive episode. A manic episode
involves a period of elevated or irritable mood and increased energy or
activity that lasts for at least a week and causes significant impairment in
daily life.
Bipolar II Disorder
This is defined by at least one
hypomanic episode (a less severe form of mania that lasts at least four days)
and one major depressive episode. People with Bipolar II don’t experience
full-blown manic episodes.
Cyclothymic Disorder (Cyclothymia)
This is a milder form of bipolar
disorder. It involves periods of hypomanic symptoms and periods of depressive
symptoms that are not severe enough to meet the criteria for full-blown
hypomanic or depressive episodes.
Causes Of Bipolar Disorder
Bipolar disorder is a complex
condition, and its exact causes aren't fully understood. However, research
suggests that a combination of several factors contributes to its development.
Here are the main factors believed to play a role:
Genetics
If a close family member has bipolar
disorder, there's an increased chance of developing the condition. Specific
genes might increase the risk, but no single gene is the direct cause.
Brain Structure and Functioning
Some studies using brain imaging
techniques, such as MRI or PET scans, have shown possible differences in the
brain structures or functions of people with bipolar disorder compared to those
without the condition.
Neurotransmitter Imbalance
Neurotransmitters are brain
chemicals that play a significant role in regulating mood and behavior. An
imbalance in these chemicals can contribute to the onset of bipolar disorder.
Hormonal Imbalances
Abnormal levels of certain hormones
might increase the risk of bipolar disorder.
Environmental Factors
Experiences such as trauma,
significant loss, high levels of stress, or abuse can be risk factors or
triggers for bipolar onset, especially when combined with other factors.
Drug or Alcohol Abuse
Substance abuse doesn't directly
cause bipolar disorder, but it can bring about an episode and worsen the
progression of the disease.
Physical Illness
Some illnesses, such as thyroid
disorders or neurological conditions, might increase the risk or act as
triggers.
Traumatic or Stressful Events
Events such as the death of a loved
one, a breakup, or other significant life changes might act as triggers,
especially in those already genetically predisposed.
Bipolar Disorder Symptoms
Bipolar disorder is characterized by
mood episodes, which can be manic, hypomanic, or depressive. The specific
symptoms vary based on the type and severity of the episode:
Manic Episode
Elevated, expansive, or irritable
mood for most of the day, nearly every day.
Increased goal-directed activity or
psychomotor agitation.
Decreased need for sleep (feeling
rested after only a few hours of sleep).
More talkative than usual or feeling
pressure to keep talking.
Racing thoughts.
Distractibility (easily
sidetracked).
Inflated self-esteem or grandiosity
(may have delusions of grandeur).
Engagement in risky behaviors such
as excessive spending, impulsive sexual encounters, or making unwise business
investments.
For a diagnosis of a manic episode,
the symptoms must last at least one week, or any duration if hospitalization is
necessary.
Hypomanic Episode (symptoms are
similar to mania but less severe)
Elevated, expansive, or irritable
mood.
Increase in activity or energy.
The episode is a clear change from
the person's usual behavior.
Symptoms must last for at least four
consecutive days.
The disturbance in mood and change
in functioning are observable by others.
The episode is not severe enough to
cause marked impairment in social or occupational functioning or to necessitate
hospitalization.
Bipolar Depression Symptoms
Bipolar depression refers to the
depressive episodes that a person with bipolar disorder experiences. The
symptoms of bipolar depression can be quite similar to those of unipolar
depression (major depressive disorder). Here are the primary symptoms of bipolar
depression:
Depressed Mood
Feeling sad, empty, or hopeless for
most of the day, nearly every day.
Loss of Interest or Pleasure
Marked disinterest in activities
that one used to enjoy, including sexual activities.
Weight and Appetite Changes
This could manifest as significant
weight loss (when not dieting) or weight gain. There may also be a decrease or
increase in appetite.
Sleep Disturbances
Experiencing insomnia (difficulty
falling or staying asleep) or hypersomnia (excessive sleeping).
Psychomotor Agitation or Retardation
Feeling restless and unable to sit
still or being slowed down in thought and movement. This symptom should be
observable by others.
Fatigue or Loss of Energy
Feeling persistently tired or
drained.
Feelings of Worthlessness or
Excessive Guilt
These feelings might be delusional,
meaning they're not based in reality.
Diminished Ability to Think or
Concentrate
This can also manifest as
indecisiveness.
Recurrent Thoughts of Death or
Suicide
This can range from a passive wish
to die to active suicidal ideation with a plan or suicide attempts.
For a diagnosis of a major
depressive episode, symptoms must last at least two weeks.
Diagnosing Bipolar Disorder
A Guide to Diagnosing Bipolar
Disorder Accurately
Diagnosing bipolar disorder can be
challenging because its symptoms can be similar to other mood disorders,
particularly unipolar depression. Additionally, individuals may seek treatment
primarily for depressive symptoms without recognizing or reporting periods of
mania or hypomania. Nonetheless, a proper diagnosis is essential, as treatment
for bipolar disorder may differ from other conditions.
Here's a general process for
diagnosing bipolar disorder
Clinical Interview
This is the most crucial tool for
diagnosis. A psychiatrist or psychologist will ask about:
Presenting symptoms.
Duration and severity of symptoms.
Patterns of mood episodes.
Family history of mental health
disorders.
Past and current medical conditions
and medications.
Substance use.
Any suicidal thoughts or behaviors.
Mood Charting
Sometimes, patients might be asked
to keep a daily record of their moods, sleep patterns, and other symptoms. This
can help identify patterns and support a diagnosis.
Physical Examination
While there's no lab test for
bipolar disorder, a doctor may do a physical exam and order lab tests to rule
out other conditions that might be causing the symptoms, such as thyroid
disease or substance abuse.
Psychological Evaluation
This involves discussing thoughts,
feelings, and behavior patterns. It might also include a questionnaire or other
formal test.
Diagnostic Criteria from the DSM-5
The Diagnostic and Statistical
Manual of Mental Disorders (DSM-5), published by the American Psychiatric
Association, provides criteria for diagnosing bipolar and related disorders.
For example:
Bipolar I Disorder
Requires at least one episode of
mania lasting a week or longer or that requires hospitalization. Depressive
episodes are common but not required for diagnosis.
Bipolar II Disorder
Requires at least one hypomanic
episode and one major depressive episode. No full-blown manic episodes are
present.
Cyclothymic Disorder
Requires at least two years (or one
year in children and adolescents) of hypomanic and depressive symptoms that
don't meet the criteria for hypomanic or depressive episodes.
Differentiating from Other Disorders
It's essential to distinguish
bipolar disorder from other conditions, such as:
Unipolar depression.
Attention-deficit/hyperactivity
disorder (ADHD).
Anxiety disorders.
Schizophrenia or other psychotic
disorders.
Personality disorders.
Substance-induced mood disorders.
Family Input
Sometimes, with permission,
clinicians might gather information from family or close friends to get a
fuller picture of the symptoms and their impact.
It's worth noting that even with a
thorough evaluation, it can sometimes take years for individuals with bipolar
disorder to receive an accurate diagnosis, mainly if they primarily seek
treatment for depressive episodes. Nonetheless, an accurate diagnosis is
crucial for guiding effective treatment and management of the disorder.
Bipolar Disorder Treatments
Bipolar disorder is a lifelong
condition, but it's manageable with the right treatment. The primary goals of
treatment are to stabilize mood, reduce the severity and frequency of manic and
depressive episodes, and help the individual lead a productive and fulfilling
life. Treatment typically involves a combination of medications and
psychotherapy.
Medications
Mood Stabilizers
These are the cornerstones of
treatment. Examples include lithium (Lithobid), valproic acid (Depakote),
divalproex sodium (Depakene), carbamazepine (Tegretol, Equetro, others), and
lamotrigine (Lamictal).
Antipsychotics
Certain antipsychotic medications
are helpful in treating bipolar disorder. Examples include olanzapine
(Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole
(Abilify), ziprasidone (Geodon), lurasidone (Latuda), and cariprazine (Vraylar).
Antidepressants
They can be effective for bipolar
depression, but they're usually prescribed alongside a mood stabilizer or
antipsychotic to prevent triggering a manic episode.
Antidepressant-Antipsychotic
A combination drug like Symbyax
combines the antidepressant fluoxetine and the antipsychotic olanzapine and
acts as a treatment for both bipolar depression and as a mood stabilizer.
Anti-anxiety Medications
Benzodiazepines can be effective in
treating anxiety and improving sleep but should be used judiciously due to the
potential for dependence and addiction. Examples include alprazolam (Xanax),
clonazepam (Klonopin), and lorazepam (Ativan).
Other Treatments
Some individuals benefit from other
medications like anticonvulsants.
Psychotherapy
This can be an essential part of
treatment. Types include:
Cognitive Behavioral Therapy (CBT)
Helps identify unhealthy, negative
beliefs and behaviors and replace them with healthy, positive ones.
Family-focused Therapy
Addresses family dynamics that might
contribute to bipolar disorder and its treatment.
Interpersonal and Social Rhythm
Therapy (IPSRT): Focuses on the stabilization of daily rhythms, such as
sleeping, waking, and eating.
Psychoeducation
Teaches the patient about bipolar
disorder, its treatments, and strategies for recognizing signs of relapse.
Electroconvulsive Therapy (ECT)
This can be an option for severe
bipolar disorder cases where other treatments haven't worked. It involves
passing electrical currents through the brain to impact neurotransmitter levels
positively.
Transcranial Magnetic Stimulation (TMS)
Uses magnets to activate the brain.
It's been approved by the FDA for treating depression.
Lifestyle and Coping Strategies
Regular routines, sleep hygiene,
stress reduction techniques, avoidance of alcohol and illicit drugs, and
regular medical check-ups can help manage symptoms and prevent relapses.
Hospitalization
In cases of severe manic or
depressive episodes, or if there's a risk of self-harm, hospitalization can be
necessary to stabilize the individual.
Managing Bipolar Disorder Daily
Managing bipolar disorder on a daily
basis requires a combination of medical treatment, lifestyle adjustments,
self-awareness, and support. Here are some strategies to consider for daily
management:
Medication Adherence
Always take your medications as
prescribed.
Keep track of side effects and discuss them with your healthcare provider. Sometimes adjustments are needed. Use pill organizers or alarms to remind you to take your medications.
Monitor Your Mood
Keep a mood journal or use mood-tracking apps. This can help identify patterns or triggers for mood swings. Be mindful of early signs of a manic or depressive episode so you can take proactive steps.
Establish Routines
Regular routines, especially for
sleep and daily activities, can provide stability.
Try to wake up, eat, work, exercise,
and sleep at the same time each day.
Healthy Lifestyle Choices
Eat a balanced diet.
Engage in regular physical activity.
Prioritize sleep hygiene to ensure a
good night's sleep.
Avoid caffeine or nicotine close to
bedtime, as they can disrupt sleep.
Avoid Drugs and Alcohol
Substance abuse can trigger mood
episodes and interfere with the effectiveness of medications.
Manage Stress
Learn relaxation techniques such as
deep breathing, meditation, or yoga.
Consider seeking therapies like
Cognitive Behavioral Therapy (CBT) to develop coping skills.
Stay Connected
Build and maintain a strong support
system of friends and family.
Consider joining a support group for
people with bipolar disorder.
Educate Yourself
The more you know about bipolar
disorder, the better equipped you'll be to deal with challenges.
Psychoeducation can be beneficial.
Avoid Triggers
Be aware of potential triggers, such
as lack of sleep, high stress, or significant changes in routine.
Limit caffeine and avoid
recreational drugs.
Establish an Emergency Plan
Identify warning signs of a severe
mood shift and have a plan in place, such as who to call or where to go for
help.
Share this plan with loved ones.
Regular Medical Check-ups
Regularly see your doctor or
psychiatrist to discuss how you're feeling, any side effects, and the
effectiveness of treatment.
Monitor physical health as well, as
some medications can affect organs like the liver or kidneys.
Limit Major Changes
While it's not always possible, try
to avoid making impulsive decisions during mood episodes. This includes major
life changes like relocating, changing jobs, or making significant financial
decisions.
Stay Hopeful
Recognize and celebrate small
victories. Even during challenging times, it's important to remember that with
proper management, many people with bipolar disorder lead full, productive
lives.
Remember, everyone's experience with
bipolar disorder is unique. What works for one person might not work for
another. It's essential to find what's effective for you and to seek support
when needed.
Bipolar Treatment Centers
Mayo Clinic
Mayo Clinic in Rochester, Minnesota.
The Mayo Clinic is a world-renowned medical center with a long history of
excellence in the treatment of bipolar disorder. They offer a variety of
treatment options, including medication, psychotherapy, and complementary
therapies.
Sierra Tucson
Sierra Tucson in Tucson, Arizona is a private
residential treatment center that specializes in the treatment of bipolar
disorder and other mental health conditions. They offer a variety of
evidence-based therapies, including individual and group therapy, medication
management, and holistic therapies.
Newport Institute
Newport Institute in Newport,
Virginia is a private residential treatment center that offers a comprehensive
approach to the treatment of the bipolar disorder. They offer a variety of
therapies, including individual and group therapy, medication management, and
family therapy.
The Meadows
The Meadows in Wickenburg, Arizona
is a private residential treatment center that offers a holistic approach to
the treatment of bipolar disorder. They offer a variety of therapies, including
individual and group therapy, medication management, and complementary
therapies such as yoga and meditation.
Zinnia Health
Zinnia Health in Lake Okeechobee,
Florida is a private residential treatment center that offers a variety of
treatment options for bipolar disorder, including medication, psychotherapy,
and complementary therapies.
When choosing a bipolar treatment center, it is important to consider the
following factors:
The level of care you need. Do you
need inpatient or outpatient treatment?
The types of therapies offered. Make
sure the center offers the therapies that are right for you.
The cost of treatment. Be sure to
factor in the cost of treatment when making your decision.
The location of the center. Choose a
center that is convenient for you to travel to.
The reputation of the center. Do
some research to make sure the center has a good reputation.
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