Bipolar Disorder—Coping with Bipolar

» Posted by on Apr 30, 2013 in Alpha Blog | 0 comments

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Bipolar disorder, also known by its older name “manic depression,” is a mental disorder that is characterized by constantly changing moods. A person with bipolar disorder experiences alternating “highs” (what clinicians call “mania“) and “lows” (also known as depression). Both the manic and depressive periods can be brief, from just a few hours to a few days, or longer, lasting up to several weeks or even months. The periods of mania and depression vary from person to person — many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder.

A manic episode is characterized by extreme happiness, hyperactivity, little need for sleep and racing thoughts, which may lead to rapid speech. A depressive episode is characterized by extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder may have up to three years of normal mood between episodes of mania or depression.

Bipolar disorder is recurrent, meaning that more than 90% of the individuals who have a single manic episode will go on to experience future episodes. Roughly 70% of manic episodes in bipolar disorder occur immediately before or after a depressive episode. Treatment seeks to reduce the feelings of mania and depression associated with the disorder, and restore balance to the person’s mood.

Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from having anything approaching a “normal” life. The emotions, thoughts and behavior of a person with bipolar disorder are often experienced as beyond one’s control. Friends, co-workers and family may sometimes intervene to try and help protect their interests and health. This makes the condition exhausting not only for the sufferer, but for those in contact with her or him as well.

Bipolar cycling can either be rapid, or more slowly over time. Those who experience rapid cycling can go between depression and mania as often as a few times a week (some even cycle within the same day). Most people with bipolar disorder are of the slow cycling type — they experience long periods of being up (“high” or manic phase) and of being down (“low” or depressive phase). Researchers do not yet understand why some people cycle more quickly than others.

Living with bipolar disorder can be challenging in maintaining a regular lifestyle. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly without reason. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending and risky sexual behavior.

Some people with bipolar disorder may even hear voices.

During severe manic or depressed episodes, some people with bipolar disorder may have symptoms that overwhelm their ability to deal with everyday life, and even reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a natural high) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect nearly every aspect of a person’s life.

Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness or episodes is particularly important. People who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.

Who Gets Bipolar Disorder

Bipolar disorder affects about 2 million people in the United States in any given year. Both men and women are affected at the same rate. There are few risk factors that reliably predict a significant increased likelihood of being diagnosed with bipolar disorder.

Genetics and one’s family history appear to both have some influence over the likelihood of being diagnosed with bipolar disorder. Bipolar disorder is more common in those who have a sibling or parent with the illness and in families having several generations affected with mood disorders.

Differing rates of bipolar disorder have not been reported for different races. Lower socioeconomic status may be slightly linked to a higher rate of bipolar disorder.

Men and women have an equal chance of being diagnosed with the disorder. The first episode in men tends to be a manic episode, while women are more likely to first experience a depressive episode.

The estimated average age for the onset of bipolar disorder is during the early 20s, although there have been reports of the disorder beginning as early as elementary school. In fact, bipolar disorder appears before age 20 in about one in five manic individuals.

Younger patients first may suffer cyclothymia, which is basically a less extreme form of bipolar disorder characterized by hypomanic and mild depressive episodes. Although people with cyclothymia display less intense symptoms, nearly half of them will progress to having a full manic episode. Younger patients who have full manic episodes are called juvenile bipolar patients.

Causes of Bipolar Disorder

The cause of bipolar disorder is not entirely known. Genetic, neurochemical and environmental factors probably interact at many levels to play a role in the onset and progression of bipolar disorder. The current thinking is that this is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain). As a biological disorder, it may lie dormant and be activated spontaneously or it may be triggered by stressors in life.

Although, no one is quite sure about the exact causes of bipolar disorder, researchers have found these important clues:

Genetic factors in Bipolar Disorder

  • Bipolar disorder tends to be familial, meaning that it “runs in families.” About half the people with bipolar disorder have a family member with a mood disorder, such as depression.
  • A person who has one parent with bipolar disorder has a 15 to 25 percent chance of having the condition.
  • A person who has a non-identical twin with the illness has a 25 percent chance of illness, the same risk as if both parents have bipolar disorder.
  • A person who has an identical twin (having exactly the same genetic material) with bipolar disorder has an even greater risk of developing the illness about an eightfold greater risk than a nonidentical twin.
  • Studies of adopted twins (where a child whose biological parent had the illness is raised in an adoptive family untouched by the illness) has helped researchers learn more about the genetic causes vs. environmental and life events causes.

Neurochemical Factors in Bipolar Disorder

Bipolar disorder is primarily a biological disorder that occurs in a specific area of the brain and is due to the dysfunction of certain neurotransmitters, or chemical messengers, in the brain. These chemicals may involve neurotransmitters like norepinephrine, serotonin and probably many others. As a biological disorder, it may lie dormant and be activated on its own or it may be triggered by external factors such as psychological stress and social circumstances.

Environmental Factors in Bipolar Disorder

  • A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder.
  • Even without clear genetic factors, altered health habits, alcohol or drug abuse, or hormonal problems can trigger an episode.
  • Among those at risk for the illness, bipolar disorder is appearing at increasingly early ages. This apparent increase in earlier occurrences may be due to underdiagnosis of the disorder in the past. This change in the age of onset may be a result of social and environmental factors that are not yet understood.
  • Although substance abuse is not considered a cause of bipolar disorder, it can worsen the illness by interfering with recovery. Use of alcohol or tranquilizers may induce a more severe depressive phase.

What is Medication-triggered Mania?

Medications such as antidepressants can trigger a manic episode in people who are susceptible to bipolar disorder. Therefore, a depressive episode must be treated carefully in those people who have had manic episodes. Because a depressive episode can turn into a manic episode when an antidepressant medication is taken, an antimanic drug is also recommended to prevent a manic episode. The antimanic drug creates a “ceiling,” partially protecting the person from antidepressant-induced mania.

Certain other medications can produce a “high” that resembles mania. Appetite suppressants, for example, may trigger increased energy, decreased need for sleep and increased talkativeness. After stopping the medication, however, the person returns to his normal mood.

Substances that can cause a manic-like episode include:

  • Illicit drugs such as cocaine, “designer drugs” such as Ecstasy and amphetamines.
  • Excessive doses of certain over-the-counter drugs, including appetite suppressants and cold preparations.
  • Nonpsychiatric medications, such as medicine for thyroid problems and corticosteroids like prednisone.
  • Excessive caffeine (moderate amounts of caffeine are fine).

If a person is vulnerable to bipolar disorder, stress, frequent use of stimulants or alcohol, and lack of sleep may prompt onset of the disorder. Certain medications also may set off a depressive or manic episode. If you have a family history of bipolar disorder, notify your physician so as to help avoid the risk of a medication-induced manic episode.

Symptoms of Bipolar Disorder

In everyday life, people have a variety of moods and feelings. These feelings include frustration, joy and anger. Usually these moods last one day rather than several days. For people with bipolar disorder, however, moods usually swing from weeks of feeling overly “high” and irritable to weeks of feeling sad and hopeless with normal periods in between.

An important distinction between bipolar disorder and the normal emotions of life is that bipolar disorder results in an inability to handle daily activities. The person cannot work or communicate effectively and may have a distorted sense of reality (for example, unrealistically high or low opinion of one’s skills).

Bipolar disorder often is not recognized by the patient, relatives, friends or even physicians. However, recognizing the mood states that occur is essential. Treatment can help a person with bipolar disorder avoid harmful consequences such as destruction of personal relationships, job loss and suicide.

During a manic phase, symptoms include:

  • heightened sense of self-importance
  • exaggerated positive outlook
  • significantly decreased need for sleep
  • poor appetite and weight loss
  • racing speech, flight of ideas, impulsiveness
  • ideas that move quickly from one subject to the next
  • poor concentration, easy distractibility
  • increased activity level
  • excessive involvement in pleasurable activities
  • poor financial choices, rash spending sprees
  • excessive irritability, aggressive behavior

During a depressed phase, symptoms include:

  • feelings of sadness or hopelessness
  • loss of interest in pleasurable or usual activities
  • difficulty sleeping; early-morning awakening
  • loss of energy and constant lethargy
  • sense of guilt or low self-esteem
  • difficulty concentrating
  • negative thoughts about the future
  • weight gain or weight loss
  • talk of suicide or death

The main method used to diagnose bipolar disorder is a thorough interview with a psychiatrist, psychologist or other mental health professional. Although there are written methods for documenting the severity and number of symptoms, those tests only complement a complete interview. They do not substitute for a face-to-face evaluation by a professional. There are not yet any blood tests or other biological tests that can be used to diagnose bipolar disorder.

Phases of Bipolar Disorder

There are a number of common types of phases that most people with bipolar disorder experience to one degree or another. The most commonly experienced type of bipolar disorder is one where the individual cycles back and forth between a state of mania (or hypomania, a lesser form of mania) and depression.

Mania

During this phase, people have an elevated mood, or “high,” which includes feelings of increased self-esteem and uniqueness. They often overestimate how much they can do and the quality of their ideas. Judgment becomes impaired and patients feel powerful over painful consequences. They feel “bulletproof” and have little regret or concern for their actions. They may have many ideas and lots of energy to carry them out.

The abundance of thoughts may be difficult to follow; such thoughts are called racing thoughts or pressured speech. People in manic episode may feel such an extreme pressure to keep talking that others do not have the opportunity to interrupt them. Manic patients’ minds are working so fast that they come up with rhymes or sing-song phrases, burst out in song or start dancing spontaneously. Their daily behavior can become disorganized or even dangerous to the point that they require hospitalization.

Manic episodes can also have psychotic symptoms present. Psychosis is a state in which a person is unable to tell the difference from reality and unreality. Psychosis symptoms include hallucinations, false beliefs about having special powers or identity (such as superhuman strength or X-ray vision). Psychotic symptoms indicate a severe mood episode that requires immediate medical attention and treatment.

People experiencing mania might begin several activities at once, never doubting that they can complete all of them. They may have so much energy that they operate on two or three hours of sleep each day. All of this energy can exhaust the family, friends and co-workers of a person with bipolar disorder.

Depression

During this phase, people with bipolar disorder may stay in bed all day, often feeling that they cannot get going. They may feel that their thoughts move slowly, and they take little pleasure in any activity. Bipolar patients in a depressed phase often feel as if they are worthless and as if their life is meaningless. They may begin to overeat and, given their low activity level, gain weight. They may speak or think of suicide, making emergency care crucial for their safety. Just as in a manic episode, psychotic symptoms may also occur during severe depressive episodes.

Mixed episode

This is a mood episode during which the symptoms of depression and mania are experienced at the same time. This can lead to irritability, hostility and physical aggression. Patients often are hospitalized for their safety and the safety of those around them. They may need a longer hospital stay or a combination of more than one medication to get well.

Rapid Cycling

This term describes the overall course of the illness over a period of 12 months. A patient with rapid cycling bipolar disorder has four or more manic, hypomanic, depressive or mixed episodes in a 12-month period. Rapid cycling bipolar disorder is difficult to treat and often is less responsive to medication. Treatment usually requires a combination of medications. This condition is more common in women, especially women who have a problem with the thyroid gland, which can involve a hormonal imbalance that mimics mania or depression. An estimated 15 to 20 percent of bipolar patients will develop rapid cycling.

Seasonal pattern

This term describes mood disorders that seem to be triggered by a particular season of the year. For example, someone who tends to become depressed during the late fall and winter and then returns to a regular mood during the spring and summer has a seasonal pattern of depression. In bipolar disorder, a seasonal-pattern patient would tend to have manic or hypomanic episodes during a specific season of the year. During the other seasons, their mood would tend to be normal neither manic nor depressed. The fall/winter depression pattern is more common than the spring/summer pattern. Suicide is far more common in March, April and May, probably due to changes in light.

If you want to learn more about what differentiates specific types of bipolar disorder and the diagnostic criteria for each, read the official diagnostic criteria for Bipolar Disorder.

Treatment of Bipolar Disorder

Although bipolar disorder is viewed as a long-term, often chronic condition, there are a variety of effective treatments available. People with bipolar disorder often seek out treatment according to what part of the cycle they’re in. When a person with bipolar disorder is in a manic or hypomanic phase, they may believe they have no further need of medications and stop taking them. When in a depressive phase, they often return to treatment.

Medication is nearly always a part of the recommended treatment course for bipolar disorder. People with undiagnosed bipolar disorder will sometimes self-medicate with alcohol or drugs to try and relieve their symptoms. However, such solutions rarely provide the type of long-term relief most people desire.

The types of treatment that are commonly prescribed for bipolar disorder include:

Treatment for bipolar disorder can be divided into three general categories. Acute treatment focuses on suppressing current symptoms and continues until remission, which occurs when the symptoms are diminished for a period of time. Continuation treatment prevents a return of symptoms from the same manic or depressive episode. Maintenance treatment prevents a recurrence of symptoms. The risks of long-term medication use must be weighed against the risk of getting sick again (relapse).

Who Treats Bipolar Disorder?

A wide range of mental health professionals help treat bipolar disorder. Medications are usually prescribed by a psychiatrist (or generally should be — a general practitioner or family physician doesn’t have the extensive background and experience in prescribing these medications on a long-term basis). Psychotherapy to help learn better ways of coping and unlearn unhelpful thinking and patterns of behavior is usually provided by a psychologist or licensed clinical social worker. Usually for an initial diagnosis, it is recommended that you consult a psychologist or psychiatrist.

People who are experiencing life-threatening symptoms, such as life-endangering impulsive behavior (e.g., substance abuse, promiscuity or aggressiveness) or psychotic symptoms (e.g., hallucinations or delusions), as well as anyone who is severely suicidal, should be evaluated by a physician. Depending on the level of potential harm to self or others, they should go to an emergency room. Doctors there often will refer them to a psychiatrist for further treatment. In some cases, hospitalization in a psychiatric facility is a standard approach.

Prognosis for Bipolar Disorder

With appropriate treatment, the outlook for someone with bipolar disorder is favorable. Most people respond to a medication and or combination of medications. Approximately 50 percent of people will respond to lithium alone. An additional 20 to 30 percent will respond to another medication or combination of medications. Ten to 20 percent will have chronic (unresolved) mood symptoms despite treatment. Approximately 10 percent of bipolar patients will be very difficult to treat and have frequent episodes with little response to treatment.

On average, a person is free of symptoms for about five years between the first and second episodes. As time goes on, the interval between episodes may shorten, especially in cases in which treatment is discontinued too soon. It is estimated that a person with bipolar disorder will have an average of eight to nine mood episodes during his or her lifetime.