Bipolar disorder is a psychiatric condition characterized by severe disturbances in mood. People suffering from bipolar disorder, a term which has replaced the outdated ‘manic depression‘, go through episodes of mania (exaggerated highs) and depression (debilitating lows) that they cannot control. Although doctors do not know the exact cause, it is believed that chemical, genetic and environmental factors all play a part. For the most part, bipolar disorder is caused by an imbalance of chemicals in the brain. If certain neurotransmitters are not properly balanced, the brain is unable to regulate moods the way it is meant to.
Symptoms
Approximately one in seven people suffers from bipolar disorder, with symptoms usually originating among men and women in their early twenties and sometimes occurring in children and adolescents. The mood swings that people with bipolar disorder cycle through are vastly different from the moods of an average individual. In adults, their manic or depressive episodes can easily last up to weeks or even months. A teenager suffering from bipolar disorder can go through cycles of mania and depression over the course of a single day. Sometimes the episodes are unpredictable and will come on without warning; other times, the episodes follow a pattern that goes along with the changing of the seasons. Rapid cycling of moods (at least four or more per year) is more common in women, children and adolescents, whereas slow mood changes over time are seen more frequently in adult men.
What is mania? Mania is characterized by an extremely elevated mood and seemingly endless energy, a decreased need for sleep, excessive irritability and anxiety, and strange or unusual thought patterns.
What is depression? Depression is a feeling of sadness and melancholy that disrupts one’s daily functioning. A person with depression loses interests in activities that were previously enjoyable, is unable to concentrate, feels fatigued, worthless and even suicidal.
Diagnosis
Bipolar disorder can be difficult to diagnose because there is no blood test or brain scan that can detect it. It also has a long history of being either undiagnosed or misdiagnosed. A physical exam is the first step towards diagnosis and blood work is taken to rule out any medical illnesses, such as syphilis, which can present significant psychological symptoms. A brain scan is ordered to exclude epilepsy and brain legions, and a verbal history is taken.
There are four types of bipolar disorder: Bipolar I, Bipolar II, Cyclothymia and Bipolar disorder NOS (Not Otherwise Specified).
Bipolar I requires one or more manic or mixed episodes. A depressive episode is not required.
Bipolar II, which is the most common form of the disease, is characterized by alternating episodes of hypomania (at least one instance) and depression. The manic stage must be present in order to distinguish bipolar disorder from standard depression.
Cyclothymic disorder involves numerous hypomanic episodes with a spattering of depression. It is usually a low grade mood disorder that does not generally interfere with daily functioning.
Bipolar disorder NOS means that the person is clearly suffering from a type of bipolar disorder but does not meet the full criteria for any of the above.
Diagnostic Criteria
Criteria for a manic episode
- Abnormally elevated mood, energy and irritability lasting at least one week
- Three or more of the following symptoms during that week: decreased need for sleep, unusually talkative, racing thoughts, unable to concentrate or easily distracted, partaking in activities with no regard to consequences (e.g. shopping sprees, promiscuity). The mood disturbance is severe enough to impair functioning and at time require hospitalization. Psychotic features may also be present.
Criteria for a major depressive episode
- Decrease in mood for a period of at least two weeks
- Five or more of the following symptoms present: depressed mood every day, lack of interest in all pleasurable activities, loss or appetite and significant weight loss, insomnia, fatigue, lack of energy, feeling worthless or guilty, unable to concentrate, indecisive, recurrent thoughts of suicide or death.
Criteria for a hypomanic episode
- A period of elevated or irritable mood lasting at least four days
- Three or more of the following symptoms: Inflated sense of self-esteem, decreased need for sleep (at least 3 hours), more talkative than usual, racing thoughts, easily distractible, partaking in activities with no regard to consequences (e.g. shopping sprees, promiscuity). What separates it from a manic episode is that hypomanic episodes are usually not severe enough as to impair functioning nor require hospitalization.
Criteria for a mixed episode
- In order to classify as a mixed episode, the criteria for both manic episodes and depressive episodes must be present every day over a period of at least one week.
Treatment
Bipolar disorder is a serious medical illness. It can be difficult for someone who does not suffer from the disease to understand, and yet it is understanding and patience that is needed to help your loved ones manage bipolarity. A bipolar individual cannot just “snap out of it” when depressed or “calm down” when manic. It is not a weakness or character flaw; the chemistry in their brain simply does not allow it. It is a biochemical disease that new information shows may be genetic in nature as well, and although there is no cure, bipolar disorder can be dealt with by working closely with a professional psychologist or psychiatrist to develop a treatment plan. Usually the treatment plan involves administration of a mood stabilizer such as lithium or Risperdal, in conjunction with talk therapy. If a well-informed patient is kept on an adequate dose of medication and participates actively in therapy sessions, he or she can live a full and successful life despite the presence of bipolar disorder.