Bipolar disorder was formerly called manic depression. It is a form of major affective disorder, or mood disorder, and affects many individuals of all socioeconomic groups. This clinical disorder can present in a number of ways and can have severe complications if not treated.
What is bipolar disorder?
Bipolar disorder is a disorienting condition that causes extreme shifts in mood. Like riding a slow-motion roller coaster, patients may spend weeks feeling like they are on top of the world before plunging into a relentless depression. The length of each high and low varies greatly from person to person.
Depressive phase symptoms
Without treatment, a person with bipolar disorder may experience intense episodes of depression. Symptoms include sadness, anxiety, loss of energy, hopelessness, and difficulty concentrating. Patients may lose interest in activities that were once pleasurable. They may gain or lose weight, sleep too much or too little, and contemplate suicide.
Manic phase symptoms
During a manic phase, patients tend to feel euphoric and may believe they can accomplish anything. This can result in inflated self-esteem, agitation, reduced need for sleep, being more talkative, being easily distracted, and a sense of racing thoughts. Reckless behaviours, including spending sprees, sexual indiscretions, fast driving, and substance abuse, are common. Having three or more of these symptoms nearly everyday for a week may indicate a manic episode.
Bipolar I vs. Bipolar II
People with bipolar I disorder have manic episodes or mixed episodes and often have one or more depressive episodes. People with bipolar II have major depressive episodes with less severe mania. They experience hypomania, a condition that is less intense than mania or lasting less than a week. Patients may seem like the “life of the party” — full of charm and humour. They may feel and function fine, even if family and friends can see the mood swing. However, hypomania can lead to mania or depression.
Mixed episode
People with mixed episode experience depression and mania at the same time. This leads to unpredictable behaviour such as sadness while doing a favourite activity or feeling very energetic. It is more common in people who develop bipolar disorder at a young age, particularly during adolescence. Some estimates suggest up to 70% of bipolar patients experience mixed episodes.
What causes bipolar disorder?
Despite many studies we are not sure what causes bipolar disorder. A leading theory is that brain chemicals fluctuate abnormally. When levels of certain chemicals become too high, the patient develops mania. When levels drop too low, depression may result.
Who is at risk of getting bipolar disorder?
Bipolar disorder affects males and females equally. In most cases, the onset of symptoms is between 15 and 30 years old. People are at higher risk if a family member has been diagnosed, especially if it is a first degree relative, but doctors and researchers do not think when the disorder occurs is based on genetics alone. A stressful event, drug abuse, or other unknown factors, may trigger the cycle of ups and downs.
Bipolar disorder and the family
Bipolar disorder can disrupt your goals at work and at home. In one survey, 88% of patients said the illness took a toll on their careers. This disorder can have a severe negative impact on the family. The unpredictable mood swings can drive a wedge between patients and their co-workers or loved ones. In particular, the manic phase may scare off friends and family. People with bipolar disorder also have a higher risk of developing anxiety disorders.
Bipolar disorder and suicide
People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without the illness. Warning signs include talking about suicide, putting affairs in order, and inviting death with risky behavior. Anyone who appears suicidal should be taken very seriously. If you have a plan to commit suicide, go to the emergency room for immediate treatment.
Diagnosing bipolar disorder
A crucial step in diagnosing bipolar disorder is to rule out other possible causes of extreme mood swings. These may include brain infection or other neurological disorders, substance abuse, thyroid problem, side effects of certain medications, or other psychiatric disorders. There is no lab test for bipolar disorder. A psychiatrist usually makes the diagnosis based on a careful history and evaluation of the patient’s mood and other symptoms.
Management of individuals with bipolar disorder
Medications are important in helping people with bipolar disorder live stable, productive lives. Between acute states of mania or depression, patients typically stay on maintenance medication to avoid a relapse.
Talk therapy can help patients stay on medication and cope with their disorder’s impact on work and family life.
Establishing firm routines can help manage bipolar disorder. Routines should include sufficient sleep, regular meals, and exercise. Because alcohol and recreational drugs can worsen the symptoms, these should be avoided. Patients should also learn to identify their personal early warning signs of mania and depression. This will allow them to get help before an episode spins out of control.
Electroconvulsive therapy can help some people with bipolar disorder, but is usually a last resort when a patient does not improve with medication or psychotherapy.
Getting help
Many people with bipolar disorder do not realize they have a problem or avoid getting help. If you are concerned about a friend or family member, talk to a healthcare provider about your concerns or seek help for your loved one on your own. Try to convince your loved one that seeking help can help him or her and various options of treatment are now available. Most important, seek help if you suspect someone you know has symptoms suggestive of bipolar disorder.
Conclusion
Bipolar disorder affects many individuals. It is a complex disorder that likely stems from a combination of genetic and non-genetic factors. We now know that it is a treatable illness — not a personality flaw. There is a medical explanation for the extreme mood swings, and effective treatments are available. Individuals or their loved ones should seek professional help.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
