Bipolar disorder

Symptoms of Bipolar Disorder 

Bipolar disorder is characterized by mood swings. The episodes of mania and depression can last from a few to several days. The intensity of symptoms can range from extreme highs (mania) to extreme lows (depression). They include:

1. Extreme low (depression)

While dealing with a period of depression, the symptoms include:

• Feelings of guilt and despair
• Lack of energy
• Difficulty in concentrating and remembering things
• Feeling hopeless, sad, or irritable most of the time
• Loss of interest in everyday activities
• Difficulty in sleeping
• Lack of appetite
• Suicidal or self-harming thoughts
• Waking up early
  
  

2. Extreme high (mania)

The mania phase of bipolar disorder may include:

• Feeling very happy or overjoyed 
• Being more active than usual ‘
• Excessive appetite for food, and drinks 
• Talking very quickly
• Easily irritated or agitated
• Disturbed or illogical thinking 
• Insomnia (hard to fall asleep)
• Easily distracted 

Note: A person may experience episodes of depression more regularly than mania in bipolar disorder. Individuals may sometimes experience a normal mood, in between these episodes.

Types Of Bipolar Disorder 

Bipolar disorder is a condition that affects your brain and your mental health. It leads to erratic mood changes that can affect your daily energy and activity levels. The different forms of bipolar disorders include: 

1. Bipolar 1 

This type of bipolar disorder is characterized by manic episodes, with or without depression symptoms. The manic episode will last longer than a week and the episodes are so bad that the person might require hospitalization to ease the symptoms.

2. Bipolar 2

It is characterized by having both manic and depressive episodes. The mania that occurs in bipolar 2 is less severe than in bipolar 1, hence it is often named hypomania. In bipolar disorder 2 a major depressive episode occurs either before or after a manic attack.

3. Cyclothymic disorder

With this type, a person experiences both manic and depressive episodes for two years or longer. The mania and depressive episodes are usually less severe than that of bipolar 1 or bipolar 2. This disorder causes periods of normalcy mixed with mania and depression.

4. Rapid cycling bipolar

In the case of rapid cycling, a person experiences episodes of mania or hypomania, followed by episodes of depression. A person may cycle between manic episodes and stable periods that can last months, weeks, or days. 

5. Bipolar with mixed features

Sometimes people experience both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. A person experiencing bipolar disorder with mixed features may feel very sad, empty, or hopeless while at the same time feeling extremely energized.

6. Other types

A person may be considered into other types if he/she experiences symptoms that do not fit into the other bipolar categories. This type of bipolar may be caused by factors in your life that can include drugs, alcohol, or underlying medical conditions. \

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Causes Of Bipolar Disorder

The exact cause of bipolar disorder is unknown. But experts believe that there are a number of factors that work together to make a person more likely to develop it. The factors are a complex combination of physical, environmental, and social factors.

Risk Factors For Bipolar Disorder
 

Researchers are trying to find the possible risk factors of bipolar disorder. Most of them agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness. Some of the major risk factors include:

1. Genetics

Research suggests that bipolar disorder is linked to genetics, as it runs in families. The family members of a person with the disorder have an increased risk of developing it too. A single gene is not responsible for bipolar disorder, instead, a number of genetic and environmental factors act as triggers.

2. Chemical imbalance in the brain 

The chemical hormones which are responsible for controlling the functioning of the brain are called neurotransmitters and bipolar disorder may be associated with chemical imbalances in the brain.

Note: An episode of mania may occur when levels of noradrenaline( neurotransmitter) are too high, and episodes of depression may occur when the level of noradrenaline becomes too low.

3. Triggering agents

A stressful condition or situation can trigger the symptoms of bipolar disorder. A few examples of stressful triggers include the death of a close family member, the breakdown of a relationship, and physical and emotional abuse. 

4. Childhood trauma

Studies demonstrate that childhood traumatic events are risk factors for developing bipolar disorders. There is a relationship between the development of bipolar disorder with prior physical, sexual, and emotional abuse. 

5. Brain structure 

Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. 

6. Substance misuse 

Bipolar is frequently co-existing with misuse of substances, including cannabis, opioids, cocaine, sedatives, and alcohol. 

7. Hormonal imbalance

Hormones may play a role in the development and severity of bipolar disorder. Studies suggest that late-onset bipolar disorder may be linked with menopause.

8. Medical illness

Bipolar is known to be coexisting with several medical and psychiatric conditions. Conditions like asthma, obesity, anxiety disorder, migraine, and head injury are associated with bipolar disorder. 

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Diagnosis Of Bipolar Disorder 

To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview, and order lab tests. The diagnosis is based on the following aspects: 

1. History and physical examination 

A general practitioner will assess the individual at the time of appointment with the following things:

• General appearance: A patient with mania is often unpredictable, and erratic. Unnatural happiness can be seen on their face however, irritability is also observed.
  
  
• Mood: The mood is often elevated or euphoric in mania. While in a depressive state, the patient will appear sad or in an elegiac mood. 
  
  
• Thought process: Patients with mania demonstrate easy distractibility, lack of concentration, and absurd behavior. A depressed patient usually has negative thoughts.
  
  
• Speech: A depressive patient would talk slowly and softly. In the case of manic, the patient will demonstrate pressured speech that is difficult to interrupt. 

2. Lab tests 

Bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder. But, certain blood tests may be required to rule out drug toxicity and other medical conditions. They include:

• Serum alcohol levels
• Urinalysis
• Thyroid panel

Note: Diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults. However, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.

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Prevention Of Bipolar Disorder 

There is no way to prevent bipolar disorder. However, getting early treatment is the first sign of preventing bipolar disorder or other mental health conditions from worsening. Some of the things to keep in mind include:

1. Be vigilant about the warning signs

Handling the symptoms early can prevent the episodes from getting worse. Involve a doctor if any significant changes are noted in the behavior of a person and seek early intervention. 

2. Practice recreational activities 

Engaging in sports and physical activity can help in improving and managing the symptoms of bipolar disorder. Outdoor activities like hiking, camping, gardening, meditation, and yoga help in effectively controlling mood swings and stress reduction. 

3. Avoid alcohol, drugs, and smoking 

Drug abuse and addiction can cause changes in the brain that lead to bipolar disorder. Alcohol has been known to intensify bipolar disorder due to its sedating effects. Moreover, these substances increase the risk of mood swings, depression, violence, and suicide.

Doctor To Visit

The doctors that can be your best option to treat and manage bipolar disorder are:

• Psychiatric
• Primary care physicians 

A psychiatrist specializes in assessing and treating patients with mental health problems. They help in managing the mental well-being of an individual.

A primary care physician plays a vital role in attending to the medical needs of patients with bipolar disorder in addition to providing medical care, by educating and supporting patients and their families.

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Treatment Of Bipolar Disorder 

The primary step in the treatment of bipolar disorder is to confirm the diagnosis of mania or hypomania. Most people with bipolar disorder can be treated using a combination of different treatments involving:

I. Medication 

1. Lithium: This drug is the gold standard for the treatment of the bipolar disorder, as long-term use has demonstrated a reduction in suicide risk. 

Note: Regular blood tests at least every 3 months while taking lithium is mandatory to make sure the lithium levels are not too high or too low.

2. Anticonvulsant medicines: Some anticonvulsant medicines include: 

• Valproate
• Lamotrigine
• Carbamazepine

3. Antipsychotic medicines: These classes of drugs are sometimes prescribed to treat episodes of mania. These include: 

• Haloperidol
• Olanzapine
• Quetiapine
• Risperidone

4. Antidepressants: Traditional antidepressants are considered experimental for treating bipolar depression. The class of antidepressants includes;

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine

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II. Cognitive treatment 

It can be helpful when used alongside medicines to treat bipolar disorder. This may include

• Psychoeducation: It is health psychology combined with behavioral counseling and even psychotherapy. This therapy is also important to teach patients some stress management techniques to cope with stressful situations more effectively.
  
  
• Cognitive behavioral therapy (CBT): It is a talking therapy that helps in managing problems by changing the way you think and behave. It is based on the concept that a person's thoughts, feelings, physical sensations, and actions are interconnected. 
  
  
• Family Focussed therapy (FFT): FFT therapists work to identify difficulties and conflicts within the family that may contribute to patient and family stress. It also educates all family members about the nature of bipolar disorder, its treatment, and ways that family members can best support their affected members. 

III.  Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is also known as ECT or electroshock therapy. This is a short-term treatment for severe manic or depressive episodes, particularly in the case of severe psychotic symptoms or when medicines seem to be effective. 

Complications Of Bipolar Disorder 

If bipolar disorder is left untreated, it can lead to longer and more severe mood changes. Someone living with bipolar disorder can also have a higher risk of the following complications:

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Alternative Therapies For Bipolar Disorder

Every mental health disorder needs comprehensive care. s. Several alternative treatments aim to reduce anxiety and stress. They include:

1. Meditation

It helps in alleviating depressed mood, and helplessness.. For people with bipolar disorder, meditation, and mindfulness may help in lightening the mood, emotional regulation, and stress management over time.

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2. Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT is a common adjunctive therapy for people with mood disorders. Its primary focus is on stabilizing the circadian rhythm (a natural, internal process that regulates the sleep-wake cycle). 

• Acupuncture 
  This therapy is believed to stimulate the central nervous system. It involves inserting very thin needles into the body at different locations and depths. This, in turn, leads to the release of chemicals into the muscles, spinal cord, and brain. This can promote physical and emotional well-being.
  
  
• Light therapy
  Also known as phototherapy, is the use of light to treat disorders. It has been to treat seasonal depression and may also be effective for people with bipolar disorder. It amplifies circadian rhythms, reversing the symptoms of depression and anxiety. 

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Living With Bipolar Disorder

There is always a taboo and stigma around mental health and communicating your thoughts to your loved ones can be a great relief. Some tips that can help caregivers and individuals suffering from bipolar disorder include:

I. Tips to help yourself

Bipolar disorder can exert control over your thoughts, and interfere with relationships if not treated. Here are a few ways that can help in managing your illness: 

1. Establish a routine: If a person has been dealing with bipolar disorder, committing to a routine can help in controlling depression and mania. 

• Always keep the energy changes caused by depression and mania under check
• Have a sound sleep of eight hours every day
• Indulge in aerobic exercise and walking to keep the stress levels under control
• Have a sound sleep of eight hours every day

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2. Pinpoint your stressors: Try to find out the times or the events that cause stress or triggers. Addressing the symptoms of mania and depression early can help in preventing a serious episode. 

3. Learn from previous episodes: Pattern recognition is essential to spot the early symptoms of an impending manic episode. Taking advice and help from family members who can recognize the early symptoms is very important. 

4. Avoid drugs and alcohol: Both these substances cause addiction and can cause emotional imbalance and interact with medications. 

II. Helping your loved ones

1. Recognize the early symptoms: The family member should recognize the early signals such as lack of sleep and babbling that can pinpoint mania. This helps in preventing a serious episode of the illness before it happens. 


2. React calmly: Even in situations where the person having an episode of mania or depression may go off, ranting at you or others, it’s important to remain calm. Try to make the person calm by listening to them and making them feel understood. 

3. Communicate well: Make time to talk about problems a person having an episode is facing. Be considerate, sound to them, and try to listen to their feelings, and challenges with empathy.

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