Bipolar Disorder (Manic Depression)

Bipolar disorder is also known as manic depressiondefine, manic depressive illness or bipolar mood disorder. It’s a psychiatric disorder in which the brain doesn’t work in the normal way.

Mood swings are quite normal and everybody goes through it at times. Quite human isn’t it? But it can create problems when the severity of it increases like in bipolar disorder, where an individual’s moods swings through extreme ups (mania) and extreme lows (depression). The person can have episodes of high mania and than could be quite normal for few days or weeks and than could go into depressive state.

According to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM –IV) a manual published by the American Psychiatric Association four categories of bipolar disorder is given so that psychiatrist or mental health professionals could diagnose the disorder effectively, Bipolar I, Bipolar II, Cyclothymia and Bipolar-not-otherwise-specified (NOS).

In manic phase a person becomes hyper active, talks a lot, gets more energetic, has racing thoughts, gets easily irritated, impatient and can take risks or impossible tasks. Sometimes manic episodes have hallucination and other psychotic symptoms (extreme cases).

The people have more risk of committing suicide under this illness. They think they are more creative and get more sociable.

While in depressive episode they will plunge into sadness, self worthlessness, hopelessness and guilt.

Who are affected by bipolar disorder?

Bipolar disorder can affect both male and female. The disorder develops in late adolescents and early adulthood. Now, the researches have found that first symptom could be seen in childhood or early adolescents. Even children can develop the disorder but the more chances are of children of parents with illness.

Around 17.4 million adults in U.S. have depressive episode each year so it means one out of every seven person has depressive episode.

And out of these depressive people around 1% to 2% has bipolar disorder.

Is unipolar and bipolar disorder same thing?

Unipolar disorder (clinical depressiondefine) and bipolar disorder are different. As in unipolar disorder a person plunges into depressive state while in bipolar disorder both mania and depressive states are there. An individual goes into and comes out of one episode to another and there could be difference in severity. ‘Fluctuation’ or ‘mood swings’ can be seen in bipolar but not in unipolar disorder.

What causes Bipolar disorder?

Bipolar disorder doesn’t have single cause but many factors combined together to produce illness. The biochemical, environmental or genetic causes can lead to onset of illness.

As this disorder is said to run in families but it’s not due to single gene but a combination of specific genesdefine. Studies on twins have shown that if one twin has bipolar disorder than its not necessary that other child will also have the disorder but there would be more chances.

Other causes could be stressful life events, failure or loss of loved ones.

brain imaging techniques such as MRIdefine (magnetic resonance imaging), PETdefine (positron emission tomographydefine) and fMRI (functional magnetic resonance imaging) has also helped in knowing that there is adequate difference in brain of people with bipolar disorder than healthy people’s brain.

What are the symptoms?

Bipolar disorder is constant swing between highs and lows- manic episode to depressive episode and one can have normal or balanced mood in between. Episode is called to the period of 'highs and lows.'

Manic episode

Depressive episode

Mixed

Mania or Manic episode

# Hyperactive

# Sleep less

# Extreme irritability

# Highly elated or euphoric mood

# Overeating

# Inflated self-esteem

# Risk taking

# Talkative

# Increase in sexual desire

# Racing thoughts or talking too fast

# Difficulty in concentrating

# Aggressive, provocative, intrusive behavior

# Poor judgment

# Think they have supernatural powers

# Have grandiose ideas

# Deny that anything is wrong

# Excessive spending, taking rash decision

The diagnosis of the manic episode is elevated mood, occurs with three or more symptoms daily for more than three or four days nearly for a week or longer.

Depression or depressive episodes

# Feeling of sadness

# Feeling of guilt, worthlessness

# Hopelessness

# Loss of interest in activities once enjoyed such as sex

# Seeks solitude

# Difficulty in concentrating or making decision

# Tired most of the time

# Suicidal thoughts

# Restlessness or irritable

# Sudden weight gain or weight loss

# Sleeping too much or cant sleep

# Chronic pain which doesn’t have any physical cause

The depressive episode could be diagnosed if an individual have five or more symptoms everyday for as long as two weeks or longer.

Hypomania is the term used when the person is in between mild to moderate mania. The symptom of mania is though present but it’s not as severe as mania itself. The person may feel good and his productivity is increased but he will not accept the fact that something is wrong with him or her and if the treatment is not started at this stage than he could go into severe mania and at last go into depression.

In severe case of mania a person can show psychotic symptoms like hallucinations (seeing or hearing things or objects which are not present in reality) and delusions (false belief). A person can believe he is Prime Minister or King or he has some supernatural power etc.

Mixed bipolar state

It is a state in which a person has continuous episodes of mania and depression. He would have suicidal thoughts, sleep very less, change in appetite either eat too much or too less and psychosis. The person could have mixed emotions like feeling sad and hopeless on one hand and full of energy on the other hand.

Cycling

In cycling phase one can have manic symptoms followed by depression episode. Than in “rapid cycling” the person can have more than four or four episode in a year and in “Ultra-ultra- rapid” cycling mood change from daily to hourly.

Suicidal tendency?

Suicide is the act of taking ones own life. A person with bipolar disorder has more chances say at least thirty percent of taking up his own life than the person suffering from major depression. A person can have suicidal thought most of the time and can attempt it but the complete suicide rate in this disorder is quite less.

A person talking about suicide should be taken seriously as its one way of asking for external help. They should be taken to psychologists or mental health professionals for treatment or they can end up taking their own lives.

An amazing thing in this disorder is that a person going into depression can do commit suicide but once he or she gets into depression than they are too lazy to do the act.

Symptoms of suicide

# Talking about ending their life

# Feel hopeless

# Giving away their loved possession to others

# Think nothing in their life is ever going to change

# Can start abusing alcohol or drugs

# Write suicidal notes

An individual showing such symptoms should be monitored and should not be left alone by themselves. Medications and dangerous instruments like knife, blade, scissors etc should be out of reach.

How to diagnose bipolar disorder?

Bipolar I – For diagnosing one with bipolar I disorder; a patient must have one or two of manic episode or mixed.

Bipolar II – This is the common type and in this disorder the patient need not to have severe mania but can swing from hypomania to depressive episode.

Cyclothymic disorder - In this the person should have both hypomanic episode and depressive episode intermingled with each other. But it should not meet the all the conditions of major depressive disorder.

Bipolar Disorder (NOS) – When an individual is suffering from some type of bipolar disorder but it does not fit any of the category above bipolar I, bipolar II and cyclothymic than it is placed in the Bipolar NOS state.

What are the treatments?

Bipolar disorder can be treated with medication but the problem is that it should be diagnosed properly as sometimes this disorder can be mistaken with schizophrenia and hence correct treatment is not provided which leads to further complications. Medication is provided by the psychiatric after proper diagnosis of the disorder. The medications are “mood stabilizer” and hence they should be taken only after its being prescribed by the doctor.

Never stop medicines before consulting your doctor.

Some people have to take medicines for longer period, many years depending on the gravity of the disorder.

At times mood stabilizing drugs are to be given along with antidepressant as the patient shows shifting of moods from manic phase to depressive phase. Other treatment could be taking thyroid pills, psychological therapies such as psychotherapy or talk therapy, cognitive behavioral therapy, family therapy and ECT (Electroconvulsive therapy).

What are the causes of relapse?

There are many causes for the relapse, few being:

# Stop medication without consulting doctor

# Lesser the amount of medication or increase the dosage

# Skip medicine for even a single day

# Abuse alcohol or drugs

# Have unhealthy lifestyle

# Sleeping too much or too less