What is Bipolar Disorder?
This disorder is also known as “manic-depressive illness”. Bipolar disorder is a brain disorder which causes unusual changes in mood, energy, activity levels, and the ability to carry out every day simple tasks. The symptoms of Bipolar disorder are extreme. The symptoms of Bipolar disorder are very different from the normal highs and lows or ups and downs, which all people experience from time to time. This disorder can result in broken & problematic relationships, poor job and or school performance, and at extreme low’s even suicide. Being given a diagnosis of Bipolar disorder is devastating but it can be treated, and help those who live with this everyday to lead full and productive lives.
What is believed to cause Bipolar Disorder?
Many scientists study the possible causes of this disorder and most agree that there is no one cause but rather, many pieces of a puzzle which fit together to make the illness appear or increase the risk that the person with these pieces may be diagnosed at some point.
Some of the puzzle pieces:
Bipolar disorder can be seen in generations of families. While not every person in the family, who may have the gene, will develop bipolar disorder, their risk of eventually doing so is higher than in those who do not carry the gene. It appears that if a child has a parent or sibling who has been diagnosed with the disorder, they are at a higher risk to develop the disorder, compared to children who do not have a family member or history of the disorder. The good news is that most children with a family member who has been diagnosed with Bipolar disorder, will not be given the same diagnosis.
There are a ton of technological advances in helping to improve the genetic research on Bipolar disorder. One example of these advances is the launch of the Bipolar Disorder Phenome Database, funded in part by the National Institute of Mental Health (NIMH). Scientists using this database will be able to link the visible signs of Bipolar disorder with the genes which may have an affect on them.
Illnesses with similar symptoms such as depression and schizophrenia are being studied by scientists to find the genetic differences that may help to increase a person’s risk for being diagnosed with Bipolar disorder. Scientists hope that by finding these genes they may also help explain how factors in the environment can also increase a person’s risk of developing Bipolar disorder.
Genes do not appear to be the only risk factor for Bipolar disorder. It appears in some cases that it is a combination of different genes and factors in the environment. In the study of identical twins, for instance, if one twin is diagnosed with Bipolar disorder that does not necessarily mean the other twin will always develop the same disorder, even though they share the same genes. Scientists suspect that many factors play a part in a diagnosis of Bipoar disorder but are still not able to fully understand how they work together to cause Bipolar disorder.
Brain structure and functioning:
To research further, brain-imaging tools, like the Functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET), give the researchers an opportunity to take images of the brain at work. With these tools, scientists are better able to study the brain’s structure and activity.
Some of these studies show how brain’s of those diagnosed with Bipolar disorder may be different from brains of people who are deemed healthy or to differentiate other mental disorder. One study using the MRI technique, found that the same pattern of brain development in children diagnosed with Bipolar disorder was also similar to “multi-dimensional impairment” which causes symptoms that may overlap with the symptoms of Bipolar disorder and Schizophrenia. The findings suggest that common pattern of brain development may be directly linked to general risk for mood changes which may be sudden and or severe.
The pre-frontal cortex in the brain seems to be smaller and have less function than that of adults who are not diagnosed as Bipolar disorder. This part of the brain is responsible for problem solving and making decisions. The development of the brain in teen year’s suggests that this is when the changes in the brain’s circuit board appears to happen. Finding the imaging tests may help detect the disorder at an early age or which may give an opportunity for early intervention and diagnosis.
One missed connection in the brain regions may cause problems forming memories, learning, and emotional issues. Scientists are striving to know more about how the brain works and how these connections work together to form a health and unhealthy brain. Learning is important and multi-faceted involving imaging tests and understanding of how all parts of the brain work together with the eventual hope of being able to predict this disorders in people and which treatments will work.
Signs and Symptoms of Bipolar Disorder:
We know about high’s and low’s in life but for people who are diagnosed as Bipolar, the highs and lows are extreme. Mental health officials refer to these extreme mood changes as “mood episodes”. One minute a person can be extremely happy or overexcited and it is referred to as a “manic episode”. At the extreme opposite end people can become very sad or feel extremely hopeless which is referred to as a “depressive episode”. There are times when both “manic episodes” and “depressive episodes” can be mixed and this is referred to as a “mixed state”. During mood episodes some people may become extremely angry and irritable which may cause them to act out violently.
When episodes happen there is an extreme change in energy, activity, sleep, and behaviors. (See the attached graphic for more information on symptoms of Bipolar Disorder.)
Who is at a higher risk of developing Bipolar Disorder?
This disorder usually develops during late teen’s or early adult years. Half of all cases begin before the age of 25 although some people may start having symptoms as early as childhood and later in life.
How do you treat Bipolar Disorder?
Diagnostic and Statistical Manual of Mental Disorders (DSM) provide the guidelines which help doctors diagnose this disorder. One of the major deciding factors is a major change in normal mood or behavior.
There are four basic types of bipolar disorder:
Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
A severe form of the disorder is called Rapid-cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year. Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age. One study found that people with rapid cycling had their first episode about 4 years earlier—during the mid to late teen years—than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men. Rapid cycling can come and go.
A Bipolar disorder diagnosis can be carried out by a doctor or other health care provider after a physical examination, conversation with patient, and medical tests. This disorder cannot be diagnosed through a blood test or brain scans, but they can help rule out other issues such as strokes, brain tumors or thyroid conditions. If the tests do not show any of the other issues then the doctor or health care provider may use a mental health evaluation or they can also provide a referral to other mental health professionals, such as psychiatrists, who will be better able to provide a Bipolar disorder diagnosis.
Some questions may be asked such as:
1. Any family history of bipolar disorder or other mental illnesses.
2. Complete history of symptoms.
3. The doctor or mental health professional should also talk to your close relatives or spouse about your symptoms and family medical history.
Doctors know that people who have Bipolar disorder who are depressed are more likely to seek help than when they are in the “mania” or “hypomania” phase. Doctors should take a detailed medical history to ensure the incorrect diagnosis of major depression is not given. People who have true depression are also referred to as “unipolar depression” since they do not experience mania.
If those who have Bipolar disorder are left untreated and or undiagnosed,symptoms can worsen causing any episodes to be closer together and more problematic over time. Delays in diagnosis can also lead to problems with work, friends and family. With an early diagnosis, people with Bipolar disorder can and do lead normal, healthy and productive lives. Treatment can reduce the amounts of episodes and their severity.
People who are Bipolar are more likely to have substance abuse issues, although no one can explain why. Some people who are diagnosed as Bipolar choose to self medicate using drug and or alcohol which may trigger an episode or make the episode last longer than it would have if the person was not self medicating. Mania itself may cause the person to drink more than they would normally.
Post-traumatic Stress Disorder (PTSD), anxiety problems and social phobia can also happen at the same time with people who have Bipolar disorder. Attention Deficit Hyperactive Disorder (ADHD) may also happen at the same time as the Bipolar disorder and has a few symptoms which overlap with this disorder, such as restlessness and becoming easily distracted.
People with bipolar disorder are also at higher risk for:
*Other physical illnesses.
The above listed illnesses may cause those suffering with Bipolar disorder to have symptoms of mania or depression or they may be, in part, due to the treatment for this disorder.
What is the treatment for Bipolar Disorder and can it be cured?
This disorder can be treated over a long-term but cannot be cured. Just like any life-long diagnosis, people with Bi-polar disorder will need medication to ensure their symptoms are well controlled. With proper treatment many of the symptoms can be controlled effectively such as mood changes but not always.
Treatment for this is just like any other life-long medical issue and requires you to work with your doctor and talk about how you really feel. By talking about it, you can start to feel better. Medication and psychotherapy work well for this disorder.
Medications helpful with Bipolar disorder:
There is not only one type of medication which can help with the symptoms of Bipolar disorder and it may take a while for you and your health professional to find the one which works. There are things which will help decide the medication which works for you. You can help by keeping a daily journal noting:
*Daily mood symptoms
This daily record of life events may help you and your doctor to keep track and manage your illness better. Let your doctor know if the medication are not helping your symptoms or if the side effects are too much for you to handle. Be your own advocate.
The types of medications generally used to treat bipolar disorder include:
Never be afraid to look up information on any drug which you are prescribed to ensure their side effects and to ensure they are the right treatment for your illness.
Some types of medications available for those with Bipolar Disorder:
*Mood stabilizers are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Lithium (also known as Eskalith or Lithobid) is an effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970’s for treating both manic and depressive episodes.
*Anticonvulsants are also used as mood stabilizers. They were originally developed to treat seizures, but they also help control moods. Anticonvulsants used as mood stabilizers include:
*Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania. It is a popular alternative to lithium. However, young women taking valproic acid face special precautions.
*Lamotrigine (Lamictal), FDA-approved for maintenance treatment of bipolar disorder. It is often effective in treating depressive symptoms.
*Other anticonvulsant medications: Gabapentin (Neurontin), Topiramate (Topamax), and Oxcarbazepine (Trileptal).
Some warnings about drugs which may be used to treat Bipolar Disorder:
Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be monitored closely for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. If you take any of these medications, do not make any changes to your dosage without talking to your doctor.
What are the side effects of mood stabilizers?
Lithium can cause side effects such as:
*Bloating or indigestion
*Unusual discomfort to cold temperatures
*Joint or muscle pain
*Brittle nails or hair.
When taking lithium, your doctor should check the levels of lithium in your blood regularly, and will monitor your kidney and thyroid function as well. Lithium treatment may cause low thyroid levels in some people. Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
Because too much or too little thyroid hormone can lead to mood and energy changes, it is important that your doctor check your thyroid levels carefully. You may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.
Common side effects of other mood stabilizing medications include:
*Stuffed or runny nose, or other cold-like symptoms.
These medications may also be linked with rare but serious side effects. Talk with your doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you’re taking. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.
Should young women take Valproic Acid?
Valproic acid may increase levels of testosterone (a male hormone) in teenage girls. It could lead to a condition called polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. PCOS can cause obesity, excess body hair, an irregular menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid. Young girls and women taking valproic acid should be monitored carefully by a doctor.
Atypical antipsychotics are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications, such as antidepressants. Atypical antipsychotics include:
Olanzapine (Zyprexa), which when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine can be taken as a pill or a shot. The shot is often used for urgent treatment of agitation associated with a manic or mixed episode. Olanzapine can be used as maintenance treatment as well, even when psychotic symptoms are not currently present.
Aripiprazole (Abilify), which is used to treat manic or mixed episodes. Aripiprazole is also used for maintenance treatment. Like olanzapine, aripiprazole can be taken as a pill or a shot. The shot is often used for urgent treatment of severe symptoms.
Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) also are prescribed to relieve the symptoms of manic episodes.
What are the side effects of atypical antipsychotics?
If you are taking these medications, don’t drive until you have adjusted to your medication.
Side effects of many antipsychotics include:
*Dizziness when changing positions
*Sensitivity to the sun
*Menstrual problems for women.
*Atypical antipsychotic medications can cause major weight gain and changes in your metabolism. This may increase your risk of getting diabetes and high cholesterol. Your doctor should monitor your weight, glucose levels, and lipid levels regularly while you are taking these medications.
In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes uncontrollable muscle movements, frequently around the mouth. TD can range from mild to severe. Some people with TD recover partially or fully after they stop taking the drug, but others do not.
Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.
However, taking only an antidepressant can increase your risk of switching to mania or hypomania, or of developing rapid-cycling symptoms. To prevent this switch, doctors usually require you to take a mood-stabilizing medication at the same time as an antidepressant.
What are the side effects of antidepressants?
Antidepressants can cause:
*Nausea (feeling sick to your stomach)
*Agitation (feeling jittery)
*Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.
Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication. You should not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.
Should women who are pregnant or may become pregnant take medication for Bipolar disorder?
Women with Bipolar disorder who are pregnant or may become pregnant face special challenges. Mood stabilizing medications can harm a developing fetus or nursing infant. But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.
Lithium is generally the preferred mood-stabilizing medication for pregnant women with Bipolar disorder. However, lithium can lead to heart problems in the fetus. In addition, women need to know that most bipolar medications are passed on through breast milk. The FDA has also issued warnings about the potential risks associated with the use of antipsychotic medications during pregnancy. If you are pregnant or nursing, talk to your doctor about the benefits and risks of all available treatments.
FDA Warning on Antidepressants:
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. For the latest information, see the FDA website.
Other treatments to be included with the medication treatment:
When done in combination with medication, psychotherapy can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
*Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
*Family-focused therapy, which involves family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication among family members, as well as problem-solving.
*Interpersonal and social rhythm therapy, which helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
*Psychoeducation, which teaches people with bipolar disorder about the illness and its treatment. Psychoeducation can help you recognize signs of an impending mood swing so you can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.
Other treatments for Bipolar Disorder:
When medication and psychotherapy does not work, Electroconvulsive Therapy (ECT), may be beneficial. Years ago this form of therapy was known as “Shock Therapy” and was given a very bad reputation due to safety of the procedure. This form of therapy, in it’s newer form, makes it possible to provide some relief for people who suffer with the severe form of Bipolar disorder who have been unable to achieve any success with other forms of treatment.
In the movies we see this form of therapy as dehumanizing and almost a form of torture. These days they take better precaution and prior to the ECT, the patient is now given a muscle relaxant and put under brief sedation or anesthesia. The patient doesn’t feel any pain consciously during the ECT. This form of treatment may last between 30 – 90 seconds with patients recovery time of 5 – 15 minutes. Patients who receive this form of treatment are able to go home the same day as the procedure.
This form of treatment may be necessary when other medical conditions make the use of the medications too risky, like pregnancy for instance. ECT is a safe and effective treatment for those who are severely depressed, manic, or suffering from mixed episodes although it is generally not used as the first choice in treatment.
Short-term side effects from ECT:
People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor they trust.
Sleep Medications — Some people with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder, however, if their sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications to help improve ability to sleep.
Herbal Supplements — An herb called St. John’s wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder while also making other medications less effective, including some antidepressant and anticonvulsant medications. Omega-3 fatty acids (most commonly found in fish oil) have been measured for their usefulness for long-term treatment of bipolar disorder resulting in mixed study results.
It’s important to tell your doctor all medications you are taking including all prescriptions, over-the-counter and or supplements which, when taken with certain medications and supplements, may cause unwanted or dangerous side effects. Write down the medications and medical conditions you may have and leave a copy in your wallet or purse for reference in case of emergency.
Today there are studies being conducted which are having some very positive clinical outcomes. We hope that with the right mixture of scientist and science, they can come up with a cure or better medications to help those who are diagnosed with Bipolar depression lead normal, productive lives with little to no side effects from any form of treatment.
If you or someone you know has Bipolar disorder, remember to look after you first and everyone after. Be your own advocate and stand up for your own mental health. You are worth it.
Great graphic for those who live with Bipolar Disorder and one that is uplifting. You are not your illness. Your illness is not you. You are you and you matter.
If you or someone you know is suffering from severe depression and or has suicidal thoughts, please contact your law enforcement’s emergency number. Thanks for reading my blog and I hope it was helpful.