Bipolar Disorder, An Emotional Rollercoaster

Living with bipolar disorder can be like living on a rollercoaster of emotions: at its highest point there can be intense mania and at its lowest, severe depression

Bipolar disorder is a common and disabling mood disorder that frequently disrupts energy, activity, sleep, cognition and behavior. It is characterized by episodes of mania, hypomania and major depression. The severity of these symptoms varies widely across patients.

What is a manic episode?

It’s an episode of predominantly elevated or irritable mood, which is unusual for the individual concerned. The mood change must last for at least 1 week (unless it is severe enough to require hospital admission).

At least 3 of the following signs must be present, leading to severe interference with personal functioning in daily living:

• Increased activity
• Increased talkativeness
• Flight of ideas or thoughts racing
• Loss of normal social inhibitions
• Decreased need for sleep
• Inflated self-esteem or grandiosity
• Distractibility or constant changes in plan
• Reckless behaviour
• Marked sexual energy

What is a hypomaniac episode?

It’s  an episode of elevated or irritable  mood, to a degree that is  unusual for the individual concerned, and which is sustained for at least 4 consecutive days.

At least 3 of the following signs must be present, leading to some interference with personal functioning in daily living:

• Increased activity or physical restlessness
• Increased talkativeness
• Difficulty in concentration or distractibility
• Decreased need for sleep
• Increased sexual energy
• Mild overspending, or other types of reckless behaviour
• Increased sociability or overfamiliarity

The manic access is usually brutal and loud while hypomania might go unnoticed; one might even think that the individual is living a joyful life!

What is a major depressive episode?

It’s an episode of depressed mood or loss of interest / pleasure lasting at least 2 weeks. . The bipolar depression is  a form of depression that  is characterized by:

• Loss of appetite
• Weight loss
• Constipation
• Reduced libido
• Early morning wakening
• Psychomotor retardation or agitation
• Poorer response to placebo treatments

Presentation

There are subtypes of bipolar disorder, which include :

• Bipolar type I disorder — patients experience at least 1 manic episode and nearly always experience major depressive and hypomanic episodes.

• Bipolar type II disorder — marked by at least 1 hypomanic episode, at least 1 major depressive episode, and the absence of manic episodes.

• 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.

• Rapid-cycling Bipolar Disorder — An extremely severe form of the disorder. Rapid cycling occurs when a person has 4 or more episodes of major depression, mania, hypomania, or mixed states, all within a year.

Bipolar disorder can thus present in a wide variety of clinical forms,, thereby increasing the likelihood of misdiagnosis

Most patients with bipolar disorder have at least one comorbid psychiatric illness; e.g. :

• Anxiety disorders
• Substance use disorders
• Attention deficit hyperactivity disorder
• Eating disorders
• Personality disorders
• Post-traumatic stress disorder (PTSD)

The estimated lifetime prevalence of bipolar disorder among adults worldwide is 1 to 3%

The mean age of onset for bipolar disorder is 18 – 20 years old

The ratio of men to women who develop bipolar disorder is approximately 1:1

Etiology and risk factors

Although a specific genetic link to bipolar disorder has not been pin pointed, research shows that bipolar disorder tends to run in families.

Risk factors may be:

• Medical, involving hormonal disruption like thyroid dysfunction or post-partum depression
• Psychiatric like cyclothymia
• Environmental/Social including major life stressors

Treatments and evolution

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and may also include education and support groups.

Medication is based on mood stabilizers that can reduce acute symptoms, without causing a switch to the opposite polarity, e.g., Lithium or Depakene. Antipsychotics can also be given, e.g., Seroquel or Risperdal. Antidepressants are usually avoided because they can trigger a manic / hypomanic episode!

For patients with bipolar major depression who are severely ill (eg, persistent suicidal ideation) and have not responded to multiple pharmacotherapy trials, ECT has been suggested (Electroconvulsive therapy, a procedure in which small electric currents are passed through the brain to induce seizures).

Some symptomatic patients remit and become euthymic (stable mental state or mood), while others transition immediately from one type of syndrome to another (eg, from major depression to mania) without an intervening period of euthymia.

Suicide attempts are common in bipolar disorder. Approximately 10 to 15 % of bipolar patients die by suicide, which is greater than the rate of suicide in the general population.

Bipolar depression is one of the most common causes of suicide in the world!

Keep in mind that everyone is different and will experience their own combination of symptoms.

Thus, it’s important to raise awareness about this condition and promote early  diagnosis of these patients,  to offer them the help they need and allow them to live fulfilling lives.