Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. Bipolar disorder is also known as bipolar disease or manic depression. People with bipolar disorder may have trouble managing everyday life tasks at school or work, or maintaining relationships. There’s no cure, but there are many treatment options available that can help to manage the symptoms.
TYPES OF BIPOLAR DISORDER
- Bipolar I Disorder—defined by manic episodes that last at least 7 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. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
- Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
- Cyclothymic Disorder (also called Cyclothymia)—defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.
- Bipolar I disorder.You’ve had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
- Bipolar II disorder.You’ve had at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode.
- Cyclothymic disorder.You’ve had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
- Other types.These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.
Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.
Although bipolar disorder can occur at any age, typically it’s diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.
MANIA AND HYPOMANIA
Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
MAJOR DEPRESSIVE EPISODE
A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:
- Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
- Marked loss of interest or feeling no pleasure in all — or almost all — activities
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
- Either insomnia or sleeping too much
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Thinking about, planning or attempting suicide
Other features of bipolar disorder
Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.
SYMPTOMS IN CHILDREN AND TEENS
Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.
Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.
The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.
Treatment aims to stabilize the person’s mood and reduce the severity of symptoms. The goal is to help the person function effectively in daily life.
Treatment involves a combination of therapies, including:
- Physical intervention
- Lifestyle remedies
It can take time to get a correct diagnosis and find a suitable treatment, as individuals react differently, and symptoms vary widely.
Drug treatments can help stabilize mood and manage symptoms. A doctor will often prescribe combination of:
- Mood stabilizers, such as lithium
- Antidepressants second-generation antipsychotics (SGAs)
- Anticonvulsants, to relieve mania
- Medication to help with sleep or anxiety
The doctor may need to adjust the medication over time. Some drugs have side effects, and they can affect individuals differently. If an individual has concerns about their drug treatment, they should talk to their doctor.
A person must:
- Tell the doctor about any other mediations they are using, to reduce the risk of interactions and adverse effects
- Follow the doctor’s instructions regarding medication and treatment
- Discuss any concerns about adverse effects, and if they feel the treatment is working
- Continue taking medication unless the doctor says it is safe to stop
- Bear in mind that the drugs can take time to work
If the person discontinues their treatment, symptoms may worsen.
PSYCHOTHERAPY AND COUNSELING
Psychotherapy can help relieve symptoms and equip a person to manage bipolar disorder.
Through cognitive-behavior therapy (CBT) and other approaches, the individual can learn to:
- Recognise and take steps to manage key triggers, such as stress
- Identify early symptoms of an episode and take steps to manage it
- Work on factors that help maintain a stable mood for as long as possible
- Engage the help of family members, teachers, and colleagues
These steps can help a person maintain positive relationships at home and work. For children and teens with bipolar disorder, a doctor may recommend family therapy.
Some people may need to spend time in the hospital if there is a risk of them harming themselves or others.
If other treatments have not helped, a doctor may prescribe electroconvulsive therapy (ECT).
Some lifestyle choices can help maintain a stable mood and manage symptoms. They include:
- Maintaining a regular routine
- Following a healthful and varied diet
- Establishing a regular sleep pattern and taking steps to prevent sleep disturbance
- Getting regular exercise
Some people use supplements, but it is essential to discuss this with a doctor first. Some alternative remedies can interact with the drugs used for bipolar disorder. They may make symptoms worse.
Exploring bipolar disorder treatment options
If your doctor determines that you have bipolar disorder, he or she will explain your treatment options and possibly prescribe medication for you to take. You may also be referred to another mental health professional, such as a psychologist, counselor, or a bipolar disorder specialist. Together, you will work with your healthcare providers to develop a personalised treatment plan.
COMPREHENSIVE TREATMENT FOR BIPOLAR DISORDER
A comprehensive treatment plan for bipolar disorder aims to relieve symptoms, restore your ability to function, fix problems the illness has caused at home and at work, and reduce the likelihood of recurrence.
A comprehensive bipolar treatment plan involves:
Medication. Medication is the cornerstone of bipolar disorder treatment. Taking a mood stabilizing medication can help minimise the highs and lows of bipolar disorder and keep symptoms under control.
Psychotherapy. Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
Education. Managing symptoms and preventing complications begins with a thorough knowledge of your illness. The more you and your loved ones know about bipolar disorder, the better able you’ll be able to avoid problems and deal with setbacks.
Lifestyle management. By carefully regulating your lifestyle, you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, eating a mood-boosting diet, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year-round.
Support. Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group gives you the opportunity to share your experiences and learn from others who know what you’re going through. The support of friends and family is also invaluable. Reaching out to people who love you won’t mean you’re a burden to others.
MEDICATION TREATMENT FOR BIPOLAR DISORDER
Most people with bipolar disorder need medication in order to keep their symptoms under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and sometimes prevent them entirely. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, you may have to try several different medications before you find one that relieves your symptoms.
Check in frequently with your doctor. It’s important to have regular blood tests to make sure that your medication levels are in the therapeutic range. Getting the dose right is a delicate balancing act. Close monitoring by your doctor will help keep you safe and symptom-free.
Continue taking your medication, even if your mood is stable. Don’t stop taking your medication as soon as you start to feel better. Most people need to take medication long- term in order to avoid relapse.
Don’t expect medication to fix all your problems. Bipolar disorder medication can help reduce the symptoms of mania and depression, but in order to feel your best, it’s important to lead a lifestyle that supports wellness. This includes surrounding yourself with supportive people, getting therapy, and getting plenty of rest.
Be extremely cautious with antidepressants. Research shows that antidepressants are not particularly effective in the treatment of bipolar depression. Furthermore, they can trigger mania or cause rapid cycling between depression and mania in people with bipolar disorder.