An In-Depth Overview of Bipolar Disorder

Bipolar disorder is a type of mood disorder that involves alternating phases of depression and elevated moods, known as hypomania or mania. While most people go through normal emotional ups and downs, those with bipolar disorder experience much more intense mood swings. These swings can lead to extreme feelings. Before we dive back into the graph, let’s clarify what depressive and manic symptoms are.

For bipolar disorder, depressive symptoms, as outlined in the DSM-5, include feeling low, losing interest in things you once enjoyed (a condition called anhedonia), changes in sleep or appetite, and low energy that can make even getting out of bed feel overwhelming. Other signs include psychomotor retardation, feelings of worthlessness or inappropriate guilt, and trouble concentrating. In severe cases, individuals may even have thoughts of death or suicide.

On the other hand, mania and hypomania present different symptoms. Mania is characterized by an extremely elevated mood that can disrupt daily life and may even involve psychosis, which can sometimes lead to a misdiagnosis of schizophrenia. According to the DSM-5, to be diagnosed with mania, a person must exhibit at least three of the following: a reduced need for sleep, feelings of grandiosity (believing they are better than others), rapid speech, racing thoughts, and distractibility.

An elevated engagement in goal-oriented activities and an overindulgence in pleasurable yet risky behaviors, such as shopping sprees, sexual activities, or gambling, characterizes mania. This state must persist for a minimum of seven days and significantly disrupt normal functioning or pose risks to others. Hypomanic episodes share similarities but require only four days and are noticeable to others without leading to functional impairment.

Bipolar Disorder is classified into three primary types: Bipolar I, which can be diagnosed after a single manic episode, as it is anticipated that a depressive episode will follow; Bipolar II, which involves at least one depressive episode and one hypomanic episode; and Cyclothymic Disorder, often regarded as a milder form of bipolar disorder, characterized by episodes of depression and hypomania that do not fully meet the criteria for major depressive or hypomanic episodes.

Some individuals may experience rapid fluctuations between these extremes, defined as rapid cycling, if they have four or more episodes of mania or depression within a year. Additionally, some may exhibit both depressive and manic symptoms simultaneously. The lifetime prevalence of bipolar disorder is estimated to be between one and three percent, affecting both males and females approximately equally, with onset typically occurring in late adolescence.

In early adulthood, the exact cause of bipolar disorder remains unclear, but it's believed that several factors contribute to its development. Research indicates a genetic connection, where having a family history of the disorder can significantly increase the risk. For instance, if a first-degree relative has bipolar disorder, the risk can be up to ten times higher. If one parent has the condition, the chance of developing it ranges from 15 to 30 percent, but if both parents are affected, that risk jumps to between 50 and 75 percent. However, just because there’s a family history doesn’t mean someone will definitely develop bipolar disorder. Environmental factors also play a role, such as experiencing major stressors like the death of a loved one, serious illness, or financial and relationship issues.

When it comes to treating bipolar disorder, the focus is on managing the acute phase and ensuring long-term stability, especially since there’s a higher risk of suicide among those affected. Psychotherapy, particularly cognitive behavioral therapy, is effective in addressing depressive symptoms and preventing relapses. Interpersonal therapy is another option, although it’s not as effective for treating manic episodes. Psychoeducation is also beneficial, as it helps individuals learn about mental health and strategies to avoid relapses. Medications are commonly prescribed, including various classes of drugs. Mood stabilizers, such as lithium, have proven to be especially effective during acute manic episodes and in preventing future relapses.

Depression needs to be carefully watched because it can lead to side effects affecting the kidneys and thyroid. There are other treatment options like carbamazepine, lamotrigine, and valproic acid, which are all anti-epileptic drugs. Antipsychotics, such as haloperidol and olanzapine, are often used during manic episodes. Research shows that using a mix of mood stabilizers and antipsychotics works better than using just one type. Antidepressants are another option, but they’re usually not used on their own since they can cause manic episodes or speed up mood cycles. However, they can be combined with mood stabilizers in some situations. For instance, the combination of olanzapine and fluoxetine is approved for treating bipolar depression. Other treatments include electroconvulsive therapy (ECT), which involves inducing seizures with electric currents, but this is mainly for severe or resistant cases. There’s also transcranial magnetic stimulation (TMS), which uses magnetic waves instead of electricity and is less intense than ECT, plus it doesn’t require general anesthesia.