Maybe you’ve heard the term “bipolar”
used to describe someone who’s moody, or who has mood swings, but this colloquial use
of the term is different from bipolar disorder. Bipolar disorder, which used to be called
manic depression, is a serious mental illness that causes a person to have dramatic shifts
in emotions, mood, and energy levels: moving from extreme lows to extreme highs. But these shifts don’t happen moment to
moment, they usually happen over several days or weeks. There are a few different types of bipolar
disorders, but there are some common features.
First, the low moods are identical to those
in a related disorder – major depressive disorder, also known as unipolar depression. Individuals with this can feel hopeless and
discouraged, lack energy and mental focus, and can have physical symptoms like eating
and sleeping too much or too little. But along with these lows, the thing that
sets bipolar disorders apart from unipolar depression is that individuals can have periods
of high moods, which are called manic episodes or hypomanic episodes, depending on their
level of severity. In a manic state, people can feel energetic,
overly happy or optimistic, or even euphoric with really high self-esteem. And on the surface, these might seem like
very positive characteristics, but when an individual is in a full manic episode, these
symptoms can reach a dangerous extreme. A person experiencing mania might invest all
of their money in a risky business venture or behave recklessly. Individuals might talk pressured speech, where
they talk constantly at a rapid-fire pace, or they might have racing thoughts and might
feel ‘wired,’ as if they don’t need sleep. Manic episodes can also include delusions
of grandeur, for example,, they might believe that they are on a personal mission from god,
or that they have supernatural power.
And they might make poor decisions without
any regard for later consequences. One way to understand these swings is by charting
them on a graph. So let’s say the y-axis is mood, with mania
and depression being on the far ends of the axis, and the x-axis is time. The average healthy individual might have
normal ups and downs throughout their life, and they might even have some pretty serious
lows once-in-awhile, maybe after losing a job or moving to a new place and feeling lonely. An individual with unipolar depression though
might have the normal highs, but they might have some crushing lows that last for a long
period and may not have an obvious trigger.
Now, for the bipolar disorders, the first
one is called Bipolar 1, and these are people that have some major lows that last at least
2 weeks, and some major highs that last at least a week or require hospitalization. That said, untreated manic episodes can last
as long as 3-6 months. Depression is seen in most cases but is not
required for a diagnosis. The second one is called Bipolar-2, and this
is when a person experiences similar lows and has additional highs called “hypomania”,
which are less severe manic episodes than we see in Bipolar 1. To qualify for a diagnosis, these hypomanic
states need to last at least four days. Once again though, these symptoms generally
last a few weeks to a few months. Alright the third one is called cyclothymia,
or sometimes cyclothymic disorder, and these individuals have milder lows as well as the
milder highs or “hypomania” like you see in Bipolar-2, and they cycle back and forth
between these two over a period lasting at least 2 years.
Sometimes, people with Bipolar disorder can
show other, less common symptoms as well, for example having what is referred to as
mixed episodes—experiencing symptoms of both depression and mania at the same time. Another symptom they might have is rapid cycling,
which describes a situation where a person has 4 or more episodes of depression or mania
within a given year. Like most mental health conditions, the exact
the underlying cause of the bipolar disorder isn’t known, and there is no single “bipolar gene”
identified, but it’s thought that there are genetic and environmental factors that
play a part.
For example, one interesting clue is that
people with family members who have bipolar disorder are 10 times more likely to have
it themselves. Another clue is that some drugs and medications
can trigger manic episodes, like selective serotonin reuptake inhibitors (or SSRIs). It’s also worth mentioning that people with
bipolar disorder often have other disorders like anxiety disorders, substance use disorders,
ADHD, and personality disorders as well, making diagnosis and treatment a real challenge. Even though there’s no cure for bipolar
disorder, identifying and treating individuals is important, since there’s a real
danger that the person could harm themselves or commit suicide. One of the oldest treatments is also one of
the most effective treatments, and that’s lithium salts. Lithium acts as a mood stabilizer—smoothing
out the highs and lows they experience. That said, it is much better at treating manic
rather than depressive episodes, and so individuals who take it often have to take other medications
as well, which can be problematic since some antidepressants (like the SSRIs) can trigger
manic episodes in individuals who are predisposed to them.
Other treatment options include antipsychotics,
anticonvulsants, and benzodiazepines, but many of these—including lithium—have side
effects that can be severe and lead to non-adherence which can be dangerous for an individual. Now, unlike certain disorders like unipolar
depression, psychological interventions, like talk therapy, or cognitive-behavioral therapy
are not particularly effective in treating the manic episodes of bipolar disorder. Having said that, they can still be very helpful
tools to help individuals with bipolar disorder in general—especially after a manic episode
has ended. They can also help an individual handle stressful
situations that might otherwise lead to a manic episode, thereby helping to prevent a potential
manic episode in the first place. Alright, so super fast recap: bipolar disorder
is a mental disorder characterized by depression, periods of lowered mood, as well as mania,
and periods of heightened mood.
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