Living With Bipolar Disorder

Bipolar disorder is best described as a disorder of the energy of the brain. People with bipolar disorder experience unusual and intense changes in mood and behavior. There are two extremes in bipolar disorder: mania and depression. During a manic episode, people feel “up,” and may be much more energetic than usual. Mania is much more extreme than a sudden burst of energy or a good mood. Manic episodes may be associated with high-risk behaviors including substance abuse, sexual promiscuity, excessive spending, and even violence. During a depressive episode, people feel “down,” have low energy, and neglect obligations. Bipolar disorder often causes problems in work, school, and relationships and may require hospitalization.

The frequency of bipolar disorder ranges from 1% for the more serious form of the illness, bipolar I disorder, to around 4.5% when all subtypes are included. Bipolar disorder affects men and women equally, and typically begins in early adulthood. When bipolar disorder begins in later life, it is often a result of physical changes in the brain.

Who develops bipolar disorder?

Anyone can develop bipolar disorder. Men and women of every age, race, ethnicity, educational level, and social and economic background suffer from bipolar disorder. Every person’s experience with bipolar disorder is unique.

How is bipolar disorder diagnosed?

Bipolar disorder is not easy to diagnose. Some people have bipolar disorder for years before the illness is diagnosed. A doctor needs to diagnose you with bipolar disorder by evaluating the nature and severity of your symptoms to determine, based on clinical experience and judgement, if you reach the threshold for a clinical disorder. The current manual that doctors use to diagnose and classify mental disorders (DSM-5) highlights the importance of energy change in making a formal diagnosis. People with bipolar disorder experience episodes of extremely low moods that meet the criteria for major depression as well as extremely high moods (mania). It is unwise to try to diagnose yourself based on the presence or absence of a “list” of symptoms. If you are concerned that you may have symptoms suggestive of bipolar disorder, you should talk with a doctor.

What are some of the signs and symptoms of bipolar disorder?

Bipolar disorder takes many forms, and its symptoms combine differently in each individual. Some people with bipolar disorder experience only a few symptoms, while others experience many.The severity of symptoms also varies by individual and changes over time.

Bipolar disorder may include depressive episodes, manic episodes, or hypomanic episodes. Sometimes the features of these episodes overlap. Doctors refer to this overlap as mixed features. Someone with bipolar disorder may experience a depressive state with mixed features (e.g. mostly depressed with some manic or hypomanic symptoms) or a manic or hypomanic state with mixed features (mostly manic or hypomanic with some depressive symptoms). For instance, if you are having a manic episode with mixed features, you will experience the elevated energy of mania along with the despair of depression.

Depressive episode

If you’ve had a change in your normal mood and have been experiencing at least 5 of the signs and symptoms below for more than 2 weeks most of the day, nearly every day, you may be experiencing a depressive episode. Symptoms of a depressive episode include:

Feelings:

  • Sadness
  • Hopelessness
  • Guilt
  • Moodiness
  • Angry outbursts
  • Irritability
  • Loss of interest in friends, family or favorite activities, including sex

Thoughts:

  • Trouble concentrating
  • Trouble making decisions
  • Trouble remembering
  • Thoughts that may not be realistic (i.e. thinking that someone you don’t know is out to get you), or seeing or hearing things that aren’t really there
  • Thoughts of harming yourself
  • Feeling that thoughts are slowed down
  • Thoughts that focus on the negative without being able to see the positive

Behaviors:

  • Withdrawing from people or becoming isolative
  • Drinking too much or more than usual, using other mind-altering substances
  • Missing work, school or other commitments
  • Attempting to harm yourself

Physical problems:

  • Tiredness or lack of energy
  • Unexplained aches and pains
  • Changes in appetite and weight (up or down)
  • Changes in sleep – sleeping too little or too much
  • Sexual problems – typically not feeling interested in sex or not feeling that you can participate in sex as well as usual

 

Manic episode

If you’ve had a change in your normal mood and have been experiencing at least 3 of the signs and symptoms below for at least 1 week for most of the day, nearly every day, you may be experiencing a manic episode. Symptoms of a manic episode include:

  • Feeling very energized (high)
  • A pathological increase in activity
  • Poor judgment and/or reckless behavior
  • Extreme moodiness (up and down moods)
  • Trouble concentrating or paying attention (distracted)
  • Feeling that thoughts are moving very quickly and -
  • Talking very fast about a lot of things
  • Trouble sleeping and not feeling that you need sleep
  • Changes in appetite
  • Unrealistic thinking or beliefs, including thoughts of superiority over others, or an unrealistically high opinion of oneself.
  • Thoughts that may not be realistic (i.e. thinking that someone you don’t know is out to get you), or seeing or hearing things that aren’t really there

 
Hypomanic episode

A hypomanic episode is very similar to a manic episode, but is less intense and shorter. A hypomanic episode is only required to last for 4 days, but still impacts a person’s functioning.

What are the different types of bipolar disorder?

There are several types of bipolar disorder, based on the specific duration and pattern of manic and depressive episodes.

Bipolar disorder actually refers to two different disorders – bipolar I disorder and bipolar II disorder.

  • Bipolar I:  is characterized by one or more extreme manic episodes or mixed episodes. Typically a person will experience periods of depression as well.
  • Bipolar II:  is characterized by episodes of hypomania (a milder form of mania) and depression that may not seem as extreme as in Bipolar I or may not last as long.

Bipolar Disorder, unspecified: is a type of bipolar disorder that does not follow a particular pattern (for example, very rapid shifts between some symptoms of mania and some symptoms of depression).  It was previously called “bipolar, not otherwise specified” in an earlier version of the manual that doctors use to diagnose and classify mental disorders (DSM-4).

Cyclothymia is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least 2 years. The severity of this illness may change over time.

Bipolar disorder with rapid cycling is diagnosed when a person experiences 4 or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder, and may be a temporary condition for some people.

Why does someone develop bipolar disorder?

We do not know exactly what causes bipolar disorder. Researchers are finding out more about the disorder by studying it. This research may help doctors do a better job of treating people with bipolar disorder. It may also help doctors identify patterns of the illness in order to predict whether a person will get bipolar disorder or experience an episode.

Research through the Heinz C. Prechter Bipolar Research Program at the University of Michigan Depression Center suggests that bipolar disorder has many causes. Although bipolar disorder tends to run in families, no one gene explains it.

Everyone’s experience with bipolar disorder is unique. But all of these experiences include features that fall into the following 7 classes of observable characteristics or phenotypes.

  • Disease – Changes in how certain chemicals function in the brain may affect bipolar disorder.
  • Neurocognitive – Changes in thinking, reasoning, and emotion processing.
  • Temperament and personality –People with bipolar disorder are frequently more reactive and “temperamental” compared to the average person.
  • Motivated behaviors – People with bipolar disorder frequently experience substance use disorders and other behavioral patterns.
  • Life story – Trauma and abuse in childhood, unfortunate life experiences and other challenges contribute to bipolar disorder in complex ways.
  • Sleep and circadian patterns -  Patterns of sleep and circadian rhythms are often different among bipolar patients, causing disruptions in daily patterns and routines.
  • Outcomes and course of illness - Measures of how someone’s symptoms change over time and respond to treatment

How is bipolar disorder treated?

For most patients with bipolar disorder, ongoing treatment is required to continually monitor and adjust medications and manage symptoms.

“Mood stabilizing” medications including lithium and certain anticonvulsant medications as well as antipsychotics can be effective in preventing episodes of either depression or mania. Antidepressants should be used cautiously as they may worsen the mood swings.

Psychotherapy is used along with medications to help patients cope with stressful life experiences that can bring about episodes. Certain kinds of therapy, such as those that focus on ways that thoughts and behaviors affect mood, how relationships are affecting mood, and monitoring daily structure are thought to be the most effective kinds of psychotherapy. Learning how to recognize early warning symptoms of a relapse is a key skill for preventing relapses. However, psychotherapy can never replace medication.

Exercise and nutrition are important lifestyle strategies for managing bipolar disorder.

Support of family members, friends and co-workers is crucial.