Bipolar disorder, previously called manic depression, is a condition that features extreme shifts in mood and fluctuations in energy and activity levels that can make day-to-day living difficult.
Someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. They go from very happy, "up," and active to very sad and hopeless, "down," and inactive, and then back again. They often have normal moods in between. The up feeling is called mania. The down feeling is depression. And sometimes, there is the mixed feeling which combines the depressed mood with the restlessness and over-activity of a manic episode.
Bipolar disorder is a serious mental illness that, if left untreated, can destroy relationships, undermine career prospects, and seriously affect academic performance. In some cases, it can lead to suicide.
It usually starts between the ages of 15 to 25, and it rarely starts after the age of 40, but it can happen at any age. Men and women are affected equally.
Forms of Bipolar Disorder
Different forms of bipolar disorder includes:
This is when you have had at least one high or manic episode, which has lasted for longer than one week.
While you may only have manic episodes, most people with Bipolar I also have periods of depression.
If left untreated, a manic episode will generally last 3 to 6 months.
Depressive episodes last rather longer, 6 to 12 months without treatment.
If you have had more than one episode of severe depression, but only mild manic episodes (called ‘hypomania’).
This is when you have more than four mood swings in a 12 month period. This affects around 1 in 10 people with bipolar disorder, and can happen with both types I and II.
Here, the mood swings are not as severe as those in full bipolar disorder, but can be longer. This can develop into full bipolar disorder.
Other specified and unspecified
This is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.
What Causes Bipolar Disorder?
It is not clear what causes bipolar disorder, but research suggests that:
Bipolar disorder runs in families - it seems to have more to do with genes than with upbringing.
There may be a physical problem with the brain systems which control our moods; this is why bipolar disorder can often be controlled with medication.
But - mood swings can be brought on by stressful experiences or physical illness.
One possibility is that some people with a genetic predisposition for bipolar disorder may not have noticeable symptoms until an environmental factor triggers a severe mood swing.
Signs and Symptoms of Bipolar Disorder
This depends on which way your mood has swung. But children and teenagers with bipolar disorder are more likely to have temper tantrums, rapid mood changes, outbursts of aggression, explosive anger, and reckless behaviour.
The feeling of depression is something most people may experience from time to time. In clinical depression or bipolar disorder, the feeling of depression is much worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:
feelings of unhappiness that don't go away
feeling that you want to burst into tears for no reason
losing interest in things
being unable to enjoy things
feeling restless and agitated
believing to have committed a crime
feeling more irritable than usual
feeling useless, inadequate, ruined, hopeless and penniless
thinking of suicide
can’t think positively or hopefully
finding it hard to make even simple decisions
difficulty in concentrating
losing appetite and weight
difficulty in getting to sleep
waking earlier than usual
feeling utterly tired
going off sex
difficulty in starting or completing things, even everyday chores
crying a lot or feeling like you want to cry, but not being able to
avoiding contact with other people.
In this state, you will have an intense sense of well-being, energy and optimism. It can be so strong that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and occasionally dangerous ways. For instance, you may believe that you are famous or have high-ranking social connections, or that you have special powers.
Like depression, it can make it difficult or impossible to deal with day-to-day life. Mania can badly affect both your relationships and your work. When it isn't so extreme, it is called 'hypomania'. Hypomania describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.
If you become manic, you may notice that you are:
very happy and excited
irritated with other people who don't share your optimistic outlook
sudden change from being joyful to being irritable, angry, and hostile
feeling more important than usual
full of new and exciting ideas that are most times unrealistic
moving quickly from one idea to another
hearing voices that other people can't hear
full of energy
unable or unwilling to sleep
more interested in sex and unprotected sex
making plans that are grandiose and unrealistic
very active, moving around very quickly
talking very quickly - other people may find it hard to understand what you are talking about
making odd decisions on the spur of the moment, sometimes with disastrous consequences
recklessly spending your money
drug and alcohol abuse
over-familiar or recklessly critical with other people
less inhibited in general.
If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong, although your friends, family or colleagues will. You may even feel annoyed if someone tries to point this out to you. You increasingly lose touch with day-to-day issues and with other people's feelings.
If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.
Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid, or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?
The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behaviour.
Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive (unipolar) disorder or other psychiatric disorders that can involve changes in mood, thinking, and behaviour.
Other conditions that may occur with bipolar disorder are:
use of drugs or alcohol to cope with symptoms
post-traumatic stress disorder (PTSD)
attention-deficit hyperactivity disorder (ADHD)
A person is more likely to seek help during a time of depression than during a "high." The National Institute of Mental Health (NIMH) urge health care providers to look for signs of mania in the person's history, to prevent misdiagnosis.
Treatment aims to minimize the frequency of manic and depressive episodes, and to reduce the severity of symptoms to enable a relatively normal and productive life.
Left untreated, a bout of depression or mania can persist for up to 1 year. With treatment, improvements are possible within 3 to 4 months.
A combination of medication, therapy, lifestyle changes, and support from family, friends and peers help individuals with bipolar disorder to stabilize their mood and to live the lives they want. Finding the treatment plan that works best for a person is critical for recovery.
The person may continue to experience mood changes, but working closely with a doctor can reduce the severity and make the symptoms more manageable.
People who also have a substance abuse problem may need more specialized treatment.
Lifestyle and home remedies
You'll probably need to make lifestyle changes to stop cycles of behaviour that worsen your bipolar disorder. Healthy lifestyles changes can be an important part of overall recovery.
Here are some steps to take:
Quit drinking or using recreational drugs. Reduce consumption of alcohol, caffeine, and similar substances. Get help if you have trouble quitting on your own.
Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.
Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do.
Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder.
Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.
Coping and support
Coping with bipolar disorder can be challenging. Here are some strategies that can help:
Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. Help educate your family and friends about what you're going through.
Stay focused on your goals. Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences. Friends and family can also join support groups to better understand how to offer encouragement and support their loved ones.
Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.
There's no sure way to prevent bipolar disorder. Attempts at prevention of bipolar disorder have focused on stress which does place genetically and biologically vulnerable individuals at risk for a more severe course of illness. There has been debate regarding the causal relationship between usage of cannabis and bipolar disorder.
However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.
If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:
Pay attention to warning signs
Avoid drugs and alcohol
Take your medications exactly as directed
If you are thinking about harming yourself or thinking about suicide, tell someone who can help right away. Get medical help immediately. Keep the name of a trusted professional (and their telephone number) for any such emergency. A short admission to hospital may sometimes be needed.
Dealing with an emergency
In severe mania, a person can become hostile, suspicious and verbally or physically explosive.
In severe depression, a person may start to think of suicide.
If you find that they are:
seriously neglecting themselves by not eating or drinking
behaving in a way that places them, or others, at risk
talking of harming or killing themselves
What to do:
Do not leave him or her alone
Try to get him or her to seek immediate help from a doctor or the nearest hospital emergency room, or call your local emergency number
Remove access to firearms or other potential tools for suicide, including medications.