Bipolar disorder: Symptoms, Causes, Treatment & Prevention

 

Bipolar disorder is a chronic mood disease that produces drastic changes in mood, energy, and behavior. The primary symptoms of bipolar disorder are manic and hypomanic episodes, and the majority of persons with the condition also experience depressed periods. Medications, talk therapy, lifestyle modifications, and other treatments can all help to manage the disease.

Bipolar disorder, formerly known as manic depression, is a mental health condition that produces severe mood swings. These include emotional highs (mania or hypomania) and lows (depression). Hypomania is less severe than mania.

When you are depressed, you may feel sad or hopeless and lose interest or enjoyment in most activities. When your mood changes to mania or hypomania, you may feel excited, full of energy, or excessively agitated. These mood swings can impair sleep, energy, activity, judgment, behavior, and the capacity to think clearly.

Mood fluctuations ranging from melancholy to mania might occur infrequently or frequently throughout the year. Each fight often lasts a few days. Some people experience extended periods of emotional stability between periods. Others may experience frequent mood fluctuations from depression to mania, or depression and mania concurrently.

Although bipolar disorder is a lifelong condition, you can control your mood swings and other symptoms by sticking to a treatment plan. Most healthcare professionals treat bipolar disorder with medications and talk therapy, commonly known as psychotherapy.

                  

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What is Bipolar Disorder?

Bipolar disorder (formerly known as manic-depressive disease or manic depression) is a lifelong mood disorder and mental health condition that causes extreme mood swings, energy levels, thought patterns, and behavior. These fluctuations might last hours, days, weeks, or months and interrupt your ability to complete day-to-day tasks.

There are a few types of bipolar disorder, each characterized by substantial mood fluctuations known as hypomanic/manic or depressed episodes. However, people with bipolar disorder are not invariably hypomanic/manic or depressed. They also have intervals of normal mood, termed as euthymia.

Symptoms:

There are numerous forms of bipolar and associated disorders:

• Bipolar I Disorder. You've had at least one manic episode, which may have preceded or followed a hypomanic or major depressive episode. Mania can sometimes lead to a loss of reality. This is known as psychosis.

• Bipolar II Disorder. You have experienced at least one major depressive episode and one hypomanic episode. But you have never experienced a manic episode.

• Cyclothymia. You've had at least two years — or one year in adolescents and teenagers — of frequent hypomania and depressed symptoms. These symptoms are not as severe as profound depression.

• Different types. These include bipolar and related diseases caused by medications or alcohol, as well as medical conditions such as Cushing's disease, multiple sclerosis, or stroke.

These include mania, hypomania (a milder form of mania), and depression. Symptoms might cause unpredictable changes in mood and behavior. This can create a great deal of distress and make your life difficult.

Bipolar II disorder is not a milder form of Bipolar I disorder. This is a different diagnosis. While manic episodes in bipolar I disease can be severe and hazardous, people with bipolar II disorder can be depressed for extended periods of time
Bipolar disorder can begin at any age; however, it is most commonly diagnosed in teens or early twenties. Symptoms differ from person to person and may change over time.

Mania and Hypomania:

Mania and hypomania are different, although their symptoms are the same. Mania is severer than hypomania. It leads to more visible troubles at the job, school, and social activities, as well as getting along with others. Mania can sometimes induce a detachment from reality, known as psychosis. You may need to stay in a hospital for treatment.

Manic and hypomanic episodes have three or more of the following symptoms:

• Being unusually lively, energetic, or agitated.

• Feeling a skewed feeling of well-being or overconfidence.

• I need far less sleep than usual.

• Being unusually talkative and speaking quickly.

• Having rapid thoughts or jumping from one subject to another.

• Being easily distracted.

Making bad choices. For instance, you might make stupid investments, go on shopping binges, or engage in risky sexual activity.

A major depression:

Severe symptoms that make it difficult to carry out daily tasks are indicative of a serious depressive episode. Going to work or school, participating in social activities, and getting along with people are some examples of these activities.

Five or more of these symptoms are present during an episode:

•  Being in a depressive mood.  You may feel sad, empty, hopeless, or emotional. 

•  Depressed children and adolescents may exhibit signs of hostility, rage, or irritation.

•  Experiencing a noticeable decline in interest or enjoyment in all or most activities.

•  Either overeating and gaining weight or losing a lot of weight without dieting. 

•  Children who don't grow as much as they should may be depressed.

•  Either too little or too much sleep.

•  Being agitated or behaving more slowly than normal.

•  Losing energy or feeling really exhausted.

• Experiencing feelings of worthlessness, excessive guilt, or unnecessary guilt.

• Unable to focus or think clearly, or struggling to make decisions.

• Suicidal thoughts, plans, or attempts.

Other features of bipolar disorder:

Bipolar disorder symptoms, including depressive episodes, might contain other features like:

• Anxiety symptoms and a sense of helplessness characterize anxious distress.

• Melancholy is characterized by extreme sadness and a profound lack of enjoyment.

• When your feelings or thoughts become detached from reality, you are in psychosis.

One way to characterize the onset of symptoms is:

• Mixed: when you simultaneously experience symptoms of mania or hypomania and depression.

• Rapid cycling occurs when you experience four mood swings in a year, alternating between significant depression, hypomania, and mania.

Symptoms in children and adolescents.

Bipolar disorders might be difficult to detect in children and teenagers. It might be difficult to determine if these symptoms are normal ups and downs, caused by stress or trauma, or symptoms of a mental health disease other than bipolar disorder.

Children and teenagers may experience unique, significant depressive, manic, or hypomanic episodes. However, the pattern can differ across persons with bipolar disorder. Moods might change quickly throughout episodes. Some youngsters may experience periods free of mood problems in between episodes.

The most visible indicators of bipolar disorders in children and teenagers may be significant mood swings that differ from their typical mood swings.

Causes:

While it is unknown what causes bipolar disorder, the following elements may be involved:

• Biological differences. People with bipolar disorder exhibit physical alterations in their brains. The significance of these changes is currently unknown, but additional research may help determine why they occur.

• Genetics. People with a first-degree relative, such as a brother or parent, are more likely to develop bipolar disorder. Researchers are searching for genes that may trigger bipolar disorder.

Risk Factors

 Factors that may increase the chance of developing bipolar disorder or trigger the first episode include:

•  Having a first-degree relative, such as a parent or brother, who has bipolar disorder.

•  Periods of high stress, such as the death of a loved one or another traumatic event

•  Drug or alcohol abuse.

Complications:

Left untreated, bipolar disorder can cause serious problems that influence every aspect of your life, including:

• Problems with drug and alcohol misuse.

• Suicide or suicide attempt.

• Legal or financial issues.

• Having trouble getting along with others.

• Poor work or school performance.

Conditions that occur simultaneously:

What appears to be bipolar disorder may instead be another disorder. Alternatively, the symptoms of bipolar disorder may overlap with those of other diseases, and you may have another medical condition that requires treatment in addition to bipolar disorder. Certain circumstances can exacerbate bipolar disorder symptoms or make treatment less effective.

Examples include:

• Anxiety disorders

• Eating disorders

• Attention-deficit hyperactivity disorder (ADHD)

• Post-traumatic stress disorder (PTSD)

• Alcohol or drug misuse

• Borderline personality characteristics or disorders

• Physical health problems include heart disease, thyroid issues, headaches, and obesity.

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, your healthcare provider may utilize numerous tools, such as:

• A physical examination.

• A complete medical history, which will include questions about your symptoms, life history, experiences, and family background.

• Medical procedures, such as blood testing, can help rule out other disorders that could be affecting your symptoms, such as hyperthyroidism.

• A mental health evaluation. Your healthcare provider may do the evaluation or refer you to a mental health professional, such as a psychologist or psychiatrist.

A bipolar disorder diagnosis requires at least one episode of mania or hypomania. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used by mental health professionals to determine the type of bipolar illness a person may be suffering from.

Your mental health practitioner evaluates the pattern of symptoms and the extent to which they interfere with your life during the most severe episodes to determine the type of bipolar disorder you have.

Individuals with bipolar disorder are more likely to have the following mental health conditions.

• Anxiety

• Attention-deficit and hyperactivity disorder (ADHD)

• Post-traumatic stress disorder (PTSD)

Substance use disorders and dual diagnosis.

Because of this, as well as the fact that memory is frequently affected during mania, causing people to forget what they experienced, it can be difficult for healthcare personnel to accurately diagnose bipolar disorder.

People with bipolar disease who are having a severe manic episode with hallucinations may be misdiagnosed with schizophrenia. Bipolar disorder can sometimes be misinterpreted as borderline personality disorder (BPD).

As a result, when speaking with your healthcare practitioner, you must be honest and detailed in expressing all of your symptoms and experiences. It can also be beneficial to include a loved one in your discussions with your physician, as they may be able to share extra information concerning your mental health.

Treatment:

How are bipolar disorders treated?

Treatment may help many people, including those suffering from the most severe types of bipolar disorders. A successful treatment plan typically includes a mix of the following therapies:

• Psychotherapy (or talk therapy).

• Medications.

• Self-management strategies include education and spotting early symptoms or potential causes of an episode.

• Exercise, yoga, and meditation are all good ways to live a healthier lifestyle. These can supplement, but not replace, treatment.

• Other therapies, such as electroconvulsive therapy (ECT), are used when medication is ineffective or when immediate symptom control is required to avoid injury.

Bipolar disorder is a lifelong condition, and thus treatment requires a lifetime commitment. It may take several months or years for you and your healthcare provider to develop a complete treatment plan that is appropriate for you. Although this may be frustrating, it is critical to continue treatment.

Mania and sadness episodes are usually recurrent. Many people with bipolar disorder do not experience mood swings between episodes, while some may continue to experience symptoms. Long-term, consistent treatment can help alleviate these symptoms.

Other mental health disorders, such as anxiety or ADHD, can make treating bipolar disorder more challenging. For example, antidepressants prescribed by healthcare professionals for obsessive-compulsive disorder (OCD) and stimulants prescribed for ADHD may exacerbate bipolar disorder symptoms and even cause a manic episode.

Again, treating these illnesses may be difficult, but it is not impossible. Stay committed to discovering a treatment plan that works for you.

What types of therapies are utilized to treat bipolar disorder?

 Psychotherapy, sometimes known as "talk therapy," can be a useful treatment option for persons with bipolar disorder.

 Psychotherapy refers to a set of techniques designed to assist you in identifying and changing troublesome emotions, thoughts, and behaviors.  Working with a mental health expert, such as a psychologist or psychiatrist, can offer you and your family support, education, and direction.

Therapy for bipolar disorder can take various forms, including:

• Psychoeducation is how mental health specialists teach people about their mental health issues.  Because bipolar illness is a complex condition, learning about it and how it affects your life can help you and your loved ones manage and cope with it more effectively.

• Interpersonal and social rhythm therapy (IPSRT): This therapy aims to improve your mood by understanding and utilizing your biological and social rhythms. IPSRT is a successful treatment for mood disorders, including bipolar disorder. It stresses approaches for improving medication adherence (taking your prescription regular), managing stressful life events, and reducing disturbances in social rhythms (daily changes in habitual behaviors). IPSRT teaches you how to protect yourself from future manic or depressed episodes.

• Family-focused therapy is intended for adults and children with bipolar disorder, as well as their caretakers. During this treatment, your loved ones will accompany you to sessions of psychoeducation about bipolar disorder, communication development training, and problem-solving skills training.

Cognitive behavioral therapy (CBT) is a systematic, goal-directed form of therapy. Your therapist or psychologist helps you become more aware of your thoughts and feelings. You'll begin understanding how your thoughts influence your behavior. CBT allows you to unlearn negative thoughts and actions while learning to acquire healthier thinking patterns and habits.

What medications are prescribed to treat bipolar disorder?

Certain medications can help manage the symptoms of bipolar disorders. Before determining which medication works best for you, you may need to test many different ones with the help of your doctor.

Healthcare practitioners typically prescribe the following medications to treat bipolar disorder:

• Mood stabilizers

• Second-generation ("atypical") neuroleptics (sometimes known as antipsychotics)

• Antidepressants

If you're on medication for bipolar disorder, you should:

•  Consult your healthcare provider about the medication's dangers, side effects, and advantages.

•  Inform your healthcare professional about any prescription pharmaceuticals, over-the-counter medications, or supplements you are currently using.
•  If you notice any concerning side effects, contact your healthcare practitioner straight away.  They may need to adjust your dosage or try another medicine.

•  Remember that bipolar dosorder medication must be used consistently and as prescribed.

• Mood stabilizers for Bipolar Disorder.

• People with bipolar disorder usually require mood-stabilizing medication for managing manic or hypomanic episodes.

Examples of mood stabilizers and their brand names are:

• Lithium (Eskalith®, Lithobid®, and Lithonate®).

• Depakene® (valproic acid).

• Divalproex sodium (depakote®).

• Carbamazepine (Tegretol®; Equetro®).

• Lamotrigine (Lamictal®).

Lithium is one of the most commonly prescribed and studied medications for bipolar disorder. Lithium is a natural salt that can reduce mania symptoms after two weeks of starting medication, but it may take weeks or months to properly manage the manic symptoms. As a result, healthcare providers frequently prescribe additional medications, such as antipsychotics or antidepressants, that help control symptoms.

Thyroid gland and kidney problems can occasionally arise while taking lithium; therefore, your healthcare provider will check the function of your thyroid and kidneys, as well as the levels of lithium in your blood, which can quickly get too high.

 Anything that reduces the amount of sodium in your body, such as switching to a low-sodium diet, excessive sweating, fever, vomiting, or diarrhea, might create a dangerous buildup of lithium in your body.  Be aware of these conditions and notify your doctor if you experience any while taking lithium.

 The following are symptoms of lithium toxicity (overdose).  If you get the following symptoms, call your doctor right away or go to the nearest emergency room:

• Blurred or double vision

• Irregular pulse

• Extremely rapid or slow heartbeat

• Difficulty breathing

• Confusion and dizziness

• Severe trembling or convulsions

• Passing a lot of pee

• Uncontrolled eye movements

• Unexpected bruising or bleeding

Neuroleptic treatments for bipolar disorder

For people with bipolar disorder, healthcare providers frequently prescribe second-generation or atypical neuroleptics (antipsychotics) in combination with a mood stabilizer. These drugs can help with both manic and depressive periods.

Only four of these drugs have been approved by the US Food and Drug Administration (FDA) to treat bipolar depression, including:

• Cariprazine (Vraylar®)

• Lurasidone (Latuda®)

• Olanzapine and fluoxetine in combination (Symbyax®)

• Seroquel® (Quetiapine)

Other drugs, including olanzapine (Zyprexa®), risperidone (Risperdal®), and aripiprazole (Abilify®), are also routinely recommended.

Antidepressants for Bipolar Disorder

Healthcare providers may prescribe antidepressant medicine to treat depressive episodes in bipolar disorder, mixing the antidepressant with a mood stabilizer to prevent provoking a manic episode.

Antidepressants are never used alone to treat bipolar disorder since they can produce a manic episode.

What are the various medical treatments for bipolar disorder?

Your healthcare professional may also examine the following therapy options for bipolar disorder:

• Electroconvulsive therapy (ECT): A brief delivery of an electric current to your brain via your scalp causes a seizure. It is most commonly used to treat patients with severe depression. ECT is an extremely safe and effective treatment for medication-resistant depression or acute life-threatening mania. It is the most effective treatment for mania if you are pregnant. ECT uses general anesthesia, so you will be asleep and pain-free throughout the operation.

• Transcranial magnetic stimulation (TMS): This therapy uses a small electromagnetic coil to deliver an electric current to your brain. Healthcare practitioners may use it to treat medication-resistant depression. It is an alternative to ECT. TMS is painless and does not require general anesthesia.

• Thyroid medications can sometimes function as mood stabilizers. Studies have demonstrated that treating females with difficult-to-treat, rapid-cycling bipolar disorders can help reduce symptoms.

• Ketamine treatment: Ketamine, an anesthetic administered in low doses via an IV, has been shown to produce short-term antidepressant and antisuicidal effects in patients with bipolar disorders.

• Hospitalization is considered an emergency treatment option for bipolar disorder. It becomes required when a person is having a severe depressive or manic episode and poses an urgent threat to themselves or others.

What lifestyle changes can help treat bipolar disorder?

Your healthcare team will most likely propose lifestyle adjustments to prevent patterns of behavior that exacerbate bipolar disorder symptoms. Some of these lifestyle modifications include:

• Quit drinking alcohol and/or using recreational drugs and tobacco: It is critical to stop drinking and using drugs, including tobacco, because they can interact with prescriptions you are taking. They can also exacerbate bipolar disorder and cause a mood episode.

• Keep a daily diary or mood chart: Tracking your daily thoughts, feelings, and actions can help you assess how well your treatment is working and/or discover potential triggers of manic or depressed episodes.

• Maintain a healthy sleep schedule: Bipolar disorder can have a significant impact on your sleeping patterns, and variations in sleep frequency can even set off an episode. Prioritize a consistent sleep schedule, which includes going to bed and waking up at the same times every day.

• Exercise: Exercise has been shown to boost mood and overall mental health, thus it may help you manage your bipolar disorder symptoms. Since weight gain is a major side effect of bipolar disorder drugs, exercise may also aid in weight management.

Meditation has been demonstrated to be useful in treating the depression that is associated with bipolar disorder.

Manage stress and maintain good relationships: Stress and anxiety may worsen mood symptoms in many persons with bipolar disorder. It is critical to manage your stress healthily and to strive to remove stressors when possible. A large part of this is keeping good relationships with supportive friends and family, as well as letting go of poisonous relationships with people who cause you stress.

What are the possible side effects of bipolar disorder medications?

Bipolar illness drugs frequently cause side effects, which vary by medication. It is critical to discuss with your healthcare professional what you can expect when taking certain medications. It is also critical to notify them if you are suffering from any side effects.

Never stop taking a medication unless your doctor instructs you to do so. Abruptly discontinuing medicine can result in significant side effects and provoke severe episodes.

The most common adverse effects of medications for bipolar disorder are:

• Weight gain.

• Metabolic dysregulation includes aberrant lipid levels (dyslipidemia), hypertension, and hyperglycemia.

• Drowsiness.

• Akathisia is defined as a state of restlessness and agitation accompanied by a strong need to move, rock, or pace.

Prevention:

 There is no certain strategy to prevent bipolar disorder.  However, seeking treatment as soon as you notice a mental health concern can help prevent bipolar disorder or other mental health issues from worsening.

 If you've been diagnosed with bipolar disorder, here are some methods to keep minor symptoms from escalating into full-blown episodes of mania or depression:

•  Pay heed to the warning indicators.  Talking to your care provider about your symptoms early on will help prevent episodes from worsening.  You may have seen a pattern in your bipolar episodes and what causes them.  If you believe you are experiencing depression or mania, contact your doctor or a mental health expert.  Ask your family or friends to keep an eye out for warning signs.

• Get enough sleep. Sleep disruption is a common cause of bipolar instability.

• Stay away from drugs and alcohol. Drinking or using illegal drugs can exacerbate your symptoms and make them more likely to return.

• Take the medicines as instructed. You may be tempted to stop treatment, but do not. Stopping your medication or reducing your dose on your own may result in withdrawal symptoms. Additionally, your symptoms may worsen or return.

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