Bipolar disorder is a brain disorder that involves periods of depression followed by elevated moods or mania (in the absence of drugs or alcohol). Normal moods may be experienced between these mood shifts, which can be mild or severe and the changes may occur gradually or quickly. This illness is also known as manic depression and is a serious illness.
The mood swings that accompany bipolar disorder are unlike the typical ups and downs that people sometimes experience as a normal part of life. They are intense and can negatively impact the person being affected. These fluctuations in mood can be dramatic enough to lead to risky behaviour, damaged relationships and/or careers, the inability to function and may even lead to suicidal tendencies if it is not treated.
Bipolar disorder is a medical illness caused by a chemical imbalance in the brain. This illness is real; it is not just a thought or feeling that can be controlled by the person affected. It is not a sign of weakness or failure. Although it is not known exactly what causes this brain disorder, research suggests that a genetic predisposition is involved.
Both men and women appear to be affected equally by bipolar disorder. Approximately one per cent of the general population is at risk for cyclic bouts of depression and mania. Youth are at the highest risk for bipolar disorder, as the first episode often occurs between the ages of 15 to 25. Sometimes, however, the first episode may not occur until many years later. Unfortunately, this illness is often mistaken for teen angst, and can sometimes also be mistaken for schizophrenia if psychosis occurs, which may delay diagnosis and treatment. Early diagnosis and treatment is key to ensuring a full and faster recovery.
Symptoms of Mania or Manic Episodes
- Increased or excessive energy, activity, and restlessness, increased interest in activities
- Excessively high, overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Rapid, unpredictable emotional changes
- Distractibility, can’t concentrate well
- Reduced or no sleep needed
- Unrealistic beliefs in one’s abilities and powers, inflated self-esteem
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive, sexual indiscretions
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
- Overreaction to stimuli, misinterpretation of event
Mania can include different states, such as hypomania, severe mania or hyper-mania, and psychosis.
Hypomania is a mild to moderate level of mania, which may feel good to the person experiencing it as they may become highly functional and productive. People experiencing hypomania are often very pleasant to be around due to their positive mood, intense interest in other people and activities.Unable to recognize this positive mood as something to be concerned about, it is not uncommon for the person affected to deny anything is wrong. This can be dangerous however, as hypomania can develop into severe mania in or can just as easily switch into a severe depression.
Severe Mania or Hypermania
Hypermania exceeds the usual spectrum of a manic episode and can lead to paranoia, hyper-sexuality (resulting in sexual promiscuity and sexual risks), reckless behaviour, overspending
PSYCHOSIS, such as hallucinations (hearing, seeing, or sensing things that are not actually there) and delusions (false beliefs not influenced by logical reasoning or cultural concepts), may sometimes occur. Usually during psychosis, the person experiences a euphoric mood and the unrealistic sense of great self-importance or grandiosity.
Symptoms of Depression (with bipolar disorder)
- Sad mood
- Preoccupation with failures or inadequacies and a loss of self-esteem
- Feelings of uselessness, hopelessness, excessive guilt
- Slowed thinking, forgetfulness, difficulty in concentrating and in making decisions
- Loss of interest in work, hobbies, people
- Social isolation
- Changes in appetite or weight (eating too little or too much)
- Changes in sleep (sleeping too little or too much)
- Decreased sexual drive
- Suicidal thoughts
A depressive episode is diagnosed if five or more of the above symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
The depressive cycle experienced by someone with bipolar disorder is very similar to major depressive illness, however, people with bipolar disorder often feel more irritable than depressed. There is also a tendency towards too much sleep when in the depressed cycle, rather than insomnia, which is more typical of major depression. Weight gain is also more common to people with bipolar disorder as opposed to weight loss, which is fairly common among depressed people.
Depression or Bipolar Disorder?
Almost all patients with bipolar disorder experience long periods of depression. For this reason, some patients may initially be misdiagnosed with depression as these are the symptoms for which assistance is often sought first.
Below is a list adapated from an article provided by Drs. S Nassir Ghaemi (MD), James Y Ko (AB), and Frederick K. Goodwin (MD) providing 11 factors that may help to determine if your depression is really bipolar disorder*:
- You have had repeated episodes of major depression.
- Your first episode of major depression occurred before age 25.
- A first-degree relative has bipolar disorder.
- Your mood and energy levels seem unusually high when you are not depressed.
- You tend to oversleep and overeat when you are not depressed.
- Your depressive episodes do not usually exceed than 3 months.
- You have lost contact with reality while depressed.
- You have had postpartum depression before.
- You have experienced mania or hypomania while taking an antidepressant
- Your antidepressant stopped working after several months.
- You have not had success after having tried three or more antidepressants
Types of Bipolar Disorder
There are several types of bipolar disorder, which relate to how far a person’s mood swings between mania and depression.
This form of bipolar disorder is characterized by extreme mood swings between severe depression and severe mania. An untreated episode of mania can last from a few days to several years, however, symptoms usually continue for a few weeks to a few months. Depression may follow shortly after mania or it ay not appear for weeks or a few months.
Bipolar II is similar to bipolar 1, but with milder episodes of hypomania that alternate with depression over time. A person with bipolar II will have at least one hypomanic episode in life. Many people with this form of bipolar disorder live normal lives.
This type of bipolar disorder is characterized by mood swings that range between mild depression and mild mania.
Mixed Bipolar Disorder
In this case, both depression and mania are experienced at the same time so that feelings of grandiose, racing thoughts, and immense energy are mixed with irritability, anger, moodiness, and feeling bad at the same time.
With rapid cycling, at least four or more episodes are experienced within a 12-month period and may include mania, mild mania, mixed state or depression. Some people might experience more than one episode weekly or even daily. Women are more likely to experience rapid cycling than men. This pattern of rapid cycling increases the risk for severe depression and suicide.
Causes of Bipolar Disorder
Although it is not known exactly what causes this brain disorder, research suggests that a genetic predisposition is involved. Findings from gene research suggest that bipolar disorder may occur as a result of many genes acting together in combination with other factors of the person and/or of their environment. Stress, illness and hormones have all been linked to bipolar disorder.
Bipolar is found in all ages, races, ethnic groups and social classes, with an equal number of men and women being affected. According to the National Institute of Mental Health, if one parent has bipolar disorder, the likelihood of you developing this illness is 15 to 30 per cent. This risk increased to between 50 and 75 per cent when both parents have the illness. However, only a fraction of those individuals who are at genetic risk actually do acquire the illness. Also of interest is that 20 per cent of adolescents with major depression develop bipolar disorder within a five-year period of experiencing their first depressive episode.
Bipolar disorder usually treated with one or more medications and requires life-long treatment overseen by a psychiatrist skilled in treating this specific disorder. Even when feeling well, treatment should continue as a preventative measure. Many other specialists may involved be a part of the treatment team, such as a psychologist, a psychiatric nurse, and a social worker.