Bipolar disorder is a mental health condition categorized under the range of mood disorders. Mood disorders are also interchangeably used as affective disorders. A state where the person experiences episodes of mania as well as depression, known as a bipolar mood disorder.
Before we understand bipolar disorder, let’s start with understanding the terms used to describe the bipolar disorder.
What is Bipolar Disorder
Affect refers to the pattern of observable behaviors, such as facial expressions, that are associated with these subjective feelings. People also express affect through the pitch of their voices and with their hand and body movements.
Mood refers to a pervasive and sustained emotional response that, in its extreme form, can color the person’s perception of the world (APA, 2000).
Depression can refer either to a mood or to a clinical state, a combination of emotional, cognitive, and behavioral symptoms. The feelings associated with a depressed mood often include disappointment and despair. Although sadness is a universal experience, profound depression is not. No one has been able to identify the exact point at which “feeling down or blue” crosses a line and becomes depression. One experience shades gradually into the next.
Mania, the flip side of depression, also involves a disturbance in mood that is accompanied by additional symptoms. Euphoria, or elated mood, is the opposite emotional state from a depressed mood. It is characterized by an exaggerated feeling of physical and emotional well-being (APA, 2000).
Symptoms of Bipolar Disorder
Although mood disorders have some symptoms in common, they are very different in terms of their prevalence and causes. Major depressive disorder, also called unipolar depression, is one of the most common of these disorders, whereas bipolar disorder (also known as manic-depression) is less prevalent (Rosenhan, D. L., & Seligman, M. E. 1989)
Depressive episode symptoms
- Emotional symptoms: overwhelming, suffocating, or numbing.
- Bodily symptoms: fatigue, loss of energy, difficulty in sleeping, and changes in appetite.
- Cognitive symptoms: extreme guilt, feelings of worthlessness, concentration problems, and thoughts of suicide.
- Behavioral symptoms: fidgeting to extreme inactivity.
Manic episode symptoms
- Elated mood: self-esteem
- Decreased need for sleep
- Pressure to keep talking
- Subjective feelings or thoughts racing through the person’s head faster than they can be spoken
Diagnosis of Bipolar Disorder
As stated in the Diagnostic And Statistical Manual Of Mental Disorders (DSM 5), the mood disturbance must be severe enough to interfere with occupational or social functioning for it to be diagnosed. A person who has experienced at least one manic episode would be assigned a diagnosis of bipolar I disorder.
The vast majority of patients with this disorder have episodes of major depression in addition to manic episodes. A person who has experienced at least one major depressive episode, at least one hypomanic episode, and no full-blown manic episodes would be assigned a diagnosis of bipolar II disorder.
Causes of Bipolar Disorder
For most mental illnesses, the etiology (cause) is broadly categorized under two heads: Nature and Nurture. This is also interchangeably used as Biological and Environmental.
Environmental causes of bipolar
- Stressful life events
- Loss of job
- Parental neglect
- Death of a loved one
- Abuse (verbal, sexual, physical)
Biological causes of bipolar
- Psychotherapy: Cognitive Behavior Therapy (CBT): It is believed that CBT can improve emotions in depressed patients by changing both cognitions (thoughts) and behaviors, which in return enhances mood. Common cognitive interventions with CBT include thought monitoring and recording, identifying cognitive errors, examining evidence supporting/negating cognitions, and creating rational alternatives to maladaptive thought patterns. CBT is a commonly used technique by therapists and can also be practiced online. Some of the best online therapy apps available today also adopt this technique.
- Genetics: If there is a genetic predisposition to developing depressive disorders, one would expect a higher rate of depression within families than that of the general population. Research supports this with regard to depressive disorders, as there is nearly a 30% increase in relatives diagnosed with depression compared to 10% of the general population (Levinson & Nichols, 2014). Similarly, there is an elevated prevalence among first-degree relatives for both Bipolar I and Bipolar II disorders as well.
- Biochemical: As you will read in the treatment section, there is strong evidence of a biochemical deficit in depression and bipolar disorders. More specifically, low activity levels of norepinephrine and serotonin have long been documented as contributing factors to developing depressive disorders.
- Endocrine system. As you may know, the endocrine system is a collection of glands responsible for regulating hormones, metabolism, growth and development, sleep, and mood, among other things. Some research has implicated hormones, particularly cortisol, a hormone released as a stress response, in the development of depression (Owens et al., 2014). Additionally, melatonin, a hormone released when it is dark outside to assist with the transition to sleep, may also be related to depressive symptoms, particularly during the winter months.
- Brain anatomy: Neurotransmitters have been implicated in the development of depressive disorders, so it should not be a surprise that various brain structures have also been identified as contributors to mood disorders. While exact anatomy and pathways are yet to be determined, research studies implicate the prefrontal cortex, the hippocampus, and the amygdala.
Treatment of Bipolar Disorder
Several ways, both psychosocial and biological, have proved to be useful in the treatment of mood disorders. The following pointers will throw some light on the prominent approaches to the treatment of bipolar mood disorders.
- Psychopharmacology—Antidepressant medications. Antidepressants are often the most common first-line attempt at treatment for major depressive disorder for a few reasons. Oftentimes an individual will present symptoms to their primary caregiver (a medical doctor), who will prescribe them some line of antidepressant medication.
- Psychopharmacology—Selective serotonin reuptake inhibitors (SSRIs). SSRIs are among the most common medications used to treat depression due to their relatively benign side effects. Additionally, the required dose to reach therapeutic levels is low compared to the other medication options.
- Tricyclic antidepressants are similar to SSRIs in that they work by affecting brain chemistry and altering the number of neurotransmitters available for neurons. More specifically, they block the absorption or reuptake of serotonin and norepinephrine, thus increasing their availability for postsynaptic neurons.
- Interpersonal Therapy (IPT): The idea behind IPT is that depressive episodes compromise interpersonal functioning, which makes it difficult to manage stressful life events. The basic mechanism of IPT is to establish effective strategies to manage interpersonal issues, which in return, will ameliorate depressive symptoms.
- Psychological treatment: Although psychopharmacology is the first and most widely used treatment for bipolar disorders, occasionally, psychological interventions are also paired with medication, as psychotherapy alone is not a sufficient treatment option. The majority of psychological interventions are aimed at medication adherence, as many bipolar patients stop taking their mood stabilizers when they “feel better.” Social skills training and problem-solving skills are also helpful techniques to address in the therapeutic setting, as individuals with bipolar disorder often struggle in this area.
Bipolar is can be misdiagnosed since the shift between the episode of mania and depression are extreme opposite and may lead to people misperceiving either of the present episodes as normal. However, it is significant to notice that there is always a pattern to these episodes, and during both episodes, the functionality is compromised in its unique ways.
If you are living with someone having symptoms of bipolar, experiencing it your own self, know that there is always help available to provide you with psycho-education and diagnose it. The symptoms of it can be controlled through medications, and therapy helps rebuild a sense of agency and emotional regulation. One doesn’t have to go through it alone.