Bipolar Disorder: Understanding the Signs, Causes, and Effective Treatments
Introduction
Bipolar disorder, formerly known as manic depression, is a complex mental health condition, characterised often by episodic mood swings between emotional highs (mania, or hypomania) and lows (depressive episodes) which can disrupt daily functioning.
These shifts in mood can significantly impact energy levels, behaviour, and the ability to carry out daily tasks (thereby, one’s quality of life).
However, with proper diagnosis, treatment, and support, individuals with bipolar disorder can lead fulfilling lives.
This article explores what bipolar disorder is, its symptoms, potential causes, and effective treatments to help individuals and their families better understand and manage this condition.
What is Bipolar Disorder?
Bipolar disorder is an umbrella term for a group of mental health conditions which can be characterised by periodic, significant changes in mood and energy levels, alongside changes in behaviour. These changes go beyond normal behavioural and/or mood fluctuations and can often interfere with daily functioning.
Bipolar disorder can be categorised broadly into three primary types:
- Bipolar I Disorder is characterised by extreme mood swings and thus least one manic episode lasting seven days or requiring hospitalisation/psychiatric treatment. In Bipolar I, depressive episodes are also common but not mandatory for diagnosis.
- Bipolar II Disorder is characterised with recurring depressive episodes alternating with hypomanic episodes, which are less severe than full-blown mania. Although in bipolar II, hypomania is less severe, depressive episodes can lead to significant impairment.
- Cyclothymia (Cyclothymic Disorder): A milder form with alternating periods of hypomanic and depressive symptoms lasting at least two years, although in cyclothymia, symptoms may not meet the full criteria for bipolar episodes.
Although symptoms may not meet the full criteria for full-blown manic or depressive episodes, cyclothymia can still impact emotional stability.
Signs and Symptoms of Bipolar:
Symptoms of Mania:
- Decreased need for sleep
- Elevated mood, excessive energy, or agitation
- Euphoria or extreme irritability
- Inflated self-esteem or grandiosity
- Impulsive behaviors, such as overspending or risky activities
- Rapid speech or racing thoughts
Symptoms of Depression:
- Persistent sadness or hopelessness
- Feelings of guilt or worthlessness
- Fatigue or low energy
- Difficulty concentrating or making decisions
- Changes in appetite (overeating/undereating) or weight (significant weight gain/loss)
- Sleep disturbances (insomnia or excessive sleep)
- Thoughts of death or suicide
The intensity and duration of these symptoms can vary, making diagnosis challenging without professional assessment.
What Causes Bipolar Disorder?
Although the exact cause of bipolar disorder is unknown, researchers believe a combination of biological, genetic, and environmental factors contribute to bipolar disorder.
- Biological Factors:
Neurochemical imbalances in brain chemicals like serotonin, dopamine, and norepinephrine can lead to mood dysregulation and cause manic, depressive and/or mixed episodes. - Genetic Factors:
A family history of bipolar disorder increases the likelihood of developing the condition, suggesting a hereditary link. - Environmental Triggers:
Stressful life events, trauma, or major life changes can trigger episodes in susceptible individuals. These external factors may not cause the disorder but can exacerbate symptoms.
Effective Treatments for Bipolar Disorder:
Managing bipolar disorder involves a combination of medication, psychotherapy, and lifestyle adjustments.
- Medication
Medications are a cornerstone of bipolar treatment in stabilising mood, reducing symptom severity and preventing the emergence of manic/hypomanic and depressive episodes.
The specific medications an individual with bipolar disorder may be prescribed are individually tailored to them based on the type and severity of symptoms they experience, in addition to their individual tolerability of the medications used.
Common medications for bipolar disorder include:
- Mood stabilisers: Mood stabilisers are a group of medications whose overall effect is stabilising mood, in individuals prescribed them, from pronounced ‘highs’ (manic, or hypomanic episodes/symptoms) on one hand and depressive ‘lows’ on the other. Commonly, lithium and/or anticonvulsants are prescribed as mood stabilisers to manage bipolar disorder symptoms, although some antipsychotics (notably, aripiprazole and quetiapine) have mood-stabilising effects alongside their antipsychotic effect.
- Lithium is one of the oldest and most effective treatments for bipolar disorder, in particular the treatment of manic (or hypomanic) episodes and maintaining remission (symptom-free periods of time, where the individual experiences no manic or depressive episodes).
In addition, anticonvulsants such as carbamazepine (Tegretol), sodium valproate or lamotrigine (Lamictal) have also been found effective in treating mood fluctuations; carbamazepine and sodium valproate are often prescribed for rapid cycling bipolar disorder, in which manic/hypomanic and depressive symptoms rapidly alternate, in addition to mixed episodes, where manic symptoms coexist with depressive symptoms, or where individuals are lithium-resistant.
- Antipsychotics: Antipsychotic medicines such as aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal) or olanzapine (Zyprexa) are used in bipolar disorder to treat severe mania or depression. Aripiprazole and olanzapine are both approved for the long-term maintenance therapy, or stabilisation of bipolar disorder, either by themselves or in conjunction with lithium/an anticonvulsant. Aripiprazole and risperidone are particularly effective for the treatment of acute mania, whereas quetiapine is utilised particularly in the treatment of bipolar depression.
- Antipsychotics are also beneficial for those who do not respond well to the use of a mood stabilising medicine alone.
- Antidepressants: These medicines include the classic class of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), alongside serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor XR).
- Antidepressants are often utilised in treatment of bipolar depression (depressive episodes which a person with bipolar may experience). However, antidepressants should be prescribed with caution, and it is recommended that antidepressants are co-prescribed with mood stabilisers to individuals with bipolar depression in order to avoid triggering manic episodes.
- Psychotherapy
Therapy is an essential component of treatment, supporting patients to develop coping strategies and improve emotional regulation.
- Cognitive Behavioral Therapy (CBT): Focuses on helping the individual to recognise and understand patterns of unhelpful thoughts and behaviours.
CBT supports you to explore your thoughts, challenge self-limiting or unhelpful thoughts and beliefs, and develop more positive, balanced ways of thinking.
- Family-Focused Therapy (FFT): Aims to involve family members alongside the individual with bipolar disorder themselves within the therapy environment, in order to enhance communication and create a supportive environment for the individual. FFT thus aims to improve communication between the individual and their family members, in addition to fostering understanding and problem-solving skills within the family unit, promoting a more supportive, understanding environment.
- By educating family members about bipolar disorder, FFT helps families to recognise early warning signs of mood episodes, promote treatment adherence, and reduce stressors that may trigger symptoms, ultimately improving long-term outcomes and strengthening relationships.
- Lifestyle Modifications
Self-care practices complement medical treatments and reduce the risk of episodes:
- Regular Exercise: Physical activity, such as moderate-intensity exercise (e.g., cardio, lifting weights) reduces stress and stabilises mood.
- Balanced Diet: Nutrient-rich foods such as fish and other seafoods, legumes, nuts, cheese, eggs and lean meat can support brain function by facilitating biosynthesis of neurotransmitters (from the amino acids found in high-protein foods) and thereby promote overall good mental health.
- Consistent Sleep Patterns: Maintaining a regular sleep schedule can help to regulate mood, particularly as sleep deprivation itself can precipitate mood episodes in bipolar disorder.
Bipolar Management: Living with Bipolar Disorder
Managing bipolar disorder requires ongoing effort and support. Effective strategies include:
- Identifying Triggers: Recognise stressors, alongside early warning signs of mood episodes.
- Building a Support System: Stay connected with family, friends, or support groups.
- Practicing Stress Management Techniques: Mindfulness, meditation, and relaxation exercises can improve emotional stability.
When to Seek Help
It’s important to seek professional assistance if you or a loved one experiences:
- Severe mood swings that disrupt daily life
- Difficulty maintaining relationships or responsibilities
- Suicidal thoughts or behaviours
Mental health professionals, such as psychotherapists and psychiatrists, can help provide the necessary diagnosis, treatment, and support for effective management.
Bipolar disorder is a treatable condition, and with the right combination of medication, therapy, and lifestyle adjustments, individuals can lead balanced, productive lives.
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