Bipolar disorder is a psychiatric illness characterized by unpredictable swings in mood. Changes in mood may vary from extreme elevation, of mood, and increased energy and activity (mania), to extreme lowering of mood and decreased energy and activity (depression), bipolar disorder can have effect on everyday activities and maintaining relationships.
Bipolar disorder is common, affecting anywhere from 0.5 per 1000 to 21 per 1000 Indians annually, and typically manifests between 20 and 30 years of age. Women have more depressive episodes and men have more manic episodes over a lifetime.
bipolar disorder is characterized by at least two episodes of mania or one episode of mania followed by one depressive episode.
A manic episode is defined by a distinct period of persistently elevated or irritable mood, lasting at least one week duration with symptoms such as:
A depressive episode is defined by the experience of following symptoms for at least 2 weeks including:
An untreated episode of mania can last from 2 weeks to 4-5 months, whereas an episode of untreated depression may last up to 6-8 months, and rarely up to a year.
An exact cause for bipolar disorder is still unknown. Several factors may be involved in the etiology, such as:
A person with a parent or sibling with bipolar disorder has 4 to 6 times higher risk of developing it, when compared to someone who doesn’t.
Loss or damage of brain cells, imbalances in neurotransmitters, mitochondrial disorders are all considered in the pathogenesis of bipolar disorder.
Bipolar disorder usually develops around the age of 25 years, or between 20 to 30 years of age. However, few show symptoms only after 40 years of age.
Bipolar disorder has been known to affect both sexes equally, however, women tend to have more depressive episodes and men have more manic episodes in their lifetime.
The thyroid hormones have an effect on brain functions as well as metabolism, growth and development. Abnormalities in the thyroid gland are associated with depression and bipolar disorder. Hypothyroidism, or reduced production of thyroid hormones is often diagnosed in such patients.
Bipolar disorder causes changes in mood and behaviour that significantly alters life on a day to day basis. Affected people show intense emotional changes.
Although bipolar disorder shows distinct symptoms, a single test does not confirm a diagnosis of bipolar disorder. Diagnosis is achieved by a combination of methods.
Before diagnosis, it may feel like something is not right and expressing yourself may be difficult. You may experience changes in mood and emotions. Feelings of hopelessness and despair can become intense. You may go from feeling full of energy one moment to feeling like your drowning in despair the next. Feeling low isn’t uncommon, and is faced by many people from time to time due to stress or other factors. But, variations in mood associated with bipolar disorder are usually more extreme. Your friends or family may also notice that something is wrong. Seek help if severe mood variations affect your daily activities or make you suicidal.
There aren’t any blood tests or brain scans that can diagnose bipolar disorder. Even then, a routine set of tests are done to rule out other causes such as hypothyroidism, substance abuse or side effects of any medicine.
Your treating psychiatrist or psychologist will ask you a series of questions to assess your overall mental health status. Evaluating bipolar disorder is done by asking about your symptoms- how long they last and how they affect your daily life. You will also be questioned on risk factors such as family history of similar illnesses and history of medication or substance abuse.
Bipolar disorder is known for its episodes of depression and mania. You will be asked about your feelings during and after such episodes. They will want to know if you feel helpless or in control during manic periods and how long they last.With your permission, they may speak to relatives and loved ones about your behavior and the changes they may have noticed for an accurate assessment. Diagnosis is made after considering all aspects of your medical history and medications you have taken in the past.
As an aid to accurate diagnosis, Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Mental & Behavioral Disorders (ICD) is used.
Diagnosing bipolar disorder in children
Bipolar disorder has also been known to affect children. Diagnosis in children is often difficult due to overlap of symptoms with Attention-Deficit and Hyperactivity Disorder (ADHD), which is a more common problem among children. If your child is not showing improvement of symptoms on treatment for Attention-Deficit and Hyperactivity Disorder, he or she may be suffering from bipolar disorder. The symptoms to look out for include:
The criteria to diagnose bipolar disorder in children is the same as for adults, and your doctor may ask you and your child a set of questions to ascertain the type and severity of symptoms.
Your doctor may also look for a family history of similar conditions and do a physical examination including blood tests to assess thyroid gland function.
Bipolar disorders include a spectrum of different types of disorders depending on the predominant symptoms.
This involves one or more manic episodes which may or may not be followed by a depressive episode.
Bipolar disorder type II is defined by one or more major depressive episodes followed by at least one hypomanic episode. Hypomania is defined by a milder form of mania.
Although it is less debilitating than Bipolar disorder I, it can cause significant distress at work or school and with relationships.
This is characterized by alternating mild depression and hypomanic episodes. The symptoms should be present for at least years for a diagnosis of cyclothymia.
Rapid cyclers suffer from a more severe form of bipolar disorder. It involves at least 4 episodes or major depression, mania, hypomania or mixed episodes within one year. Rapid cycling disorder is seen more commonly in women compared to men.
This category is for people with symptoms of bipolar disorder that do not fit into the above mentioned types. It is diagnosed when multiple symptoms of bipolar disorder are identified, but do not fit the criteria for any of the sub types. They include rapid mood changes that do not last enough to qualify for bipolar disorder episodes and those with multiple episodes of hypomania without major depressive periods.
An array of treatments are available for the management of bipolar disorder, usually involving a combination of psychotherapy, medications and lifestyle changes.
Medications for bipolar disorder, like all mental illnesses are available only as prescription-only drugs and must not be self-prescribed at any cost. Your treating doctor with adjust dosages and duration based on your symptoms and taper them accordingly.
Psychotherapy includes a combination of cognitive behavioral therapy, interpersonal and social rhythm therapy and psychoeducation:
This type of therapy is by communicating with your therapist, helping you to understand your thinking patterns, coming up coping strategies and ways to manage your condition.
Psychoeducation helps your loved ones and you to understand bipolar disorder and what it means to be diagnosed with it. Understanding your situation helps family and friends cope with it and manage it better.
Interpersonal and social rhythm therapy (IPSRT) helps by focusing on daily activities such as sleeping, exercising and eating. Effectively managing these activities help maintain a balance in your daily life and coping with bipolar disorder.
Other supplementary treatment options may be recommended to you such as:
Making changes in your daily activities are simple steps that will help you manage bipolar disorder such as:
Bipolar disorder is characterized by severe mood changes between both highs- being joyful and energetic and lows- being weary and uninterested.
Coping with these changes can be difficult with depressive episodes especially making it challenging to get through the day. Here are some suggestions to help improve your mood during a depressive phase.
1. Stick to a routine
Unhealthy eating and sleeping habits can make your symptoms worse and make coping with depression harder. Consider these healthy practises to inculcate in your daily life:
2. Give your day structure
Similar to eating and sleeping on schedule, scheduling other activities of your day also helps coping with bipolar disorder.
Creating lists of daily tasks and chores and ticking them off as you complete them, gives your day meaning and helps achieve a sense of satisfaction. You can use reminders, calendars or notes to keep track of your activities. Ensure you have made provisions for adequate breaks and periods of free time in between, so you do not get exhausted or frustrated. Always prioritize your medical appointments to help you get better sooner.
3. Stay active
Exercising has been shown to improve mood and alleviate symptoms of depression. Exercising for thirty to forty minutes for at least three to four times a week gives best results.
4. Fight the fear
When you are depressed, activities that you usually like to do, may seem too taxing or disinteresting, such as reading a book or meeting friends. Despite lack of motivation, try to participate in activities you usually like. This can actually help improve your mood. While you may fear that you may not enjoy the activities as much, do not let that stop you from trying them out, you will end up feeling better.
5. Don’t keep to yourself
Being depressed can make being in social situations seem overwhelming. It is important not to isolate yourself as being alone can aggravate symptoms of depression. Spend time in groups that share your interests or stay in touch with family and friends. Knowing you have the support of loved ones helps elevate your mood.
6. Find new ways to relieve stress
This may be the least of your interests when you are in a depressed mood. But engaging in new activities could help alleviate your symptoms. Activities that are known to calm your senses such as aromatherapy, getting a massage or even learning yoga may help being relaxed and happier.
7. Join support groups
Being around and talking to people with bipolar disorder will be reassuring and let you know you are not alone. Discussing your feelings during depressive episodes and listening to other coping methods can be both beneficial and therapeutic.
Living with bipolar disorder can put an enormous strain on your relationships, especially romantic relationships. Being honest and open about your condition is the best approach to managing your relationship. Whenever you are ready to open up about your illness, these facts will help them understand you better:
One of the best ways to make your relationships work is by adhering to your treatment and following your doctors advice. This helps in keeping your symptoms at bay, allowing you more time to focus on your relationships.
Bipolar disorder can be controlled and you can manage to have a functioning lifestyle even if there is no cure. Following a treatment plan and making modifications in your lifestyle can go a long way.
Unless severe depressive episodes requiring brief hospitalization occur, bipolar disorder can be managed by medication and therapy alone.
Getting over an episode may seem impossible and very hard, but remember that there are always ways to improve your mood and cope with your illness.
Don’t hesitate to call your therapist or loved ones when you need help.
Incase of suicidal thoughts that you are not able to fight or ignore, call your local suicide helpline number. Counselors are available 24/7 and are there to help.
what your personality used to be like according to the people around you. Tell your doctor how you feel you are different now, and how your symptoms are affecting your daily life. Also ensure that you have understood the different treatment options and what might be most suitable for you.
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