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Bipolar Disorder:
Symptoms, Causes, Risk Factors, Diagnosis & Treatment

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1.What is bipolar disorder?

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.

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2.What are the symptoms of bipolar disorder?

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:

  • Inflated self-esteem or grandiosity
  • Reduced need for sleep
  • Pressure to keep talking
  • Flight of ideas or racing thoughts,
  • Easy distractibility
  • Increased goal directed activity or restlessness
  • Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

A depressive episode is defined by the experience of following symptoms for at least 2 weeks including:

  • A feeling of sadness or hopelessness
  • Loss of interest in almost all activities
  • Reduced energy levels or easy fatigability
  • Inability to concentrate
  • Reduced self esteem and self confidence
  • Sense of worthlessness or excessive guilt
  • Bleak or pessimistic views of future
  • Thoughts of suicide or attempting to end your life.
  • Either insomnia or sleeping too much
  • Decreased appetite

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.

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3.What are the causes for bipolar disorder?

An exact cause for bipolar disorder is still unknown. Several factors may be involved in the etiology, such as:

Genetic factors:

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.

Biological abnormalities of the brain:

Loss or damage of brain cells, imbalances in neurotransmitters, mitochondrial disorders are all considered in the pathogenesis of bipolar disorder.

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4.What are the risk factors involved in bipolar disorder?

Lifestyle risk factors:

  • Extreme stress
  • Physical or sexual abuse
  • Physical illness
  • Substance abuse
  • Death of a loved one
  • Excessive worry, about work or relationships

Age as a risk factor:

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.

Gender as a risk factor:

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.

Hormonal factors:

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.

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5.How is bipolar disorder diagnosed?

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.

Physical examination

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.

Mental health evaluation

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:

  • Emotional outbursts
  • Periods of being sad or upset
  • Hyperactivity
  • Aggressive behaviour
  • Impulsiveness
  • Irritability

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.

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6.What are the types of bipolar disorder?

Bipolar disorders include a spectrum of different types of disorders depending on the predominant symptoms.

Bipolar disorder type I:

This involves one or more manic episodes which may or may not be followed by a depressive episode.

Bipolar disorder type II:

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.

Cyclothymia

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 cycling bipolar disorder

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.

Not otherwise specified

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.

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7.How is bipolar disorder treated?

An array of treatments are available for the management of bipolar disorder, usually involving a combination of psychotherapy, medications and lifestyle changes.

Medical therapy:

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:

Psychotherapy includes a combination of cognitive behavioral therapy, interpersonal and social rhythm therapy and psychoeducation:

Cognitive behavior therapy

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

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

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 treatment options:

Other supplementary treatment options may be recommended to you such as:

  • Acupuncture
  • Electroconvulsive therapy

Lifestyle modifications:

Making changes in your daily activities are simple steps that will help you manage bipolar disorder such as:

  • Maintaining a routine for sleeping and eating
  • Recognizing mood swings
  • Asking a friend or relative for support on your treatment plans
  • Talking to a doctor or therapist

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8.Living with bipolar disorder

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:

  • Improve your diet by including more vegetables, pulses and fibres.
  • Eat at fixed times throughout the day, including fixed times for snacks and meals.
  • Try to get seven to nine hours of sleep every night.
  • Wake up and sleep at the same time everyday.

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.

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9.How does bipolar disorder affect family and relationships?

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:

  • How long you have been affected
  • What to expect during such episodes
  • How you usually cope with these episodes
  • How they can help you
  • 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.

    The bottom line

    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.

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10.Bipolar Disorder FAQs: All your concerns addressed.

Q.  What does bipolar mean?

  1. Bipolar means having or relating to two poles or extremes. Similarly, bipolar disorder is typically characterized by extreme variations in mood, namely depression or lows, and mania, or highs.

Q.  How is bipolar disorder different from depression?

  1. The major difference between clinical depression and bipolar disorder is the presence of manic or hypomanic (a milder form of mania) episodes. It is important to understand that the presence of a depressive episode is not enough to diagnose bipolar disorder. Even the history of one episode of mania is sufficient for a diagnosis of bipolar disorder in a depressed person.

Q.  How many types of Bipolar disorders are there and how do you characterize them?

  1. There are three main types of bipolar disorders namely:
    • Bipolar I
    • Bipolar II
    • Cyclothymia
    In Bipolar I, you experience one or more episodes of mania, with or without any occurrence of a depressive episode. The 2nd type, i.e., Bipolar II, includes multiple mania episodes alongside one or more episodes of depression. The person suffering from the third type, i.e., Cyclothymia shows a regular switching pattern between episodes of mild mania and mild depression, and the symptoms usually last for a year.

Q.  At what age is Bipolar disorder usually diagnosed?

  1. Generally, the first signs of bipolar disorder are seen in between the age group of 15 to 25 and can persist through a lifetime. Though in rare circumstances, doctors can diagnose symptoms of mania even in young children or in adults over the age of 65 years.

Q.  How to differentiate between the signs of Mania or Hypomania?

  1. When an individual suffers from a manic episode, they feel euphoric and irritable for at least a week. Some of the most common symptoms of a manic episode are:
    • Considerable boost in energy leading to restlessness
    • Unable to concentrate and thus easily distracted
    • Visible signs of Insomnia
    • Racing thoughts thus rapidly switching between ideas
    • Lack of judgment
    • Exhibits an aggressive behavior
    The symptoms of hypomania are similar to mania but are in general less severe and of shorter duration. If an individual suffers from hypomania, hospitalization isn’t required and there’s negligible functional impairment.

Q.  What Are the Signs of Depression?

  1. Usually, the onset of a depressive episode is characterized by an individual feeling low on energy, empty and hopeless about everything. Besides, he/she can also experience any of the following symptoms:
    • Feeling of guilt
    • Increased fatigue and tiredness
    • Loss of interest in activities he/she find pleasure into
    • Poor concentration affecting decision-making ability
    • Restlessness and irritability
    • Unintentional weight gain or weight loss
    • An abrupt change in appetite
    • Suicidal thoughts

Q.  If I am diagnosed with bipolar disorder, will I be on medication for the rest of my life?

  1. Not as a hard and fast rule. Duration of medication required, depends on multiple factors like severity of episodes, number and frequency of episodes, family history etc. Your individual requirement may be worked upon by you and your psychiatrist together.

Q.  Can someone have medical conditions that mimic symptoms of bipolar disorder?

  1. Many medical conditions can affect mood, mimicking bipolar disorders. It is important to rule out these conditions before making a diagnosis. They include:
  • Hypothyroidism. Thyroid dysfunction has been known to affect mood and can cause depressive episodes.
  • Brain tumours, especially ones that involve or compress the amygdala, which is the region of the brain that decides your mood, can cause similar symptoms.
  • Neurological infections such as Lyme disease, HIV or syphilis should be ruled out based on associated symptoms and signs.
  • Treatment history of a high dose of steroids, medications for tuberculosis or HIV, have been reported to affect mood.
  • Vitamin deficiencies, especially vitamin B12 can cause neurological deficits and affect mood.

Q.  Is there any difference between “Unipolar depression” and “Bipolar depression”?

  1. Individuals who encounter recurrent episodes of major depression are known to suffer from “Unipolar depression” (or clinical depression). In this state, people only experience frequent periods of low or depressed mood. When individuals who suffer from bipolar disorder go through low, depressed phases, they are said to experience “bipolar depression”.
    The symptoms in both the unipolar and bipolar depression are the same. However, the only difference is that an individual who has unipolar depression doesn’t experience the high periods of mania (if it’s severe) or hypomania (in case of mild). Understanding the same is important because depending on the severity of the symptoms, the treatment gets determined.

Q.  What do I need to tell my doctor about my illness?

  1. Before you visit your doctor, it may be advisable to first prepare a list of things that you would like to share to help him or her understand your condition better:
  • Write down the symptoms you have had
  • Write down key personal information about yourself
  • Make a list of medications you are on
  • Write down all the questions and queries you have
  • Take a friend or family member along with you.

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.

Q.  What’s the best diet plan I must follow if I’m suffering from bipolar disorder?

  1. If you’re suffering from bipolar disorder, you can benefit from eating plant-based foods such as fruits and vegetables, whole grains, nuts, etc. You must minimize salt and intake of processed foods like juices while should try including more high-fiber content in your diet. Including high-fiber content, fermented foods, yogurt, etc. helps in the growth of good bacteria within your body strengthening your immunity.

Q.  What treatment options work best to cure Bipolar Disorder?

  1. While there’s no exclusive cure available to treat bipolar disorder, there are certain steps you can undertake to ensure there’s a considerable improvement in your mental health. In general, treatment for bipolar disorder can include medication, therapy, or a combination of the two. Medications usually include mood stabilizers or antidepressants.
    The combination of psychotherapy (CBT) along with medication is also known to highly benefit the individuals who suffer from bipolar disorder and helps in preventing the relapse of stabilized cases.
    Apart from standard therapy, you can also rely on natural remedies like yoga, physical exercise, acupuncture, or supplementing your diet with omega-3 fatty acids food items to cure the disease.

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