We have all heard about bipolar disorder, but do you know what it is? What are the causes? What are the symptoms? The purpose of this article is to give you a short overview of everything you need to know.

Overview

Bipolar disorder is a set of mood disorders in which patients suffer from episodes of depression and mania. It is a serious mental health condition that used to be known as manic depression.^1,2 Depressive episodes are characterized by low mood and lack of energy, while manic episodes are characterized by extreme happiness, irritability and restlessness. Bipolar disorder can profoundly impact the individual’s life, and affect their work, relationships, and general well-being.³

Causes of bipolar disorder

The exact cause of the disorder is still unknown, but it is believed to be a combination of environmental, neurological, and genetic factors. Researchers have shown that bipolar patients may have differences in brain structure and levels of neurotransmitters, such as norepinephrine and dopamine, which are known to play a role in regulating mood.² 

Bipolar disorder has a strong genetic component. Twin studies have revealed that the heritability of the disorder is between 60% to 80% and slightly lower estimates have been demonstrated in family studies.^5,6 However, it is rare for bipolar disorder to affect multiple family members. Most patients are isolated cases.⁷ It is critical to also note that no single gene has been identified as the sole cause of the disorder. 

Apart from genetic factors, various family-specific and individual-specific environmental and social factors might also play a role.⁸ Traumatic life events such as physical and sexual abuse, neglect, and the loss of a loved one can trigger or worsen the manifestation of the disorder in individuals with a genetic predisposition.⁹ Stress and use of alcohol and drugs can also worsen the symptoms of bipolar disorder. There is a 16% to 39% prevalence of post-traumatic stress disorder (PTSD) in patients with bipolar disorder.^10,11 However, over 50% of bipolar patients do not fulfill the PTSD criteria but have reported childhood trauma.¹² Childhood trauma causes biological and molecular modifications in individuals with bipolar disorder.¹³

Before birth, infections in the mother’s uterus can have an impact on the mental health of the child, and increase their vulnerability for bipolar disorder.^19,20,21 Furthermore, maternal smoking has been suggested to increase the risk of several mental illnesses,²² including bipolar disorder.^23,24  Interestingly, seasonal changes appear to affect the frequency of manic and depressive episodes, with mania often occurring during the spring and summer and depression peaking during the winter and spring.^25,26

Signs and symptoms of bipolar disorder

As previously mentioned, bipolar disorder is characterized by extreme mood swings ranging from manic to depressive episodes. Understanding the signs and symptoms of the disorder is critical for early diagnosis and subsequent treatment. 

Manic episodes are periods of elevated and irritable mood and energy levels. Common symptoms of a manic episode include:⁴

1. Decreased need for sleep
2. Increased energy
3. Racing thoughts
4. Easily distracted
5. Inflated self-esteem
6. Rapid speech
7. Excessive appetite
8. Reckless and impulsive behavior
9. Increased participation in activities that are pleasurable but have the potential for painful consequences

Depressive episodes are periods of persistent low mood and decreased energy levels. Common symptoms of a depressive episode include: 

1. Sadness, emptiness and hopelessness
2. Decreased energy
3. Fatigue
4. Lack of interest in activities
5. Alterations in appetite
6. Trouble waking up or falling asleep
7. Difficulty making decisions
8. Forgetfulness 
9. Suicidal thoughts

It is significant to note that not all individuals with bipolar disorder experience both types of episodes. Some experience more frequent and severe episodes than others and symptoms of episodes vary between individuals. Some people might also experience both depressive and manic symptoms within the same episode. Nevertheless, people can have milder symptoms. For instance, some individuals experience hypomania, which is a less serious mania form. In a hypomanic episode, an individual may feel able to get things done and that nothing is wrong, while their family members and friends might recognize the changes in the individual’s behavior. It is important to seek proper treatment for people with hypomania since, if left untreated, they can develop severe depression or mania.⁴

Management and treatment for bipolar disorder

Bipolar disorder can have a profound impact on a person’s life, relationships, and work. Although bipolar is a lifelong illness, with the appropriate treatment and support, a person with bipolar disorder can lead a fulfilling life. Long-term and appropriate treatment can help even the most severe bipolar disorder forms. This usually includes a combination of psychotherapy and medication.^4,

Psychotherapy, also known as talking therapy, uses a variety of techniques to help treat individuals with bipolar disorder. Its aim is to help the individual to identify and modify certain thoughts, emotions, and behaviors. It is a form of guidance and support for individuals with bipolar disorder as well as their families.^4, For instance, cognitive behavioural therapy (CBT) is an effective form of therapy for some symptoms of bipolar disorder, such as depression and insomnia. Moreover, there are specific therapies for bipolar disorder, such as interpersonal and social rhythm therapy (IPSRT), as well as family-focused therapy.^4,

Symptoms of bipolar disorder can also be managed by medication. Mood stabilizers, like lithium or valproate, and atypical antipsychotics are the most common medications prescribed by doctors. Mood stabilizers can help prevent or reduce the severity of episodes. Some treatment plans include medications that target anxiety and sleep. Antidepressant medications can trigger manic episodes and therefore they should not be taken alone, but in combination with mood stabilizers.⁴

Management of symptoms can be also done with lifestyle choices. Individuals must maintain a regular routine, follow a healthy diet, exercise regularly, and establish healthy sleep patterns without disruption. Supplements could also be used to help individuals develop these healthy habits.

FAQs

How is bipolar disorder diagnosed?

Proper diagnosis and treatment of bipolar disorder can help people live healthy lives. The first step is to talk to a mental health professional. They will take a comprehensive history of symptoms and experiences, family history, and medical background, including a mental health assessment to evaluate mood swings and symptoms. Bipolar disorder is then diagnosed into one of several typesusing the DSM-5 criteria.²⁹ 

A mental health professional may also complete a physical examination in order to rule out any otherconditions that could be causing symptoms. 

Overall, bipolar disorder is usually diagnosed based on the symptoms of the person, their medical history, family history, and experiences. Accurate diagnosis is especially critical in youth. Once a bipolar disorder diagnosis is received it is lifelong. People will always live with this condition. Note that it can be difficult to distinguish bipolar disorder from depression since people tend to seek help when they are in a low mood. Furthermore, there are many bipolar disorder subtypes, which can complicate diagnosis).^1,4,,27

How can I prevent bipolar disorder?

Bipolar disorder cannot be prevented, but you should seek treatment at the earliest sign possible so that the condition does not worsen. If diagnosed with bipolar disorder, there are some strategies to prevent symptoms from developing into full-blown depression and mania episodes. Initially, you should pay attention to any signs. If you have identified patterns in your behavior that trigger episodes, you should inform your loved ones about these patterns, so they are fully aware. If you think you are falling into an episode, call your doctor immediately. Cut drugs and alcohol as these substances can worsen your symptoms. Do not stop treatment at any time even if you want to. Stopping your medication may worsen your symptoms or trigger withdrawal.^,

Who is at risk of bipolar disorder?

There are some factors that may increase the probability of developing bipolar disorder:⁴

1. If you have a first-degree relative with bipolar disorder (parent, sibling)
2. Substance abuse (drugs and alcohol)
3. Highly-stressful life events. This may be a traumatic event such as the death of a loved one

How common is bipolar disorder?

Bipolar disorder is a common mental health condition. The World Health Organization (WHO) reported that 40 million people had bipolar disorder in 2019.²⁸ The condition is found in people of all ethnicities, sexes, and races and most often develops in late teens.²⁹

What are the types of bipolar disorder?

The American Psychiatric Association  divides bipolar disorder into four subtypes:²⁹

1. Bipolar disorder type I: General episodes of depression and at least one manic episode
2. Bipolar disorder type II: Serious protracted depressive episodes and at least one hypomanic episode
3. Cyclothymic disorder: Several periods of depressive and hypomanic symptoms that are not severe enough to be full depressive or manic episodes 
4. Bipolar disorder not otherwise specified: Hypomanic-like and depressive episodes that do not fall into any of the other subtypes

It is critical to note that the different subtypes may be similar in their symptomology and can be hard to differentiate.

When should I see a doctor?

Individuals with bipolar disorder often don’t recognize their extreme mood swings and how much this emotional instability affects their lives and relationships. Therefore, they don’t seek proper treatment. Moreover, some individuals enjoy the euphoric feelings, and may feel that they are more productive due to their symptoms. Nevertheless, these euphoric feelings are always accompanied by depressive episodes.

If you experience any manic or depressive symptoms, you should see a mental health professional or your doctor.. A bipolar disorder-experienced mental health professional can help you get the treatment you need.

Thoughts of suicide are common in people with bipolar disorder. If you have suicidal thoughts, you might need to get emergency help. You should call your local emergency number if you are at immediate risk of suicide or self-harming. If someone close to you is in immediate danger of suicide or self-harming, you should call your local emergency number and stay with that person until professional help arrives.

Summary

In conclusion, bipolar disorder is a mental health condition affecting millions of people. It involves episodes of both mania and depression which can impact the person’s life and well-being. The exact cause of the disorder is not known but it is thought to be a combination of genetic and environmental factors. 

Early diagnosis and proper treatment are significant in the management of symptoms. Treatment involves several strategies such as therapy, medication, and lifestyle changes. The individuals that are diagnosed should work closely with their mental health team to make an appropriate treatment plan that satisfies their needs. With the right support, individuals with bipolar disorder can lead fulfilling lives.