Bipolar disorder

Reviewed by Jessica Muñoz, Jessica Muñoz is a registered nurse and educator with 20 years of experience in critical care emergency nursing, specializing in patient care, education, and evidence-based practice. She holds multiple certifications and serves as a Patient Safety Coordinator.

Bipolar disorder, previously referred to as “manic depression,” is a mental health condition characterized by extreme mood swings, oscillating between emotional highs (mania or hypomania) and lows (depression).

During depressive episodes, individuals may endure feelings of sadness, hopelessness, and a waning interest or pleasure in daily activities. Conversely, during manic or hypomanic phases—less intense than full-blown mania—individuals may experience heightened energy, euphoria, or excessive irritability. These mood swings can disrupt energy levels, activity patterns, sleep, behavior, cognitive clarity, and judgment.

Episodes of mood changes may manifest multiple times within a year or infrequently. While most individuals experience some emotional symptoms between episodes, some may remain unaffected.

Despite being a lifelong condition without a definitive cure, bipolar disorder can be managed through adherence to a treatment regimen. Typically, treatment involves a combination of psychological counseling (psychotherapy) and medication.

Symptoms

Symptoms of bipolar and related disorders manifest in various forms, often leading to sudden shifts in mood and behavior, causing significant distress in the individual’s life.

• Bipolar I disorder is characterized by at least one manic episode, which may be followed by hypomanic or severely depressive episodes. In some cases, manic episodes can lead to a detachment from reality known as psychosis.

• Bipolar II disorder involves at least one major depressive episode and one hypomanic episode, without experiencing full-blown mania.

• Cyclothymic disorder entails experiencing hypomanic symptoms for at least two years, along with periods of depressive symptoms, though less severe than major depression, often occurring since childhood or adolescence.

• Additionally, there are other types of bipolar and related disorders caused by factors such as certain medications, alcohol, or underlying medical conditions like multiple sclerosis, stroke, or Cushing’s disease.

• It’s important to note that Bipolar II disorder is not merely a milder form of Bipolar I disorder but rather a distinct condition. While Bipolar I disorder may entail severe and potentially harmful manic episodes, Bipolar II disorder is often characterized by prolonged depressive episodes, leading to significant impairment.

Bipolar disorder can emerge at any age but is frequently diagnosed during adolescence or early adulthood. Symptoms vary from person to person and can evolve over time.

Causes

The precise origins of bipolar disorder remain elusive to scientists, although there is a prevailing belief that genetic inheritance plays a significant role. Bipolar disorder is widely acknowledged as one of the most hereditary psychiatric conditions, with over 60% of individuals affected having at least one close biological relative with the disorder. However, it’s crucial to note that having a family member with bipolar disorder does not guarantee its development in an individual.

In addition to genetic factors, other elements contribute to the onset of bipolar disorder. Changes in brain structure and function have been observed in individuals with the disorder, although diagnosis cannot solely rely on brain scans. Environmental factors such as trauma or stress, including major life events like serious illness, the loss of a loved one, financial setbacks, or divorce, can trigger manic or depressive episodes and may also influence the occurrence of bipolar disorder.

Presently, ongoing research endeavors aim to unravel the intricate interplay between various risk factors and bipolar disorder. Scientists seek to understand how these factors contribute to its onset, explore preventive measures, and advance treatment options for the condition.

Bipolar disorder and other conditions

Certain symptoms of bipolar disorder bear resemblance to various other medical conditions, posing challenges for healthcare providers in making accurate diagnoses. It’s not uncommon for individuals with bipolar disorder to also experience co-occurring mental health disorders or conditions, such as substance use disorder, anxiety disorder, or eating disorders. Additionally, individuals with bipolar disorder are at increased risk of developing physical ailments like heart disease, diabetes, thyroid disease, migraine headaches, and obesity.

Psychosis may occur during severe episodes of depression or mania, wherein individuals may experience delusions or hallucinations. These psychotic symptoms often reflect the extreme mood of the individual. For instance, during a manic episode, individuals may hold unrealistic beliefs of possessing immense wealth, fame, or extraordinary powers. Conversely, during a depressive episode, individuals may falsely believe they are financially ruined, helpless, have committed a crime, or may harbor unrecognized serious illnesses.

Due to the presence of multiple mental conditions, individuals with bipolar disorder who experience psychotic symptoms are sometimes misdiagnosed with schizophrenia. When individuals exhibit symptoms of bipolar disorder alongside separate periods of psychosis, they may be diagnosed with schizoaffective disorder.

Anxiety disorders are commonly associated with bipolar disorder, and individuals may also present with symptoms of attention-deficit hyperactivity disorder (ADHD). Moreover, individuals with bipolar disorder may be prone to substance misuse, engaging in high-risk activities during manic episodes due to impaired judgment. The detrimental effects of substance use can significantly impact not only the individual but also their family, friends, and healthcare providers, underscoring the importance of identifying and addressing coexisting mental health disorders.

Furthermore, individuals with bipolar disorder may also struggle with eating disorders, such as binge eating or bulimia, further complicating their overall mental health picture.

Prevention

Preventing bipolar disorder entirely is not feasible; however, timely intervention with proper treatment at the earliest signs of a mental health disorder can significantly mitigate the worsening of bipolar disorder or related mental health conditions.

For individuals diagnosed with bipolar disorder, adopting precautionary measures can help prevent minor symptoms from escalating into severe episodes of depression or mania. It’s crucial not to overlook warning signs and to address symptoms promptly to prevent episodes from becoming unmanageable. Recognizing patterns in bipolar episodes and identifying triggers can be beneficial. Seeking medical assistance promptly when experiencing symptoms of mania or depression is vital. Involving family members or friends to monitor for warning signs can provide additional support.

Avoiding alcohol and drug consumption is advisable as these substances can exacerbate symptoms and increase the risk of recurrence. Additionally, adhering strictly to medication regimens as prescribed is essential. Discontinuing medication or altering dosages without medical supervision can lead to the resurgence of symptoms, emphasizing the importance of consistent treatment adherence.

Diagnosis

Bipolar disorder is typically diagnosed by a mental health professional or psychiatrist through a comprehensive assessment. This evaluation involves reviewing the patient’s medical history and symptoms related to both depression and mania. Accurate diagnosis necessitates the expertise of a trained professional.

During a doctor’s visit, it’s advisable to bring along a spouse or close friend who may offer insights into the patient’s behavior that may not be readily apparent to the individual. Open communication with the doctor is crucial, especially if symptoms resemble those of bipolar I or bipolar II disorder. In such cases, the doctor may recommend a referral to a mental health specialist for further evaluation if symptoms are deemed serious.

The diagnostic process may also entail additional assessments, such as blood tests and a detailed physical examination. While there are no definitive markers for bipolar disorder in blood tests, these examinations aid in ruling out other potential causes for the disorder, contributing to a more accurate diagnosis.

Treatment

A psychiatrist, a medical doctor specialized in diagnosing and treating mental health conditions, particularly bipolar and related disorders, can provide optimal treatment for patients. Collaborating with a treatment team comprising a psychologist, a psychiatric nurse, and a social worker enhances the effectiveness of care.

Bipolar disorder is a lifelong condition, and treatment aims to prevent symptom exacerbation. Treatment options vary depending on the patient’s needs and may include:

1. Medications: Patients are prescribed medications to stabilize mood and behavior.
2. Continued treatment: Lifelong medication management is essential, even during periods of remission, to prevent symptom recurrence or escalation.
3. Day treatment programs: Day programs offer structured assistance and counseling to support recovery.
4. Substance abuse treatment: Individuals struggling with substance abuse require specialized treatment to effectively manage bipolar disorder.
5. Hospitalization: Hospitalization may be recommended for patients exhibiting dangerous behavior, psychosis, or suicidal ideation. Psychiatric treatment in a hospital setting helps stabilize mood and ensure safety.

Initial treatments for bipolar disorder may involve psychological counseling (psychotherapy), medication management, education, and participation in support groups to manage symptoms effectively.

Work cited

• Bipolar Disorder, 2022. MayoClinic.org. Bipolar disorder - Symptoms, and Causes - Mayo Clinic
• Bipolar Disorder, 2024. The National Institute of Mental Health. NIMH » Bipolar Disorder
• Bipolar Disorder, 2022. Clevelandclinic.org. Bipolar Disorder (Manic Depression): Symptoms & Treatment