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What is Bipolar Disorder?

Bipolar disorder is a common but often misunderstood mental health condition marked by dramatic shifts in mood, energy, and activity levels, making daily life challenging. However, with the proper treatment and support, many individuals with bipolar disorder lead productive and fulfilling lives. This article explores the various types of bipolar disorder, their symptoms, and effective management strategies.

Understanding Bipolar Disorder

Bipolar disorder encompasses a spectrum of mental health conditions characterized by extreme mood swings, fluctuations in energy levels, and varying degrees of functional ability. These mood swings, called mood episodes, can persist from days to weeks. Manic or hypomanic episodes feature intense happiness or irritability, while depressive episodes are marked by profound sadness or a loss of joy.

In the United States, bipolar disorder is more common than many realize, affecting about 1 in 40 adults and approximately 1% of American teenagers [17]. Unlike some other mental health conditions, bipolar disorder affects both men and women equally [17].

There are three main types of bipolar disorder:

Bipolar I Disorder

Bipolar I disorder is characterized by at least one manic episode, which involves a period of abnormally elevated, expansive, or irritable mood lasting at least one week or requiring hospitalization [7, 16]. Depressive episodes are also common but not required for diagnosis. People with Bipolar I experience extreme mood swings, including full-blown manic and severe depressive episodes [19]. This disorder typically begins in late adolescence or early adulthood, with symptoms usually appearing between 20 and 29 [19].

Bipolar II Disorder

Bipolar II disorder involves at least one hypomanic episode (a period of elevated mood that is less severe than mania) and at least one major depressive episode [12]. Individuals diagnosed with Bipolar II undergo major depressive episodes and hypomanic episodes, however, they don’t experience full-blown mania [19]. Bipolar II is marked by more extended periods of depression, which can be very debilitating and often includes seasonal mood changes [19].

Cyclothymic Disorder

Characterized by frequent mood swings that alternate between mild depression and hypomania without reaching the severity of major depressive or manic episodes. This condition often begins early in life, frequently before age 10, and involves short periods of normal mood. People with cyclothymic disorder typically have relatives with bipolar disorder and respond to similar treatments [19].

Some people may have symptoms of bipolar disorder that don’t fit neatly into the main categories. These are known as other specified and unspecified bipolar and related disorders, and they still present significant challenges.

Understanding its different forms and symptoms is crucial for effectively managing the condition. Early diagnosis and comprehensive treatment plans are essential to enhance quality of life and minimize the impact of bipolar disorder on daily functioning.

What Causes Bipolar Disorder?

Bipolar disorder is a complex condition with no known single cause, but research suggests that several factors, or a combination of factors, may contribute to its development, including:

Genetic and Family Influences [15, 18]

Studies have shown that specific genetic factors are associated with an increased risk of developing bipolar disorder. Individuals who develop bipolar disorder are more likely to have family members with similar symptoms. While genetics may play a role, environmental and social factors within the family dynamic are also thought to influence the development of the disorder.

Environmental Stressors and Childhood Trauma [15, 18]

Life experiences and environmental factors significantly contribute to the development of bipolar disorder. Adverse childhood experiences, such as emotional abuse, neglect, or traumatic events, increase the likelihood of developing the condition. Additionally, significant life events like childbirth, divorce, unemployment, disability, and early parental loss are associated with higher risks of bipolar disorder. Many adults with bipolar disorder report experiencing stressful life events before a manic or depressive episode.

Brain Chemistry [15, 18]

The causes of bipolar disorder are thought to involve imbalances in brain chemicals that regulate mood, such as dopamine and serotonin. While specific dysfunctions in these neurotransmitter systems have not been identified, research suggests that their imbalances may contribute to the development of the disorder.

Stressful Life Events [18]

Stressful experiences or situations, such as relationship breakdowns, financial worries, trauma, or isolation, can trigger the onset of bipolar symptoms or intensify existing symptoms.

Medication, Drugs, and Alcohol [18]

Certain medications, alcohol, and recreational drugs can induce bipolar symptoms. Some medicines can cause mania or depression as side effects, while substance use can mimic the symptoms of bipolar disorder. If you have concerns about the potential impact of medication, alcohol, or recreational drugs on your mental health, it’s important to discuss them with your doctor to ensure proper management and treatment.

Related: What Causes Mental Illness?

Symptoms of Bipolar Disorder

Understanding the bipolar disorder symptoms is essential for recognizing and managing the condition. Here are the key signs to look out for during manic and depressive episodes:

Manic Episode Symptoms

During manic episodes, symptoms may include [4]:

  • Feeling extremely happy, euphoric, or “up.”
  • Increased energy and activity levels
  • Racing thoughts and rapid speech
  • Impulsive or reckless behavior
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep

Depressive Episode Symptoms

During depressive episodes, symptoms may include [4, 20]:

  • Feeling sad, hopeless, or empty
  • Loss of interest in activities once enjoyed
  • Fatigue and lack of energy
  • Difficulty concentrating
  • Changes in sleep and appetite
  • Thoughts of death or suicide

Mixed Features:

Some people may experience both manic and depressive symptoms together in what is called a “mixed episode.” [20]. This can include the presence of depressive features during a manic episode or manic features during a depressive episode. Symptoms such as insomnia, agitation, appetite changes, psychotic features, and severe symptoms such as suicidal ideation are highlighted in these cases [10].

Bipolar Disorder Diagnosis

Diagnosis is typically made by mental health professionals, like psychiatrists or psychologists, through a comprehensive evaluation of an individual’s symptoms, history, and functioning, as well as ruling out other potential causes [20]. While a physical examination and lab tests cannot confirm bipolar disorder, they are essential for ruling out other conditions that might mimic its symptoms, such as thyroid disorders [10].

Family history is another crucial factor, as 80% to 90% of bipolar patients report having relatives with mood disorders, indicating a strong genetic component [10]. A detailed family history can provide valuable insights, especially if there are family members with undiagnosed bipolar disorder who exhibit similar symptoms [10].

A bipolar disorder diagnosis is based on the presence of distinct manic or hypomanic episodes in addition to depressive episodes. Certain behaviors associated with bipolar disorder, such as instability in family relationships, frequent job changes, financial difficulties, and impulsive or reckless actions, can also help establish the diagnosis [10].

Diagnostic Criteria for Bipolar Disorder

Mental health professionals rely on specific criteria to diagnose different types of bipolar disorder:

Bipolar I Disorder [9, 3]:

  • Presence of at least one manic episode lasting at least seven days or requiring hospitalization
  • Manic episodes involve abnormally elevated, expansive, or irritable moods and increased energy/activity levels that significantly impair functioning.
  • May also experience major depressive episodes

Bipolar II Disorder [3, 9]:

  • Presence of at least one hypomanic episode (less severe than mania) lasting at least four days.
  • Hypomanic episodes involve elevated mood, increased energy/activity, and impaired functioning, but not to the extent of mania.
  • Must also have at least one major depressive episode.

Cyclothymic Disorder [21]:

  • Chronic, fluctuating hypomanic and depressive symptoms for at least two years.
  • Symptoms are present on more days than not, with no more than two months of neutral mood.
  • Hypomanic and depressive symptoms do not meet the full criteria for manic, hypomanic, or major depressive episodes.
  • Mood disturbances are less severe than in bipolar disorder.

General Diagnostic Guidelines

In addition to the specific criteria for different types of bipolar disorder, there are general guidelines that health professionals follow:

  1. The presence of distinct periods of elevated mood (mania or hypomania) and periods of depressed mood, with intervening periods of normal mood [4]. These mood episodes must be a clear change from the person’s normal behavior and functioning.
  2. The mood episodes must cause significant distress or impairment in social, occupational, or other important areas of functioning [3, 20].
  3. The symptoms cannot be better explained by another medical condition, substance use, or medication [20]].
  4. The type of bipolar disorder (I, II, or cyclothymic) is determined by the severity and duration of the mood episodes [5].

Bipolar disorder is often diagnosed during late adolescence or early adulthood. In some cases, bipolar symptoms can appear in children. Although symptoms may vary over time, bipolar disorder usually requires ongoing treatment [20].

Comorbid Conditions

Patients with Bipolar Disorder often have other mental health conditions in addition to bipolar disorder; when someone has more than one condition, this is referred to in the medical community as having comorbid conditions.

Patients with bipolar disorder often suffer from other mental disorders, such as [10]:

Many times, people with bipolar disorder may also have health conditions such as cardiovascular and metabolic disorders [10].

Can You Live Normally With Bipolar Disorder?

It is possible to live a normal life with bipolar disorder through proper treatment and management. While bipolar disorder is a lifelong condition, long-term treatment can help manage symptoms and help you live a balanced life [20].

How Common is Bipolar Disorder?

According to the National Institute of Mental Health, approximately 5.7 million (2.6%) adults in the United States aged 18 and older have bipolar disorder [11]. Bipolar disorder typically begins around the age of 25, though it can start in childhood or later in life. It affects men and women equally and is present across all demographics. More than two-thirds of people diagnosed with bipolar disorder have at least one close relative with the same condition or major depression, indicating a considerable genetic component [11].

How Does Bipolar Disorder Affect the Brain?

Bipolar disorder significantly impacts brain function, leading to various cognitive and emotional changes that vary depending on the person’s mood state.

Structural Changes in Manic Episodes

During manic episodes, bipolar disorder can lead to a decrease in brain matter, particularly affecting areas crucial for decision-making and emotional control. This process may involve accelerated thinning of brain layers, influenced by factors like inflammation and stress [1].

Neurochemical Impact

High levels of inflammation and stress during manic states can physically alter brain structure and affect its function, including how emotions are processed and managed [1].

Limbic System Hyperactivity

Both during depressive phases and periods of remission, there’s increased activity in the limbic system, which includes the amygdala. This heightened activity makes it challenging to differentiate between emotionally charged and neutral information, impacting emotional processing [8].

Orbitofrontal Cortex Dynamics

The orbitofrontal cortex (OFC) is affected differently in bipolar disorder. During manic episodes, it becomes dysregulated, leading to issues like impulsivity and poor decision-making [8]. Outside of these episodes, there tends to be less activity in this area, which is crucial for managing emotions and decisions [6].

Amygdala Function

Depressive episodes in bipolar disorder are associated with reduced amygdala activation, which is vital for emotion processing. In contrast, manic or euthymic states show increased amygdala activity [6].

Prefrontal Cortex Challenges

Bipolar individuals may experience decreased activation in the right dorsolateral prefrontal cortex (DLPFC), affecting cognitive tasks and working memory during depressive episodes [6]. Conversely, there is often increased activity in the left anterior prefrontal cortex (BA10) during depressive states, indicating heightened cognitive effort for tasks requiring attention and decision-making [6].

Genetic Vulnerability and Cognitive Tasks

Cognitive impairments, such as sustained attention difficulties, may persist even during periods of remission, serving as indicators of genetic vulnerability to bipolar disorder [8].

Understanding these brain changes is crucial for developing effective strategies to support individuals with bipolar disorder and mitigate the long-term impacts on their cognitive and emotional well-being.

What Is the Main Difference Between Major Depressive Disorder and Bipolar Disorder?

The main difference between major depressive disorder (MDD) and bipolar disorder is in the presence of manic or hypomanic episodes in bipolar disorder [10]. While MDD is characterized solely by depressive episodes, bipolar disorder includes both depressive episodes and periods of mania or hypomania [10].

Additionally, a patient’s response to treatment can be revealing. A history of poor or no response to multiple trials of antidepressants might suggest bipolar disorder rather than MDD [10]. Furthermore, a lack of improvement with antidepressants or a rapid switch to manic/hypomanic states after taking them suggests bipolar disorder rather than MDD [10]. Other mood disorders, like MDD, involve only depressive episodes without any manic or hypomanic episodes.

Related: Bipolar vs. Unipolar Depression: What’s the Difference?

When to Seek Help for Bipolar Disorder

Someone should seek help for bipolar disorder if they experience the following symptoms. [9, 18]:

  • Periods of extreme mood swings ranging from severe depression to manic episodes characterized by elevated mood, energy, and impulsive behavior.
  • Mood episodes are severe enough to cause significant distress or impair daily functioning, relationships, work, or other important aspects of life.
  • Thoughts of self-harm or suicide during depressive episodes.
  • Risky or reckless behavior during manic episodes, such as excessive spending, promiscuous behavior, or substance abuse.
  • Psychotic symptoms like delusions or hallucinations during manic or depressive episodes.
  • More frequent mood episodes (rapid cycling).
  • A family history of bipolar disorder, as there is a strong genetic component.

The key is to seek professional help from a health care provider as soon as possible when experiencing symptoms, as early diagnosis and treatment can help manage the condition and prevent further episodes or complications [9, 18].

Bipolar Disorder Treatments and Management

Bipolar disorder is usually treated with a combination of psychiatric medication and several types of psychotherapy.

Medications to treat bipolar disorder [7, 20]:

  • Mood stabilizers like lithium, valproic acid, lamotrigine, and carbamazepine are the primary medications used to control manic and depressive episodes. They help stabilize mood swings.
  • Antipsychotics such as olanzapine, risperidone, quetiapine, aripiprazole, and others may be prescribed, often in combination with mood stabilizers, to control acute manic or mixed episodes.
  • Antidepressants are sometimes used adjunctively with a mood stabilizer to treat bipolar depression but must be used carefully as they can potentially trigger mania or rapid cycling.

Psychotherapy [7, 20]:

  • Cognitive behavioral therapy (CBT) helps identify and change unhelpful thought patterns and behaviors associated with bipolar disorder.
  • Family-focused therapy involves family members and aims to reduce stress and improve communication and problem-solving
  • Interpersonal and social rhythm therapy (IPSRT) helps stabilize daily routines and sleep schedules, which can influence mood episodes.
  • Psychoeducation teaches patients and families about the disorder, recognizing warning signs of relapse, treatment adherence, and strategies to promote stability.

Research has shown that incorporating talk therapy into medications can reduce the recurrence rates of bipolar disorder by 50% or more [7].

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is emerging as a promising treatment for bipolar disorder, particularly for managing bipolar depression. TMS uses magnetic fields to stimulate targeted areas of the brain, like the prefrontal cortex, which helps regulate mood [2].

It is FDA-approved for major depression that hasn’t responded to other treatments and works by altering brain activity  [2 r]. TMS is generally safe, with the most common side effects being headaches and scalp discomfort, while serious risks like seizures or memory problems are rare [2].

Research into TMS as a treatment for bipolar disorder is expanding. A 2020 study involving 44 people with bipolar disorder examined the use of TMS during depressive phases. The results showed that 77% of participants who completed the TMS treatment experienced at least a 50% improvement in depression scores on the Montgomery-Asberg Depression Rating Scale (MADRS) [14]. Additionally, 41% of participants who underwent at least 25 TMS sessions achieved remission, significantly reducing their depressive symptoms [14].

A 2019 review of clinical trials also supports TMS’s effectiveness in reducing depressive symptoms during bipolar depressive episodes. However, evidence for its effectiveness in addressing manic symptoms is less consistent [13].

In short, TMS therapy can be effective for depressive episodes associated with bipolar disorder. Due to the fact that it’s not FDA approved to treat bipolar, it isn’t covered by insurance. However, it can be used as a cash pay, off-label treatment if mental health professionals determine its viability for treating bipolar disorder in patients.

Accessing Help and Support

Living with bipolar disorder can be challenging, but it is manageable with proper treatment and support. Numerous effective bipolar disorder treatments, including medication, psychotherapy, and emerging therapies like Transcranial Magnetic Stimulation (TMS), provide hope and relief for those affected. With the proper care, many individuals with bipolar disorder can lead fulfilling, productive lives.

If you or a loved one is navigating bipolar disorder, manic depression, anxiety disorders, or other forms of mental illness, contact Neuro Wellness Spa. Our compassionate and skilled psychiatry and therapy team offers a variety of treatments that can support those with a bipolar disorder diagnosis, including psychiatry for medication management, psychotherapy, and Transcranial Magnetic Stimulation (TMS therapy), to help manage symptoms effectively and get you back on your feet. We will help you tailor a treatment plan customized to your individual needs. Take the first step towards a more stable and fulfilling life by contacting Neuro Wellness Spa today. Your mental health journey deserves expert support and understanding.

References

  1. Abé, C., Liberg, B., Klahn, A. L., Petrovic, P., & Landén, M. (2023). Mania-related effects on structural brain changes in bipolar disorder – a narrative review of the evidence. Molecular Psychiatry, 28(7), 2674–2682. https://doi.org/10.1038/s41380-023-02073-4
  2. Agarkar, S., Mahgoub, N., & Young, R. C. (2011). Use of transcranial magnetic stimulation in bipolar disorder. The Journal of Neuropsychiatry and Clinical Neurosciences, 23(2), E12–E13. https://doi.org/10.1176/jnp.23.2.jnpe12
  3. American Psychiatric Association. Bipolar I and Bipolar II Disorders. https://www.psychiatry.org/getmedia/98fd2c17-93f0-42cd-9f41-755d77b862a5/APA-DSM5TR-BipolarIandBipolarIIDisorders.pdf
  4. American Psychological Association. (2015, February 15). Recognizing the signs of bipolar disorder. https://www.apa.org/topics/bipolar-disorder/recognizing
  5. American Psychiatric Association. What Are Bipolar Disorders? https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
  6. Altshuler, L., Bookheimer, S., Townsend, J., Proenza, M. A., Sabb, F., Mintz, J., & Cohen, M. S. (2008). Regional brain changes in bipolar I depression: A functional magnetic resonance imaging study. Bipolar Disorders, 10(6), 708–717. https://doi.org/10.1111/j.1399-5618.2008.00617.x
  7. Bobo, W. V. (2017). The diagnosis and management of bipolar I and II disorders: Clinical practice update. Mayo Clinic Proceedings, 92(10), 1532–1551. https://doi.org/10.1016/j.mayocp.2017.06.022
  8. Clark, L., & Sahakian, B. J. (2008). Cognitive neuroscience and brain imaging in bipolar disorder. Dialogues in Clinical Neuroscience, 10(2), 153–163. https://doi.org/10.31887/DCNS.2008.10.2/lclark
  9. Cleveland Clinic. Mood Disorders. https://my.clevelandclinic.org/health/diseases/17843-mood-disorders
  10. Culpepper, L. (2014). The diagnosis and treatment of bipolar disorder: Decision-making in primary care. The Primary Care Companion for CNS Disorders, 16(3), PCC.13r01609. https://doi.org/10.4088/PCC.13r01609
  11. Depression and Bipolar Support Alliance. Bipolar Disorder Statistics. https://www.dbsalliance.org/education/bipolar-disorder/bipolar-disorder-statistics/
  12. Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical Research Ed.), 381, e073591. https://doi.org/10.1136/bmj-2022-073591
  13. Gold, A. K., Ornelas, A. C., Cirillo, P., Caldieraro, M. A., Nardi, A. E., Nierenberg, A. A., & Kinrys, G. (2019). Clinical applications of transcranial magnetic stimulation in bipolar disorder. Brain and Behavior, 9(10), e01419. https://doi.org/10.1002/brb3.1419
  14. Goldwaser, E. L., Daddario, K., & Aaronson, S. T. (2020). A retrospective analysis of bipolar depression treated with transcranial magnetic stimulation. Brain and Behavior, 10(12), e01805. https://doi.org/10.1002/brb3.1805
  15. Jain, A., & Mitra, P. (2023). Bipolar Disorder. In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK558998/
  16. McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet (London, England), 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0
  17. Mental Health America. How common is bipolar disorder? https://screening.mhanational.org/content/how-common-bipolar/
  18. Mind.org.uk. Bipolar disorder. https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/treatment-for-bipolar/
  19. Mondimore, F. (2021, April 16). What are the different types of bipolar disorder? Psychology Today. https://www.psychologytoday.com/us/blog/bipolar-101/202104/what-are-the-different-types-bipolar-disorder
  20. National Institute of Mental Health. Bipolar Disorder. https://www.nimh.nih.gov/health/publications/bipolar-disorder
  21. Substance Abuse and Mental Health Services Administration. Bipolar Disorder. https://www.samhsa.gov/mental-health/bipolar
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