Bipolar Disorder

Formerly known as manic-depressive illness or manic depression, Bipolar disorder is a brain disorder that causes changes in a person's mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood).

There are two types of bipolar disorder. All types involve marked changes in mood, energy, and activity levels. These mood episodes range from extremely “up,” elated, irritable, or energized behaviors (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I Disorder is defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.  

 The criteria for a manic episode involve:

  • A period of abnormally elevated , expansive or irritable mood , lasting at least 1 week.
  • Inflated self esteem & grandiosity.
  • Decreased need for sleep.
  • More talkative than usual flights of ideas , racing thoughts & distractibility.
  • Increase in goal directed activities ( socially or at work  ).
  • Excessive involvement in pleasurable activities that have risky consequences ( e.g., sexual indiscretions, overspending or foolish business investments ).

Episodes of depression with mixed features (having depressive and manic symptoms at the same time) are also possible, where the symptoms are either intermixed or alternate rapidly every few days.

Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder. •Bipolar II is more common than Bipolar I. It evolves into Bipolar I in 5-15 % of cases.  

Symptoms

Prevalence

The prevalence of bipolar disorder across the world varies from 0.3 to 1.2 percent by country. Globally, an estimated 46 million people in the world had bipolar disorder in 2017, with 52 and 48 percent being female and male, respectively. In almost all countries women are more likely to experience bipolar disorder than men. It starts in adolescence & early adulthood , average age of onset is 22 years old. In 2/3 of cases manic episodes immediately precede or immediately follow a depressive episode. Nearly 70 % are nearly symptom free between episodes

Prognosis

The prognosis for bipolar disorder varies depending on which type of bipolar disorder you have.People with bipolar I disorder frequently have other mental disorders such as anxiety disorders, substance use disorders, and/or attention-deficit/hyperactivity disorder (ADHD). Such people have a higher likelihood of relapse than individuals without co-occurring conditions. The risk of suicide is significantly higher among people with bipolar I disorder than among the general population. People with bipolar disorders are at a relatively high risk for suicide. Annually, about 10 to 17% percent of those with a bipolar disorder diagnosis commit suicide. Bipolar disorder is a lifelong, incurable condition, but symptoms can usually be successfully managed with medication, as well as therapy or some form of counseling.

When to seek help

Treatment

  1. Pharmacotherapy 

Antidepressants (Monoamine Oxidase Inhibitors, Tricyclic, SSRI, SNRI, Atypical)  

Mood Stabilizers (Lithium, Anticonvulsants) 

Antipsychotics. 

  1. ECT
  1. Psychotherapy (CBT, Behavioral Activation Treatment, IPT, Family & Marital therapy) 
  1. Avoiding triggers 

Where possible, you can often manage your risk factors to help maintain a more stable mood. This might include: 

  • avoiding alcohol or substance use 
  • avoiding stress or practicing stress-reduction techniques 
  • aiming to maintain a regular pattern of sleep and exercise 

These can all help boost your mental health and keep your mood stable.