Bipolar disorder: causes, symptoms, diagnosis and treatment

You might have heard about bipolar disorder. But what is bipolar disorder? How can you find out whether you have bipolar disorder or not? This article will help you in this matter; it will cover all the necessary details regarding bipolar disorder.

Bipolar disorder is a brain disorder characterized by mood swings as well as extreme shifts in energy, activity levels and decreased ability to perform tasks. Its other name is manic depressive disorder because a person suffering from this disorder fluctuates from mania to depression. These two changes occur in an episodic pattern, the one episode alternating with the other one. It is a severe disease that can disturb one’s daily routine activities and functions severely.

If you are having this disorder, gradually you will start losing your interest in your family and relationships, you’ll have no passion and charm for work and disturbing thoughts will prevail. It is a worldwide disorder affecting both genders and all racial groups. It is more common in young adults and teenagers, but can occur in children too. Fortunately, it is a treatable disorder and by the aid of treatment you can live a peaceful life.

What are the likely causes?

Genetic

As bipolar disorder run in families so it has a strong link with genetics. Some people inherit certain genes which increases the likelihood to develop bipolar disorder in them. So, if you have a parent or sibling with bipolar disorder you are susceptible too. Family history of this disorder increases the chance to develop it, but exceptions are always there. Some people who are family positive for bipolar disorder may never develop the disease. The genes involved in bipolar disorder are not known till now. The study conducted on bipolar disorder till now, have shown that there is no single gene for this disorder. Instead, multiple genes are involved.

Environmental factors

Some environmental factors trigger bipolar disorder. Traumatic events are the main triggers, these include:

• Mental stress
• Physical or sexual abuse
• Emotional abuse
• Significant loss
• Death of a loved one or close family member (bereavement)
• Moving house
• Delivery
• Personal triggers can also be a cause, these can be:
• Sleep disturbance
• Physical illness
• Overwhelming problems in daily routine life like problems with relationships, work or money.

Chemical imbalance in the brain

It is believed that bipolar disorder occurs largely due to chemical imbalance in the brain. The chemicals that aid in the communication between neurons (nerve cells) are known as neurotransmitters. These neurotransmitters play a key role in the controlling your mood, any imbalance in the levels of these chemicals can cause drastic changes leading to depressed or sad mood and euphoria. It is proposed that of all neurotransmitters noradrenaline is mainly associated with bipolar disorder. Mania occurs due to its high levels in the brain while its very low levels are associated with depression. Increased amount of the neurotransmitter, dopamine, are also associated with mania.

Biological abnormalities

MRI and other brain imaging techniques when used to study the structure and function of the brain revealed that there are some differences in the brains of people with bipolar disorder from those of normal. These differences are mainly in the structure of those parts that control your moods. Functional differences and some other differences can also be a reason of bipolar disorder.

Hormones

Hormones are regulatory substances produced by cells or glands. They act like messengers and help in the communication between different cells or organs. Any imbalance in them can trigger bipolar disorder.

What can be the signs and symptoms of bipolar disorder?

Symptoms of bipolar disorder depend on its phase, that is, whether it is manic phase or depressive phase. The symptoms of manic bipolar disorder differ from that of depressed bipolar disorder.

Symptoms of manic bipolar disorder

Mania is abnormally elevated mood or energy level. It is an extreme sense of optimism and well being. In this phase you think that are out of this world and superior to all. This can have serious consequences too.

Let’s know the sign and symptoms of people with manic bipolar disorder:

• Extreme happiness and excitement (euphoria)
• Feeling of superiority
• Irritation
• Over confidence
• Exhilaration
• Rapid and extreme talks
• Having lots of new ideas and beliefs
• Unusually high energy levels
• Inability to sleep
• Grandiose and unrealistic planning or believing that they possess some special powers and are on an important mission
• Very active, moving quickly
• Unusual behavior
• Making on the spot decisions without thinking about their consequences
• Over-familiar
• Very high self-esteem
• Impaired judgment in some cases
• Racing thoughts (thoughts that come and go quickly)
• Aggressiveness
• Raised libido
• More involvement in risky and dangerous things
• Concentrating difficulties; these people can be easily distracted
• Missing work or unsatisfactory work
• Psychoses - believing and thinking things that are not real
• Being easily irritated
• They waste large money on unnecessary or harmful things

Symptoms of depressive bipolar disorder

Slight feeling of depression can be normal for every person on occasions, but these symptoms are much worse in people suffering from bipolar disorder. These are:

• Feeling of unhappiness at all times
• Extreme sadness
• Insomnia - inability to sleep and other sleep problems
• Anxiety
• Feeling of guilt
• Bursting into tears or feeling that they want to cry but for no reason
• Loss of interest in all the things
• Unable to enjoy life fully
• Restless or agitated behavior
• Very low or no self-confidence
• Hopelessness
• Increased irritability
• Feeling of being useless or inadequate
• Suicidal thoughts
• Negative thoughts
• Inability to make decisions
• Difficulty in concentration
• Weight loss
• Loss of appetite
• Feeling of tiredness and fatigue
• Constipation
• Decreased sex drive
• Avoidance of social contacts
• Feeling of despair and gloom
• Psychoses or difficulty in differentiating fantasy from reality
• Self-doubt
• Early wake ups

Seasonal affective disorder

It is a disorder in which mood fluctuates with the season. It is common in some bipolar disorder patients both in the manic and the depressive phase. It is noticed that mania occurs late springs and summer while depression is common in the late autumn and winter.

Mixed state bipolar disorder

Some people with bipolar disorder may experience symptoms of mania and depression together, called as a mixed state bipolar disorder.

How to diagnose bipolar disorder?

General history and examination

When you go to your general practitioner, he will take a complete history. He also goes for physical examination, then after ruling out other causes if he suspects the bipolar disorder he’ll refer you to a psychiatrist.

Laboratory tests

Lab tests like blood and urine sampling are done to rule out other diseases.

Psychological evaluation & mood charting

The psychiatrist will ask you a few questions regarding your disease to access the presence or absence of bipolar disorder. He will ask about your symptoms, and which symptom appeared first and when? He will ask questions regarding manic or depressive phase and your feelings in those phases. He will also ask questions about suicidal thoughts. He will like to know about family history and medical background. If family history is positive he will ask for its details and will like to meet that person too. In order to know about your mood swings completely the doctor will ask you to maintain a record of your mood fluctuations, sleep patterns and other related symptoms.

What is the diagnostic criteria for bipolar disorder?

To diagnose bipolar disorder, there is a special criterion that must be followed. These criteria were proposed in the Diagnostic and Statistical Manual of mental disorders (DSM). According to these criteria, there are three categories for bipolar disorder. These are as follows:

• Bipolar 1 disorder: You will be diagnosed to have bipolar 1 disorder when you have had at least one manic or one mixed episode. Depressive episode may or may not be there. Bipolar 1 disorder varies from person to person and the diagnosis is mainly based upon symptoms.
• Bipolar 2 disorder: In order to be bipolar 2 disorder positive you must have a history of at least one major depression and one episode of hypomanic (it is a mood state characterized by persistent disinhibition and pervasive elevated mood as well as thoughts and behavior associated with bipolar disorder. It has further categories based upon signs and symptoms. It causes difficulties in routine life.
• Cyclothymic disorder: If you have had many episodes of hypomania and depression, but never had a full manic episode, mixed episode and a major depressive disorder then you are having cyclothymic disorder. Usually there comes a history of two or more years in this disorder.

Treatment

Basically, there are two treatments for bipolar disorder. One is lifestyle changes and the other one is medical treatment.

Lifestyle changes

Quit drinking and addiction

Avoid smoking, drinking and use of addictive drugs. Alcohol abuse is the greater risk factor. In short, use of all sorts of addictions should be avoided.

Regular exercises

Regular and moderate exercises can help you in managing mood. Exercises release endorphins in the brain that make one feel good and can also help with sleep. Yoga helps in easing depression and mood swings. Massage therapy may help relieve anxiety and stress associated with bipolar disorder.

Sleep

Take plenty of sleep. Peaceful and calm sleep is very important in managing mood.

Herbs and home-made therapies

Omega 3 fatty acids help in improving functioning of brain and depression in patients with bipolar disorder. Magnesium supplements are also beneficial. They decrease severity of mania as well as help in the declining of rapid cycling of bipolar disorder. There is an herb which is natural antidepressant known by the name “St. John’s Wort”. Although it is beneficial but can lead to a number of side effects. It can become a cause of mania in some people and can interfere with other anti-depressants.

Medical treatments of bipolar disorder

Lithium

Lithium is the most effective drug for bipolar disorder. It prevents extreme fluctuations in the mood and stabilizes it. It also helps in the treatment of other symptoms too. Lithium is a bit dangerous drug and can cause kidney and thyroid problems. So, proper monitoring of patients with periodic blood tests is necessary when they are using this drug. Some other common adverse effects are gastrointestinal problems, dry mouth and restlessness.

Anticonvulsants

Anticonvulsants are helpful in bipolar disorder as these drugs help in preventing and managing episodes of bipolar disorder especially episodes of mixed bipolar disorder. These drugs include valproic acid, lamotrigine and divalproex. Adverse effects of each of these drugs vary and depend upon which medication you are taking.

Antipsychotics

Antipsychotics include risperidone, olanzapine, aripiprazole and quetiapine. Of these only quetiapine is FDA approved. Side effect varies with the drug.

Antidepressants

Antidepressants are the drugs which are used for the treatment of depression. They play a role in managing the depressive phase of bipolar disorder. There is a risk that these drugs can trigger manic bipolar disorder.

Symbyax

Symbyax is a drug which is approved by the US Food and Drug Administration for bipolar disorder. This drug was prepared by combining fluoxetine (an antidepressant) and olanzapine (an antipsychotic). Symbyax works as a mood stabilizer. It also helps in the management of depression. It can cause many side effects that include weight gain, sexual problems, decrease appetite and drowsiness.

Benzodiazepines

Benzodiazepines are the anti anxiety drugs. Sleep and stress improvements can occur with them.

Psychotherapy

Psychotherapy is beneficial in bipolar disorder as it provides support to the patients. It can give education and guidelines about the management of disease.

Several types of this therapy are:

Cognitive behavioral therapy

The main focus of this therapy is to identify unhealthy, negative beliefs, harmful thoughts and behaviors and to replace them with healthy and positive thoughts.

Psycho-education

It tells you about the illness and its treatment so that you can take treatment before the occurrence of severe episode.

Family therapy

This therapy involves psychiatrist, you and your family. The family members help you in identifying and coping the triggers.

Group therapy

It involves a forum to interact with and learn from other people in a similar situation.

Interpersonal therapy

It helps you in the improvement of your relations and in the management of daily routine activities.