Understanding Mental Illness: Bipolar Disorder

Previously termed as ‘Manic-Depressive Disorder’, this condition is characterized by mood fluctuations between the two extremes: ‘low’ depressive episodes and ‘high’ manic or hypomanic (the watered-down down version of manic), episodes. Known to be triggered by extreme stress, drastic life changes, neural dysfunction or genetic factors, a bipolar disorder commonly affects both men and women between 15-25, rarely occurring after 40, consult to your doctor as soon as possible.

Types:

Bipolar disorder is divided into 4 distinct types based on mood changes:

• Bipolar I Disorder: Manic episodes lasting for at least 7 days or less (if symptoms are severe enough to require hospitalization), depressive episodes lasting for at least 2 weeks, or both.
• Bipolar II Disorder: At least 1 major depressive, and 1 hypomanic episode without any occurrence of a manic episode. However, it is not a milder version of bipolar I, but a separate diagnosis with an extended depressive period.
• Cyclothymic Disorder (aka cyclothymia): Numerous hypomanic and depressive symptoms spanning 2 years in adults and 1 year in children and adolescents, which do not meet the diagnostic requirements of either hypomanic or depressive episodes.
• Other Specified and Unspecified Bipolar and Related Disorders: Bipolar symptoms that do not fit into any of the above categories, or result from drug and alcohol abuse, or a medical condition such as Cushing’s Disease, multiple sclerosis, or stroke.

Symptoms:

The distinct symptoms of individual ‘episodes’, along with differences in differences in bipolar symptoms between, children, men and women include:

1- Depression:

Experiencing 5 or more of these symptoms indicates a bipolar depressive episode:

• Feelings of sadness, emptiness, despair, hopelessness, and/or worthlessness
• Extreme lethargy and decreased activity
• Insomnia or oversleeping
• Concentration and memory issues
• Inability to enjoy previously favorable activities
• Thoughts of suicide and death
• Increased or decreased appetite
• Unexplained weight loss
• Irritability in children and teens

2- Mania:

3 or more symptoms constitute a manic episode:

• Feeling elated, ‘jumpy’, or ‘high’
• Increased energy and activity levels
• Talking and thinking really fast on multiple topics
• Agitation and irritability
• Euphoria (an exaggerated sense of well-being and self-confidence)
• Trouble sleeping
• Risqué behavior, like excess overspending
• Symptoms of psychosis, i.e. delusions and hallucinations, in extreme cases.

While mania is highly obvious, hypomania often manifests as increased productivity and mood boosts noticeable only by close friends and family of the sufferer.

3- Children and Teens:

While displaying distinct major depressive, manic, or hypomanic episodes, rapid mood swings during such episodes and absence of mood symptoms between two episodes make a positive diagnosis difficult in children and teens, as it can often be confused with stress, trauma, and other mental health problems.

4- Women:

They are usually diagnosed later in life (20s-30s), experience 4 or more episodes of mania and depression within a year simultaneously with other conditions like anxiety disorders, thyroid disease, and migraine, have more depressive than manic episodes, that are usually mild, with an elevated risk of relapse due to hormonal changes pertaining to menstruation, pregnancy, or menopause.

5- Men:

Men are diagnosed earlier in life, experience highly severe episodes, particularly manic episodes, have substance abuse issues, and are less likely to seek medical care, and more likely to commit suicide.

Note: People might only experience 1-2 bipolar episodes in their lifetime or have multiple episodes. Moreover, each episode might last for several weeks or longer, and most might not experience normal ‘rest-periods’ very often.

Co-Occurring Conditions:

Bipolar disorder might be worsened by a pre-existing condition, or may simultaneously cause another condition requiring separate treatment, such as:

• Eating disorders
• Substance abuse
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Physical health problems, like heart disease, thyroid problems, headaches, or obesity.

Diagnosis:

Since most symptoms might also be indicative of an underlying physical health condition, such as hypertension or cardiovascular disease, doctors will first conduct a physical exam, including blood and urine tests. If no underlying condition is detected, you may be referred to a mental health specialist, who will perform a mental health evaluation, and might ask you to track your mood changes via a ‘mood journal’ to confirm a bipolar diagnosis.

Moreover, bipolar disorder is often misdiagnosed as schizophrenia (if examined during a manic episode), or major depression and Borderline Personality Disorder (if examined during a depressive episode), which is why an accurate diagnosis requires symptoms of mania and/or depression that either requires hospitalization or last for 7 days.

Treatment:

Although a permanent diagnosis, both mood extremes can be managed and controlled by following these simple steps for a normal, well-functioning daily life:

• Learn to recognize and avoid episode triggers by keeping a mood chart or journal, for instance.
• Take daily mood stabilizers, to prevent episode occurrence, along with anti-depressant, anti-psychotic, and anti-anxiety medications to treat the main symptoms of either episode if, and when it occurs. Also, be patient and work with your doctor in finding the right medicines for you, as no medication has identical effects on everyone.
• Consider psychotherapy, particularly CBT (Cognitive Behavioural Therapy), Relationship, and Family Therapy.
• Regular exercise along with a nutrient-rich diet.
• Take up constructive activities and hobbies for stress-management, and which provide a sense of achievement to combat depressive episodes.

People diagnosed with bipolar disorder can lead normal, constructive lives. So if you or someone you know displays the above-stated, symptoms, do not refrain from seeking professional help.

At oladoc, you can find a Psychiatrist in Karachi, Multan and Islamabad and get an appointment. Moreover, you can also get an appointment by calling our helpline: 042-3890-0939.