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Article written and designed by Cosimo Simeone, Msc, PgdDip, Bsc, Physiotherapist

Bipolar disorder is becoming more prevalent nowadays. Greater awareness and a deeper understanding of its symptoms certainly contribute to its increased detection.

The diagnosis rates for bipolar disorder have surged from 11.5 to 24.5 per 100,000 person-years. However, bipolar disorder isn’t the only mental health issue on the rise. Depression rates have also climbed in recent years.

Previously called manic-depressive illness, bipolar disorder causes people to face unexpected mood swings. These changes in mood, combined with shifts in energy, activity levels, and concentration, can make daily tasks a struggle. There are three primary forms of this disorder.

Most people first show signs of bipolar disorder around the age of 25. However, some may experience it during their teenage years, and a few might even begin in childhood. The disorder affects both genders equally, with about 2.8% of the U.S. population receiving a diagnosis. Out of these, an alarming 83% of cases are considered severe.

Moreover, examining global data, Brazil, Australia, and Finland have the most individuals diagnosed with bipolar disorder. On the other hand, many Asian countries report lower numbers.

Symptoms and Signs:

Bipolar disorder presents a mix of symptoms that make everyday tasks tough and can impact friendships and jobs. Here are the main types of symptoms:

High Moods (Mania):

  • Feeling really upbeat even when things are rough.
  • Bursting with new plans and ideas.
  • Jumping quickly between different thoughts.
  • Speaking super fast.
  • Hearing things others can’t.
  • Getting annoyed easily.
  • Feeling on top of the world.
  • Having trouble staying on one topic.
  • Finding it hard to sleep or not wanting to.
  • Thinking you’re capable of more than you are.
  • Making hasty choices which might lead to: wasting money, risky behavior with others, misusing drinks or drugs, betting carelessly, and not thinking decisions through.

Milder High Moods (Hypomania):

  • Similar to above, but less intense.

Low Moods (Depression):

  • Feeling down.
  • Lacking energy and drive.
  • Seeing everything in a negative light.
  • Feeling bad about yourself.
  • Losing interest in fun stuff.
  • Struggling to focus or choose.
  • Becoming snappy.
  • Sleep issues – either too much or too little.
  • Eating more or less than usual.
  • Putting on or losing weight unintentionally.
  • Thinking of hurting oneself or ending one’s life.

Very Strong Symptoms (Psychosis):
Sometimes, the symptoms can get so strong that one might:

  • See, hear, or feel things that aren’t real.
  • Hold onto false beliefs. Like during a high, one might feel they’re very special or watched over. In addition, during a low they might feel super guilty or even like they’re invisible.

Types of Bipolar Disorder:

  1. Bipolar I Disorder: The most severe type. It’s defined by at least one major manic episode. While depressive phases can happen, they aren’t necessary for this diagnosis.
  2. Bipolar II Disorder: Different from Bipolar I, it involves regular depressive episodes and occasional milder manic moments (called hypomania). Some people with Bipolar II might later show symptoms of Bipolar I.
  3. Cyclothymia: This is a milder form where people experience light manic and depressive episodes. Over time, some might develop Bipolar I or II.
  1. Bipolar Disorder with Mixed Features: People feel both manic and depressive symptoms at the same time. It’s like having high energy but also feeling very sad.
  2. Bipolar with Seasonal Features: About 1 in 4 people with bipolar disorder feel more depressed during autumn and winter. Come spring or summer, those with Bipolar I may feel manic, and those with Bipolar II may feel lightly manic (hypomanic).
  3. Bipolar with Rapid Cycling: People have four or more mood episodes in a year. The mood can change fast, even within hours or days. If changes happen four times in a month, it’s called “ultra-rapid cycling.” It’s more common in women and may not last forever.
  4. Unspecified Bipolar: For those whose symptoms don’t fit neatly into other categories. No matter the specifics, help and treatment are crucial.

Causes:

Understanding the exact cause of bipolar disorder is tricky. Still, experts think several things might make a person more likely to have it. These reasons can be physical, from the environment, or from personal experiences.

Genetics:

Having a family member with bipolar disorder can increase your chance of having it too.

It’s not about just one gene. Instead, a mix of genes and outside factors might lead to the disorder.

Common Triggers:

Stressful or big life events can start episodes of bipolar disorder.

Some triggers include:

  • Ending important relationships.
  • Going through trauma, whether physical, emotional, or sexual.
  • Losing someone you’re close to.

These big changes can lead to feelings of deep sadness at any point in life.

Other things that might bring out bipolar symptoms are:

  • Getting sick.
  • Not sleeping well.
  • Big problems in daily life, like money troubles, job stress, or relationship issues.

Brain Chemistry:

Some believe that bipolar disorder happens because of unbalanced brain chemicals. These chemicals, called neurotransmitters, include names like noradrenaline, serotonin, and dopamine.

Research suggests that if these chemicals aren’t balanced right, you might get bipolar symptoms. As an example, feeling extremely happy and active (manic) might come from having too much noradrenaline, while feeling very sad (depressed) could be from not having enough.

Diagnosis:

Physical check-up: A doctor might conduct a thorough physical examination and order laboratory tests to rule out other potential causes for your symptoms.

Meeting with a psychiatrist or mental health practioner: If needed, a doctor might suggest seeing a psychiatrist. This specialist will discuss your feelings, thoughts, and actions. You could also complete a mental health questionnaire.

Sometimes, to gather more information, the psychiatrist might talk to close friends or family, with your approval.

Tracking mood patterns: The specialist might ask you to maintain a daily log, noting your mood fluctuations, sleeping habits, and other relevant factors to aid in diagnosis.

Bipolar disorder criteria: To confirm a diagnosis, the psychiatrist will compare your symptoms with the established guidelines for bipolar disorders in the DSM-5, a manual by the American Psychiatric Association, where you can also find some useful resources.

Diagnosing in Children:

Diagnosing bipolar disorder in kids and teens uses adult criteria, but their symptoms can show differently and might not fit the standard diagnostic boxes.

Children might also have other conditions like ADHD or behavioral issues, complicating the diagnosis. It’s advisable to consult a pediatric psychiatrist familiar with bipolar disorder for an accurate diagnosis.

Treatment of Bipolar Disorder:

Lifelong Care

  • Medication: It’s often the first step in stabilization. It’s crucial to continue medication, even when you feel better. Stopping can trigger a relapse.
  • Consistent Treatment: This includes medications and potentially day programs, offering both support and counseling.
  • Avoiding Substance Abuse: If alcohol or drugs are a challenge, addressing this is paramount. Substance abuse can significantly hinder bipolar disorder management.
  • Hospital Care: In severe cases, such as when there’s a risk to oneself or when one is detached from reality, hospitalization might be necessary.

The Medication Route

Medications are crucial for symptom management. Here are some you might encounter:

  • Mood Balancers: e.g., Lithobid (lithium), Depakote (divalproex sodium), and Lamictal (lamotrigine).
  • Antipsychotics: e.g., Zyprexa (olanzapine) and Seroquel (quetiapine).
  • Antidepressants: Sometimes used alongside mood stabilizers.
  • Anxiety Relievers: Short-term use of benzodiazepines might be suggested.

Finding the right medication can be a journey. It may require experimentation under a doctor’s guidance. Importantly, if you face side effects, consult with your doctor rather than quitting medication abruptly. If you’re pregnant or considering it, review your medications with your doctor due to potential risks to the baby.

The Role of Psychotherapy

Counseling can play a pivotal role in managing bipolar disorder:

  • Routine Management (IPSRT): This therapy emphasizes the importance of a stable daily routine.
  • Cognitive Behavioral Therapy (CBT): Here, the aim is to shift negative thought patterns to positive ones and understand your bipolar triggers. You can book an appointment with one of our mental health practioner here to try the CBT therapy and its effectiveness.
  • Education: Understand your condition. The more you know, the better equipped you’ll be.
  • Family Therapy: This promotes understanding and support within the family unit.

Alternative Therapies:

For those not responding to conventional treatments, there’s Electroconvulsive Therapy (ECT). It involves a controlled electric shock to the brain and can be effective in severe cases. Transcranial Magnetic Stimulation (TMS) is another technique under exploration.

Natural remedies:

  1. Fish Oil: High in omega-3 fatty acids (EPA and DHA), which may impact mood-related brain chemicals. Countries with higher fish consumption have lower bipolar disorder rates. Benefits include mood stabilization and reduced depression symptoms. However, some research suggests it might not directly benefit bipolar disorder.
  1. Rhodiola rosea: This root could assist in treating mild depression but can cause insomnia and nausea. Always consult a doctor due to potential drug interactions.
  2. S-adenosylmethionine: A naturally occurring body substance, believed to help with depression. However, it can trigger manic episodes in high doses and interact with other medications.
  3. Choline: A water-soluble vitamin which might help manage mania. However, more research is needed.
  4. Inositol: Beneficial for those on lithium therapy, this synthetic vitamin can potentially reduce lithium’s side effects.
  5. Calming Techniques: Including massage therapy, yoga, acupuncture, and meditation, these can alleviate stress and support traditional treatments, although they don’t cure bipolar disorder.
  6. IPSRT (Interpersonal and Social Rhythm Therapy): Focuses on managing stress, maintaining routines, and adopting good sleep habits. It can reduce manic and depressive episodes when combined with medication.
  7. Lifestyle Measures: Regular exercise, 7-8 hours of sleep, and a nutritious diet can complement treatments and help stabilize mood.

Treatment for Younger Patients
Children and teenagers might face similar treatments as adults but tailored to their specific needs:

  • Medications: Prescriptions based on adult research but adapted for younger individuals.
  • Counseling: Essential for younger patients, helping them cope with daily life and addressing any learning or social challenges.
  • Education and Support: Schools can play a crucial role in supporting younger individuals. Understanding their condition can significantly aid in their daily lives.

Remember, managing bipolar disorder is a journey, and with the right support and treatment, you can a have a better and healthier life.

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