Exploring Bipolar Disorder: Understanding the Highs and Lows of Mood Swings
By Shubhika Nyati and Tanuj Zachariah
1- What is Bipolar Disorder?
2- Symptoms of Bipolar Disorder
3- Types of Bipolar Disorders
4- Causes and Risk Factors
5- Understanding the Impact of Bipolar Disorder
6- Management and treatment
1- What is Bipolar Disorder?
Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.
There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder aren’t always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.
Manic episodes
A key feature of bipolar disorder is manic episodes. To meet the criteria for bipolar disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode.
Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
People who are in manic states may indulge in activities that cause them physical, social or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly. They also occasionally develop psychotic symptoms, such as delusions and hallucinations, which can cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder.
People with certain types of bipolar disorder experience hypomania, which is a less severe form of mania. It doesn’t last as long as manic episodes and it doesn’t interfere with daily functioning as much.
Depressive episodes
During a depressive episode, you experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression, such as: Tiredness. Changes in appetite. Feelings of worthlessness and hopelessness.
2- Symptoms of Bipolar Disorder -
The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while people with bipolar II disorder or cyclothymia experience hypomanic episodes.
But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states don’t always follow a set pattern, and depression doesn’t always follow manic phases. A person may also experience the same mood state several times — with periods of euthymia in between — before experiencing the opposite mood.
Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.
An important aspect of the mood changes is that they’re a departure from your regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression.
The severity of the depressive and manic phases can differ from person to person and in the same person at different times.
Signs and symptoms of manic episodes
Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
Signs and symptoms of a manic episode include:
Excessive happiness, hopefulness and excitement.
Sudden and severe changes in mood, such as going from being joyful to being angry and hostile.
Restlessness.
Rapid speech and racing thoughts.
Increased energy and less need for sleep.
Increased impulsivity and poor judgment, such as suddenly quitting your job.
Making grand and unattainable plans.
Reckless and risk-taking behavior, such as drug and alcohol misuse and having unsafe or unprotected sex.
Feeling like you’re unusually important, talented or powerful.
Psychosis — experiencing hallucinations and delusions (in the most severe manic episodes).
Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger — some people become suicidal in manic episodes, not just depressive episodes.
If a person is having an intense manic episode, especially if they’re experiencing hallucinations and delusions, they may need to be hospitalized to protect themselves and others from possible harm.
Signs and symptoms of hypomania
Some people with bipolar disorder have milder manic-like symptoms. This is called hypomania. With hypomania, you may feel very good and find that you can get a lot done. People with hypomania can often function well in social situations or at work.
You may not feel like anything is wrong during a hypomanic episode. But your family and friends may notice your mood swings and activity level changes and think that they’re unusual for you. After hypomania, you might experience severe depression.
Signs and symptoms of depressive episodes
The symptoms of depressive episodes in bipolar disorder are the same as those of major depression. They include:
Overwhelming sadness.
Low energy and fatigue. Lack of motivation.
Feelings of hopelessness or worthlessness.
Loss of enjoyment of things that were once pleasurable for you.
Difficulty concentrating and making decisions.
Uncontrollable crying.
Irritability.
Increased need for sleep.
Insomnia or excessive sleep.
A change in appetite, causing weight loss or gain.
Thoughts of death or suicide (suicidal ideation). If you’re experiencing suicidal ideation (thoughts of suicide), it’s important to seek immediate care.
Signs and symptoms of a mixed episode
The symptoms of a mixed episode include both manic and depressive symptoms together. During a mixed episode, you have the negative feelings and thoughts that come with depression but also feel agitated, restless and high energy.
People who experience mixed episodes often describe it as the worst part of bipolar disorder.
3- Types of Bipolar Disorders -
There are four types of bipolar disorder, including:
Bipolar I disorder: People with bipolar I disorder have experienced one or more episodes of mania. Most people with bipolar I will have episodes of both mania and depression, but an episode of depression isn’t necessary for a diagnosis. The depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episodes must last at least seven days or be so severe that you need hospitalization. People with bipolar I can also experience mixed states (episodes of both manic and depressive symptoms).
Bipolar II disorder: People with bipolar II experience depressive episodes and hypomanic episodes. But they never experience a full manic episode that’s characteristic of bipolar I disorder. While hypomania is less impairing than mania, bipolar II disorder is often more debilitating than bipolar I disorder due to chronic depression being more common in bipolar II.
Cyclothymic disorder (cyclothymia): People with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood (euthymia), but these periods last fewer than eight weeks.
Other specified and unspecified bipolar and related disorders: If a person doesn’t meet the diagnostic criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation, it’s considered other specified or unspecified bipolar disorder.
4- Causes and Risk Factors
Scientists don’t yet know the exact cause of bipolar disorder.
But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions — more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesn’t necessarily mean you’ll also develop it.
Other factors that scientists think contribute to the development of bipolar disorder include:
Changes in your brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition. Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder. Scientists are currently performing research to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset and what role they may play in its treatment.
5- Understanding the Impact of Bipolar Disorder-
Bipolar disorder can affect individuals in various ways, depending on the severity of mood swings and the frequency of episodes. People with bipolar disorder often face challenges such as:
Emotional Turbulence: The rapid transitions from high to low moods can be overwhelming, leading to emotional instability and strained relationships.
Impaired Functioning: During manic or depressive episodes, daily functioning can be severely impacted, affecting work, school, and social activities.
Risky Behaviors: Manic episodes can lead to impulsive decisions, substance abuse, or other risky behaviors that have long-term consequences.
Stigma and Misunderstanding: People with bipolar disorder may face stigma and discrimination due to misunderstandings about the condition.
6- Management and treatment -
How is bipolar disorder treated?
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of the following therapies:
Psychotherapy (talk therapy).
Medications.
Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
Helpful lifestyle habits, such as exercise, yoga and meditation. These can support, but not replace, treatment.
Other therapies, such as electroconvulsive therapy (ECT) in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, it’s important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder don’t have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
If you have other mental health conditions in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat the conditions. For example, the antidepressants healthcare providers prescribe to treat obsessive-compulsive disorder (OCD) and the stimulants they prescribe to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode.
Again, even though it may be difficult to treat these conditions, it’s not impossible. Be sure to stay committed to finding a treatment plan that works for you.
What types of therapy are used to treat bipolar disorder?
Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder.
Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family.
Different types of therapy for bipolar disorder include:
Psychoeducation: Psychoeducation is the way mental health professionals teach people about their mental health conditions. As bipolar disorder is a complex condition, learning about the condition and how it can affect your life can help you and your loved ones manage and cope with it better.
Interpersonal and social rhythm therapy (IPSRT): This therapy is designed to help you improve your moods by understanding and working with your biological and social rhythms. IPSRT is an effective therapy for people with mood disorders, including bipolar disorder. It emphasizes techniques to improve medication adherence (taking your medication regularly), manage stressful life events and reduce disruptions in social rhythms (day-to-day differences in habitual behaviors). IPSRT teaches you skills that let you protect yourself against the development of future manic or depressive episodes.
Family-focused therapy: This therapy is for adults and children with bipolar disorder and their caregivers. During this treatment, your loved ones will join you in therapy sessions of psychoeducation regarding bipolar disorder, communication improvement training and problem-solving skills training.
Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
