Understanding Bipolar Disorder

Bipolar Disorder: Treatment, Symptoms, Cause and Diagnosis

Bipolar disorder is a mental health condition experienced by 1 in 50 Australians annually.

People with bipolar disorder experience extreme mood changes, impacting their behaviours and relations with others. They find difficulties maintaining a normal mood, and the severe mood swings can result in manic symptoms or a manic episode, depressive symptoms and major depressive episodes, and manic depression. Mood episodes generally last weeks before changing.

With treatment, bipolar disorder can be managed and an individual’s quality of life can improve.

Here’s everything you will need to know:

1. What is bipolar disorder?
2. Types
3. What are bipolar disorder episodes?
4. Symptoms
5. Causes
6. How is it diagnosed?
7. Treatment

What Is Bipolar Disorder?

Bipolar disorder is a mental illness, grouped within the different mood disorders. Bipolar disorder is mainly categorised by extreme mood swings, ranging from manic to depressive.

These swings are known as ‘episodes’, and they are prolonged in nature.

A person with diagnosed bipolar disorder might experience major depression for weeks on end, followed by weeks of feeling abnormally high. The mood extremes are exhausting for people dealing with bipolar disorder, and differ greatly from what are to be considered ‘normal’ changes in mood.

While it is normal for people to experience mood swings, individuals with diagnosed bipolar disorder experience these swings in a more extreme way, often struggling with emotional regulation and fluctuation.

Bipolar disorder impacts the everyday functioning of individuals, affecting their quality of life including with relationships, school, and work.

The extreme mood changes often result in exhaustion – physically, mentally, and emotionally. Episodes drain energy, leaving the person to feel depleted.

What Are The Types Of Bipolar Disorder?

There are various types of bipolar disorder, including:

• Bipolar I disorder: One episode of mania, coupled with a period of depression.
• Bipolar II disorder: One episode of hypomania, coupled with a period of depression. The depressive episodes experienced from bipolar II are often more severe than bipolar I.
• Cyclothymic disorder: Mood changes are less severe than bipolar I and II, however symptoms are still difficult to manage.

Other lesser-known types include:

• Other specified bipolar related disorder
• Unspecified bipolar related disorder
• Substance or drug induced bipolar disorder
• Medical condition induced bipolar disorder

Mental health professionals can assist in the specific diagnosis, based on symptoms and behaviours present, in order to effectively instigate a treatment plan.

What Are Bipolar Disorder Episodes?

People experiencing bipolar disorder experience both depressive and manic episodes. Episodes can last for more than a week, changing sporadically without an identified trigger.

Depressive Episodes

A bipolar disorder depressive episode causes the person to feel extreme sadness, hopelessness, lack of enthusiasm and interest, and little to no pleasure in things. Other common symptoms and behaviours include:

• Withdrawal from friends and family, school, and work
• Loss of energy
• Low self-esteem
• Suicidal thoughts
• Excessive sleep
• Guilty feelings
• Difficulty with physical exertion.

Manic Episodes

Manic, or hypomanic, episodes cause the person to have an extremely high mood, excessive energy and activity, prone to agitation, rapid speech, inability to sleep, and often have racing thoughts.

Other common symptoms and behaviours include:

• Feelings of euphoria
• Elevated mood
• Impulsive behaviour
• Highly creative
• Poor appetite and weight loss
• Risk taking, substance abuse, unsafe sex
• Grandiose plans
• Excessive communication with others
• Inability to concentrate
• Delusional
• Experiencing hallucinations
• Dressing in bright colours, more expressive

What Are The Symptoms Of Bipolar Disorder?

Early warning signs of bipolar disorder are symptoms of hypomania. Hypomania is when an individual experiences high energy, acts impulsively, and feels extremely great. This is often the first symptom noticeable for those with bipolar disorder.

Symptoms of hypomania includes:

• Inability to sleep
• Irritability
• Argumentative
• Emotional intensity
• High energy
• Motivation with new plans
• Inability to concentrate
• Rapid speech
• Uncontrollable thoughts
• Increased sex drive
• Paranoid thoughts
• Substance abuse
• Losing track of time
• Forgetting to eat
• Impulsive actions, including impulsive and excessive spending
• Hyper-awareness into everyday occurrences, generating ‘symbolism’
• Persuasive
• Over-committing to projects, work, school
• Not resting and taking adequate breaks.

People with bipolar I disorder can also experience psychotic symptoms such as delusions and hallucinations.

• Delusions: Illogical, irrational beliefs. They can be grandiose or persecutory in nature, the former meaning they believe they have special powers, or the latter being feeling paranoid that someone or something is a threat to them.
• Hallucinations: Seeing, hearing, sensing things that are not there or are not real.

If a person experiences hypomania without psychosis, they are more likely to be diagnosed with bipolar II disorder.

What Causes Bipolar Disorder?

The exact cause of bipolar disorder is unknown, however it has been linked to environmental factors and genetic factors.

Environmental Factors

Bipolar disorder has been linked to environmental factors such as childhood upbringing and stressful life events.

Early adulthood plays a crucial role in emotional development as it generally solidifies values present during childhood. Childhood trauma is a leading cause for many mental illnesses, bipolar disorder included.

Genetics

Genetic factors are a large contributor for individuals being diagnosed with bipolar disorder.
There are greater chances for children of parents with bipolar disorder to also have the disorder, compared to children of parents without.

If both parents have bipolar disorder, there is a 40% chance their child will also develop this mood disorder.

Substance Abuse

Manic and hypomanic episodes can be triggered by substances, and even more so with substance abuse. Substances that can trigger episodes include excessive amounts of caffeine, prednisone, and illicit substances including cocaine, ecstasy, and amphetamines.

Physical Illness

Physical illnesses cannot cause bipolar disorder, however, some of the symptoms of bipolar disorder may overlap and misdiagnosis can occur.

How is Bipolar disorder diagnosed?

Oftentimes, bipolar disorder is misdiagnosed as depression. Symptoms of depression are sometimes the same symptoms for those dealing with bipolar disorder, as the depressive phase of the disorder is generally more evident than the manic phase.

A mental health professional can provide medical advice to assist in diagnosis, taking into consideration the individual’s mental health history, family history, and experiences to see if it matches any of the diagnostic criteria for the bipolar disorder categories.

They can also rule out other mental health conditions or related disorders, like depression, anxiety, or another type of disorder.

What Treatment Is Available For Bipolar Disorder?

Bipolar disorder is a chronic mental illness that requires consistent managing, not curing. It is treatable with effective management and medical professionals can help manage bipolar disorder and related symptoms.

Long-term treatment is often required for individuals to maintain a healthy balance in their lives.

Treatment options include a combination of:

• Medication
• Psychological therapies, including psycho-education, cognitive behavioural therapy, mindfulness strategies, interpersonal relationship therapy and family-focused therapy.
• Lifestyle changes, including improving sleep patterns.

The goals of treatment include:

• Acute management: Stabilisation of emotions when experiencing depressive/manic episodes.
• Long-term management: Maintenance of stabilisation of emotions, coupled with preventative measures to control the likelihood of relapse occurring.

However, one of the major barriers in the treatment of bipolar disorder is medication and treatment non-compliance (source). That is, when an individual with the disorder stops taking their medication and seeking out continued counselling. This often occurs due to a lack of awareness of their condition. In particular, when a person with bipolar disorder is experiencing a manic episode, their mood is elevated. In these situations, they often do not feel as though they require help and support.

Another barrier to medication non-comp is due to the medication itself. For example, people often report that the medication makes them feel drowsy and removes the elevation experienced during their manic episodes.

Therefore, if you are a caregiver or significant other of a person diagnosed with bipolar disorder, it is important to recognise the risks of not seeking treatment as well as the long-term impacts this has on their close relationships, work and social functioning.