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What is Bipolar Disorder?
Bipolar disorder or manic-depressive illness is a mental disorder that affects daily activities of individuals in both positive and negative ways. People with bipolar disorder suffer from elevated moods of mania and subsequently, depression. These unpredictable mood episodes can affect a person’s energy levels, behavior, physical health, and even affect those around them (especially family members). Bipolar disorder is not uncommon. In fact, bipolar disorder is the sixth leading cause of disabilities worldwide and affects approximately 3 percent of the global population. According to the National Institute of Mental Health, there are over 5.7 million cases of bipolar disorder in the United States alone.
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Symptoms of Bipolar Disorder
People suffering from bipolar disorder experience primarily two mood episodes: depression and mania. During the manic stage, people feel euphoric, energetic, and elated. They become creative and hyperfocused, set goals and start working. During this stage, many people go days without sleeping and not feel tired. They also become fearless and often take risks that they usually would not. While the manic stage does sound scary, it’s actually the better part of the bipolar disorder for most people. The other half of the illness is the depressive part. A depressive episode can lead to a sudden feeling of sadness, loneliness, a loss of energy and the drive to work. This is the stage that drives the illness for most people. They can easily get irritated and even feel suicidal at times.
Characteristics of Manic and Depressive Episodes according to NIMH:
Symptoms of a manic episode:
● High energy
● Increased activity
● Delirious
● Confused/Disorganized
● Little need for sleep
● Flight of ideas
● Easily irritated
● Racing thoughts
● Hypergoal directed with little completed tasks
● High risk behavior
Symptoms of a depressive episode:
● Feeling sad, lonely, hopeless
● Have decreased activity and energy levels
● Change in sleep pattern
● Lose of interest
● Feel worried and empty
● Difficulties concentrating
● Forgetful
● Change in appetite
● Feel tired or “slowed down”
● Suicidal thoughts
It can be hard to differentiate life’s ups and downs from symptoms of bipolar disorder. However, if you see the above symptoms for more than two years, then it’s highly plausible that the person may be suffering from a form of bipolar disorder.
Causes of Bipolar Disorder
Scientists have not been able to identify a direct single cause of bipolar disorder but many factors play an important role in the development of a bipolar disorder.
Genetic Influences
Many studies have suggested that about “8 to 10 percent of the first-degree relatives of a person with bipolar I illness can be expected to have bipolar disorder.” That’s almost 5-10 times higher than the general population. Other studies conducted on twins show that despite identical twins sharing the same genes, it’s possible that one may develop bipolar disorder while the other may not.
Neurochemical Factors
Increase in neurotransmitters like dopamine and glutamate is linked to the manic phase of bipolar disorder. Increase in dopamine in particular is said to result in secondary homeostatic downregulation of key systems and receptors. Studies have also found that glutamate levels are increased during the manic phase and return to normal once the phase is over. Other neurochemicals like 5-hydroxyindoleacetic acid, VMAT2 and norepinephrine also increase and decrease with bipolar disorder phases.
Psychological Factors
Our social environment plays a big role in how the illness progresses over time. A stressful or low social support environment can make depressive episodes even more frequent. Over time, these episodes may become independent of our social environment.
Diagnosing the Bipolar Disorder
While there is no test to diagnose any kind of bipolar disorder, psychiatrists can use observation and patient’s medical history to see if they fit the criteria of bipolar disorder stated in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The diagnoses usually begins with a physical examination which may include blood tests and PET scans to rule out the possibility of any other illness. Patients are then asked to visit a psychiatrist.
One thing to note is that most people suffering from bipolar disorder only decide to visit the doctor when they’re going through a depressive episode which might cause the physician to diagnose the patient with major depressive disorder. That’s why it’s imperative that the patient must disclose whatever they can remember about their medical records from at least two years ago.
The average age at which bipolar disorder symptoms start to be first seen is 25 years old. Though it’s not impossible for symptoms to begin during adolescence or much rarely, during childhood.
There is a common misconception that bipolar disease is just one disease but instead, bipolar disorder has various subtypes with different symptoms and treatments. DSM-5 states three main subtypes and two features of bipolar disorder.
Bipolar I Disorder
Bipolar I Disorder is characterized by the presence of manic episodes. This means people with Bipolar I Disorder will experience extreme levels of mania but not extreme levels of depression. Symptoms still include depressed mood, anxiety, guilt, and lack of energy, however, none of the symptoms are severe enough to qualify as a mixed or a major depressive episode. Another thing to notice is that it’s entirely possible that the individual will develop depressive symptoms later on in life even if they are currently only experiencing manic symptoms.
Bipolar II Disorder
Another form of the bipolar disorder is the Bipolar II Disorder where a person does not feel full-blown episodes of mania but instead suffers from less severe episodes called hypomania along with full-blown episodes of major depressive episodes. Bipolar II disorder is just as common as bipolar I disorder and occurs equally in both genders.
The Manic-Depressive Spectrum. Source: Frederick K. Goodwin and Kay R. Jamison. (2009). Manic Depressive Illness. Copyright © 1990. Oxford University Press, Inc.
Cyclothymic Disorder
Cyclothymic Disorder is a mild or less severe form of full-blown bipolar disorder. Symptoms of cyclothymia are similar to that of bipolar disorder (depression and mania) but they are much less severe Symptoms of cyclothymia include sudden loss of interest in things that the person once enjoyed, social isolation, anxiety, and sadness. Although no exact cause has been discovered, studies show that genetics play a big role cyclothymia and that cyclothymic individuals are at a much greater risk of developing full-blown bipolar disorder later in life.
Mixed features
Mixed features in bipolar disorder is a condition when the person experiences both manic and depressive episodes at the same time with no interval in between. It’s possible that the person will feel happy and full of energy one day and the other day the person might lose all interest and energy. Sometimes a manic and depressive episode might occur in a single day. Mixed features are also called mixed episodes and are not at all uncommon.
Rapid cycling
Rapid cycling is a common feature of bipolar disorders where an individual experiences four or more manic or depressive episodes in a year. While the minimum threshold for rapid cycling is four episodes every year. Most people suffer from a lot more than just four in a year. Only 50 percent of bipolar individuals suffer from rapid cycling permanently while for the other 50 percent, rapid cycling is a temporary phenomenon and disappears within 2 years.
Treatment and Outcomes
Different types of medications and therapies are available to treat the different forms of bipolar disorder, however, results vary from person to person. In order to get the best treatment possible, you’ll have to talk to a psychiatrist who can prescribe the best combination of medication, therapies, and lifestyle changes for you. Treatments for bipolar disorder include:
Pharmacotherapy
Antidepressant, mood-stabilizing, antianxiety and antipsychotic drugs are usually prescribed to bipolar patients depending on their subtypes and severity. These medications usually come with many side effects which is why only 50 percent of patients respond positively to the medication positively. However, the remaining 50 percent show “clinically significant response when switched to a different antidepressant or to a combination of medications.”
Psychotherapy
Psychotherapy is also known as talk therapy or counseling. Over the years, many forms of psychotherapy have been developed and almost all have them show positive results. Some common types of psychotherapy listed by NIMH are:
- Cognitive behavioral therapy (CBT)
- Family-focused therapy
- Interpersonal and social rhythm therapy
- Psychoeducation
Brain Stimulation Therapies
When medication and psychotherapy do not deliver significant improvements, physicians often turn to brain stimulation therapy such as electroconvulsive therapy (ECT) which marked improvement in 80 percent of manic patients. Other brain stimulation therapies include transcranial magnetic stimulation, deep brain stimulation, and bright light therapy.
While treatment of bipolar disorder is now more accessible than ever, a vast majority of people do not receive adequate treatment. According to the National Comorbidity Survey-Replication, only 40 percent of people suffering from mood disorders receive minimally adequate treatment while the remaining 60 percent receive no treatment or inadequate treatment.
vmat2 is a protein but I think it still applies.