What is Bipolar Disorder? (AN INSIDER’S VIEW)

Looking back now, I didn’t recognize that I had a problem at all – I just thought everything was fantastic during the highs and that I was just going through a rough patch during my debilitating lows. In my mind, it didn’t even occur to me that I had a mental illness, let alone bipolar 2 – I thought I was perfectly fine. Except, hindsight is 20/20 and after doing some research on my very angry outbursts and high irritability levels, it slowly dawned on me that I might need help. Looking back now, I see all my extreme highs and lows throughout the last several years and I have to admit; I was oblivious for a long time. I used to believe that I could just tell myself to toughen up and power through my intense feelings at work and school but I never knew why I was suffering, I thought everyone had good and bad days. I still have to remind myself it’s not me being weak and lazy when I’m feeling down but that I have a real, severe mental health condition.

My hope is to shed some light on a very misunderstood mood disorder and help those that have been affected by bipolar disorder understand their (or loved ones’) condition with more clarity. Currently managing my bipolar symptoms on a day-to-day basis and having been through both the spirit-soaring highs, soul crushing lows, and the periods of normalcy in between; I can give you a comprehensive, insider’s view of what bipolar disorder is really like.

So, what is bipolar disorder (BD)?

Also known as manic depression, bipolar disorder is a serious mental health condition that causes the sufferer to go through episodes of extreme depression to euphoria (severe mood swings) with some individuals feeling relatively normal in between. In addition to the extreme changes in mood, it also affects your energy and overall ability to function. For me, it’s like being on a rollercoaster that I can’t get off of. I never know if I’ll be up or down or how long the “ride” will last this time – days, weeks or longer?

Normally, my experience has been that I’ll have a depressive episode that lasts for a few days, every month or two, and I end up taking time off work (which I absolutely hate) but the bad feelings usually go away on their own and I feel better. Recently though, I’ve been feeling extremely low and very anxious for several weeks; much longer than I’ve ever experienced before. Sometimes, I come out from a depressive episode slowly and  feel very neutral and calm and then I go through a “good/normal” phase for a few weeks. Sometimes though, I come flying out of a depressive episode in an amazing mood while feeling everything is awesome and I become super productive and focused for about a week or so. (Just a note: this is more rare for me because I usually feel mostly down and tired than “up” and amazing.) The good times last until my next depressive episode decides to start. And, the cycle continues.

What are the types of bipolar disorder?

There are 3 specific subtypes of bipolar disorder: Bipolar 1, Bipolar 2, and Cyclothymia.

Bipolar 1 requires at least one manic episode for the diagnosis and while depressive episodes are much more common in most cases, they are unnecessary for the diagnosis.

For bipolar 2, there are no manic episodes but one or more hypomanic episodes and one or more major depressive episodes. Hypomanic episodes are not as extreme as manic episodes (for example no severe social or occupational impairment and no psychosis) so it can be harder to diagnose. Most people only report the severe depression – not the periods of being in a great mood with high productivity as they may not realize anything is wrong.

Cyclothymia is when a person experiences periods of hypomanic episodes with depression that does not meet the definition of major depressive disorder.

What are the signs and symptoms of bipolar disorder?

When you think of bipolar disorder symptoms, you’re most likely picturing the manic part of the disorder not the depressed, sad side of things. Mania, hypomania, depression and mixed affective disorder are the major defining elements of bipolar disorder and they come in different severities. There are also a wide number of other symptoms that often come with bipolar disorder but are not part of the official diagnosis which will be discussed below.

Manic Episodes

Bipolar symptoms such as speaking in an uninterruptible, rapid manner; have a short attention span; increase in goal-orientated activities; agitation and racing thoughts among other things, are all classic signs of mania. Those that have this disorder may also partake in behaviours that are impulsive or high risk in nature like going on wild spending sprees or promiscuity.

At the extreme end, bipolar mania causes individuals to hear voices (sometimes to the point of psychosis) and/or be delusional and have distorted thoughts/ideas about the universe. To meet the definition of a manic episode, the behaviours listed above must prevent the individual from working and socializing normally with others. If nothing is done to address and treat a manic episode, it can sometimes last between 3-6 months.

Hypomanic Episodes

Milder mania is called hypomania and individuals experiencing it are more goal-oriented, productive, energetic, talkative, creative and overall excitable people.  For some, including me, hypomania may manifest itself into a period of high irritability combined with poor judgment where anything can touch a nerve and set you off.  Normally though, I feel really amazing during this stage. It’s like I’m on top of the world, where I can accomplish anything and I feel happy. However, there are many ways to experience different episodes and this is only my experience. Others may find it equally painful to go through these episodes.

Hypomanic episodes do not cause a significant decrease in a person’s inability to work or socialize instead, they might even increase their abilities as hypomania has been thought to be a defense mechanism against depression. There are also no psychotic features like hallucinations and delusions and a hospital stay would be unnecessary because a hypomanic episode would rarely, if ever, turn into mania.

For those that have bipolar 1 they generally go through the more intense mania while those that have bipolar 2 typically go through the milder hypomania. Those going through a hypomanic episode will generally deny that anything is wrong with them (like me) and they tend to forget that their actions affect others as well (also like me.)

Depressive Episodes

Meanwhile, depressive episodes have many symptoms including: hopelessness, self loathing or feelings of worthlessness, ongoing feelings of sadness, loss of interest in previously enjoyed activities,  irritability or anger, excessive or inappropriate guilt, sleeping too much or too little, fatigue, lack of concentration, changes in appetite and/or weight, and thoughts of death or suicide.

In extreme cases, the individual may develop psychosis as a symptom (also known as severe bipolar disorder with psychotic features) and they may experience symptoms such as delusions and hallucinations during this time. A major depressive episode will typically last about 2 weeks and if not treated, can result in suicide.

Mixed Affective Disorder

Mixed affective disorder or mixed state is a period during which symptoms of both mania and depression occur at the same time. Someone experiencing a mixed state may feel manic symptoms like grandiose thoughts while at the same time experience depressive symptoms like feeling suicidal. During a mixed state episode, there is a much higher risk of suicidal behaviour. In my own experience, this is because you feel strong depressive feelings like worthlessness and you have the energy to do something about it. Other feelings may include wild mood swings and reduced impulse control.

Associated Features and Coexisting Conditions

Although not part of the official diagnostic criteria, there are several characteristics that are commonly connected to bipolar disorder. For example in adults with the disorder, there may be changes in cognitive abilities and processes including impaired memory and reduced attention spans. However, bipolar disorder has also been strongly linked to creativity. Those with manic depression also tend to have difficulty maintaining relationships with others but it’s not on purpose. I’m very aware that those around me walk on eggshells because I experience moments of irrational anger and even though I know I’m being illogical, it’s extremely difficult to control the thoughts racing through my mind. Along with my irrational anger, I also experience exaggerated responses to minor irritations like loud noises or anything else that startles me.

The diagnosis of bipolar disorder can be further complicated by other coexisting conditions including panic disorder, eating disorder, substance abuse, obsessive-compulsive disorder, premenstrual syndrome, attention deficit hyperactivity disorder and social phobia. There should be a careful analysis of the signs and symptoms a person is displaying to establish a comprehensive treatment plan that can address both conditions.

What causes bipolar disorder?

The exact cause of bipolar disorder is still unknown but scientists believe there is a complex relationship between genetic and environmental factors. Researchers believe that some people are born with a predisposition to bipolar disorder, which means that they are more likely to develop the disorder because it’s in their genes. Environmental factors are also a consideration in the development of manic depression such as stressful life events that may trigger a relapse of symptoms or lead to an onset of the illness.

There have been studies that indicate bipolar disorder can run in the family although not everyone with a family history will develop this disorder. Generally, those with a first-degree relative (parents, siblings, children etc.) with a mood disorder are most likely to develop a mood disorder themselves.

In some people, environmental factors like a stressful life event can trigger the onset of the illness. Stressful events might include trauma, grief over the death of a loved one, moving into a new home, job loss, the birth of a child etc. Drug or alcohol use may also be a factor.

Can I prevent bipolar disorder?

There have been attempts to prevent bipolar disorder by focusing on early stressors such as high conflict families or childhood hardship. Although stress is not diagnostically the cause of bipolar disorder, it does put genetically vulnerable individuals at a higher risk for the worst course of the illness. There has also been debate on the causal relationship between the use of marijuana and bipolar disorder.

Are you sure it’s bipolar disorder… or something else?

There are several other mental disorders that have similar signs and symptoms that are normally seen in bipolar disorder such as attention deficit hyperactivity disorder, schizophrenia, major depressive disorder and some personality disorders like borderline personality disorder. Although there is no test for bipolar disorder, imaging and blood tests can help rule out other disorders that present similar symptoms to bipolar disorder including hyperthyroidism or hypothyroidism, a chronic disease, or an infection such as syphilis or HIV.

Common medications that may induce a manic episode include antidepressants, thyroid hormone, stimulants (such as cocaine or methamphetamines), Parkinson’s disease medication and certain antibiotics to name a few. Bipolar disorder is normally diagnosed during adolescence or early adulthood but onset can happen throughout the life cycle. For those individuals that have an onset of bipolar symptoms mid to late in life, additional testing may be required.

How do I manage bipolar disorder?

To manage the symptoms, there are a number of psychotherapeutic and pharmacological techniques used to treat BD as well as the “self-help” route.

Some may require hospitalization during the manic episodes in bipolar 1. This can be voluntary or sometimes involuntary. There are support groups and intensive outpatient programs available as well.

Psychotherapy tries to reduce the primary symptoms, recognize triggers and uses techniques to try to stay in remission. Cognitive behavioral therapy has been shown to be an effective way to prevent a relapse sometimes in conjunction with other therapies.

Medication is an alternative route that is used to treat bipolar disorder and one I use myself in addition to therapy sessions. Personally, it has helped me manage my symptoms tremendously although I am experiencing side effects like weight gain and tiredness. Lithium is the most known drug for bipolar disorder and there are also anticonvulsant medications as well as antipsychotics that are used to treat the symptoms for BD. Antidepressants can be used as well, but usually in conjunction with another medication as they are not recommended for use by themselves.

What else do I need to know about Bipolar Disorder?

Bipolar disorder is a lifelong illness where there are moments of partial or full recovery in between periods of relapse. There are increased rates of disability and premature death with bipolar disorder and so it is considered a major health problem worldwide. Generally, bipolar disorder co-occurs with other psychiatric and medical problems and because it is difficult to diagnose, treatment may be delayed for an individual suffering with it.

The best thing to do to manage the symptoms are to stick with your medication regime consistently to prevent a relapse. I know that bipolar medications have side effects and the severity of them vary greatly. Many people do not take their meds on a regular basis for a number of reasons but mostly because of the side effects.

Rapid cycling (4 or more episodes in a year) is correlated to the most risk of self-harm and suicide. This means that a person can experience severe mood swings every few months on a “rapid” basis. There is also a degree of loss of cognitive function and it seems to increase as time goes on. Although during mania you feel very goal oriented, mania actually impairs social and occupational functioning. A large number of people actually remain unemployed for a year after a hospitalization for mania.

Hopefully, I have shed some light on a very misunderstood illness that I and many people around the world suffer with. I have to remember it’s a lifelong disease so it’s going to be a process managing bipolar disorder every day. This is what I thought would be the most helpful/useful info on the disorder but there is so much more out there. If you would like me to go over any other topics or questions you have please send me a message or leave me a comment below.

 

 

 

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