Understanding Bipolar Disorder: A comprehensive Guide

When was the last time you felt sad, angry, mad, or anxious?

Today, we have apps that can track our mood every day without you having to really think about how you are feeling. An understanding of how every human experiences different moods will help you understand the complexities of Bipolar Disorder. 

Bipolar disorder is a mood-based disorder. This disorder is episodic, where a person may experience a few days to weeks of depression alternating between a euphoric mood with periods of neutral mood as well. Imagine life as a roller coaster ride and emotions as the ups and downs of the journey. As human beings, we all go through mood shifts on a day-to-day basis. For someone with bipolar disorder, this emotional roller coaster can have higher peaks (mania) and lower valleys (depression) compared to the typical ups and downs experienced by most people. The key characteristic of bipolar disorder is the presence of both manic and depressive episodes, creating a cycle of extreme highs and lows in emotions.

Our understanding of the disorder has expanded with scientific advances. Let’s understand what it entails to have Bipolar Disorder by understanding the symptoms of both Mania and Depression:-

Mania

In a manic episode, a person may experience extreme euphoria, which is different from general happiness about life. There is an intense sense of elation about everything in life which is different from the usual optimism we experience. Some of the features are mentioned below:-

1. Decreased need for sleep

It isn’t your usual not being able to sleep before an exam; this is when the mind is at a heightened level of activity, and suddenly it’s 4 am, and you still don't feel sleepy. It can also mean feeling alert and active with just 2 hours of sleep. 

2. Inflated Self-Esteem 

An example of this can be that a person out of nowhere begins to believe that they can be the captain of the Indian National Cricket team with no cricketing experience whatsoever or happens to think that they can take the stock market by storm when they haven't invested ever in life. One may experience a heightened level of confidence surrounded by self-importance, which often has no basis in reality or is delusional. 

3. Heightened Activity

A shared experience can be having multiple thoughts about various things. This often leads to extreme distractibility. There can be a massive increase in energy which becomes evident in speech, body language, and movement.  It is almost as if you begin by cooking a lavish meal for 10 people, getting on a call with your friend to start a new company, rushing to an NGO because you want to help animals who can't speak for themselves, and then wanting to play tennis without really completing any activity. 

4. Impulsive Decision Making

Sudden and excessive involvement in activities that can lead to painful consequences. Engaging abruptly in activities with the potential for adverse outcomes, such as extravagant spending on high-end cars despite financial constraints, impulsive real estate investments, pursuing multiple physical relationships without regard for long-term commitments, excessive binge eating, or consuming substances in dangerous quantities.

Depression 

In a depressive episode, a person may experience extreme levels of low mood and difficulty in doing things for a period of time, which is different from the general sadness that everyone experiences from time to time. Some of the features are mentioned below:-

1. Lack of Interest

A person experiencing an episode of depression may not feel interested in day-to-day activities. This is different from boredom. There is no interest in pursuing activities that used to bring pleasure to the person before. 

2. Sudden shifts Physiologically

Sleep and appetite are commonly affected; the person is either unable to fall asleep for several hours or is sleeping more than usual. Energy levels are at an all-time low despite having a longer sleep duration. Sudden shifts in food intake can be seen, and people often find it difficult to carry out essential functions like bathing and brushing their teeth.

3. Diminished ability to concentrate

To make differentiation from the everyday here, a person experiencing a depressive episode may experience a lack of attention and concentration on basic tasks such as folding clothes or making tea, and complex tasks feel extremely difficult to initiate. Memory lapses and indecisiveness may also be seen.

4. Worthlessness, Helplessness, Hopelessness

While the mood is generally low, the emotional field is marred by feelings of heightened insignificance, a belief that neither they nor others around them can help them come out of this phase, and a cemented loss of hope in living, which often leads to suicidal thoughts.

It is essential to understand that not everyone who experiences the disorder experiences all the symptoms.  Research helps us understand that typically, a person experiences the first episode of mania around the age of 25 years. For someone to be diagnosed with Bipolar Disorder the features of a manic episode should typically last for a week consistently, and that of a depressive episode for two weeks. These episodes may occur occasionally or multiple times in a year. 

Interesting fact

Suppose a human has experienced a manic episode but not a depressive episode. In that case, they will likely receive a diagnosis of Bipolar Disorder, but the same is not valid if episodes begin with Depression. Through scientific observations, we know that if a person has experienced the euphoria of a manic episode, they are also going to share the lows of Depression sooner or later. 

Different Types of Bipolar Disorder

1. Bipolar I Disorder: Experiences of manic episodes that last for at least seven days or are severe enough to require hospitalization. Depressive episodes should last two weeks as well. 
2. Bipolar II Disorder: Unlike Bipolar I, individuals with Bipolar II experience hypomanic episodes, which are less severe than full-blown manic episodes. Similar to Bipolar I, depressive episodes are a component of Bipolar II. 
3. Cyclothymia: Cyclothymia is characterized by chronic fluctuations in mood, but the highs (hypomanic symptoms) and lows (depressive symptoms) are less severe compared to Bipolar I and II. To be diagnosed with cyclothymia, the symptoms must persist for at least two years in adults.

Why does Bipolar Disorder happen?

A natural question at this point is why does a human being go through these episodes of mania and depression. There is no one clear answer; however, we know that bipolar disorder is influenced by a variety of factors. 

• There's a genetic aspect, meaning it can run in families. Some specific genes are linked to imbalances in brain chemicals like serotonin, dopamine, and norepinephrine, which affect mood.
• When we look at the brain, people with bipolar disorder often show differences in certain areas. The amygdala, which regulates emotions, and the pre-frontal cortex, which handles decision-making, may function differently. Also, changes may be seen in the Basil Ganglia, a part of the brain related to reward processing and motivation.
• The environment plays a role too. Stressful events in life or using substances may contribute to the development of bipolar disorder. 

Help with Bipolar Disorder

1. Bio-psycho-social: At Mave Health, we believe in helping people holistically. As Bipolar disorder impacts different areas of life, we need a qualified team of psychiatrists, clinical psychologists, and psychiatric social workers. Medications such as antipsychotics and mood stabilizers, with a combination of Cognitive Behavioural & Family Therapy, in addition to rehabilitation efforts help with improving functionality for Bipolar Disorder. Mave Health offers skilled mental health professionals with years of experience in dealing with Bipolar Disorder systematically. A complete Biopsychosocial approach helps in effective management.
2. Identify triggers: Many clients who have experienced Bipolar Disorder often mention how, before a full-blown manic episode, they can notice some signs. As you familiarize yourself with the disorder with the help of a professional, maintaining a diary to identify early triggers to both manic and depressive episodes can help.
3. Routine: Adopting a stable routine, including regular sleep patterns and consistent meal times, can be helpful. Regular exercise and a balanced diet contribute to overall well-being.

Helping a loved one with Bipolar Disorder

The effects of Bipolar Disorder can be devasting for the person and a difficult experience for their loved ones to observe. 

• A strong recommendation for a loved one would be to accompany the family member affected by Bipolar Disorder to seek professional support.
•  Invest some time in indulging in family therapy to understand the triggers and how you, as an observer, can help recognize early signs of a manic and depressive episode. 
  

Disclaimer: If you have experienced any of these symptoms or know a loved one who has experienced it, please seek professional help to understand your symptoms and treatment.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

American Psychiatric Association. (2021, January). What are bipolar disorders? Psychiatry.org. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

Dr. Tracey Marks. (2019, July 31). How To Tell what Mania and Hypomania Really Look like [Video]. Youtube. https://youtu.be/jMleT_rj0xY?si=ZJofbSf41WyXFtt9

Healthline. (2023, February 1). The History of Bipolar Disorder: From Ancient Greece to Today. Healthline.https://www.healthline.com/health/bipolar-disorder/history-bipolar#bipolar-disorder-today

Manji HK, Quiroz JA, Payne JL, Singh J, Lopes BP, Viegas JS, Zarate CA. The underlying neurobiology of bipolar disorder. World Psychiatry. 2003 Oct;2(3):136-46. PMID: 16946919; PMCID: PMC1525098.