OTHER DISORDERS

Bipolar Disorder

Credit: Osmosis

Kanye West, Demi Lovato and Carrie Fisher are just a few of the famous names who have opened up about their diagnosis and experience with bipolar disorder. Despite their diagnosis, these celebrities have gone on to have extremely successful careers. Fisher once said individuals who live with bipolar disorder should be “issue[d] medals” as they battle with the disorder, a sentiment we wholeheartedly agree with. An often misunderstood disorder, read on to find out what bipolar disorder actually is and how we can help others with the diagnosis.

What is Bipolar Disorder? 

Bipolar disorder is a chronically recurring condition that results in mood swings that have the highs of mania and the lows of major depression.  

There are three main types of bipolar disorder – bipolar I, bipolar II and cyclothymic disorder. The main difference between the bipolar I and II is the intensity of manic episodes. Bipolar I requires a diagnosis of mania, while bipolar II requires a diagnosis of hypomania, which refers to less severe manic episodes. Cyclothymic disorder is similar to bipolar disorder, but the severity of depressive and manic episodes do not meet the intensity for a diagnosis of bipolar disorder.  

Manic and Depressive Episodes  

We are more familiar with depressive episodes, but what exactly is a manic episode?

A manic episode is a period of heightened mood and energy that is not typical of an individual. Behaviours that may be exhibited include grandiosity, being distracted, a reduced need for sleep, and excessive involvement in activities that have a high chance of negative consequences (e.g., going on spending sprees). The symptoms of hypomania are similar to those observed in a manic episode, but they occur at a lower intensity.

A major depressive episode, also seen in major depressive disorder, is marked by a depressed mood for most of the day and a loss of interest or pleasure in activities. A few symptoms that may manifest are significant weight loss or decrease in appetite (when not dieting), insomnia, feeling worthless, reduced ability to concentrate, and recurring suicidal thoughts.  

Bipolar I 

For an individual to be diagnosed with bipolar I, they must have experienced at least one manic episode, with or without depression, distinguishing it from Major Depressive Disorder. To prevent a misdiagnosis, this occurrence of manic and depressive episodes should not be better explained by other disorders, such as schizophrenia.  

Bipolar I has an equal occurrence amongst male and females. The onset of a first episode of mania or depression typically occurs in early adulthood, but can also occur throughout the life cycle — even as late as 70!  

Bipolar II 

For a diagnosis of Bipolar II, it is necessary to have a hypomanic episode and a major depressive episode. The main difference between a hypomanic episode from a manic episode is the length of the episode — hypomania occurs when the episode occurs for four consecutive days consecutively; mania occurs for a week. If the individual meets the criteria for a manic episode, bipolar II cannot be diagnosed. The individual also has to have experienced a major depressive episode.  

The average age of onset for bipolar disorder is around the mid-20s. The number of hypomanic and depressive episodes also tend to be higher in bipolar II across the lifetime compared to bipolar I.   

Cyclothymic disorder  

Cyclothymic disorder is a bipolar-related disorder. While the symptoms are similar, the criteria for diagnosis of cyclothymic disorder comprises of two years of numerous periods of fluctuating hypomanic and depressive episodes that are insufficient to meet the criteria for mania, hypomania or major depression.  

Onset of symptoms also begins at an earlier age of around early adolescence. Cyclothymic disorder is sometimes viewed as a precursor to bipolar disorder, as there is a 15-50% risk that the individual will eventually develop either bipolar I or II.  

“Eh you bipolar ah?”  

Bipolar disorder is commonly misconstrued as “mood swings”, and this often adds to the stigma surrounding the disorder. Although the mood swings experienced by people with bipolar disorder are characterised by extreme peaks and troughs, much like a sine wave, these changes in moods are often characterised by extreme energy, activity and sleep. The extent of these changes are rather extreme and are not typical for the individual in particular – in fact, they often last up to weeks at a time! Thus, when you wake up feeling sad because your favourite coffeeshop was closed but end up feeling happier in the evening when you walk your dog, you most likely do not have bipolar disorder!  

Another common misconception that people have about episodes of mania, no thanks to popular media, is that it makes people extremely creative and productive. In reality, while mania can indeed initially make an individual feel good, the situation could take a turn for the worse if the individual does not receive help. Some individuals even end up losing touch with reality. Hence it is important to seek help as soon as possible.  

Causes  

Like many other disorders, there is no single, contributing cause for bipolar disorder. The main factors that increase one’s risk of developing bipolar disorder are biological in nature. Genetics is the main predictor, as first-degree relatives (e.g., a parent) of individuals with bipolar are at a higher risk of the disorder (8-10% risk). Imbalance of neurotransmitters like dopamine have also been linked to manic activity.  

Aside from biological factors, psychological factors also precipitate depressive episodes and trigger them. An example would be (past and/or present) stressful events – they increase an individual’s risk to bipolar disorder because they activate underlying vulnerabilities in them. For example, stressful events in one’s childhood (e.g., physical abuse), coupled with recent life stressors in adulthood (e.g., financial hardship) could predispose one to a major depressive episode, due to faulty core beliefs learnt in the past. Substance abuse is also associated with the occurrence of bipolar disorder. 

Addressing it

Addressing Bipolar Disorder often involves symptom management with a wide range of medication – mood stabilisers, antipsychotics and antidepressants. The process of finding the right dosage and concoction of medication often takes up to a few weeks or months of experimentation, as each individual requires a unique dosage.  

To complement medication and improve the results of the management plan, adjunctive psychological therapies are also used. These therapies target social and environment contexts to reduce the onset of symptoms and episodes in individuals. Cognitive Behavioural Therapy (CBT) can also be used to identify negative beliefs and replace them with more positive ones, reducing triggers of episodes. Psychological interventions used in combination with medication improves the likely prognosis of the patient and results in a greater reduction in relapses.  

More invasive techniques like Electroconvulsive Therapy (ECT) are only used as a last resort for addressing Bipolar Disorder, such as if the patient is unable to be treated by medicine.

Prognosis 

In general, the prognosis depends on the severity of the symptoms presented by the individual and/or the presence of other psychiatric comorbidities. However, factors like social support and receiving professional aid improve the likely prognosis of the disorder.  

How can I support someone with bipolar disorder?  

Educating yourself about the disorder is a great start so great job for reading this article! Here are some tips for you to support someone with Bipolar disorder.   

  1. Learn about the disorder - By understanding the symptoms of a manic and depressive episode, it can help you react appropriately during these severe mood swings. 

  2. Be there for them - You can listen actively to what they are saying, while not necessarily having to provide answers to them all the time! While it doesn’t sound like much, it allows the individual to feel more accepted and comfortable with their condition. As much as possible, make sure they know that you’re with them in this fight – affirmation and social support will help them manage depressive episodes better!  

  3. Take care of yourself - It’s always easy to get caught up when caring for others and caring for someone with bipolar can be tough – so don’t forget to take care of yourself!