Manic-depression: Alternating moods of abnormal highs (mania) and lows (depression). These days it is more commonly known as bipolar disorder, the change from “manic depression” to “bipolar disorder” was made in 1980. It was done to include symptoms such as hypomania and exclude some others while attempting to reduce the stigma associated with the disorder.
It is a severe type of depressive disease. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. Mania often affects thinking, judgment, mood, energy and social behavior in ways that cause serious problems, embarrassment and the ability to carry out day to day tasks. Bipolar disorder is often a chronic recurring condition.
Bipolar disorder is commonly associated with episodes of mood swings ranging from depressive lows to manic highs. The exact cause of bipolar disorder isn’t known, but a combination of genetics, environment and altered brain structure and chemistry may play a role. There are three types of bipolar disorder.
All three types involve clear changes in mood, energy, and activity levels. Manic episodes may include symptoms such as high energy, reduced need for sleep and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts. Less severe manic periods are known as hypomanic episodes.
- Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
- Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
- Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment this is because it is not curable but highly manageable. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.
SO, WHAT EXCATLY CAUSES BIPOLAR DISORDER?
The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:
- Biological differences.People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
- Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
- Others. Other factors such as a traumatic life event, postmortem depression, high levels of stress or loss of a loved one can all contribute or lead an individual to develop bipolar disorder
According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession.
In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year. The symptoms are often grouped into two:
Mania or hypomania
Hypomania and mania are elevated moods. Mania is more intense than hypomania.
Symptoms can include:
- impaired judgment
- feeing wired
- sleeping little but not feeling tired
- a sense of distraction or boredom
- missing work or school
- underperforming at work or school
- feeling able to do anything
- being sociable and forthcoming, sometimes aggressively so
- engaging in risky behavior
- increased libido
- feeling exhilarated or euphoric
- having high levels of self-confidence, self-esteem, and self-importance
- talking a lot and rapidly
- jumping from one topic to another in conversation
- having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
- denying or not realizing that anything is wrong
Some people with bipolar disorder may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities.
During an episode of bipolar depression, a person may experience:
- a feeling of gloom, despair, and hopelessness
- extreme sadness
- insomnia and sleeping problems
- anxiety about minor issues
- pain or physical problems that do not respond to treatment
- a sense of guilt, which may be misplaced
- eating more or eating less
- weight loss or weight gain
- extreme tiredness, fatigue, and listlessness
- an inability to enjoy activities or interests that usually give pleasure
- difficulty focusing and remembering
- sensitivity to noises, smells, and other things that others may not notice
- an inability to face going to work or school, possibly leading to underperformance
In severe cases, the individual may think about ending their life, and they may act on those thoughts.
If a “high” or “low” episode is very intense, the person may experience psychosis. They may have trouble differentiating between fantasy and reality.
If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:
- Anxiety disorders
- Eating disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Alcohol or drug problems
- Physical health problems, such as heart disease, thyroid problems, headaches or obesity
- Memory loss.
How is bipolar disorder diagnosed?
A diagnosis of bipolar disorder is made only by taking careful note of symptoms, and their severity, length, and frequency. The most telling are periods of hypomania or mania. Reviewing history from close friends and family is often very helpful to distinguish bipolar disorder from major depression.
Bipolar disorder cannot be cured. It is considered a chronic illness, like diabetes, and must be carefully managed and treated throughout your life. Treatment usually includes both medication and therapies, such as cognitive behavioral therapy. Medications used in the treatment of bipolar disorders include:
- mood stabilizers such as lithium (Eskalith or Lithobid)
- atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal)
- anti-anxiety medications such as benzodiazepine are sometimes used in the acute phase of mania
- anti-seizure medications (also known as anticonvulsants) such as divalproex-sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
- People with bipolar disorder will sometimes be prescribed antidepressants to treat symptoms of their depression, or other conditions (such as co-occurring anxiety disorder). However, they often must take a mood stabilizer, as an antidepressant alone may increase a person’s chances of becoming manic or hypomanic (or of developing symptoms of rapid cycling).