Bipolar Disorder: A disorder of extremes

What is Bipolar Disorder?

The United States’ National Institute of Mental Health defines Bipolar disorder as, “…a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” This is also known as a manic-depressive disorder because shifts in mood range from manic episodes (i.e., periods of energetic or “up” behavior) to depressive episodes (i.e., periods of hopelessness, sadness, or “down” behavior). “Up” or “down” episodes can range from 7 days to multiple weeks.

This disorder is more common in women than in men, with a ratio of approximately 3:2. The average age of onset is 25 years, with onset in men being at an earlier age than in women.

bipolar_disorderWhat causes bipolar disorder?

The exact causes of bipolar disorder are unknown. However, studies have shown alterations or imbalance in neurotransmitters (naturally-occurring chemicals in the brain). Research also indicates physical changes in brain structure in patients suffering from bipolar disorder. None of the research, however, is conclusive about the cause of this ailment.

What are the risk factors?

Family History – Bipolar disorder in the family increases the risk of developing this illness, especially if a first-order relative (e.g., parent or sibling) suffers from it.

Genetics – Previous research has shown an increase in the likelihood of developing bipolar disorder with the presence of certain genes; however, findings are inconclusive.

How does it manifest?

As mentioned above, bipolar disorder is characterized by mood episodes. Mood episodes, besides being of the manic, hypomanic, or depressive type, include features like intense emotional changes and changes in sleep pattern. Some of the other symptoms experienced by a patient are included in the table below:

People having a manic episode may:

People having a depressive episode may:

     Feel very “up,” “high,” or related

     Have a lot of energy

         Have increased activity level

      Feel “jumpy” or “wired”

      Have trouble sleeping

      Become more active than usual

      Talk really fast about a lot of different things

          Be agitated, irritable, or “touchy

     Feel like their thoughts are going very fast

      Think they can do a lot of things at once

      Do risky things, like spend a lot of money or have reckless sex

      Feel very sad, down, empty, or hopeless

      Have very little energy

      Have decreased activity levels

      Have trouble sleeping, they may sleep too little  or too much

      Feel like they can’t enjoy anything

      Feel worried and empty

      Have trouble concentrating

      Forget things a lot

          Eat too much or too little

      Feel tired or “slowed down”

      Think about death or suicide

Source: National Institute of Mental Health

Episodes have been shown to be triggered by drug or alcohol abuse, traumatic experiences (e.g., death of a loved one), periods of high stress.


How is it diagnosed?

Bipolar disorder is usually diagnosed through psychological evaluation and mood charting. A physical exam may also be required to rule out other medical problems that might be causing the symptoms.

What is the treatment?

Bipolar disorder is usually treated with a combination of medications and psychotherapy to provide support and guidance. The objective of treatment is to prevent or minimize mood swings and to introduce stability in the patient.

Medications used to treat this disorder include:

  • Mood stabilizers
  • Atypical antipsychotics
  • Anti-depressants
  • Anti-anxiety medications

Treatment for bipolar disorder requires heavy involvement from caregivers and the treating physician, to enable accurate and quick titration of medication doses as well as appropriate strategies for psychotherapy including, but not limited to, cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy, electroconvulsive therapy (ECT), etc.

If you or a loved one are thinking about suicide, please reach out to your family doctor.

For more information, please refer to the following sources:

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