Bipolar Disorder is a mood disorder that impacts mood regulation and causes extreme mood swings leading to fluctuations between emotional highs, or mania, and lows, or depression. Depression can include the experience of sad or hopeless feelings, a loss of interest in activities, sleep and appetite disturbances, and lethargy. Mania is not the opposite of depression, as it can be just as damaging and uncomfortable as depression. During mania a sense of euphoria and extreme energy can be felt, which can lead to less sleep, impulsivity, and difficulties in controlling behaviors and emotions.
Types of Bipolar Disorder:
Not everyone experiences all or the same symptoms of Bipolar Disorder. This is demonstrated through the classifications of Bipolar Disorders into Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder. These variations allow symptoms to be identified more clearly and treatment to be focused on the exact issues created by the symptoms.
Bipolar I Disorder must include at least one manic episode which can be preceded or followed by hypomania or depression. The mania symptoms must cause significant distress and impairment in everyday life and can often lead to a hospitalization for treatment or possibly trigger a psychotic break.
Bipolar II Disorder must include at least one major depressive episode that lasted at least two weeks and one hypomanic episode that lasted a minimum of four days. A full manic episode was never present. The distress and impairment in this diagnosis is caused either by the depressive episodes or the unpredictable changes in mood.
Cyclothymic Disorder must include a pattern of symptoms that have been present for a minimum of two years in adults and one year in children and adolescents; including, periods of hypomania and depression. Symptoms must be present at least half of the time, and never fully go away for a period of longer than two months.
Symptoms of Bipolar Disorder:
According to the DSM-5, a manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week and includes persistently increased and goal-directed activity or energy. A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least four consecutive days. Symptoms are determined to be of a manic episode verses a hypomanic episode when they are severe enough to cause noticeable difficulty at work, school, or in social activities and relationships, require hospitalization, or trigger a psychotic break. Symptoms of both include:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts
- Increased goal-directed activity
- Impulsive and unusual behavior (risk taking, increased sexual behavior, increased spending)
According to the DSM-5 criteria for a major depressive episode is met when five or more symptoms are present for at least a two week period and represent a change from previous mood and functioning. At least one of these symptoms must be a depressed mood or loss of interest or pleasure. Symptoms may include:
- Depressed mood most of the day, almost every day, including feeling sad, empty, hopeless, irritable, or tearful
- Markedly reduced interest or feeling no pleasure
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
- Either insomnia or sleeping excessively
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death or suicide, or suicide planning or attempt
How is Bipolar Disorder Treated?
A combination of medication and psychotherapy is the most commonly recommended and most successful route of treatment. When symptoms are severe, psychiatric hospitalization may be needed to stabilize medication and maintain safety; however, in most cases treatment can be managed long term by a Psychiatrist and Psychotherapist. Medications may include mood stabilizers, anti-psychotics, antidepressants, and anti-anxiety medications and must be taken continuously even when symptoms are not present in order to maintain stability. Psychotherapy may include Cognitive Behavioral Therapy (CBT), Psychoeducation, and other techniques. CBT focuses on identifying unhealthy, negative beliefs and thoughts and replacing with healthy, positive ones. It also focuses on learning strategies to cope with stress and manage emotions. Psychoeducation should focus on learning about the diagnosis and understanding symptoms and how to control them, as well as educating family members to increase support. Other treatment options can include Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS).