Manvi Verma
” Bipolar disorder is a challenge, but it can set you up to be able to do almost anything else in your life.”-Carrie Fisher
Ever thought how we will feel if there are continuous ups and downs in our moods; from feeling of euphoria to dysphoria accompanied by discomfort always. Sounds alarming, isn’t it? It actually is alarming when there is need of medications or therapy for everything we need to do.
Imagine being in this scenario, disheartening with a felling of despair and dread where we don’t know how will we be feeling the next moment? The thought of dying in one moment to having high bouts of energy in the next second.
Bipolar disorder is a serious mental condition in which common emotion become extremely and often variably magnified. It was previously known as manic depression and was signified by episodes of depression and episodes of abnormally elevated mood that lasts from days to weeks each. People with bipolar disorder rapidly shift from intense happiness and energy to sadness, fatigue and confusion.
This disorder cause alters in mood, energy and ability to functions. It includes three different conditions: Bipolar I, Bipolar II and cyclothymic. Mood episodes are differentiated as Manic, Hypomanic and Depressive episodes.
There are times where they have normal mood as well. Severe elevated mood or associated with psychosis is known as mania and if it is less severe it is called hypomania. Manic episodes have decreased need of sleep.
Manic Episode
In manic episodes, the person is very energetic or irritable in an extreme way for most of the days and has high bouts of energy than normal for at least one week and shows increased self esteem or granulosity with reduced need for sleep. They talk more than loudly, quickly and more than normal.
They are easily distracted, multitasking and scheduling tasks more than what can be completed in a way with risky behavior and have uncontrollable thoughts, changing ideas or topics. The changes are very significant and clearly visible to others.
The symptoms include dramatic mood swings. During manic episode, person may feel high or on the top of the world or uncomfortable and irritated whereas in depressive episodes, the person may feel sad and gloomy between these episodes there are time lapses of normal moods.
They are severe enough to cause dysfunction and problems. Manic episodes can start anytime from when a person is in early childhood to later adulthood. The average age is recorded as eighteen years for manic episodes.
Hypomanic episodes
Hypomanic episodes are just like manic episodes. They are less severe and last for four days in continuation. There are major depressive episodes of two weeks in which the person experience intense sadness or despair, feeling helpless, gloomy or worthless, and restless or agitated.
Person loss interest in activities, he/she once enjoyed. Sleep is also disturbed; either there is too much drowsiness or close to no sleep. There is either increased or decreased appetite along with slow speech or movements. Energy is lost and difficulty in concentrating or remembering and making decisions accompanied with a large number of thoughts of death and suicide.
These disorders can disturb person’s life and relationships with family and cause difficulty in working. Bipolar I has at least one manic episode with or without depressive episode. It is accompanied by Attention Deficit Hyperactivity Disorder, Anxiety Disorder or Substance Abuse.
Risk of suicide is higher in people with bipolar disorder. 80-90% cases are accounted in people who have relative with either depression or bipolar disorder that is strong hereditary component. Those with first degree relatives with bipolar disorder are at tenfold higher risk in comparison to normal population. 30-50% has a history childhood abuse and long term stress and with earlier onset there are increased rates of suicide attempts and co-occurring disorders such as PTSD.
Over period of twenty year; 6% of those with bipolar disorder died by suicide and 30-40% are engaged in self harm. Rarely, bipolar disorder may occur as end product in association with neurological condition or injury such as stroke, HIV, multiple sclerosis, traumatic brain injury etc.
Bipolar II disorder includes person with at least one major depressive episode and at least one hypomanic episode. These people return to normal functions between episodes. They often seek treatment due to depressive symptoms which are severe. They are often accompanied by other mental illness like anxiety disorder or substance abuse disorder.
The treatment is similar to that of bipolar I which is medication and psychotherapy. Treatment of each person is different that is treatment is individualized.
Cyclothymic disorder
Cyclothymic disorder is a milder form of bipolar disorder including many mood swings along with hypomania and depressive state. People experience emotional ups and downs; less severe than bipolar I and II.
The symptoms are periods of hypomania and depressive symptoms for at least two years during those two years, mood swings last for at least half time and never stopped for more than two months. Treatment includes talk therapy which help with stress of high and low moods. They may start and stop treatment overtime.
Treatment includes use of mood stabilizers such as lithium and a few anti-convulsants for relapse prevention. Anti-psychotics are advised during acute manic episodes in cases where mood stabilizers are poorly tolerated or where compliance is not so good.
If the symptoms of bipolar disorder are due to drugs or any other medical problems then the diagnosis is not bipolar disorder. Anti-depressants can be effective but shows implications of triggering manic episodes. ECT, electroconvulsive therapy is also effective in acute manic and depressive episodes; especially with psychosis and catatonia. Involuntary treatment is necessary sometimes if affected person is refusing treatment. If person is a risk to others and themselves then admission top psychiatric hospital is important.
The aim of management is to treat acute episodes with medication and work with patients in long-term to prevent further incidence and optimizing function using pharmacological and psychotherapeutic techniques.
People with bipolar I needs hospitalization voluntary or involuntary with manic episodes. Medications differ according to episodes treated. Psychotherapy helps the person in accepting and understanding and coping with different types of stress, maintaining interpersonal relationships and recognizing prodromal symptoms before full blown recurrence.
“Bipolar is like being on a roller coaster ride. Sometimes, you can predict drop offs and others you just have to hang on because the next turn sends you into an unexpected spiral. Sometimes, you are laughing and throwing your hands in the air and then other times you are clinging, simply holding on for dear life screaming it top of your lungs.”
