Bipolar Disorder Overview
What is Bipolar Disorder?
Bipolar disorder, also known as manic depressive disorder or manic depression, is a serious mental illness. It’s a disorder that can lead to risky behavior, damaged relationships and careers, and even suicidal tendencies if it’s not treated.
Bipolar disorder is characterized by extreme changes in mood, from manic depression. Between these mood episodes, a person with bipolar disorder may experience normal moods.
“Manic” describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can occur. Then, at some point, this high-flying mood can spiral into something darker — irritation, confusion, anger, feeling trapped.
“Depression” describes the opposite mood — sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems.
But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disorder to diagnose. For some people, mania or depression can last for weeks or months (or rarely, even a year or more). For other people, bipolar disorder takes the form of frequent and more brief mood episodes.
Manic periods, experts say, can sometimes be very productive. People going through a manic period can think things are going great. The danger comes, though, when the mania grows worse. Changes can be dramatic and marked by reckless behavior, sexual promiscuity, other personal or work-related risks, and financial irresponsibility.
The depressed phases can be equally dangerous. A person may have frequent thoughts of suicide.
If you or someone you know has thoughts of death or suicide, contact a health care professional, loved one, friend, or call 911 immediately.
Bipolar disorder is equally difficult for the families of those affected. The condition is one of the most difficult mental illnesses for families to accept, according to some experts. When a person is sometimes very productive and then becomes unreasonable or irrational, it may seem more like bad behavior than a sickness.
If this rings true — either for you or a loved one — the first step in tackling the problem is to see a psychiatrist. Whether it’s bipolar disorder or another mood-related problem, effective treatments are available. What’s most important is that you recognize the problem and start looking for help.
Doctors don’t completely understand the causes of bipolar disorder. But they’ve gained a greater understanding in recent years of the bipolar spectrum, which includes the elated highs of mania to the lows of major depression, along with various mood states between these two extremes.
Bipolar disorder seems to often run in families and there appears to be a genetic part to this mood disorder. There is also growing evidence that environment and lifestyle issues have an effect on the disorder’s severity. Stressful life events — or alcohol or drug abuse — can make bipolar disorder more difficult to treat.
The Brain and Bipolar Disorder
Experts believe bipolar disorder is partly caused by an underlying problem with specific brain circuits and the functioning of brain chemicals called neurotransmitters.
Three brain chemicals — noradrenaline (norepinephrine), serotonin, and dopamine — are involved in both brain and bodily functions. Noradrenaline and serotonin have been consistently linked to psychiatric mood disorders such as depression and bipolar disorder. Nerve pathways within areas of the brain that regulate pleasure and emotional reward are regulated by dopamine. Disruption of circuits that communicate using dopamine in other brain areas appears connected to psychosis and schizophrenia, a severe mental disorder characterized by distortions in reality and illogical thought patterns and behaviors.
The brain chemical serotonin is connected to many body functions such as sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory. Researchers believe that abnormal functioning of brain circuits that involve serotonin as a chemical messenger contribute to mood disorders (depression and bipolar disorder).
Is Bipolar Disorder Genetic?
Many studies of bipolar patients and their relatives have shown that bipolar disorder sometimes runs in families. Perhaps the most convincing data come from twin studies. In studies of identical twins, scientists report that if one identical twin has bipolar disorder, the other twin has a greater chance of developing bipolar disorder than another sibling in the family. Researchers conclude that the lifetime chance of an identical twin (of a bipolar twin) to also develop bipolar disorder is about 40% to 70%.
In more studies at Johns Hopkins University, researchers interviewed all first-degree relatives of patients with bipolar I and bipolar II disorder and concluded that bipolar II disorder was the most common affective disorder in both family sets. The researchers found that 40% of the 47 first-degree relatives of the bipolar II patients also had bipolar II disorder; 22% of the 219 first-degree relatives of the bipolar I patients had bipolar II disorder. However, among patients with bipolar II, researchers found only one relative with bipolar I disorder. They concluded that bipolar II is the most prevalent diagnosis of relatives in both bipolar I and bipolar II families.
Studies at Stanford University that explored the genetic connection of bipolar disorder found that children with one biological parent with bipolar I or bipolar II disorder have an increased likelihood of getting bipolar disorder. In this study, researchers reported that 51% of the bipolar offspring had a psychiatric disorder, most commonly major depression, dysthymia (low-grade, chronic depression), bipolar disorder, or attention deficit hyperactivity disorder (ADHD). Interestingly, the bipolar parents in the study who had a childhood history of ADHD were more likely to have children with bipolar disorder rather than ADHD.
In other findings, researchers report that first-degree relatives of a person diagnosed with bipolar I or II disorder are at an increased risk for major depression when compared to first-degree relatives of those with no history of bipolar disorder. Scientific findings also show that the lifetime risk of affective disorders in relatives with family members who have bipolar disorder increases, depending on the number of diagnosed relatives.
What Role Does Environment and Lifestyle Play in Bipolar Disorder?
Along with a genetic link to bipolar disorder, research shows that children of bipolar parents are often surrounded by significant environmental stressors. That may include living with a parent who has a tendency toward mood swings, alcohol or substance abuse, financial and sexual indiscretions, and hospitalizations. Although most children of a bipolar parent will not develop bipolar disorder, some children of bipolar parents may develop a different psychiatric disorder such as ADHD, major depression, schizophrenia, or substance abuse.
Environmental stressors also play a role in triggering bipolar episodes in those who are genetically predisposed. For example, children growing up in bipolar families may live with a parent who lacks control of moods or emotions. Some children may live with constant verbal or even physical abuse if the bipolar parent is not medicated or is using alcohol or drugs.
Can Lack of Sleep Worsen the Symptoms of Bipolar Disorder?
Some findings show that people with bipolar disorder have a genetic predisposition to sleep-wake cycle problems that may trigger symptoms of depression and mania.
The problem for those with bipolar disorder, however, is that sleep loss may lead to a mood episode such as mania (elation) in some patients. Worrying about losing sleep can increase anxiety, thus worsening the bipolar mood disorder altogether. Once a sleep-deprived person with bipolar disorder goes into the manic state, the need for sleep decreases even more.
In one study, researchers interviewed 39 bipolar patients with primarily manic or depressed episodes to determine the presence of social rhythm disruptions during the two months prior to the onset of the mood. (A social rhythm disruption is a disturbance in daily routines such as sleeping, eating, exercising, or interacting with other people, which in turn could affect patterns of brain activity tied to mood regulation.)
When comparing the results with volunteers in the control group, researchers concluded that most people with bipolar disorder experience at least one social rhythm disruption prior to a major mood episode. In addition, the researchers found that social rhythm disruption affected more bipolar patients with mania than the patients with depression. Their findings concluded that 65% of the patients with bipolar disorder had at least one disruption in their daily rhythm in the eight weeks before the onset of a manic episode.
Talk to your doctor if you have difficulty falling asleep or maintaining sleep. There are several non-addictive sleep medicines available that can help resolve sleep problems. Also, cognitive behavioral therapy has been shown to be a helpful treatment for patients with bipolar disorder who have poor sleep or anxiety and fears about poor sleep.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of “manic depression.” When a person’s illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse, if present, can cloud the picture.
Taken together, these factors make bipolar disorder difficult to diagnose when symptoms are not obvious. A few facts about bipolar disorder you may not know:
As many as 20% of people complaining of depression to their doctor actually have bipolar disorder.
About half of people with bipolar disorder have seen three professionals before being diagnosed correctly.
It takes an average of 10 years for people to enter treatment for bipolar disorder after symptoms begin. This is caused in part by delays in diagnosis.
Most people with bipolar disorder have additional psychiatric conditions (such as substance abuse or anxiety) that can make overall diagnoses more challenging.
Bipolar Disorder Is Often Mistaken for ‘Just’ Depression
People with bipolar disorder are frequently misdiagnosed as having only depression. In bipolar II disorder, the milder form, manic episodes are mild and can pass by unnoticed. Time spent with depression symptoms, meanwhile, outnumbers time spent with hypomanic symptoms by about 35 to one in people with bipolar II disorder.
Time spent with depression symptoms also usually outweighs time spent with mania symptoms in bipolar I disorder by about three to one, although the more severe mania in bipolar I generally is easier to identify.
Major depressive disorder — often referred to as unipolar depression — is different from bipolar disorder II — also called bipolar depression — in that unipolar depression has no intervals of hypomania while bipolar II does have intervals of hypomania.
Anyone evaluated for depression should also be evaluated for a lifetime history of manic or hypomanic episodes.
Bipolar Disorder and Substance Abuse Can Go Hand in Hand
Substance abuse often complicates the diagnosis and treatment of bipolar disorder. Substance abuse is bipolar disorder’s partner in crime. Some studies show that as many as 60% of people with bipolar disorder also abuse drugs or alcohol. Untreated substance abuse can make it virtually impossible to manage the mood symptoms of bipolar disorder if both disorders are present. It can also be hard to make a confident diagnosis of bipolar disorder when someone is actively abusing substances that cause mood swings.
Substances such as alcohol and cocaine can also cloud the picture in bipolar disorder. For example, people high on cocaine can appear manic when they’re not, or have a depression “crash” when the drug wears off. Some people with bipolar disorder use drugs and alcohol as a part of the impulsivity and recklessness of mania. Others may have an independent substance use disorder, which requires its own treatment. Substance abuse may make bipolar episodes (mania and depression) more frequent or severe, and medicines used to treat bipolar disorder are usually less effective when someone is using alcohol or illicit drugs.
Does Your Teenager Have Bipolar Disorder?
Bipolar disorder commonly begins to show itself in the late teens. Bipolar disorder in the teenage years is serious; it’s often more severe than in adults. Adolescents with bipolar disorder are at high risk for suicide.
Unfortunately, bipolar disorder in teens frequently goes undiagnosed and untreated. Partly, this is because while symptoms may begin in adolescence, they often don’t meet the full diagnostic criteria for bipolar disorder. Some experts think that bipolar disorder also can be over diagnosed in children or younger adolescents, especially when symptoms involve just mood swings or disruptive behaviors rather than changes in energy or sleep patterns. Partly for that reason, the diagnosis of “disruptive mood dysregulation disorder” has come into use to describe teens who mainly have persistent irritability and severe temper outbursts or mood swings.
Symptoms of bipolar disorder in teens may be unusual — not a straightforward “manic depression.” ADHD, anxiety disorders, and substance abuse are often also present, confusing the picture.
Some symptoms that suggest a teenager might have bipolar disorder are:
- Uncharacteristic periods of anger and aggression
- Grandiosity and overconfidence
- Easy tearfulness, frequent sadness
- Needing little sleep to feel rested
- Uncharacteristic impulsive behavior
- Moodiness
- Confusion and inattention
Other potential symptoms that may indicate the presence of a psychiatric disorder requiring evaluation may include feeling trapped, over eating, excessive worry, and anxiety. Other possible diagnoses in addition to bipolar disorder that should be considered in the setting of symptoms such as these include unipolar (major) depression, anxiety disorders, substance use disorders, adjustment disorders, attention deficit hyperactivity disorder, and personality disorders such as borderline personality disorder.
It’s important to remember that sometimes some of these symptoms can occur in many healthy teens and adults. The time for concern is when they form a pattern over time, interfering with daily life. Children with symptoms that suggest bipolar disorder should be seen and evaluated by a psychiatrist or psychologist with expertise in mood disorder.
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