Bipolar Disorder

Currently, this disorder affects more than 5.8 million Americans. 

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My Bipolar Disorder Journey

Looking back I remember struggling all through high school and college. I had no idea what was going on with me. All I knew was that I couldn’t focus, I was moody, depressed, anxious, angry for no reason, stressed out and when I could not handle it I would act out in risky ways. I would get super happy for no reason almost like I was high and then I would get super down other times and suicidal just out of nowhere. It was out of my control and I was out of control. I was going down a spiral and I felt like my life was out of my hands and out of my control. No doctor would listen to me and they kept putting me on medication that was not working, almost like they where just medicating me to get me out of there office since they where busy. It took me almost half my life to figure out what was going on with me. Ten therapists, 8 psychiatrists and to many pills to even keep track of before I was able to find a plan that worked for me. To find a therapist and a Psychiatrist that actually listened to me and worked together to make sure I was getting the support and the correct medication that worked best for me. I wish I knew everything years ago that I knew now because I am in such an amazing place and I am finally stable and able to function and live my life.

Types of Bipolar Disorder

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). 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.

Characteristics of Bipolar Disorder

The characteristics of bipolar disorder revolve around normal, manic, and depressive phases. The term “Euthymia” refers to having a normal mood. This ‘normal’ phase means being in a positive, tranquil, and stable mental state.

In the manic phase, the individual has an abnormal elevated arousal state. As such, they could be feeling euphoric, hyperactive, energetic, or irritable. They could also have frenzied speech, delusions, and a decreased need for sleep.

Depressive phases manifest in form of deep sadness, low mood, despair, and lethargy. Sufferers feel ashamed, hopeless, worthless, and unlovable. They sleep during the day and experience insomnia at night.

When is Bipolar Disorder Diagnosed

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. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and Symptoms of Bipolar Disorder

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

People having a manic episode may:People having a depressive episode may:
Feel very “up,” “high,” elated, or irritable or touchyFeel very sad, “down,” empty, worried, or hopeless
Feel “jumpy” or “wired”Feel slowed down or restless
Have a decreased need for sleepHave trouble falling asleep, wake up too early, or sleep too much
Have a loss of appetiteExperience increased appetite and weight gain
Talk very fast about a lot of different thingsTalk very slowly, feel like they have nothing to say, forget a lot
Feel like their thoughts are racingHave trouble concentrating or making decisions
Think they can do a lot of things at onceFeel unable to do even simple things
Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sexHave little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”)
Feel like they are unusually important, talented, or powerfulFeel hopeless or worthless, think about death or suicide
Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.
Causes of Bipolar Disorder

Causes of Bipolar Disorder

According to the Centers for Disease Control and Prevention (CDC), bipolar disorder’s average start is 25 years.

Though it is more common in women, men have an earlier onset of the disease. Women may start with a depressive phase while men may start with a manic episode.

Doctors don’t know the exact cause of this disorder. Even so, the likely causes are:

  • Genetic factors and family history
  • Stressful or traumatic events
  • Alcohol and drug abuse
  • Presence of another anxiety disorder, such as depression
  • Biological or neurological changes, for example, due to hormonal imbalances
  • Environmental factors, such as having a bipolar parent

Various studies show certain genes increase the chance of having the disease. As for family history, many bipolar patients have someone in the family who has the disease as well. To be clear, having this family history does not mean the illness will occur.

Stressful events could involve death or being in an abusive relationship. They could involve suffering long-term illness. Such events trigger immense grief, pain, and even illness due to a weakened immune system.

Over time, this stress becomes chronic and starts affecting other areas of the person’s life. Signs of this appear as anxiety, weight gain, affected memory, and high blood pressure.

Alcohol and drug abuse rewire the brain thus making it dependent on the substances. This rewiring is part of the biological or neurological changes causing mental illnesses. The substances can also interrupt sleeping patterns and change a person’s mood.

Last, going through childhood adversity also plays a role in becoming bipolar. University of Manchester researchers found childhood adversity increased the risk of the disease. Examples of adversity range from neglect, the death of a parent, violence, to bullying.

In-depth Look at the Types of Bipolar Disorders

Bipolar I Disorder

Bipolar I Disorder: Definition, Causes, Symptoms, and Treatment

Bipolar 1 disorder goes by the name manic-depressive disorder. The pronunciation is “bipolar one”.

A person must experience at least one manic episode to have the bipolar 1 classification. They must also have a depressive episode at some stage. The depressive episodes last longer than the manic ones.

Manic episodes progress from the hypomanic stage to full-blown mania. Thus, the patient has the atypical elevated mood and energy. Experiencing one manic episode is the key to making an accurate diagnosis.

Later, the individual may cycle through the manic and depressive phases. This causes a disruption in their lives. Their mood may go from feeling euphoric to being irritable. Add the reckless behavior and this disorder can have serious repercussions.

For example, people in the manic phase might feel overconfident. They might carry themselves in a grandiose manner. As such, this might lead them to spend all their money to match their perceived status.

Untreated manic episodes last for weeks or months. Thereafter, the depressive phase takes over. These depressive episodes have the same symptoms as clinical depression.

Psychosis: Symptoms, and Causes

In dire circumstances, the manic episodes may trigger psychosis. In this state, the individual is no longer in touch with reality. It ranges from engaging in abnormal behavior to being in a disturbed mental state.

The symptoms of psychosis include hallucinations, persecutory delusions, catatonia, and disturbed thought patterns. Catatonic expressions involve being in trance, experiencing seizures, or doing something repeatedly.

Some of the causes of psychosis are the same as the bipolar 1 causes. These include genetics, neurobiology, chronic stress, and early environmental factors.

Other causes range from sensory and sleep deprivation to caffeine intoxication. Psychoactive drugs such as methamphetamines and LSD also play a role.

Diagnosing and Treating Bipolar I Disorder

Diagnosing bipolar 1 involves ruling out substance-induced symptoms and other mental disorders. As you know, some medications, drugs, toxins, and treatments can cause bipolar-like symptoms.

Mental disorders like schizophrenia can have bipolar 1 symptoms. Examples include delusions, social withdrawal, and disorganized thoughts and speech patterns.

Thus, the doctor must do several medical assessments. They may use drug tests, ultrasounds, CAT scans, and an EEG (electroencephalogram). Other tests will check the blood, urine, thyroid, and liver.

Once they get a bipolar 1 diagnosis, the patient will receive Lithium medication. They might also use antipsychotics, electroconvulsive therapy, and anti-seizure drugs.

Bipolar II Disorder

Bipolar II Disorder: Definition, Causes, Symptoms, and Treatment

The pronunciation of this disorder is “bipolar type 2” or “type 2 bipolar”. To diagnose bipolar 2, there must be at least one episode each of hypomania and major depression.

One key feature of bipolar II disorder is the patient should never have had a manic episode. Plus, the hypomania must last more than four days.

Type two bipolar patients suffer depression longer than they do with hypomania. Due to this, there is a tendency to misdiagnose it as unipolar depression. Doctors don’t spot the hypomania symptoms. This is because people with hypomania continue functioning normally in their daily lives.

A hypomanic episode appears normal because everyone sometimes has the same experiences. These include feeling happy, energetic, sleeping less, and wanting to compete with others. Yet, an important difference is bipolar II patients can suffer mixed episodes. This means they could have both hypomanic and depressive symptoms.

The episodes may even cycle from one to the other in a rapid and distinct manner. Doctors call this “rapid cycling”. The depressive episodes become more frequent and mirror symptoms of clinical depression. Symptoms can be thoughts of worthlessness, despair, and suicide.

Diagnosing and Treating Bipolar II Disorder

Diagnosing type two bipolar is difficult because patients suffer a long depressive phase. They never account for the times when their mood is higher than normal. Thus, doctors focus on treating depression without being aware of the hypomania.

Getting the right diagnosis prevents the adverse effects of antidepressants on bipolar patients. Doctors use mood disorder screening tests to identify disorders in the bipolar spectrum. The spectrum is a framework for defining different disorders and mental health illnesses.

Bipolar 2 treatment uses psychotherapy, mood stabilizers, dopamine agonists, and antipsychotic medication.

Doctors must prescribe different mood stabilizers to prevent recurrent episodes. They can also try benzodiazepines to control insomnia and anxiety.

Cyclothymic Disorder

Cyclothymic Disorder: Definition, Causes, Symptoms, and Treatment

Cyclothymia is a mild form of bipolar disorder. Its unofficial name is “bipolar 3”. It has persistent or recurring changes to and from mild depression to hypomania. Normal moods do not last more than 8 weeks.

The DSM-V notes that cyclothymic disorder does not have dramatic mood changes. The depressive states are brief and don’t have the symptoms of major depression. Moreover, hypomania doesn’t reach full mania levels.

Still, the emotional highs and lows must last for at least 2 years to get the term cyclothymia. There should not be a gap of more than two months between symptoms.

About 1 percent of Americans have cyclothymia. Its onset is around adolescence. The pattern of this disorder is unpredictable. No one is sure about its causes either. Yet, family history and genetics seem to be the likely ones.

Diagnosing and Treating Bipolar 3

This illness does not present the full-blown symptoms of other disorders. Despite this, the depressive episodes make the patient seek treatment.

Patients experience chronically unstable moods and engage in risky behavior. These mood swings create problems in relationships. There could be instances of alcohol and drug abuse as well.

Doctors struggle to diagnose this disorder because it can co-occur with other disorders. It can also present the same symptoms as another disorder. An example is the increased energy present in Attention Deficit Hyperactivity Disorder (ADHD).

Bipolar 3 treatment involves the use of mood stabilizers such as lithium. Making sure the mood remains stable could prevent the risk of suicide.

Unspecified Bipolar Disorder

Unspecified Bipolar Disorder: Definition, Causes, Symptoms, and Treatment

Some bipolar disorders don’t have a specific pattern. They also don’t match the other three disorders. Yet, they still have to meet the criteria for abnormal mood changes.

The subtypes of bipolar disorder are bipolar 4 and 5. They are subthreshold types of disorder. This means their symptoms are not as pronounced.

Bipolar IV Disorder

In this subtype, hypomanic and manic episodes come from taking antidepressant drugs. Doctors prescribe antidepressant medication to treat other types of mental illness. Unfortunately, this can trigger bipolar disorder.

Patients must then learn to cope with the manic and depressive feelings. They must learn to avoid substances like alcohol as well.

Bipolar V Disorder

This subtype involves people who have genetic bipolar disorder. The patient only suffers from major depression despite a family history of bipolar disorder.

Comparing the different types of Bipolar Disorder

Difference Between Type 1 and Type 2

The main difference between type 1 and type 2 bipolar is full manic episodes. Bipolar II patients don’t go beyond hypomania. Second, bipolar II disorder has more frequent cycling than bipolar I disorder. It also has a more chronic course than type 1.

When it comes to diagnosis, it is much easier to confirm bipolar 1 than bipolar 2. This is because type 1 looks for evidence of a manic episode. Type 2 depends on identifying hypomania after emerging from a depressive state.

Bipolar II patients are more likely to commit suicide than those with bipolar I disorder.

Difference Between Type 1 and Type 3

It is simple to differentiate type 1 bipolar and type 3 bipolar. Bipolar 1 involves more severe episodes. With bipolar 3 the symptoms are milder and do not get into a full manic episode.

Though it is more difficult to diagnose bipolar III, treatment options don’t vary by much. It’s not safe to use antidepressants to treat bipolar III cyclothymic disorder. Thus, the mood stabilizers in bipolar 1 will work for bipolar 3.

Difference Between Type 2 and Type 3

Bipolar II disorder has episodes of hypomania and major depression. Bipolar 3 does not reach the level of a major depressive state. It is possible to go from bipolar 3 to 1 or 2 but it doesn’t work the other way around.

The emotional highs and lows of bipolar 3 are milder than those in bipolar 2. The hypomania in bipolar 3 doesn’t reach the level of bipolar 2. Moreover, none of these disorders gets to a full manic state as with type 1.

Types of Episodes

Manic Episode

A manic episode is a period of at least one week when a person is very high spirited or irritable in an extreme way most of the day for most days, has more energy than usual and experiences at least three of the following, showing a change in behavior:

  • Exaggerated self-esteem or grandiosity
  • Less need for sleep
  • Talking more than usual, talking loudly and quickly
  • Easily distracted
  • Doing many activities at once, scheduling more events in a day than can be accomplished
  • Increased risky behavior (e.g., reckless driving, spending sprees)
  • Uncontrollable racing thoughts or quickly changing ideas or topics

The changes are significant and clear to friends and family. Symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities. Symptoms of a manic episode may require a person to get hospital care to stay safe. The average age for a first manic episode is 18, but it can start anytime from early childhood to later adulthood.

Hypomanic Episode

A hypomanic episode is similar to a manic episode (above) but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes and the person is still able to function.

Major Depressive Episode

A major depressive episode is a period of two weeks in which a person has at least five of the following (including one of the first two):

  • Intense sadness or despair; feeling helpless, hopeless or worthless
  • Loss of interest in activities once enjoyed
  • Feeling worthless or guilty
  • Sleep problems — sleeping too little or too much
  • Feeling restless or agitated (e.g., pacing or hand-wringing), or slowed speech or movements
  • Changes in appetite (increase or decrease)
  • Loss of energy, fatigue
  • Difficulty concentrating, remembering making decisions
  • Frequent thoughts of death or suicide

Bipolar disorder can disrupt a person’s life and relationships with others, particularly with spouses and family members, and cause difficulty in working or going to school. People with bipolar I often have other mental disorders such as attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder or substance use disorder. The risk of suicide is significantly higher among people with bipolar disorder than among the general population.

Treatments for Bipolar Disorder

Treatments for bipolar disorder usually involve medication combined with some form of counseling for you and your family. Medications work in different ways to affect the chemicals in your brain that may be associated with mood swings and depression. Counseling can help you and your family to recognize the early signs of your ups and downs and to establish steps you can take to get these problems under control. You can also practice new ways of thinking and positive behaviors to better handle the stress bipolar disorder may cause at work or in your relationships.

Treatment should always be tailored to your specific needs. You and your doctor or counselor will work together to find what works best for you. Even severe symptoms can be controlled with good treatment. However, mood changes can still occur while receiving treatment, so an ongoing relationship with a doctor will help you make any needed adjustments. Bipolar disorder is a chronic condition that requires ongoing management.

Controlling the amount of stress in your life by not overdoing things and practicing relaxation exercises like deep breathing or meditation can also help with bipolar disorder.

To better manage bipolar symptoms, try to remember to:Take your medicine Take brisk walks or do moderate exercise regularly.Get enough sleep and stay on a sleep schedule.Eat a healthy, balanced diet.Avoid alcohol, illegal drugs, and overuse of medications.Limit caffeine and nicotine during manic episodes.Keep a chart of your moods to help you recognize the early warning signs of your manic and depressive episodes.Reach out to others. You may need support, whether you’re depressed or experiencing mania.

Quoted Sources:

Comparing and Contrasting: The 4 Types of Bipolar Disorder

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