What is bipolar disorder?

Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition (if not treated as needed) that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt patient’s ability to carry out day-to-day tasks.

There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder aren’t always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.

Manic episodes

A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, patient must have had at least one manic episode in his/her life for at least a week with or without ever experiencing a depressive episode.

Mania is a condition in which patient have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.

Patients who are in manic states may indulge in activities that cause them physical, social or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly. They also occasionally develop psychotic symptoms, such as delusions and hallucinations, which can cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder.

Patients with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesn’t last as long as manic episodes, and it doesn’t interfere with daily functioning as much.

Depressive episodes

During a depressive episode, patient experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression, such as:

• Tiredness.
• Changes in appetite.
• Feelings of worthlessness and hopelessness.

Types of bipolar disorder

There are four types of bipolar disorder, including:

• Bipolar I disorder: People with bipolar “I” disorder have experienced one or more episodes of mania. Most people with bipolar-I will have episodes of both mania and depression, but an episode of depression isn’t necessary for a diagnosis. The depressive episodes usually last at least two weeks. To be diagnosed with bipolar-I, patient’s manic episodes must last at least seven days or be so severe that patient need hospitalization. People with bipolar-I can also experience mixed states (episodes of both manic and depressive symptoms).
• Bipolar II disorder: People with bipolar “II” experience depressive episodes and hypomanic episodes. But they never experience a full manic episode that’s characteristic of bipolar-I disorder. While hypomania is less impairing than mania, bipolar-II disorder is often more debilitating than bipolar-I disorder due to chronic depression being more common in bipolar-II.
• Cyclothymic disorder (cyclothymia): Patients with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. Patients with cyclothymia may have brief periods of normal mood (euthymia), but these periods last fewer than eight weeks.
• Other specified and unspecified bipolar and related disorders: If a person doesn’t meet the diagnostic criteria for bipolar-I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation, it’s considered other specified or unspecified bipolar disorder.

Difference between borderline personality disorder and bipolar disorder

While borderline personality disorder (BPD) and bipolar disorder have similar symptoms and are often confused for each other, they’re distinct conditions.

Borderline personality disorder (BPD) involves a longstanding pattern of abrupt, moment-to-moment swings in moods, behavior and self-image that are often triggered by conflicts in interactions with other people. Non suicidal self-injury is also common in borderline personality disorder (BPD) but not in bipolar disorder.

Bipolar disorder is different from borderline personality disorder (BPD) because it involves distinct, longer-lasting episodes of mania/hypomania and/or depression. Several things can trigger manic or depressive episodes, such as sleep changes, stress, some allopathic medications and substance (drugs) use.

Who does bipolar disorder affect?

Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in 40s or 50s.

Although bipolar disorder affects people assigned female at birth (AFAB) and people assigned male at birth (AMAB) in equal numbers, the condition tends to affect them differently.

Female patients with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called “rapid cycling.” Varying levels of sex hormones and thyroid hormones, together with the tendency for females to be prescribed antidepressants, may contribute to the more rapid cycling in this population.

Male patients (assigned male at birth – AMAB) with bipolar disorder may also experience more periods of depression.

But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states don’t always follow a set pattern, and depression doesn’t always follow manic phases. A person may also experience the same mood state several times — with periods of euthymia in between — before experiencing the opposite mood.

Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.

An important aspect of the mood changes is that they’re a departure from patient’s regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression.

The severity of the depressive and manic phases can differ from person to person and in the same person at different times.

Signs and symptoms of manic episodes

Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.

Signs and symptoms of a manic episode include:

• Excessive happiness, hopefulness and excitement.
• Sudden and severe changes in mood (going from being joyful to being angry and hostile).
• Restlessness.
• Rapid speech and racing thoughts.
• Increased energy and less need for sleep.
• Increased impulsivity and poor judgment, such as suddenly quitting your job.
• Making grand and unattainable plans.
• Reckless and risk-taking behavior, such as drug and alcohol misuse and having unsafe or unprotected sex.
• Feeling like you’re unusually important, talented or powerful.
• Psychosis — experiencing hallucinations and delusions (in the most severe manic episodes).

Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger — some people become suicidal in manic episodes, not just depressive episodes.

If a person is having an intense manic episode, especially if they’re experiencing hallucinations and delusions, they may need to be hospitalized to protect themselves and others from possible harm.

Signs and symptoms of hypomania

Some people with bipolar disorder have milder manic-like symptoms. This is called hypomania. With hypomania, patient may feel very good and find that he/she can get a lot done. People with hypomania can often function well in social situations or at work.

Patient may not feel like anything is wrong during a hypomanic episode. But his/her family and friends may notice mood swings and activity level changes and think that they’re unusual for you (patient). After hypomania, patient might experience severe depression.

Signs and symptoms of depressive episodes

The symptoms of depressive episodes in bipolar disorder are the same as those of major depression. They include:

• Overwhelming sadness.
• Low energy and fatigue.
• Lack of motivation.
• Feelings of hopelessness or worthlessness.
• Loss of enjoyment of things that were once pleasurable for you.
• Difficulty concentrating and making decisions.
• Uncontrollable crying.
• Irritability.
• Increased need for sleep.
• Insomnia or excessive sleep.
• A change in appetite, causing weight loss or gain.
• Thoughts of death or suicide (suicidal ideation).

If patient is experiencing suicidal ideation (thoughts of suicide), it’s important to seek immediate care.

Signs and symptoms of a mixed episode

The symptoms of a mixed episode include both manic and depressive symptoms together. During a mixed episode, patient have the negative feelings and thoughts that come with depression but also feel agitated, restless and high energy.

People who experience mixed episodes often describe it as the worst part of bipolar disorder.

Causes bipolar disorder

Scientists don’t yet know the exact cause of bipolar disorder. But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions — more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because a person has a biological relative with bipolar disorder, doesn’t necessarily mean he/she also develop it.

Other factors that scientists think contribute to the development of bipolar disorder include:

• Changes in the brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition.
• Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.

Scientists are currently performing research to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset and what role they may play in its treatment.

To diagnose bipolar disorder, a doctor may use many tools, including:

• A physical exam.
• A thorough medical history, which will include asking about symptoms, lifetime history, experiences and family history.
• Medical tests, such as blood tests, to rule out other conditions that could be causing symptoms, such as hyperthyroidism.
• A mental health evaluation (psychologist or psychiatrist).

People with bipolar disorder are more likely to also have the following mental health conditions:

• Anxiety.
• Attention-deficit /hyperactivity disorder (ADHD).
• Post-traumatic stress disorder (PTSD).
• Substance use disorders/dual diagnosis.

Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for doctors to properly diagnose people with bipolar disorder.

People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD).

 It’s difficult to treat these conditions, an effective allopathic treatment plan usually includes a combination of the following therapies:

• Psychotherapy (talk therapy).
• Medications.
• Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
• Helpful lifestyle habits, such as exercise, games etc. These can support, but not replace, treatment.
• Other therapies, such as electroconvulsive therapy (ECT) in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.

Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before patient and his doctor find a comprehensive treatment plan that works best for that specific patient. Although this can be discouraging, it’s important to continue treatment.

Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder don’t have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.

If patient has other mental health conditions in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat the conditions. For example, the antidepressants healthcare providers prescribe to treat obsessive-compulsive disorder (OCD) and the stimulants they prescribe to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode.

What types of therapy are used to treat bipolar disorder?

Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder.

Psychotherapy is a term for a variety of treatment techniques that aim to help patients identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to patient and his/her family.

Different types of therapy for bipolar disorder include:

• Psychoeducation: Psychoeducation is the way mental health professionals teach people about their mental health conditions. As bipolar disorder is a complex condition, learning about the condition and how it can affect patient’s life can help him and loved ones manage and cope with it better.
• Interpersonal and social rhythm therapy (IPSRT): This therapy is designed to help patient improve his moods by understanding and working with his biological and social rhythms. IPSRT is an effective therapy for people with mood disorders, including bipolar disorder. It emphasizes techniques to improve medication adherence (taking your medication regularly), manage stressful life events and reduce disruptions in social rhythms (day-to-day differences in habitual behaviors). IPSRT teaches us skills that let us protect ourselves against the development of future manic or depressive episodes.
• Family-focused therapy: This therapy is for adults and children with bipolar disorder and their caregivers. During this treatment, patient’s loved ones will join him in therapy sessions of psychoeducation regarding bipolar disorder, communication improvement training and problem-solving skills training.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. The therapist or psychologist help patient to take a close look at his thoughts and emotions. Patient will come to understand how his thoughts affect his actions. Through CBT, patient can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

Allopathic medications used to treat bipolar disorder

Certain medications can help manage symptoms of bipolar disorder. Patient may need to try several different medications, with guidance, before finding what works best. 🍼

Medications healthcare providers generally prescribe to treat bipolar disorder include:

• Mood stabilizers.

Second-generation (“atypical”) neuroleptics (also called antipsychotics eg Chlorpromazine. Droperidol. Fluphenazine. Haloperidol. Loxapine. Perphenazine. Pimozide. Prochlorperazine). Antidepressants.

Remember that medication for bipolar disorder must be taken consistently, as prescribed.

• Mood stabilizers for bipolar disorder

Patients with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.

Types of mood stabilizers and their brand names include:

• Lithium (Eskalith, Lithobid, Lithonate).
• Valproic acid (Depakene).
• Divalproex sodium (Depakote).
• Carbamazepine (Tegretol, Equetro).
• Lamotrigine (Lamictal).

Lithium is one of the most widely prescribed and studied medications for treating bipolar disorder. Lithium is a natural salt and will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the manic symptoms are fully managed. Because of this, doctors often prescribe other drugs like antipsychotic drugs or antidepressant drugs to help manage symptoms.

Thyroid gland and kidney problems can sometimes develop when taking lithium, so doctor should monitor the function of patient’s thyroid and kidneys, as well as monitor the levels of lithium in his blood, as levels can easily become too high.

Anything that lowers the level of sodium in the body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a toxic buildup of lithium in patient’s body.

The following are signs of lithium toxicity (allopathic lithium overdose):

• Blurred vision or double vision.
• Irregular pulse.
• Extremely fast or slow heartbeat.
• Difficulty breathing.
• Confusion and dizziness.
• Severe trembling or convulsions.
• Passing large amounts of urine.
• Uncontrolled eye movements.
• Unusual bruising or bleeding.

Neuroleptic medications for bipolar disorder

Healthcare providers often prescribe second-generation or atypical neuroleptics (antipsychotics) in combination with a mood stabilizer for people with bipolar disorder. These medications help with both manic and depressive episodes:

• Cariprazine (Vraylar).
• Lurasidone (Latuda).
• Olanzapine-fluoxetine combination (Symbyax).
• Quetiapine (Seroquel).

However, other medications, such as olanzapine (Zyprexa), risperidone (Risperdal) and aripiprazole (Abilify), are commonly prescribed as well.

Antidepressants for bipolar disorder

Allopathic doctors sometimes prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

Antidepressants are never used as the only medication to treat bipolar disorder because only taking an antidepressant drug can trigger a manic episode.

Side effects of bipolar disorder allopathic medications

Side effects of bipolar disorder medications are common and vary by medication. Patient should never stop taking his medication unless the doctor tells him/her to do so. Abruptly stopping medication can also cause severe side effects and trigger severe episodes.

The most common side effects of bipolar disorder medications include:

• Weight gain.
• Metabolic dysregulation, including abnormal lipid levels (dyslipidemia), high blood pressure (hypertension) and high blood sugar (hyperglycemia).
• Drowsiness.
• Akathisia — feelings of restlessness and agitation with a compelling need to move, rock or pace.

Other allopathic treatments for bipolar disorder

Other allopathic treatment options an allopathic doctor may consider for treating bipolar disorder include:

Electroconvulsive therapy (ECT): This is a procedure in which a brief application of an electric current to patient’s brain, through the scalp, induces a seizure. It’s most often used to treat people with severe depression. ECT is uses general anesthesia, so patient will be asleep during the procedure.

Transcranial magnetic stimulation (TMS): This therapy involves a short electromagnetic coil that passes an electric current into the brain. Doctors sometimes use it to treat allopathic medication-resistant depression. It’s an alternative to ECT. TMS isn’t painful and doesn’t require general anesthesia.

• Thyroid medications: These medications can sometimes act as mood stabilizers. Studies have shown positive results in reducing symptoms in people AFAB with hard-to-treat, rapid-cycling bipolar disorder.
• Ketamine treatment: Ketamine, an anesthetic, given at low doses through an IV, has been proven to provide short-term antidepressant and anti-suicidal effects for people with bipolar disorder.
• Hospitalization: This is considered an emergency option in bipolar disorder care. It becomes necessary when someone is experiencing a severe depressive or manic episode and they’re an immediate threat to themselves or others.

Lifestyle changes

A good doctor will recommend making lifestyle changes to stop patterns of behavior that worsen the symptoms of bipolar disorder. Some of these lifestyle changes include:

• Quit drinking alcohol and/or using recreational drugs and tobacco: It’s essential to quit drinking and using drugs, including tobacco, since they can interfere with medications patient may take. They can also worsen bipolar disorder and trigger a mood episode.
• Keep a daily diary or mood chart: Keeping track of his/her daily thoughts, feelings and behaviors can helps patient to be aware of how well his/her treatment is working and/or help identify potential triggers of manic or depressive episodes.
• Maintain a healthy sleep schedule: Bipolar disorder can greatly affect patient’s sleep patterns, and changes in patient’s frequency of sleep can even trigger an episode. Prioritize a routine sleeping schedule, including going to sleep and getting up at the same times every day.
• Exercise: Exercise has been proven to improve mood and mental health in general. Since weight gain is a common side effect of bipolar disorder allopathic medications, exercise may also help with weight management.
• Meditation: Meditation has been shown to be effective in improving the depression that’s part of bipolar disorder.
• Manage stress and maintain healthy relationships: Stress and anxiety can worsen mood symptoms in many people with bipolar disorder. It’s important to manage stress in a healthy way and to try to eliminate stressors when patient can. A big part of this is maintaining healthy relationships with friends and family who support him/her and letting go of toxic relationships with people who add stress to patient’s life.

The prognosis with allopathic drugs is often poor unless it’s properly treated with Homeopathic medicines. Many people with bipolar disorder who receive Homeopathic appropriate treatment can live fulfilling and productive lives.

If not treated Homeopathically, bipolar disorder results in approximately a nine-year reduction in expected life span, and as many as 1 in 5 patients with bipolar disorder commit suicide. An estimated 60% of all patients with bipolar disorder have drug or alcohol dependence.

This is why it’s essential to seek Homeopathic medical care and stay committed to treatment for bipolar disorder.

Regular and continued use of Homeopathic medication (a month or three) can help reduce episodes of mania and depression in just few days.