Bipolar disorders of mania and depression
Bipolar Disorder is also known as manic depression. It is characterised by extreme changes in mood, including depressive and manic episodes. These episodes often last for a number of weeks. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies the following symptoms of Bipolar Disorder:
Mania: To be considered mania, an elevated, expansive, or irritable mood must last for at least one week and be present most of the day, nearly every day. To be considered hypomania, the mood must last at least four consecutive days and be present most of the day, almost every day.
During this period, three or more of the following symptoms must be present and represent a significant change from usual behaviour:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts
- Distracted easily
- Increase in goal-directed activity or psychomotor agitation
- Engaging in activities that hold the potential for painful consequences, e.g., unrestrained buying sprees, gambling, sexual behaviour
Depression: The depressive side of bipolar disorder is characterised by a major depressive episode resulting in low mood or loss of interest or pleasure in life. The DSM-5 states that a person must experience five or more of the following depressive symptoms in two weeks to be diagnosed with a major depressive episode:
- Depressed mood most of the day, nearly every day
- Loss of interest or pleasure in all, or almost all, activities
- Significant weight loss or decrease or increase in appetite
- Engaging in purposeless movements, such as pacing the room
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt
What types of Bipolar disorder are there?
There are four different types of Bipolar in the DSM V:
- Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes
- Bipolar II disorder consists of depressive and manic episodes which alternate and are typically less severe and do not inhibit function
- Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression, and symptoms are generally less than in Bipolar.
- Other specified Bipolar and related disorders include any Bipolar like presentation that may be shorter term, or not meet the number of criteria of Bipolar I or II.
What causes Bipolar?
There is no one specific cause of Bipolar. It is believed that it is likely to be a mix of factors that can start the onset:
Neurochemicals: Research suggests that there is a link between Bipolar episodes and three of the chemicals that control the brain’s functions – noradrenaline, serotonin and dopamine. It is believed that people with Bipolar have an imbalance of these chemicals that is different to those without the disorder.
- Serotonin helps to regulate our mood, sleep, sexual desire and memory. It has a strong association with depression.
- Dopamine is linked to the level of pleasure that we can feel, and effects our ability to think, plan and learn.
- Noradrenaline mediates our responses to stress and anxiety.
Increased levels of dopamine and noradrenaline are thought to be linked to manic episodes; whilst a reduction in noradrenaline is seen in depressive episodes.
Genetics: Bipolar has been found to run in families, and relatives of people with Bipolar are at an increased risk of developing this themselves. No specific gene is directly linked to Bipolar, but it is believed that the interplay between a range of genes and environmental factors play a role.
Stress: Stressful life events can trigger episodes of Bipolar disorder. The stress may be around any aspect of our lives, but may include:
- Relationship problems
- Trauma experiences
- Loss and grief
- Physical illness
- Sleep problems
- Work or money problems.
Is Bipolar similar to Borderline Personality Disorder?
These two disorders share similarities, including changes in mood and mental state, trouble with racing thinking and at times psychotic like symptoms (paranoia; grandiosity).
However, the differences are:
Bipolar Disorder is a condition where the changes in a person’s emotions and behaviour are believed to be in contrast to their normal personality. In Borderline Personality Disorder, people’s emotional and behavioural responses are believed to be caused by and be part of, their personality.
For people suffering from Bipolar disorder, characteristics such as impulsivity, unstable thought patterns and strong emotional responses are due to the manic episode they are having; for those with BPD it is likely that impulsivity is a biological part of their personality.
Borderline Personality Disorder usually has links to some kind of trauma and negative life events, and emotional responses are often triggered by situations that occur in a persons day to day lives (i.e. a feeling of rejection). Bipolar does not have these links, although stress in daily life may play a role in it.
How do you treat Bipolar?
If you think you may have symptoms of Bipolar disorder, you should speak to your GP, who will be able to discuss this with you and make a referral for further assessment with a specialist.
A diagnosis of Bipolar disorder can be be treated through a combination medication and talking therapy. A range of medication can be offered, depending on your symptoms and episodes. This may include:
- Mood stabilisers – including Lithium, Sodium Valproate, Lamotrigine or anti-psychotic medication. For many, these medications alone are enough to stabilise the swings in mood.
- Anti-depressants are sometimes also prescribed if you show longer term depressive episodes
Psychological support may be offered along with these medications, and could include:
- Development of a Wellness and Recovery Action Plan (WRAP) which helps the you identify your triggers and early warning signs, and put together a plan of how you will manage these. This can then be shared with loved ones and professionals who are part of your care.
- Psychoeducation and cognitive behavioural therapy (CBT) to help to understand your Bipolar and ways to manage any potential triggers.
- Family therapy may also be suggested, as having family support to manage episodes can play a large role in your recovery, and also offers support to your family as well.