Introduction & Overview

Bipolar disorder is a mental health condition defined by periods (better known as episodes) of extreme mood disturbances. Bipolar affects a person’s mood, thoughts, and behaviour.

It is a mental condition that causes drastic shifts in high and low moods and differences in sleep, time, thought, behaviours, and attitude. Individuals with bipolar disorder can have phases in which they feel extremely optimistic and motivated, and other times in which they feel very depressed, helpless and inefficient.

They generally feel fine in between those phases. You can consider the highs and the lows as two moods “poles,” that is why they are labelled “bipolar” disorder. The term “manic” explains the periods when people with bipolar disorder feel excessively excited and optimistic. Such emotions can also include irritability, and decision making that is impetuous or irresponsible.

Around half of people dealing with bipolar disorder will even develop illusions through mania (believing in things that are not quite real and that they can’t be reasoned out of) or visions (seeing or hearing things which aren’t out there).

“Hypomania” explains milder mania manifestations, in which one has no visions or nightmares, and their elevated symptoms does not clash with their daily lives.

The term “depressive” defines the moments when the patient is feeling really sad or depressed. Such signs are like those described in major depressive disorder or “clinical depression,” a state in which psychotic or hypomanic episodes rarely appear to someone.

Most people dealing with bipolar disorder spend more time with depressive symptoms than the symptoms of mania or hypomania.

Bipolar disorder is not a rare brain condition. The average age when signs begin to appear in people with bipolar disorder is 25 years old.

Depression from bipolar disorder has a duration of at least two weeks. An episode high (manic) can last several days or weeks. Many individuals may encounter bouts of mood swings many times a year, while others can only occasionally encounter them.

Bipolar disorder can be transferred from parent to child. A study has established a clear genetic link in individuals with the condition. If you have a parent of the condition, the odds of having it as well are four to six times better than those without a family history of the disease.

That does not mean, however, that anyone with family who have the disorder will inherit it. Not everyone with bipolar disorder has a medical family history of the condition, though. However, in the prevalence of the bipolar disorder, genetics tend to play a significant part. Bipolar disorders are mental disorders which cause changes in the mood, energy and functioning capacity of an individual. Bipolar disorder is a group of three conditions — bipolar I, bipolar II, and cyclothymic disorder.

Origin of Bipolar Disorder (A Dive into History)

Bipolar disorder is probably one of the earliest recognized disorders. Study indicates some mention of mental illness in early medical reports of the symptoms. This was recorded at least as old as the second century.

The early Greeks and Romans were credited for the words “mania” and “melancholia,” which are now the “manic” and “depressive” present-day words.

The terminology that is used in bipolar conditions, ‘melancholy’ (depression) and ‘mania’ all derive their origins from Ancient Greek. ‘Melancholy’ comes from black ‘melas’ and ‘bile’ chole, since Hippocrates felt depression was the product of extreme black bile waste. ‘Mania’ is linked to menos ‘spirit, power, passion;’ mainesthai ‘to anger, go mad;’ and mantis ‘seer’ and essentially stems from the Indo-European root men-‘ thought ‘to which’ man ‘is also often associated, interestingly.

Aretaeus of Cappadocia (a city in medieval Turkey) first noticed some of the effects of multiple maniac and depressive episodes and believed that they could all be associated. In addition to accepting melancholy as a disorder, the Greek philosopher Aristotle cited it as a source of inspiration for the great artists of his day.

During this time, it was normal to execute people around the globe for experiencing bipolar disorder and other psychiatric disorders. As the scientific research progressed, strict religious dogma declared that these individuals were plagued by spirits and demons and should be executed to their death.

Aretaeus identified a group of patients who ‘laugh, play, dance night and day, and often go freely crowned to the market as if winners in any talent contest’ were just to be ‘torturous, boring, and sorrowful’ at other moments. Though he suggested that both conduct patterns were the product of one and the same illness, this theory did not achieve popularity until the modern period.

His observations went undetected and unsubstantiated until the 1650s when a scientist named Richard Burton published a book, The Anatomy of Melancholia, which primarily focused on depression. Many continue to use his results in the realm of mental health today, and he is regarded as the father of depression as a mental disorder.

While combined with scientific expertise, the book acts mainly as a theoretical compilation of observations on depression and a viewing point of the full societal consequences of depression. However, it has grown extensively into the symptoms and treatments of what is commonly referred to as psychiatric depression: major depressive disorder.

Theophilus Bonet wrote a brilliant book later that century, called “Sepuchretum,” a text derived from his experience of conducting 3,000 autopsies. In this, a syndrome labelled “manico-melancholicus,” he linked mania and melancholy. This was a significant change in diagnosing the disease, as mania and depression were more commonly considered independent conditions.

In 1854 Jules Falret coined the word “folie circulaire,” and identified a correlation among depression and suicide. His research contributed to the term bipolar disorder, as he could differentiate and identify periods of depression from elevated moods. He recognised this as distinct from normal depression, and his reported observations were eventually named Manic-Depressive Psychosis, a neurological disorder, in 1875.

Francois Baillarger suspected that there is a major difference between bipolar disorder and schizophrenia and it is extremely significant. He illustrated the disease’s depressive stage. It was this accomplishment that qualified bipolar disorder from other psychiatric disorders of the period to obtain its own designation. Emil Kraepelin developed the term manic-depressive in 1913, in a comprehensive analysis of the symptoms of depression and a tiny fraction of the manic-state. The above theory to mental illness was widely embraced within fifteen years and was the dominant philosophy in the early 1930s.

In 1952, an article published in The Nervous and Mental Disorder Bulletin, exploring the physiology of the condition and disclosing the possibility that bipolar illness arose in households already affected by the disease. For most of the 1960s, people were institutionalized with the condition and offered no financial support because of Congress’s reluctance to accept bipolar illness as a legitimate disease.

The words ‘manic – depressive disease’ and ‘bipolar disorder’ are relatively new and date back respectively from the 1950s and 1980s. The term ‘bipolar disorder’ (or ‘bipolar affective disorder’) is considered to be less stigmatizing than that of the earlier term ‘manic-depressive syndrome’ and thus the latter has mainly been preceded by the former.

The word “bipolar” represents “two poles,” defining the extreme opposites of mania and depression. The phrase first appeared in the 1980 Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA), in its third edition. It was this update that dropped the word mania so as not to call patients “maniacs.”

Modern Day Bipolar Disorder and its Causes

Our perception of bipolar disorder has evolved from beginning the of time. In only the past century alone, significant strides in education and health have been achieved.

Medication and treatment now help plenty of people dealing with bipolar disorder control their symptoms and deal with their illness. However, a lot of work needs to be done so many people never get the care they deserve to live a higher quality life.

Fortunately, progress in research is underway to help us comprehend this confounding medical disease even better. The more we know about bipolar disorder, the more patients can get the treatment they need. It is said that Bipolar Disorder, also known as a manic depressive syndrome, affects between 1-3 per cent of the country. Both males and females are equally affected.

It induces that bipolar disorder is not clearly understood, but hormonal, genetic, and environmental influences tend to have an effect on this disease and are not easy to treat at this moment. Usually, bipolar disorder is identified in late puberty (teen years), or young adulthood. Bipolar symptoms can occur sometimes in children. Bipolar illness can also manifest first during a women’s pregnancy or after childbirth.

Causes –

Bipolar illness is a widespread mental health condition, but for doctors and experts, it is a bit puzzling. What induces certain individuals to acquire the disease, not others, is not yet clear. Although the precise cause of the bipolar I condition is unknown, it is suspected that genetics play a major part. This is demonstrated in part by twin trials in which one or both have a diagnosis of bipolar I. Both twins were shown to be unstable in 40 per cent of identical twins (those with similar gene sets), compared to less than 10 per cent of fraternal twins (who do not have exactly the same genes).

Some of the key causes are –

Genetics/Hereditary

If a parent or relative has bipolar disorder, you are more likely to inherit the disease than most individuals. Though, it is important to keep in mind that certain people with their family history who have bipolar disorder do not experience it.

The brain

The structure of your brain will influence your disease risk. Anomalies in your neural structure or functioning may increase the probability.

Environmental conditions

It is not just what’s in your system that will raise your risk of having bipolar disorder. Other external factors play a role too. Like extreme stress, physical sickness/illness, and/or trauma (person dealing with Post Traumatic Stress Disorder PTSD).

It is important to note that a combination of the above factors gives a clear diagnosis of the mental disorder but is not the only diagnosis methodology that is adopted. Clinical testing to remove any potential factors will definitely require an accurate diagnosis. These will include a drug examination, imaging scans (CT scan or brain MRI), electroencephalogram (EEG), and a complete battery of blood checks for diagnosis.

Types of Bipolar Disorder

Bipolar I

Bipolar I is described as having at least one manic episode occurring. Before and after this psychotic phase, you can have hypomanic or major depressive symptoms. This definition of bipolar disorder refers similarly to men and women. An individual with bipolar I condition may have a major depressive episode, or may not. The signs of a psychotic episode can be so serious you will need hospital treatment.

Manic episodes are typically characterized by the following:

Remarkable energy

Restlessness

Difficulty focusing

Euphoric emotions (extreme happiness)

Unsafe actions

Poor or no sleep

Bipolar II

People with this form of bipolar disorder experience one big episode of depression which lasts for a minimum of at least two weeks. Many also experience at least one case of hypomania, which lasts for four days. It is believed that this form of bipolar disorder is more prominent in women.

Usually, people with bipolar 2 do not suffer depressive spells that are severe enough to require hospitalisation.

Bipolar 2 is often misdiagnosed as depression because the main symptom at the moment the person seeks medical attention may be suicidal signs. Where no manic spells suggest bipolar disorder, the priority is on the symptoms of depression. Typical signs that occur in a major depressive episode include:

Insomnia or hypersomnia

Unexplained or unpredictable crying

Extreme tiredness

Loss of interest in things the person usually enjoys

Frequent Suicidal thoughts

Cyclothymia

Episodes of hypomania and depression arise in individuals with cyclothymia. Both signs are slower and less severe than the bipolar I or bipolar II disorder induced by mania and depression. Many people dealing with this disorder report only one to two months at a time when their moods are normal.

Individuals with cyclothymia undergo mental ups and downs but with signs that are less severe than those of bipolar I or II.

Cyclothymic condition signs include:

Multiple cycles of hypomanic and depressed symptoms, for at least two years, but the symptoms do not meet the standard requirements for the hypomanic or depressive event.

The signs (mood swings) continued at least half the time over the two-year cycle and have never ceased for more than two months.

Cyclothymic condition recovery may include medicine as well as talk therapy. Talk counselling can assist other people with the pressures of persistently high and low moods. Some with cyclothymia can start treatment and stop it over time.

Many depressive disorders are not pattern-specific. These are not meeting the other three conditions, either. Yet, the requirements for unexplained shifts in mood also need to be followed.

For example, a person may experience mildly depressed or hypomanic symptoms that last for cyclothymia longer than the two years stated.

Symptoms & Diagnosis

Mania

A manic episode is a lot more than just a sense of elation, high energy, or being distracted. During a manic episode, the mania is so intense that it can interfere together with your daily activities. It’s difficult to redirect someone during a manic episode toward a calmer, more reasonable state.

People who are within the manic phase of emotional disturbance can make some very irrational decisions, like spending large amounts of cash that they can’t afford to spend. they’ll also engage in high-risk behaviours, like sexual indiscretions despite being during a committed relationship.

An episode can’t be officially deemed manic if it’s caused by outside influences like alcohol, drugs, or another health condition.

Hypomania

A hypomanic episode may be a period of mania that’s less severe than a full-blown manic episode. Though less severe than a manic episode, a hypomanic phase remains an incident within which your behaviour differs from your normal state. The differences are going to be extreme enough that individuals around you will notice that something is wrong.

Medically, a hypomanic episode isn’t considered hypomania if it’s influenced by drugs or alcohol.

Depression

Through an episode of depression a person may encounter:

Intense sorrow

Hopelessness

Loss of motivation

Losing confidence in things they once loved

Bouts of too little or too much sleep

Suicidal thoughts

While this is not a rare occurrence, bipolar disorder may be difficult to identify due to its varying symptoms.

Diagnosis in teens/adolescents

Angst-filled behaviour and temper tantrums are nothing new to the typical parent of a young person. The shifts in hormones, plus the life changes that include puberty, can make even the foremost well-behaved teen seem a bit upset or overly emotional from time to time. However, some teenage changes in mood could also be the results of a more serious condition, like manic depressive illness.

A manic depressive disorder or bipolar disorder diagnosis is commonest during the late teens and early adult years.

For teenagers, the more common symptoms of a manic episode include:

being extremely joyful

“acting out” or misbehaving

taking part in risky actions

abusing substances like drugs and alcohol

thinking about sex more than just curiosity

becoming overly sexual or sexually active

having trouble sleeping but not displaying signs of fatigue or being tired

having an awful irascibility

having trouble staying focused, or being easily distracted

For teenagers, the more common symptoms of a depressive episode include:

sleeping plenty or deficient

eating an excessive amount of or not enough

feeling very sad and showing little excitability

withdrawing from activities they enjoy and friends

Racing suicidal thoughts and thoughts about death

Diagnosing and treating manic depressive illness can help teens live a healthy life.

Treatment & Healthcare Options

Multiple options for treatments are available which will facilitate and manage people dealing with bipolar disorder. These include medications, counselling, and lifestyle changes that people dealing with bipolar disorders can adapt. Some natural remedies may additionally be helpful.

Medications

Recommended medications may include:

mood stabilizers, like lithium (Lithobid)

antipsychotics, like olanzapine (Zyprexa)

antidepressant-antipsychotics, like fluoxetine-olanzapine (Symbyax)

benzodiazepines, a sort of anti-anxiety medication like alprazolam (Xanax) which will be used for short-term treatment

Psychotherapy

Recommended psychotherapy treatments may include:

Cognitive behavioural therapy

Cognitive-behavioural therapy could be a variety of talk therapy. You and a therapist speak about ways to manage your manic depression. they’ll facilitate your understand your thinking patterns. They will also facilitate and understand your disorder and come up with positive coping strategies.

Psychoeducation

Psychoeducation could be a reasonable counselling methodology that helps the family and friends of people dealing with bipolar disorder to understand the disorder. Knowing more about manic depression will facilitate your understanding and help those in your life dealing with bipolar disorder manage it.

Interpersonal and social rhythm therapy – Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, like sleeping, eating, and exercising. Balancing these everyday basics can facilitate your manage your disorder.

Other treatment options may include:

electroconvulsive therapy (ECT)

sleep medications

supplements

acupuncture

Lifestyle changes

There also are some simple steps you’ll be able to take at once to assist and manage bipolar disorder:

keep a routine for eating and sleeping

learn to acknowledge mood swings

ask a relative to support your treatment plans

talk to a doctor or licensed healthcare provider

Other lifestyle changes also can help relieve depressive symptoms caused by manic depression.

Living with Bipolar Disorder

Bipolar disorder is for sure a chronic mental disease, meaning people dealing with bipolar disorder will address it for the remainder of their life. However, that doesn’t mean one can’t live a contented, healthy life.

Treatment can help manage the changes in moods and address one’s symptoms. To utilise the foremost out of treatment, one should make a care team to assist them throughout. Additionally, along with the primary doctor, search out a psychiatrist and psychologist. Through talk therapy, these doctors can facilitate your address symptoms of manic depressive illness that medication can’t help.

You may also want to hunt out a supportive community. Finding people who’re also living with this disorder can provide you with a bunch of individuals you’ll depend on and switch to for help.

Finding treatments that job for you requires perseverance. Likewise, patients should be patient with themselves as they learn to manage manic depressive illness and anticipate the changes in mood.

While dealing with bipolar disorder is often a true challenge, it can help to take it one day at a time and focus on identifying shifts in behaviour and mood patterns. 

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