Bipolar Disorder (BPD)

INTRODUCTION

Bipolar disorder. What exactly is it? Perhaps you’ve heard of it through the internet or social media, or perhaps you haven't got a clue as to what it is. Bipolar disorder is a lifelong mental health condition that affects millions worldwide. This article will break down the basics, from its types and symptoms to treatment options, providing you a clearer understanding of this complex condition.

Frequency

Bipolar disorder is a lifelong mental health condition that is typically associated with episodes that range from depressive lows to manic highs. It is estimated that 40 million people worldwide live with this disorder. According to the National Institutes of Health (NIH), bipolar disorder affects approximately 2.4% of the global population. Additionally, an estimated 4.4% of adults in the United States experience bipolar disorder at some point in their lifetime. The illness is reported to be most prevalent in young adults—specifically those who are 18-29 years old. Keep in mind, however, that this data is not concurrent as it was taken from the year 2001 to 2003.

The 4 Types of BPD and Their Differences

Though many have heard of bipolar disorder, some aren’t aware that there are four types of bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and unspecified bipolar disorder. Now, what exactly differentiates each of these disorders? Bipolar I and II are the more common bipolar disorders. A key feature of bipolar I is the presence of manic episodes. To be diagnosed with bipolar I, one would have to experience manic episodes that last for at least seven days. This can occur with or without depressive episodes, with the latter being more frequent. Bipolar II, on the other hand, is defined by a pattern of both hypomanic and depressive episodes. Unlike bipolar I, those with bipolar II never experience a full manic episode. Additionally, according to Cleveland Clinic, chronic depression is more common in people who have bipolar II, as opposed to bipolar I. Bipolar I and bipolar II appear to be the most common in the population. Cyclothymic disorder is on the rarer side of mood disorders. Those with cyclothymia experience recurring hypomanic and depressive symptoms. However, these symptoms lack the intensity to be considered hypomanic or depressive episodes. Lastly, there is the unspecified bipolar disorder. As the name might suggest, those who don’t quite meet the criteria for bipolar I, bipolar II, or cyclothymic disorder are diagnosed with unspecified bipolar disorder. According to NAMI, those with this disorder experience or have experienced periods of “clinically significant abnormal mood elevation”.

Bipolar 1 vs. Bipolar 2

Manic, Depressive, and Hypomanic Episodes

Now, what are these episodes? What is the difference between manic, depressive, and hypomanic episodes? Imagine feeling hyper for days on end—impetuous, manic. That is a state that many with bipolar I go through. Manic episodes—the main attribute of bipolar I—are periods of time in which someone experiences one or more symptoms of mania. Mania is a condition in which an elevation in mood, activity, energy, etc. Symptoms of such can include feelings of invincibility, lack of sleep, reckless behavior, rapid thoughts or speech, or possessing false beliefs or perceptions. Hypomanic episodes are a milder form of manic episodes, as suggested by the prefix ‘hypo’, meaning beneath or under. Simply put, hypomanic episodes are the less intense version of manic episodes. Depressive episodes, on the other hand, are a period of time when one experiences a ‘low’ or ‘depressive’ mood. Symptoms of these depressive episodes include tiredness, loss of appetite, and feelings of unworthiness. Due to the similarities of bipolar II and depression, oftentimes people are misdiagnosed—this is also because the criteria for diagnosing one with either are the same/overlap in the DSM 5(Diagnostic and Statistical Manuel of Mental Disorders). However, according to NIH, women with bipolar II are more likely to have an earlier age of onset, experience more than five mood episodes, and experience feelings of worthlessness. Additionally, they are more likely to have unstable sleep, which includes both insomnia and hypersomnia. In conclusion, while bipolar disorder is a disorder characterized by extreme mood swings, symptoms will depend on what type of disorder they have—and what kind of episodes they experience.

Treatments

You may be wondering, how exactly is bipolar disorder treated? Unfortunately, there is no cure for bipolar disorder. However, with treatments, people can learn to manage their symptoms. There are many forms of treatment for bipolar disorder, and as the illness is lifelong, treatments tend to be, too. Some main treatments for bipolar include medications and psychotherapy.

Medication

According to Mayo Clinic, medicines used to treat bipolar disorder can include mood stabilizers, antipsychotics, antidepressants, a combination of antipsychotics and antidepressants, or in some cases, antianixety medications. Mood stabilizers are medications that aid in controlling manic or hypomanic episodes. In some cases, they can also help with depressive episodes. Carbamazepine (which, according to National Institute of Health (NIH), is an anticonvulsant that is “used to manage and treat epilepsy, trigeminal neuralgia, and acute manic and mixed episodes” in bipolar disorders) and valproic acid (an anticonvulsant that can treat seizures, bipolar disorders, and in some instances, epilepsy) are examples of mood stabilizers. Olanzapine and cariprazine are medications classified as antipsychotics that are also used to treat bipolar. Antidepressants are prescribed to manage, well, depression. However, when it comes to bipolar disorder, antidepressants should always be prescribed with either a mood stabilizer or antipsychotics. This is because they can also trigger manic or hypomanic episodes. An example of an antidepressant-antipsychotic combination is the medication Symbyax. It combines fluoxetine and olanzapine and is approved to treat bipolar disorder. Antianxiety medications are prescribed to those with bipolar to ease anxiety and improve sleep. However, they’re almost always used on a short-term basis.

Psychotherapy

Another common treatment for bipolar disorder is psychotherapy, also known as talk therapy. Psychotherapy is a type of treatment for mental issues that uses psychological approaches. Some of the many types of therapy that one could use to treat bipolar include CBT, interpersonal and social rhythm therapy. CBT stands for cognitive behavioral therapy. According to Cleveland Clinic, it helps the management of mental health issues through a “structured, goal-oriented type of talk therapy.” Interpersonal and social rhythm therapy (IPSRT) is primarily used to treat bipolar disorder. It’s a form of psychotherapy focused on stabilizing a patient's daily routines by addressing both interpersonal issues in their "social rhythms" with the goal of managing mood symptoms by regulating their circadian rhythms. Lastly, psychoeducation is another type of therapy that can be used for those with bipolar and endless other mental health issues. It is not a type of psychotherapy, though it is a strategy of teaching patients and families about mental disorders, their treatments, personal coping techniques, etc.

Therapy and medications, however, are not the only methods to disorders such as bipolar disorder. ECT, ketamine, or even simply minimizing the stress of one’s life are all treatments for bipolar.

Importance of Learning About BPD

In conclusion, bipolar disorder is a complex condition that affects millions of people worldwide, yet it is manageable with the right treatment and support. Understanding its types, symptoms, and treatment options is a crucial step toward reducing stigma and promoting empathy. Though living with bipolar disorder may come with challenges, with ongoing care and understanding, it’s possible to lead a fulfilling and balanced life.