Bipolar disorder is a serious chronic (long-term) illness associated with disturbances of behaviours. It is characterised by episodes of mania (greatly elevated mood, high or “on top of the world”) or hypomania (mildly elevated moods) and depression (low moods) that impairs functioning and may require frequent admissions. Bipolar disorder affects one’s mood, energy levels and activity levels with changes from being “up” to being “down”. This simply means that people with bipolar disorders have moods that are on one extreme or the other. It used to be called manic depression.
Manic episodes involve elevated or irritable moods, hyperactivity, inflated self-esteem, a reduced need for sleep and rapid speech. Mania or depression can occur first and either episode may be more dominant but is typically separated by periods of normal moods. Mania or depression can last for weeks or months and in some people, these episodes swing rapidly with a short period of normal mood in between.
What are the types of bipolar disorder?
There are two main types of bipolar disorder.
Type 1: Usually begins with severe episodes of mania and then depression.
Type 2: This is less severe mania (hypomania – elevated mood but the symptoms are not as severe or extreme as in true mania.)
A third type of bipolar disorder is called Cyclothymic disorder and involves a prolonged period (up to two years) of hypomania and depressive illness.
Who is affected by bipolar disorder?
According to the World Health Organisation, around 45 million people worldwide are affected by bipolar disorder. There is no gender predilection but it is commoner in younger people between 18 and 24. People who have manic attacks but do not experience depressive episodes are also classified as having bipolar disorder.
What causes Bipolar Disorder?
The specific cause of bipolar disorders is unknown. It is thought to be due to the imbalance of some chemicals in the brain however this is not proven. Some events may trigger an episode of bipolar disorders. These include:
- extreme stress
- overwhelming problems
- life-changing events
It is known that bipolar disorder may be inherited as one’s risk of developing it is higher (five to ten times more) if you have a first degree relative with bipolar disorder.
What are the symptoms of bipolar disorder?
The symptoms of bipolar disorder are often due to the phase the person is in which can be manic or depressive.
Manic Symptoms: These typically develop over a week and can last for a few weeks or longer. They usually cause a feeling of “high” in affected persons causing excessive happiness or irritability, with some of the following symptoms also seen.
- Grand ideas about oneself and one’s self-importance.
- Easily distracted.
- Increased energy: moving around quickly, not feel like eating and requiring fewer hours of sleep.
- Wearing bright clothes or being unkempt.
- Wanting to do lots of pleasurable things which can often lead to painful consequences. For example, spending a lot of money (which you often cannot afford), being less inhibited about sexual behaviour.
- Making rash decisions, often on the spur of the moment.
- Flight of ideas. This means that there is a rapid change from one idea to another.
- Being full of new ideas and plans. Often the plans are grandiose and unrealistic.
- Drinking a lot of alcohol, or take illegal drugs.
Severe mania may also cause psychotic symptoms (for example, hearing voices which are not real (hallucinations), or have false beliefs (delusions).
Usually, you do not realise that you have a problem when you are high. But, as the illness develops, to others your behaviour can be bizarre. Family and friends tend to be the ones who realise that there is a problem. But, if someone tries to point out that you are behaving oddly, you tend to become irritated as you can feel really good.
Depressive Symptoms: These are typical depressive (low) moods that are persistent and continuous for weeks. One may experience:
- Low mood with reduced energy,
- Lack of joy from day-to-day activities,
- Feelings of despair,
- Low self-esteem
- Weight loss
- Reduced appetite
- Altered sleep pattern with early morning wakening
- Loss of libido
In severe cases, delusions may set in.
How is the diagnosis of bipolar disorder made?
If you have symptoms of mania, often you do not realise that there is anything wrong. It is typically your friends or family who are the ones who can see that you are not your usual self. There are no physical tests or scans to do in making a diagnosis of bipolar disorder however your doctor may request for specific blood tests to distinguish bipolar disorder from physical illness.
What are the treatment options for bipolar disorder?
Mania episodes may last between four to six months and may cause severe restrictions in functioning. This is typically followed by episodes of depression. This cycle may occur multiple times a year and as such, treatment is offered to shorten the duration of symptoms or to prevent these episodes from occurring. Treatment options medicines such as Lithium (mood stabiliser), antidepressants, antipsychotics and cognitive behavioural therapy (talk therapy). Bipolar disorder is lifelong and management is continuous.