What is bipolar disorder?

Bipolar disorders (or Manic depression) are known as mood disorders. People who are afflicted with depression on it’s own are said to have a major depressive disorder or “unipolar depression”. People with both manic and depressive episodes or people with manic episodes alone are said to have a bipolar disorder. The term “unipolar mania” and “pure mania” are sometimes used for people with bipolar disorder who do not have depressive episodes.

The relationship between unipolar depression and bipolar depression is not clearly understood. However, the theory regarding the relationship between the two suggests that unipolar depression and bipolar depression represent two different disorders.

People normally experience a wide range of moods including normal, elevated, or depressed and usually there is a sense of control of their moods and affect. Mood disorders are characterised by a loss of that sense of control and is usually accompanied by feelings of helplessness, hopelessness and worthlessness. People with depressed mood have a loss of energy and interests, feelings of guilt, difficulty in concentrating, loss of appetite, and thoughts of death or suicide

People with elevated mood or manic episodes demonstrate expansive or irritable mood, having too many ideas at once, distractibility, decreased sleep, heightened self-esteem, and grandiose ideas. Others signs associated with the mood disorders include change in activity level and functions such as sleep, appetite, sexual activity, and other biological rhythms. These disorders virtually always result in impaired interpersonal, social, and occupational functioning.

Bipolar disorder is less common than major depression. About 1% of the population experience bipolar disorder compared to 10% of men and about 20% of women who experience a major depression. Roughly 1 of every 15 depressed persons experiences bipolar disorder. However, in hospitals the ratio of bipolar disorder to depression is about equal. Unlike major depression, bipolar disorder affects males and females equally. Bipolar disorders can begin from childhood through to about 50 years of age. The average age of onset is about 30 years.

Bipolar Disorder

This disorder most often starts with depression (75% of the time in females and 67% in males) and is a recurring illness. Most people experience depression and mania , although approximately 10 – 20 % experience only manic episodes. The manic episode typically has a rapid onset (hours or days), but they may evolve over a few weeks. An untreated manic episode lasts about 3 months; therefore, it is unwise to discontinue treatment prior to that time. Time between episodes usually stabilises at about six to nine months.

Manic Episodes

Elevated, expansive or irritable mood is the hallmark for manic episodes. Although uninvolved people may not recognise the unusual nature of the person’s mood, those who know the person recognise it as abnormal for that person. Alternatively, the mood may be irritable especially if the person’s plans are interrupted. Often a person exhibits a predominant mood of euphoria, early in the course of the illness, and irritability later in the process.

In addition to these symptoms, people with mania often exhibit other symptoms such as:

– distractibility

attention easily drawn to irrelevant or unimportant things

– decreased need for sleep

the bipolar sufferer may feel rested after only a few hours of sleep.

– excessive involvement in pleasurable activities which have a high potential for harmful consequences

such as shopping where the person engages in unrestrained buying sprees, sexual activity (or indiscretions), or foolish business investments.

– increase in goal-directed activity

either socially, at work or school, or sexually. The person is often preoccupied by religious, political, financial, sexual, or self-defeating ideas that may evolve into thinking that is not reality based.

– increased talkativeness and a pressure to keep talking

their increased talkativeness may be seen by excessive use of the telephone, especially long distance calls during the early hours of the morning.

People with mania often drink alcohol excessively, perhaps in an attempt to self-medicate. Other behaviours that are seen in mania are excessive gambling, a tendency to disrobe in public places, wearing clothing and jewelry in bright colours and in unusual combinations, and an inattention to small details (such as forgetting to hang up the phone). Occasionally, people with mania engage in child-like play.

Mania in adolescence:

Mania in adolescence is often misdiagnosed as sociopathy or schizophrenia. Symptoms of mania in adolescence may include psychosis, alcohol or drug abuse, suicide attempts, academic problems, philosophical brooding, obsessive-compulsive symptoms, multiple physical complaints, marked irritability resulting in fights, and other anti-social behaviours. Although many of these symptoms can be seen in normal adolescence, severe or persistent symptoms should cause the clinician or family members to consider the possibility of the teenager having a bipolar disorder.

Family and friends may notice problems in areas such as:

– school truancy

– school failure

– occupational failure

– interpersonal relationships

– increased antisocial behaviour

The causes of Bipolar Disorder are currently unknown and no single cause has been identified. However, a number of different factors are believed to be associated with the onset of this mood disorder. These are:

Biological Factors

Certain biochemical substances in the brain (i.e. neurotransmitters called the biogenic amines) are believed to be involved in this condition. It is suggested that some people may have a genetic predisposition to depression because of an imbalance in these brain chemicals. The antidepressant medications work to restore the imbalance in the brain chemicals. Mania is commonly treated with drugs such as lithium carbonate and citrate.

Genetic factors:

Twin and adoptive studies provide strong evidence of a genetic influence for Bipolar Disorder. The fact that this disorder runs in families is also consistent of a biological cause. Approximately 50% of all bipolar sufferers have at least one parent with a mood disorder. If one parent has bipolar disorder, there is a 27% chance that any child will have a mood disorder; if both parents have bipolar disorder, there is a 50 – 70% chance that a child will have a mood disorder.

Life Events and Environmental Stress

Some clinicians believe that life events play the primary role in depression. The environmental stressor most associated with depression onset is the loss of a spouse. However, the triggering event can be from any cause and can also be due to a build-up of smaller events and little perceived support.

Some evidence shows that changes in sleep-wake schedule or sleep deprivation may precipitate or exacerbate a manic or mixed episode.

1. The family can help by being supportive and acknowledging the person’s emotions.

2. The person with depression will usually find it difficult to cope with normal activities. A demonstrated understanding of this by family and friends is advisable and support for the depressed person with encouragement to engage in “fun” activities (during the depressed stage).

3. Encourage the person to properly comply with taking their prescribed medication.

4. Reduce stressful events

5. Do not blame or try to help by suggesting that the person “try harder”.

6. Try to not become over involved or withdraw from the individual.

7. Positively encourage and reward any signs of improvement in behaviours and/or mood.

8. Positively reinforce the person when they have managed to use coping strategies such as self-monitoring their behaviours, adhering to proper sleep schedules, and using problem-solving skills.

DO’S

Validate and express understanding of the person’s feelings. For example:

“I can understand how you might feel that way”

Encourage the individual to take action to seek out professional help (this may involve a family member to find the name and contact of an appropriate referral, due to the lack of motivation in the depressed state).

Encourage the individual to learn about the disorder in order to help facilitate an understanding of what they are experiencing and the problems that appear to be commonly associated with bipolar disorder. This may further encourage the person to seek out professional help.

DON’TS

Tell them that they shouldn’t feel or act that way or punish them for not demonstrating control of their depressive and manic behaviours.

Tell them that they should think positively without first helping the person to learn how to acquire the necessary skills to achieve this goal.