My friend says she's bipolar. What is that?

Q: My friend has these crazy moods that go from being depressed to having lots of energy. She says she is bipolar. What is that?

A:  Everyone has ups and downs in mood. Feeling happy, sad and angry is normal. Bipolar disorder, or as it used to be called, manic-depressive illness, is a serious medical condition that causes people to have extreme mood swings and it affects how people think and behave.

Bipolar disorder usually consists of three states:
1. High state called mania
2. Low state called depression
3. Well state - feel normal and function well  

Bipolar Disorder (manic-depressive) is much less common than major depression but it's important to understand that it is different. Bipolar disorder is distinctive by the dramatic changes in mood, energy and behaviour including cycling mood changes of extreme highs (mania), mixed episodes, extreme lows (depression), and periods of normal functioning (wellness) which can last from hours to months at a time. Bipolar disorder affects approximately 1% of the population, typically starting in late adolescence or early adulthood, usually between ages 15 – 25, and affects men and women equally. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Bipolar disorder is commonly misdiagnosed as depression. One of the reasons is that most people with bipolar disorder seek help when they’re in the depressive stage of the illness. When they’re in the manic stage, they don’t recognize the problem. What’s more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic. Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse.

In a depressed phase, people with bipolar disorder may have some or most of the symptoms of major depression. When in a manic phase, which may last from days to months, people with bipolar disorder can be extremely energetic, active, talkative, and irritable and often talk about big plans for fame or success which often gets them into trouble. They can also get into trouble because of their increased interest in sex and sexual activity, and wanting to spend lots of money.

After an initial episode, people with bipolar disorder usually experience alternating periods of mania, depression and wellness for the rest of their lives. There is currently no cure for bipolar disorder. But staying with treatment, even when you’re feeling well, can help keep the condition under control and reduce the chance that the episodes will worsen over time.

Bipolar disorder is mainly treated with medication and psychotherapy. Medication helps to stabilize moods, while therapy helps people detect patterns and triggers and develop strategies for managing stress.

Only recently has there been an increasing acceptance that children can have Bipolar disorder because of the difficult diagnosis symptoms that overlap with other disorders and the course of the disorder in children is often quite different. However, Bipolar disorder among children is generally treated in much the same way as it is among adults, with a combination of therapy and medication.

Types of Bipolar Disorder

Bipolar disorder is actually a spectrum of disorders, usually measured in terms of severity and duration of mania and one disorder that combines symptoms of both bipolar disorder and schizophrenia.

The spectrum runs from:

Severe mania – hypomania – normal mood – mild depression - severe depression

<----------------------------------------------------------------------------------------------------------------->

Bipolar I Disorder (mania or a mixed episode) – The classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.

Bipolar II Disorder (hypomania and depression) – In Bipolar II disorder, the person doesn’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.

Cyclothymia (hypomania and mild depression-sometimes called Bipolar III disorder) Cyclothymia is a milder form of bipolar disorder. It consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.

Hypomania: Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but they are able to carry on with their day-to-day lives and they never lose touch with reality. To others, it may seem as if people with hypomania are merely in an unusually good mood. But it can escalate into full-blown mania or be followed by a major depressive episode.

Schizoaffective Disorder: Schizoaffective disorder combines symptoms of bipolar disorder with symptoms of schizophrenia, including hallucinations.

Symptoms

A Manic Episode condition:

• An elevated mood is a mood described as feeling “high” or “on top of the world”.
• An expansive mood is a mood where someone shows little restraint in expressing one’s emotions, has an exaggerated sense of one’s own abilities and is easily agitated.
• An irritable mood is unfortunately poorly defined in the DSM IV .It is a folk concept referring to easy provocation to anger and aggression.

In addition to these one of these three types of moods, one must also have at least three of the following symptoms (or four if the mood is irritable):

• They can have an inflated sense of self-esteem and feel that they are far more important than they actually are which can become delusional, like believing that they are very important people or have some special mission.
• People in manic episodes will often stop sleeping, sometimes nearly entirely. They simply never get tired and are unable to rest. When they do rest, they may feel that they are completely rested after only a few hours sleep, but in reality they are becoming sleep-deprived and physically exhausted.
• They may become extremely talkative, making it difficult to have conversations with them, as they may not let you talk. They often talk very fast too called pressured talk. Where there speech just can’t keep up with their thoughts and they trying to push out words as quickly as possible.
• Manic people’s thoughts and ideas race through their minds incredibly quickly and they often become incoherent and they may feel like they have no conscious control over how fast they come and go.
• They are often easily distracted. The person focuses on small things others wouldn’t notice but may not see the “big picture”.
• People in manic episodes especially “driven and will tend to work toward specific goals, which are often unattainable.
• Someone in a manic state usually finds it difficult to sit still, and will feel uncomfortable doing so. They may constantly fidget, scratch continuously or rock back and forth.
• They will often excessively engage in a number of pleasurable activities such as shopping, gambling or sex, but significantly underestimate or ignore the consequences.

Bipolar Disorder and Suicide

Bipolar disorder has one of the highest rates of suicide among mental illnesses The depressive phase of bipolar disorder is often very severe and suicides usually take place during depressive states or mixed states. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. In addition, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease, so it is important to be aware and seek help if you need it from a distress center, suicide line or other trusted person.

What causes Bipolar Disorder?

It is not known what causes bipolar disorder. Research suggests that it tends to run in families and drug abuse and stressful or traumatic events may contribute to or trigger episodes as well.

What are the triggers for Bipolar Disorder?

Bipolar disorder also has what is called an “onset”. Often times, this first onset is especially severe. Most people with bipolar disorder don’t simply become manic at random. Instead, there are standard triggers that bring about the “onset” of the disorder, which is the first of usually many episodes.

The disorder makes people more vulnerable to emotional and physical stress. As a result, stresses, such as upsetting experiences, substance use or lack of sleep, can trigger episodes, even though they do not actually cause the disorder. These things do not cause the illness but they can trigger or set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

• Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability.
• Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode or make the disease worse. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
• Medication – Certain medications, especially antidepressant drugs, can trigger mania as well as common things like cold medicine and caffeine.
• Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
• Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania           

What can you do?

While medication is an important part of treating bipolar disorder, a combination of medication and therapy is far more likely to help people prevent relapses and to provide a better life overall.

It is important to remember that depression and bipolar disorder are treatable. Friends and family can be supportive by learning all they can about the condition affecting their loved one. If you spot the symptoms of bipolar depression in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse.

What are the things I need to do to get well? 

The most effective treatment is a combination of medication and psychotherapy. There are also certain lifestyle choices that can help:

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
• Pay attention to the warning signs. Find out what triggers episodes. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.
• Get exercise. Physical activity reduces symptoms of depression. Consider walking, jogging, swimming, gardening, or any other physical activity.
• Medication – Medication is the cornerstone on bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control.
• Psychotherapy – Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
• Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important, avoiding alcohol and drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year round.
• Seek support. It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.