What is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a chronic mental illness characterized by swings between depression and grandiose moods. Over five million people live with the illness. The disorder often runs in families, affects women and men equally, and appears around the average age of twenty-five.

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Credit to flickr.com user Al King. Used with permission under a Creative Commons license.

To fully explain bipolar disorder, we must first look at the two “poles” of the disease: mania and depression. Mania includes racing thoughts, elevated mood, over-excitement, a lack of a need to sleep, irritability, impulsive decisions, and sometimes delusions. Depression includes feeling sad or sluggish, overeating, insomnia or over-sleeping, severe lack of energy, trouble making decisions, and possibly thoughts of suicide. People with bipolar disorder can swing between these two states over periods of days, weeks, months, or even years. Rapid cycling occurs when four or more mood episodes happen over the course of a year, which is difficult to treat. Four episodes per day is called “Ultradian Cycling.”

Mixed episodes occur when symptoms of mania and symptoms of depression happen at the same time, increasing the risk of suicide. It is very difficult to treat a mixed episode, as most medications do not treat both sets of symptoms at the same time.

Children with bipolar disorder tend to have tantrums that last for hours, and possibly turn violent. Thirty percent of kids who have a major depressive diagnosis will eventually receive a diagnosis of bipolar disorder. During mania, kids tend to have trouble sleeping, be irritable, and speak quickly about a variety of topics. Depressive episodes see children complaining a lot about stomachaches or headaches, have no interest in fun, and possibly think about death or suicide.

There are three types of the disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is diagnosed when a person suffers from manic symptoms longer than seven days, or severe enough to require immediate hospitalization. Depressive episodes often last two weeks or more. Both states prevent normal function, and require treatment in order for the individual to fully live their life.

Bipolar II

Four times more common than Bipolar I, Bipolar II is characterized by both depression and hypomanic (“below mania”) episodes, but not full-blown mania.  Often productive, persons with Bipolar II are rarely hospitalized.

Cyclothymia

Cyclothmia is a tricky diagnosis with manic symptoms less severe than Bipolar I and depressive symptoms less severe than Bipolar II. Impact on productivity varies; some individuals may be hyper-productive with little impairment, whereas others are manic or severely depressed for most of their lives. Cyclothimics may have periods of stability, but those last less than eight weeks.

There are several risk factors under consideration. Genetics may play a part, though studies of identical twins have found that one twin may develop the disorder while the other twin does not. Brain scans show that the structure of the brains of sufferers of bipolar disorder have differently sized portions of the brain compared to healthy people. Family history seems to contribute as well, as those who have a family history of the disorder tend to develop it more often than those who do not.

Treatment for bipolar disorder requires a range of psychotherapy and mood stabilizing drugs like lithium and Depakote. Electroconvulsive therapy (ECT) is also used, with mixed results. Several illnesses are comorbid with bipolar disorder, such as Attention Deficit Hyperactivity Disorder (ADHD) or anxiety-related illnesses. These related conditions make it difficult to treat the underlying bipolar disorder, as stimulants used to treat ADHD can sometimes trigger a manic episode. 

With treatment, people with bipolar disorder can lead productive, healthy lives, managing their illness as it comes.

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