Being poles apart – all you need to know about Bipolar Disorder

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An illness with a little over 3% of the world population suffering from it – which is quite a lot; is relatively unknown and has little or no awareness here in India. I am talking about bipolar disorder, also known as manic – depressive illness. Bipolar disorder is a brain disorder which is characterized by unusual shift in moods, activity, energy and the ability to carry out day to day tasks (National Institute of Mental Health, USA). The moods are poles apart that are a shift between an elevated mood known as mania and chronic depression. The disorder can lead the patients to have poor relationship formation, poor performance in school, college or work even if smart.  Bipolar disorders can be treated however, and can lead normal lives with continuous treatment. Many victims are usually faced with social stigma, as those around them unable to understand them.

There is no specific cause for this disorder. But there are several factors –

Genetic – There are cases where this disorder runs from generation to generation. However, there have been cases where children with absolutely no genetic history have also been victims. Some scientists suggest if patients of schizophrenia or depression are in the family then the children are likely to have bipolar disorder as the symptoms are related. The table below shows how many are liable to have bipolar disorder in the family.

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Image courtesy – www.mentalhelp.net

Physiological (Brain functioning) – Some functional MRI and other procedures indicate that those with bipolar have different brains than those of healthy people or of those with other mental illnesses. One study suggests that the pattern of brain development in those with bipolar disorder was similar to those with multi – dimensional impairment – a disorder that causes symptoms that overlap a little with bipolar disorder and schizophrenia. Also, the brain’s prefrontal cortex in those with bipolar is different from others. It is smaller and less functional. The prefrontal cortex is the usually responsible for making decision s and solving problems.

As mentioned earlier, there is a drastic shift between the moods. There are called episodes – manic episode and depressive episode. So a long period of being extremely happy or ‘high’ will be contrasted with long periods of feeling hopeless or depressed. This is also followed by extreme irritability and loss of interest in activities that the person usually enjoys. The manic episode usually consists of  talking very fast, jumping from one idea to another, having racing thoughts, being distracted easily, endlessly taking on activities and new projects, extreme restlessness, sleeping little or not being tired, having an unrealistic belief in one’s abilities, impulsive behaviour and engaging in pleasurable, high-risk behaviour. They may also experience hallucinations or delusions. The depressive mode consists of feeling tired, inability to concentrate, remember, and make decisions, restlessness or irritability, a change in eating, sleeping, and other habits, constant thoughts of death or suicide, and even attempting it. Sometimes there is an overlap between the moods; it is called the mixed state. Bipolar disorder usually develops in adolescence or early adulthood. Very few develop it late.

The major types include –

  • Bipolar I Disorder — manic or mixed episodes that last at least seven days, or symptoms that are so severe that the person needs to be admitted in the hospital. The depressive mode usually last two weeks.
  • Bipolar II Disorder — a pattern of depressive and hypomanic episodes. Not very severe.
  • Bipolar Disorder Not Otherwise Specified (BP-NOS) — when the symptoms don’t coincide with those given above. But the behaviour is outside one’s normal range.
  • Cyclothymic Disorder — a mild form. Have both hypomania as well as mild depression for at least 2 years. The symptoms do not meet the criteria of any other type of bipolar disorder.
  • Rapid-cycling Bipolar Disorder – this occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, in one year. This is more common in those who have had their first bipolar episode at a very young age.  It affects more women than men and may come and go.

The disorder cannot be diagnosed via blood tests or brain scans. But they are usually done to rule out other diseases or disorders. A trained psychiatrist will usually diagnose it after an interview with the person. The disorder is usually diagnosed when the person is in a depressive mode. However, a person’s medical history should be checked and also if the person has experienced any severe trauma. Chronic depression should not be confused with bipolar disorder. The latter is not caused by trauma. If left untreated, bipolar disorder can worsen. With continuous treatment, the person can lead a normal and a healthy life or in the case of Rapid – cycling Bipolar disorder, the severity is considerably reduced. However, it cannot be cured. The person needs to be under someone’s care as those with bipolar disorder usually resort to substance abuse.

Treatment usually includes a series of medications or mood stabilizers the most common of them being Lithium (Eskalith or Lithobid).  However, all the mood stabilizers have a high number of side – effects like drowsiness, dizziness, nausea, col – like symptoms, acne, bloated stomach, dry mouth, diarrhoea, constipation etc. At times, even anti – depressants are described. Psycho-therapy is also a major part of the treatment.

A person with bipolar disorder needs to be treated with extreme understanding and empathy. The victim usually needs someone who’ll listen. If a friend or someone in the family shows such symptoms, go to a doctor immediately.