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Bipolar Disorder FAQs

What is Bipolar Disorder?

Bipolar disorder is a type of mood disorder characterized by severe shifts in mood, levels of energy and behaviour. The shifts in mood are more extreme than the usual ups and downs that everyone goes through once in a while. In bipolar disorder, there is an alternating between episodes of depression (low mood) and mania (elevated mood). Bipolar disorder is a severe mental health condition having debilitating impact on a person’s functioning in different spheres of life.

What are the symptoms of bipolar disorder?

In bipolar disorder there are swings between depression and euphoric or irritable mania, punctuated by symptom-free periods known as euthymia.

The symptoms of an episode of mania include:

  • Sustained abnormal mood; i.e., elevated or irritable
  • Heightened sense of self-importance
  • Excessive talkativeness
  • Decreased need for sleep; in other words, feeling rested with as little as 3 hours of sleep
  • Poor concentration; easily distracted by irrelevant stimuli
  • Racing thoughts, increased rate of speech and sudden shifts of topics/ ideas
  • Increase in either goal-directed activity or restlessness characterized by engagement in seemingly purposeless activity
  • Excessive involvement in risky activities; lowered inhibitory control

The symptoms of a depressive episode include:

  • Low mood
  • Reduced interest in previously enjoyed activities
  • Increase or decrease in appetite and/or weight
  • Trouble sleeping or sleeping too much
  • Reduced energy or feeling fatigued easily
  • Slowing of movements and speech or increase in restlessness or agitation which is severe enough to be noticed by others
  • Feelings of worthless and/or guilt
  • Reduced capacity for thinking, concentrating or making decisions
  • Thoughts of death, suicidal ideas or gestures

People with bipolar disorder may also exhibit symptoms of a “mixed” episode in which the symptoms of mania and depression co-exist during the same period. 

Are there different types of bipolar disorder?

Yes. There are several different types of bipolar disorder, the most important ones of which are:

Bipolar I disorder: This is characterized by the experience of atleast one episode of mania.

Bipolar II disorder: This is marked by the experience of at least one episode of depression and one episode of hypomania, but there is an absence of the experience of an episode of full mania. Hypomania is characterized by much of the same features as that of mania, but with reduced severity. Episodes of hypomania may be lesser in intensity as well as duration than an episode of mania, and cause lesser degree of functional impairment.

Cyclothymic disorder: This is conceptualized as a mild form of bipolar II disorder and marked by episodes of hypomania and depressive syndrome, neither of which are severe enough to meet full criteria for mania or depression.

Rapid cycling disorder: These are bipolar disorders that recur regularly with very short intervals between episodes. The recurrent episodes may be depressive, manic, hypomanic, or mixed. The convention specifies that there must be atleast 4 distinct episodes in a year to qualify as rapid cycling. 

How to understand whether a person exhibiting symptoms of depression may actually have bipolar disorder?

The diagnosis of bipolar disorder is complicated by a number of factors. If the symptoms are comparatively mild or the swings more infrequent, then it becomes more difficult to arrive at the correct diagnosis. A diagnosis of bipolar disorder should be made by a Psychiatrist. Bipolar disorder should be suspected when the following are present:

  • Family history of bipolar disorder
  • Early age of onset
  • Trait mood lability
  • Hyperthymic temperament
  • Periodic impulsivity
  • Periodic irritability
  • Irregular behaviours such as frequent change of jobs
  • Rapid onset and offset of short duration depressive episodes

The presence of none of these, by themselves, can confirm a diagnosis of bipolar disorder. But their presence, especially in combination, should cause one to consider the presence of a potential bipolar disorder diagnosis.

What causes bipolar disorder?

Bipolar disorder is marked by a multi-factorial causality. For purpose of discussion, they may be divided into the following broad areas:

  • Genetic
  • Biological, and
  • Psychosocial

Genetic: Bipolar disorder runs in families and there is a strong inheritable component to it. The closer the association with relatives affected by the disorder, the higher is the risk. The genetic contribution in bipolar disorder is greater than that in depression.

Biological: Imbalances in chemical messengers, or neurotransmitters, in the brain play a large role in the development of this disorder. Research has shown some evidence for increased norepinephrine and dopaminergic activity during episodes of mania.

Structural imaging studies have shown that some structures of the brain such as basal ganglia and amygdala are enlarged in bipolar disorder.

Psychosocial: Stressful life events can act as triggers for the development of bipolar disorder. Further, a perceived lack of social support can increase a person’s vulnerability to developing the disorder. Certain personality factors such as elevated levels of striving for achievement and sensitivity to rewards in the environment are predictive of symptoms of mania. 

How is Bipolar disorder treated?

Treatment for bipolar disorder includes pharmacotherapy (medications) and psychotherapy. The initial choice of treatment will be based on whether the patient is manic or depressive, the severity of symptoms, and the particular subset of symptoms that are perceived as most problematic. Anti-depressants, mood-stabilizers and anti-psychotics are commonly used in the treatment of bipolar disorder.

            Psychotherapy is often used as an adjunct to pharmacological treatment and can include different modalities depending on the suitability for the particular person. Family support and psychoeducation are very important components in bipolar disorder.