Bipolar Disorder and Life

Manic Depression

Previously known as manic-depressive illness, people with bipolar disorder can lead a content, productive, full life if treated.  Throughout a lifetime, everyone has regular ups and downs that differ from the symptoms of bipolar disease. This illness often destroys relationships, produces poor work performance, and at times the symptoms lead to suicide. For everyone involved coping with bipolar disorder can be challenging.

Bipolar Disorder is a neurobiological condition that severely affects the functioning of almost 5.5 million Americans or 2.6 percent of the population, and 51 percent of these people do not receive treatment. At least half of all cases develop the disease before age 25, and the symptoms are relentless (NIMH, 2014). This brain disorder produces extraordinary changes in someone’s’ capacity to perform daily tasks because it alters energy and activity levels that cause a shift in mood.  Recognized by the dramatic mood swings, someone who is in turmoil has emotions that erupt from the crashes of depression to the peaks of mania. When depressed, people feel hopeless, sad, guilty, and have no interest, energy, orSymptoms of Bipolar pleasure. There may be excessive crying, withdrawal behaviors along with a tendency to focus on the negative parts of life. The Mayo Clinic states that suicide risks for people having this illness 20 years or more are over 6 percent, and self-harm or suicide attempts occur in 30-40 percent of the population. The depressed mood about-faces and those afflicted then feel grandiose, euphoric and full of energy. The pronounced elevation in mood is labeled mania or hypomania, depending on the intensity and severity. People may act unusually happy, energetic, or irritable, and the need for sleep is diminished. During this phase, careless choices are often made, and there is little attention paid to the ramifications or outcomes of these poor decisions. In some, the symptoms of depression and mania occur at the same time along with shifts in mood that may occur many times per day or only a few times a year.

Despite the fact that mania or hypomania’s signs are the defining characteristics of the diagnosis, depressive symptoms are more common than manic, and people consume a considerable amount of time living in misery. For example, a 12-year longitudinal research investigation included 146 people with bipolar I who were asked to complete weekly mood ratings. They reported depressive symptoms being three times more common (Judd et al., 2002).  The outcome of this study explores the fact that these diagnosed cases spent 32 percent of their time with symptoms of sub-clinical depression throughout the 12-year study. Bipolar disorder is difficult to recognize during the initial stages, and many have symptoms for years before obtaining accurate treatment and diagnosis. For those having a first episode of depression, it is often not possible to predict who will have recurrent depression and who will develop a manic episode, thus making the bipolar diagnosis difficult. It is not unusual for someone to spend more than eight years pursuing treatment before receiving an accurate diagnosis and the person may discuss their symptoms with three to four different physicians. The National Institutes of Health explains that the number one explanation of untimely death is suicide, with 15- 17 percent taking their lives as a result of adverse symptoms that occur from lack of treatment.

Diagnosing Bipolar Disorder

The modern psychiatric view of bipolar disorder has its birthplace in the nineteenth century. Historically, there were little advancements and discoveries made for many centuries until the French psychiatrist Jean-Pierre Falret published a document in 1851 describing “la folie circulaire,” meaning circular insanity. Falret proceeds to record the first known case describing someone transforming from being severely depressed to manic excitement. He also noticed that the condition reoccurred in families, and accurately theorized that one of the causes was genetic in nature. Jean-Pierre Falret and Jules Baillarger in 1854 independently presented characterizations of the illness in Paris to the Académie de Médicine. Baillarger explaining that the illness was a “dual-form insanity” (folie à double), and Falret tagged the syndrome circular Diagnosing Bipolarinsanity (folie circulaire). Along with the accurate portrayal, Falrets’ genetic connection is a characteristic that medical professionals believe to this very day. While the investigations and research of medicine progressed, strict religious dogma continued to believe that a mentally disabled person was possessed by demons and should be put to death, and those afflicted across the globe were executed.

Being an older term “manic–depressive illness” was considered to be stigmatizing, thus, generating a change in language to “bipolar disorder” or ‘bipolar affective disorder.” It was a revision of the American Psychiatric Diagnostic and Statistical Manual that the term mania be removed to prevent society calling those diagnosed “maniacs.” The previous diagnosis of manic depression closely associates with psychosis. However, not all patients who battle with mania and depression become psychotic. Therefore, psychosis was not a requirement for diagnosis. In our modern time, bipolar disorder is a cyclical mood state that involves periods of severe disruptions in behavior and mood, mixed with times of recovery. The significant characteristics are the individual’s struggle with hypomania or mania, having grandiose beliefs, an expansive affect that associates with an increase in drive and a decreased need for sleep. These symptoms can cause psychosis, especially if not treated (Andreasen & Black, 2006).  A few psychiatrists and some practitioners in the mental health profession continue to prefer the term “manic–depressive illness” believing it more accurately matches the description.

The Causes of Bipolar Illness

1.   Genetic Pre-Disposition

Bipolar is more common in those who have a relative with the disease and scientists are attempting to locate genes that may involve Bipolar and geneticsprovoking an episode.  Approximately fifty percent have a family member with depression which is also considered a mood disorder. Someone who has one parent with the disease has a twenty-five percent chance of developing the condition and investigations into adopted twins have inspired researchers to learn more about the genetics (Serretti & Mandelli, 2008).  The sibling of a non-identical twin who has the disorder has a twenty-five percent chance of developing the disease, which is the same risk as if one parent had bipolar disorder. An identical twin, meaning someone who has exactly the same genetic make-up has an even greater risk of receiving a diagnosis, an eightfold greater chance than a non-identical twin.

2.   Physiological Conditions

Bipolar disorder is fundamentally a biological illness that materializes in a precise area of the brain. As an organic disease, the onset may hibernate only to be activated or triggered by life events such as psychological or social stress.  The importance of treatment techniques Bipolar and Neurotransmittersusing a biological, psychological and sociological approach strategy is critical in maintaining stability.

Neurotransmitters are brain chemicals that are the nerve conduction messengers seem to play a significant role and also associate with other mood disorders. An imbalance or dysfunction in these messengers, such as, norepinephrine, serotonin and specific hormones may relate to causing or triggering events. Those with the diagnosis appear to have physical changes in the brain. The full value of these unusual differences continues to be under investigation and may at some point in the near future assist in pinpointing a relationship (Lahera, Freund & Sáiz-Ruiz, 2013).

3.   Environmental Conditions 

A life experience may trigger a mood episode in someone who has a genetic pre-disposition to develop the disease. Physical and emotionalBipolar and trauma health practices, even without a genetic family history or documented hormonal problem can activate an episode. A significant loss, abuse, stress, or other traumatic life events play an important role in diagnosis and treatment. Although substance use is not considered to be a direct cause, use of alcohol or tranquilizers may induce a more severe depression. The use of amphetamines can worsen a hypomanic phase, interfere with obtaining an accurate diagnosis, create problems with the ability to perform and hamper the recovery. The diagnosis of bipolar disorder seems to be increasing both in adults and children and this uptick may be due to improvements of the professions ability to assess for the illness or the outcome of changing social, cultural and environmental conditions (Schmitt et., al., 2014).

4.   Medication

Bipolar and medicationA few antidepressants are known to cause a manic state, particularly in those who are susceptible to bipolar illness leads to the importance of obtaining an accurate family history. People who have had a previous manic episode or those who have a family history of bipolar must be managed flawlessly. Do to the fact that a depressive episode may shift quickly into a manic episode when an antidepressant medication is prescribed, an anti-manic drug may also be recommended. This addition creates a “ceiling,” to protect from antidepressant-induced mania. Other prescription drugs can produce a euphoria that resembles mania. Appetite suppressants and thyroid medications may induce a diminished need for sleep, and an increase in talkativeness and energy, however, after discontinuation of the drug, their mood will return to normal.

Treatment of Bipolar Disorder

Those with undiagnosed bipolar disorder tend to self-medicate using alcohol or drugs in efforts to relieve their depressed or manic moods. However, such band-aides rarely provide the kind of long-term aid most people desire and mood stabilizers are always a part of the endorsed treatment plan. Despite the fact that bipolar disorder is considered to be a persistent, chronic condition, there are indeed various effective treatments (Sagman & Tohen, 2009). Those with the illness often seek out therapy according to the depressive or manic cycle in which they are experiencing. When in a manic or hypomanic phase, people usually believe that there is no longer a need for treatment and discontinue. When experiencing a depressive phase, the symptoms are often too uncomfortable to bear and they return for help.

Treatment for bipolar disorder is often divided into three main sections. In the acute or crisis stage, the approach concentrates on reducing symptoms. This focus will continue until remission occurs and when the symptoms have subsided for a considerable time period. Continuation therapy prevents a relapse of symptoms from the current depressive or manic event. Maintenance treatment prevents future recurrences of symptoms and assist the client learning long-term coping styles focusing on controlling mood fluctuations. The draw-backs of long-term medication use are then examined and weighed against the risks of relapse. Unfortunately, those with untreated bipolar disorder have symptoms which tend to deteriorate because the crisis events usually increase in frequency and severity. On the positive side, there are various coping skills and practices that people can develop to manage the symptoms.

Coping Tips for those with Bipolar Disorder

Coping with Bipolar Tips

Become alcohol and drug-free  Substance abuse is an enormous problem that interferes with achieving a positive treatment outcome because the usage effects one’s cognitive functioning and mood. Many people believe that illicit drugs help them cope with symptoms when they are in fact, contributing to mood and sleep disorders. Approximately fifty percent of those diagnosed with bipolar illness have problems with substance abuse, many in attempts to self-medicate. Straight talk on addictions explains the bio-psycho-social process of addictions in detail.

Take medications on schedule and as prescribed Medications can help people function and lesson mood swings, however, sticking to a schedule may not be always an easy task. Some of these medications require maintaining a blood level and laboratory testing to check for accuracy. Higher levels can be toxic and produce physiological symptoms, and skipping doses can precipitate a relapse.

Learn about medication and side effects The ideal approach in managing side effects is to educate yourself as much as possible about the medication and monitor for possible complications. Ask your physician, pharmacist or any health care provider to provide you with material to read about the drug.

Monitor Weight  Varying from person to person the side effects of medications prescribed to treat this illness, including Depakote, Lithium and many antipsychotics can trigger weight gain and eventually cause a metabolic disorder. There are various diets and fitness programs that help prevent weight gain from becoming another problem.

Attend Weekly Counseling Sessions  Once the mood is stabilized psychiatry visits usually decrease to once a month. Regular therapy, typically cognitive-behavioral or interpersonal therapy can help people develop a daily routine, learn ways to cope with feelings, understand thoughts and assist in maintaining stable relationships. Health psychologists will also communicate with the psychiatrist and provide ways to manage medication side effects. Therapy is crucial for a successful treatment outcome.

Be Aware of Stressors and Triggers  Sleep disturbances, withdrawal, stress, social isolation, and any irregularity from the usual routine can lead to growing signs of depression or mania. Life alterations such as, getting a divorce, a change in job, buying a house, having a baby, being newly married, or going to college, may disrupt the mood. Anytime people feel that they are not in sync with the world can be a trigger and practicing mindfulness techniques will help develop stability and awareness.

Socialize  Over-stimulation can be anxiety provoking and trigger symptoms, but so can isolation or under stimulation and this is why it is critical to learn how to cultivate balance. Moving thoughts away from problems and focusing the mind onto an activity can be very beneficial, such as an outdoor sport, hobby or volunteer work.

Develop a Support Network  Try to accept friends or family that are supportive and attempt to share your life and they might be able to assist in avoiding stress or help recognize the signs of depression or mania. There is also the opportunity to become active in organizations such as, The National Alliance on Mental Illness (NAMI) or The Depression and Bipolar Support Alliance.

Strive to Receive an Adequate Amount of Sleep  People with bipolar disorder have problems with insomnia, and irregular sleep habits can provoke a depressive or manic episode. Approximately twenty-five percent of those with this condition sleep too much or take long naps, and about thirty-three percent have insomnia under their normal mood states. Try to schedule regular daily activities such as walking or exercising along with setting an alarm to wake up at the same time every day.

Maintain Hope and be Proactive  Physicians often try various combinations and doses of medication before they find the right cocktail.  Be aware of what symptoms the drug is targeting and ask questions. If the medication is not working or side effects are too disturbing do not stop taking the medication before discussing your options with a physician. Being a good client means following the treatment plan and having an open discussion with your physician along with taking charge of your health.

Suggestions for Loved Ones Friends and SocietyManaging Bipolar

A.   Do Not Miscalculate the Perils

Because research has shown:

  1. The yearly average suicide rate of those having bipolar disorder is ten to twenty times that of the general population.
  2. At minimum twenty-five to fifty percent, of those diagnosed will attempt suicide.
  3. In the sufferer’s lifetime, the majority or eighty percent will have at least one attempt at suicide and suicidal ideation.
  4. In the weeks before their death, seventy-five percent who succeeded in committing suicide mentioned having suicidal thoughts and questions are explored by the mother of this book.

Listen seriously to what this person is saying and discuss how you can help.  Sometimes a little release of stress works at others hospitalization may be the solution.

B.   The Illness does not Define the Person

Those that are bipolar accept the illness as being a part of their identity; however, one piece of the pie is not the whole. When someone is diagnosed bipolar, of course, the illness is a part of their life, and some have more signs than others; therefore, coping with symptoms plays more significant role. Stereotyping someone with a mental illness leads to errors and misunderstandings. There are doctors, politicians, scientists, lawyers, celebrities, artists, psychologists, teachers, and students that have this illness, and the list continues, because mental health has no favorites.

C.   Try not to use Common Place Phrases

Many people use common phrases such as “stop and smell the roses” because it is easier than directly facing the situation, and allowing words to reflect what you hear and see takes effort. Those that are struggling with emotional difficulties are often manipulated with these clichés in place of real interest and as with most people they appreciate the attempts when others express their true thoughts, feelings and concerns.

D.   Do not give up Hope

Those who are experiencing an emotional crisis take what others have to say seriously, and this is why friends, loved ones and society must never give up hope. People in turmoil cannot quite see the world clearly, and their vision of the world is blurry, trusting in others at times to guide the way. They need others to believe in them and in a future that does not center on hospitalizations, medications and physicians. Bipolar disorder is a long-term condition that must be thoroughly managed throughout the patient’s life. In the majority of cases, the condition can be treated with medications, psychological counseling, monitoring moods along with following a treatment plan.

Live Well

© Dr. Cheryl MacDonald

Health Psychology for Everyday Life the book

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Health Psychology

 Cheryl Ann MacDonald Psy’D

Health Psychology of San Diego

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Health PsychologyReferences

Cover Image: CanStockPhoto |focalpoint

Anderson, I., Haddad, P., Scott, J. (2012) Bipolar Disorder.  BMJ  Clinical Research Ed.  345: e8508 .

Andreasen, N., Black, D.  (2006)  Introductory Textbook of Psychiatry. (4th ed.). Arlington, VA: American Psychiatric Publishing, Inc.

U.S. National Institutes of Health Bipolar Disorder: NIH Publication No. 95-3679″.  Retrieved Sept. 18. 2014 from http://web.archive.org/web/20080429204140/http:/www.pueblo.gsa.gov/cic_text/health/bipolar/bipolar.htm

Fast, J., Preston, A.  (2012). Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner (The New Harbinger Loving Someone Series) New Harbinger Publications

Geddes, J., Miklowitz, D. (2013) Treatment of bipolar disorder. Lancet 381 (9878): 1672–82

Judd, L., Akiskal, H., Schettler, P. (2002) The Long-Term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Archives of General Psychiatry. 59:530–537.

National Institute of Mental Health Bipolar Disorder. Retrieved on October 15, 2014 from  http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.

Sagman, D., Tohen, M. (2009) Comorbidity in Bipolar Disorder: The Complexity of Diagnosis and Treatment. Psychiatric Times.

Schmitt, A., Malchow, B., Hasan, A., Falkai, P. (2014). The impact of environmental factors in severe psychiatric disorders. Frontiers of Neuroscience 8 (19).

Serretti, A., Mandelli L. (2008).  The genetics of bipolar disorder: Genome ‘hot regions,’ genes, new potential candidates and future directions.  Molecular Psychiatry 13 (8): 742–771