Bipolar Disorders

Bipolar disorder is broadly classified into three primary types that all involve clear changes in mood, energy and activity levels. These can range from periods of intense emotional states called mood episodes or manic/hypomanic episodes and depressive or sad episodes. Manic episodes include extreme elation, irritation or energized behavior. Depressive episodes include being down or sad, indifferent, or hopeless.  Less severe manic periods are called hypomanic episodes.

1. Bipolar I Disorder: This type features one or more manic episodes or severe manic symptoms interspersed with major depressive episodes. A manic episode is characterized by elevated mood, heightened energy, and decreased need for sleep for at least one week. During this period, the individual may engage in reckless behaviors and may lose touch with reality. When the individual experiences four or more episodes of mania or depression within one year, this is called “rapid cycling”. People with bipolar 1 disorder often have other mental disorders such as anxiety, substance use disorder or ADHD.
2. Bipolar II Disorder: Characterized by at least one hypomanic episode and one major depressive episode. Hypomania is a milder form of mania, which may not be as disruptive but still constitutes a change in functioning. A major depressive episode includes symptoms such as persistent sadness, loss of interest, and hopelessness for at least two weeks.
3. Cyclothymic Disorder: (Also called Cyclothymia) This subtype involves chronic fluctuating moods over a period of at least two years, including numerous episodes of hypomania and depressive symptoms that do not meet the criteria for major depressive episodes.

Some people can experience symptoms of bipolar disorder that do not match the three types above. This is called a related disorder, or unspecified bipolar disorder.

Bipolar disorder is caused by a combination of genetic, environmental and neurological factors. 80%-90% of people with bipolar disorder have a relative with bipolar disorder or depression. Environmental factors include stress, and sleep disruption. Drug and alcohol use can trigger mood episodes. An imbalance in brain chemicals may be related to dysregulated brain activity.

Diagnosis is often challenging due to the overlapping symptoms with other psychiatric conditions such as unipolar depression, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD). Comprehensive assessment involves clinical interviews, psychiatric evaluations, and sometimes neuroimaging or other diagnostic tests to rule out medical conditions that might mimic bipolar disorder.

An effective treatment plan typically includes a combination of medication and psychotherapy, with lifestyle adjustments. Medication therapy is the cornerstone of treatment. It typically includes mood stabilizers like lithium, antipsychotics, and sometimes antidepressants, although the latter must be used cautiously due to the risk of triggering manic episodes. Some medications that target sleep or anxiety may be needed.

Most patients with bipolar disorder have poor insight about their condition. Almost half of patients discontinue treatment abruptly and without supervision and tend to self-medicate.

Psychoeducation is psychotherapy that combines elements of cognitive behavior therapy, group therapy and education. It is aimed at adjusting lifestyle to cope with bipolar disorder. It is information-based behavioral training that includes awareness of the illness, treatment adherence, early detection of warning signs, relapse and avoidance of potential triggers such as illegal drugs and sleep deprivation.

The goal is to provide the patient and family the information they need to work with mental health professionals for a better overall outcome. It aids in crisis management and suicide prevention.

In severe cases, electroconvulsive therapy (ECT) may be considered. Comorbid conditions, such as substance abuse or anxiety disorders, must also be addressed for effective management.

While bipolar disorder is a lifelong condition. When treated people with bipolar disorder can lead full and productive lives. However, nonadherence to medication and lack of proper management can lead to complications such as increased risk of suicide, substance abuse, and social or occupational dysfunction.

Bipolar disorder is a complex psychiatric condition requiring accurate diagnosis and multidimensional treatment strategies. Advances in understanding the neurobiological underpinnings are ongoing, and newer pharmacological and psychotherapeutic interventions continue to evolve. Early diagnosis and effective management are crucial for improving the long-term outcomes for individuals affected by this disorder.