Bipolar disorder is a common and severe mental illness. There are four types of bipolar disorder, and this article describes each one.
Bipolar disorder, formerly called manic depressive illness or manic depression, is a severe and persistent mental illness. The hallmark of this mental disorder is experiencing extreme changes in mood. Patients can have periods of incapacitating depression and then switch off to life-altering mania. Bipolar patients may have difficulties managing everyday tasks, often struggling at school and work.
As of this date, there is no permanent cure. However, treatment helps manage symptoms and improves the quality of life of these patients.
Bipolar disorder is a relatively common disease. In the United States, approximately 2.8% of adults have bipolar disorder. According to the National Institute of Mental Illness, 4.4% of U.S adults experience bipolar disorder symptoms at some point in their lives. About 89% of bipolar disorder sufferers had serious impairment in everyday activities, and 17% had a moderate impairment.
The age of onset varies greatly among patients. It can begin at childhood (pediatric bipolar disorder) or after the age of 50. Most individuals start having symptoms in their 20s. I am a medical doctor, and in this article, I will explain everything you need to know about bipolar disorder.
What causes bipolar disorder?
Currently, science hasn’t been able to isolate a specific cause of the bipolar disorder. Apparently, there is a genetic component involved. Individuals with a first degree relative (parent or sibling) with the condition are more likely to have bipolar disorder.
Researchers are still working on finding the genes involved in the disease. Bipolar disorder patients also experience physical changes in their brains, like loss and atrophy of neurons in the hippocampal region. The causes and significance of these findings remain unknown.
What are the symptoms of bipolar disorder?
Bipolar disorder has periods of profound and prolonged depression that alternate with periods of mania, an excessively elevated mood. Patients with bipolar illness can also experience hypomania, which is similar to mania but less severe. Patients suffer unpredictable changes in mood and behavior, which causes significant distress for both the patient and those close to him.
What is a manic episode?
Manic episodes feature at least a week of profound mood disturbance with at least three of the following:
- Feeling of grandiosity or inflated self-esteem: During that period, patients feel excessively confident, unbeatable, and capable of achieving amazing things.
- Decreased need for sleep: During a manic episode, patients can feel perfectly rested after just three hours of sleep a day.
- Being more talkative than usual: Patients talk more than usual. It can be hard for others to interrupt them or get a word in during a conversation.
- Distractibility: During that period, patients might find it hard to keep themselves focused and are easily distracted.
- Involvement in harmful or dangerous activities: During a manic episode, patients may engage in unusual activities with potentially harmful consequences. Examples include expending extraordinary and irresponsible amounts of money, applying for a loan, substance abuse, and engaging in unusual sexual activity (without protection or multiple partners).
- Increased activity: During that time, patients can be more active than usual and engage in multiple tasks or projects.
The mood disorder is significant enough to cause disturbances at work in daily life and put the patient or others in danger. In order to make a diagnosis, the episode cannot be a consequence of substance abuse or another medical condition.
A hypomanic episode has the same symptoms as a manic episode but not as intense. In that case, the mood disturbance is not strong enough to put the patient in danger or cause severe occupational disturbances. A hypomanic person is not likely to spend all his savings or do dangerous drugs.
What is a major depressive episode?
A major depressive episode includes a depressed mood that lasts for more than two weeks. Bipolar depression symptoms are severe enough to cause difficulty in getting through everyday tasks, such as going to school, attending social engagements, going to work, and maintaining relationships of any kind. The diagnosis requires at least five of the following symptoms:
- Depressed mood for the major part of the day.
- Diminished interest in activities or pleasures the patient used to enjoy.
- Excessive weight loss or excessive weight gain with changes in appetite
- Difficulty sleeping or too much sleep
- Fatigue or loss of energy, patients usually look wore down or less active than usual.
- Feeling worthlessness or excessive guilt, patients may feel regret or guilt about current or past events and relationships
- Decreased concentration, inability to focus and making decisions
- Suicidal thoughts or recurrent thoughts of death.
- Feeling agitated or slowed down.
What are the four types of major depression?
There are four different types of bipolar disorder:
Bipolar disorder type 1: The diagnostic criteria require at least one manic episode preceded or followed by an episode of major depression. In some cases, patients present with psychotic symptoms during their manic episodes. Psychosis implies a break of reality that may include auditory or visual hallucinations. When psychosis differential diagnosis with conditions like schizophrenia and delusional disorder is mandatory.
Bipolar II disorder: To make the diagnosis of type 2 bipolar disorder is necessary to have had at least one episode of major depression and at least one episode of hypomania without ever having a manic episode. The difference is simple, a hypomanic episode does not cause significant problems with family or work, nor puts life in danger. Psychotic episodes do not occur in bipolar disorder type 2.
Cyclothymic disorder: Cyclothymia or cyclothymic disorder is a mild form of bipolar disorder. In cyclothymic disorder, sudden and frequent mood changes are in bipolar disorder type 1 and 2. The difference is that, in this case, depressive symptoms are not severe enough to match the criteria of major depression. There are no major depressive episodes in cyclothymic disorder.
Many people with cyclothymic disorder have mild symptoms and never reach out to a mental health professional, which means cyclothymic often goes undiagnosed and untreated. During a mild depressive episode, you might feel sluggish and lose interest in things, but this doesn’t prevent you from doing your normal activities.
Other: These include bipolar disorder-like symptoms produced by certain drugs, alcohol, or a medical condition, like multiple sclerosis or a stroke. These conditions can produce bipolar symptoms or a mood disorder that fits in the bipolar spectrum.
What is the difference between bipolar disorder type 1 and bipolar disorder type 2?
As previously stated, the main difference between bipolar I and bipolar II disorder is the magnitude of the manic episodes.
Persons with bipolar I disorder experience severe manic symptoms, one manic episode can lead to decisions with severe consequences to their future life. During a manic episode, patients can lose their jobs, go to jail, go bankrupt, and put their lives in danger. Patients with a manic episode often need to be hospitalized.
On the other hand, hypomanic episodes seen in bipolar II disorder have many of the same symptoms, but in a less severe form. Hypomanic episodes rarely lead to serious, life-changing consequences, sometimes symptoms are mild enough for no one to suspect a mental health disorder.
However, it is a mistake to look at bipolar II disorder as it was a milder form of bipolar I disorder. Patients with bipolar II disorder are more likely to suffer from severe depression than those with bipolar I disorder. In fact, bipolar II disorder is often misdiagnosed as a depressive disorder. Depression can be as devastating as mania and may even lead to suicide.
What is the most severe type of bipolar disorder?
The scientific community considers that bipolar disorders type I and II are more severe than the cyclothymic disorder. This is because patients with these types of bipolar disorder experience the extreme of manic and depressive moods. Patients with bipolar disorder type I will experience severe manic episodes. In contrast, patients with bipolar disorder type II will experience major depressive episodes.
Cyclothymic disorder patients, on the other hand, experience a milder version of both extremes. People with the cyclothymic disorder can have a normal mood for a long time and then have short episodes of mild depression or hypomania. Persons with other specified and unspecified bipolar-type and bipolar related disorders might experience episodes of mania, hypomania, or depression. Still, events are too short to fit the diagnostic criteria for bipolar disorder I, II, or cyclothymic disorder.
Can bipolar turn into schizophrenia?
This question has no simple answer, because, in psychiatry, the definition of a disease depends on its symptoms, not its causes. In other medical specialties, diseases are mostly defined by their biological mechanisms. Take fluid in the lungs; for example, in the early 20th century, every person who had fluid insider their lungs was diagnosed with pleurisy.
Nowadays, we know that many different mechanisms can lead to liquid accumulating on the lungs, like pneumonia, heart failure, tumor, and many others.
Psychiatric disorders like bipolar disorder and schizophrenia are like pleurisy. They are better thought of as syndromes rather than specific diseases. The diagnosis doesn’t depend on laboratory tests or imaging studies. The diagnosis is made if a patient meets the symptoms criteria in the DSM-5 manual.
The problem is that schizophrenia and bipolar disorder share many of the same symptoms.
For example, psychosis and paranoia are diagnostic hallmarks of schizophrenia but can also be present in a manic phase of bipolar disorder type I. So, if a bipolar patient has frequent manic episodes with psychosis and mild, infrequent depressive episodes he might be diagnosed with schizophrenia.
To make matters more complicated, many patients experience changes in their symptom patterns over the years. These patients might switch from having mostly depressive moods to having frequent psychotic episodes, and then again returning to depression. Although by definition, a person cannot have schizophrenia and bipolar disorder simultaneously, many patients struggle for years with mixed symptoms, which are hard to classify into one specific syndrome. Some of these patients can be diagnosed with schizoaffective disorder.
What is a schizoaffective disorder?
If a person who meets the criteria for schizophrenia also experiences major mood disturbances (depression, mania, or hypomania) for at least half the time he meets the criteria from schizophrenia, he might have a schizoaffective disorder. Just like bipolar disorder, a schizoaffective disorder can lead to major problems functioning ant work, school, and social situations. The diagnosis requires at least one major mood episode (major depressive episode, or a manic episode) and at least two weeks with psychotic symptoms in which mood symptoms are absent. There are two types of schizoaffective disorder:
- Bipolar type: Which includes features of both mania and depression
- Depressive type: Which includes only episodes of depression
Symptoms depend on the type and vary from person to person. Common symptoms include the following:
- Delusions: Having and maintaining false beliefs even when there is overwhelming evidence of the contrary
- Hallucination: Experiencing things that aren’t there
- Bizarre behavior
- Symptoms of depression
- Problems with maintaining personal hygiene and personal care
- Periods of mania
- Impaired occupational, academic and/ or social functioning
How is bipolar disorder diagnosed?
The diagnosis is made if the symptoms and clinical features match the diagnostic criteria established in the DSM-5. However, there are two reasons for doing some laboratory testing in this context. The first reason is to rule out any underlying medical conditions that can also cause mood swings, depression, and mania. Conditions like chronic encephalitis and Wilson’s disease are entirely treatable and produce similar symptoms.
The second reason is that bipolar disorder treatment includes the use of medications that require certain body systems to work properly, particularly the kidneys and the bone marrow.
Necessary workup in bipolar disorder includes:
- A complete blood count: A complete blood count helps ruling out anemia as a cause of depression. Lithium, one of the primary drugs used to manage bipolar disorder, can cause bone marrow suppression, so it is important to check the blood cell count in these patients.
- Electrolytes: Certain electrolyte abnormalities like hypercalcemia, hypo, and hypernatremia can cause mood abnormalities.
- Fasting glucose: Atypical antipsychotics used in manic episodes can lead to weight gain and problems with body glucose.
- Thyroid profile: Hyperthyroidism can cause mania and hypothyroidism can cause depression.
- Creatinine and blood urea nitrogen: To check out kidney function.
- Substance and Alcohol screening: Amphetamines and cocaine can be present in a mania-like disorder. However, alcohol and substance abuse can coexist with a primary bipolar disorder.
What kind of treatment is available for bipolar disorder?
Successful outpatient treatment is based on four fundamental pillars:
- Psychotherapy: Most studies show that patients that receive psychotherapy have lower relapse rates, higher quality of life, increased occupational and social functioning, and more favorable symptom improvement. Broadly put, psychotherapy aims to develop an understanding of the illness, avoiding triggers, recognizing early signs of relapse and ensure medication adherence. Psychotherapy is of great help in medicated patients. However, it is still an adjuvant to medication. Without medication, psychotherapy alone won’t do anything.
- Developing a good support network: Having a healthy support system of family and friends can also reduce the risk of relapses and improve quality of life. The people in your support system don’t need to be able to cure you, they just need to be able to listen. The more people a person can turn to and be good listeners, the more likely they are to manage his moods. It might be a good idea to join a bipolar disorder support group where patients can talk with people who understand what they are going to and honestly say, “I’ve been there.”
- Patient education: A good doctor will educate the patient and the family about the condition. Both the patient and those around him need to know about situations that might trigger a relapse, the dangers of substance abuse, and the importance of treatment adherence.
- Medication monitoring and support: Medications make an incredible difference in the lives of those suffering from bipolar disorder. However, most of them have important side effects and require constant monitoring. Many patients feel reluctant about taking medication, therapy must address those feelings and encourage them to take the medications.
What drugs are used in bipolar disorder treatment?
Pharmacologic treatment depends on the patient’s mood (manic or depressive) and the severity of those symptoms. Some of the most common medications include:
- Lithium: Lithium is a mood stabilizer. It is a first-line agent for the treatment of manic episodes, is helpful in relapse prevention, and has anti-suicidal action. Unfortunately, it causes many side effects, which include hypothyroidism, hyperparathyroidism, and weight gain. Monitoring blood levels is vital for this medication.
- Typical and Atypical antipsychotics: Antipsychotics treat manic episodes, strong hypomania, and mood stabilization. Atypical antipsychotics or second-generation antipsychotics are preferred over typical antipsychotics because they cause fewer adverse effects. However, some of them still cause nausea, dizziness, headaches, and weight gain.
- Benzodiazepines: Benzodiazepines are anxiolytic drugs that should only be used for short periods because of its addictive qualities.
- Antidepressants: In cases of bipolar depression, antidepressants like fluoxetine should only be used in combination with a mood-stabilizing agent.
When is hospitalization required?
Hospitalization in a mental health facility is a must for patients that exhibit severe symptoms. Indications for inpatient treatment include the following:
- Danger to self: During a depressive episode, a patient may present with a significant risk of suicide. A person with a severe manic episode may forget to sleep or eat, putting himself in danger.
- Danger to others: A person with severe depression might attempt to kill people close to them to spare them the suffering.
- Presence of marked psychotic symptoms
- Absolute inability to function
- Total loss of control
What can I do to prevent relapses?
There is no sure way to prevent relapses. However, some of the following strategies might help:
- Pay attention early warning signs: After some time, you might identify a pattern of triggers and early symptoms. Some early symptoms of a manic include Insomnia, racing thoughts, being irritable, being easily distractible, and having an increased sexual appetite.
- Avoiding drugs and alcohol: Mind-altering substances can make symptoms come back and make them worse.
- Take your medications exactly as directed: Going cold turkey on medication can cause withdrawal effects and make symptoms worse.
How do you know if therapy is working?
Because what causes the bipolar disorder is still unknown, and the cerebral pathways involved in the disease are yet being studied, it is difficult to find a single treatment that works for everyone. Bipolar disorder treatment is a trial and error process in most cases. Ideally, treatment should improve or at least stabilize the patient’s mood without or with minimal side effects. However, there are other possibilities:
- Not feeling any effects: Pharmacologic therapy for bipolar disorder, as in many other mental health disorders, takes a while to start making effects. In general, mood stabilizers take at least two weeks before they begin taking effect, and antidepressants take around 4 to 6 weeks. Sometimes you might not feel any significant changes yourself, but those around you. It is essential to talk two of those around you about how they think you have been doing. However, if you or those around you don’t notice a difference after a significant period, you might need a dose or treatment adjustment.
- Medication loses its effect after some time: There is a chance that after a while, treatment stops being as effective as it once was. This is because, sometimes, the body develops tolerance against a specific drug. The solution, in most cases, is taking higher dosages of the drug in question. However, every treatment decision has to have the approval of your physician.
- Unpleasant side effects: Some common side effects of bipolar medication include: weight gain or loss, drowsiness, tremors, blurred vision, decreased libido, and changes in appetite.
What can you do if you are having symptoms of it?
This tool is a bipolar disorder symptoms checker. It would help anybody who wants to find out the likelihood of them having this condition. It gathers the most important signs, symptoms, and risk factors of the disease. The most important thing is that it is free and would only take a few minutes.