Don't you have the same problem? Let's talk about bipolar disorder.

Do you sometimes feel suddenly happy, but the next day you feel very sad and bored with life? Or has someone you know had this experience? This is not just something else, perhaps the cause of this is bipolar disorder. Today, we will talk about this simply, in a way that you can understand.

What is Bipolar Disorder?

Simply put, bipolar disorder is a long-term mental health condition . It was previously called "manic-depressive illness" or "manic depression." It's characterized by sudden, dramatic changes in your mood, energy levels, thinking, and behavior. These changes can last for hours, days, weeks, or even months. They can also interfere with your ability to function normally.

Bipolar disorder is characterized by two main mood fluctuations: manic or hypomanic episodes and depressive episodes. However, this does not mean that a person with bipolar disorder is always in one of these two episodes. They also have periods of normal mood. We call this "euthymia."

Why is the name "manic-depressive illness" no longer used?

There are several reasons for this:

• In the past, doctors used the term "manic depression" to refer to a wide range of mental illnesses. Now, as mental illness classification systems, such as the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) , have evolved, using the name "bipolar disorder" makes the diagnosis clearer.
• The words "manic" and "mania" have a lot of stigma and negative connotations in society, especially words like "maniac." Similarly, people use the word "depression" to describe normal sadness, even if it's not clinical depression . The name "bipolar disorder" distracts from these two words.
• "Bipolar disorder" is a more medical, clinical term than "manic depression." It carries less emotional weight.
• The name "manic depression" does not cover the cyclothymic or hypomanic (such as bipolar II disorder) forms of this condition.

What are the main symptoms of bipolar disorder?

Let's now see what happens during these periods of mania and depression.

Manic episodes

Bipolar I DisorderPeople with bipolar disorder are likely to experience these manic episodes. This is when your mood becomes unusually high, sometimes even very angry. At the same time, your emotions, thoughts, energy, speech, and behavior all change dramatically. This high energy level and behavior are very different from your usual self, and it is noticeable to others.

When in a manic state, some people may do things that are physically, socially, or financially harmful to themselves. For example, they may suddenly spend large amounts of money, gamble, or drive recklessly. Sometimes , psychotic symptoms , such as delusions and hallucinations, may also occur. This can sometimes make it difficult to distinguish bipolar disorder from other illnesses, such as schizophrenia.

In some types of bipolar disorder, for example, people with Bipolar II Disorder experience a state called hypomania . This is a less severe and milder episode than mania. It doesn't last as long as manic episodes and doesn't interfere with daily functioning as much.

Depressive episodes

During a depressive episode, you may feel very sad and hopeless. You may also lose interest in things you used to enjoy. Other symptoms of depression may also appear:

• Tiredness, fatigue.
• Changes in appetite (increase or decrease).
• Feeling worthless is a sign of hopelessness.
• The inability to do anything.
• I feel like crying.

What are the types of bipolar disorder?

There are four main types of bipolar disorder:

1. Bipolar I Disorder: These people have experienced one or more manic episodes. Many people have both manic and depressive episodes, but you can still be diagnosed with bipolar I if you have only manic episodes without a depressive episode. Depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episode must last at least seven days or be severe enough to require hospitalization. These people can also have mixed episodes , which are episodes where both manic and depressive symptoms are present.

2. Bipolar II Disorder: These people experience depressive episodes and hypomanic episodes. But they never experience the full manic episodes that are common in bipolar I. Although hypomania is less disruptive than mania, bipolar II disorder can sometimes be more distressing than bipolar I. This is because chronic depression is more common in bipolar II.

3.Cyclothymic Disorder (Cyclothymia): These people have a persistently unstable mood. They alternate between hypomania and mild depression for at least two years. They may have brief periods of euthymia, but these periods are less than eight weeks.

4. Other specified and unspecified bipolar and related disorders: If a person does not exactly meet the criteria for bipolar I, II, or cyclothymia, but has a clinically significant level of abnormal mood elevation, they fall into this category.

What is the difference between borderline personality disorder (BPD) and bipolar disorder?

Borderline Personality Disorder (BPD) and bipolar disorder can be confused because they share some of the same symptoms. However, they are two different conditions.

BPD is characterized by long-term, sudden changes in mood, behavior, and self-image . These are often caused by conflicts in relationships with others. BPD is associated with a higher incidence of nonsuicidal self-injury, which is not as common in bipolar disorder.

Bipolar disorder differs from BPD in that it involves clear, long-lasting episodes of mania/hypomania and/or depression . These episodes of mania or depression can be triggered by a variety of factors. For example, sleep disturbances, stress, and the use of certain medications and drugs.

Who gets bipolar disorder?

It can develop in anyone. It usually starts around the age of 25. But very rarely, it can start at a younger age, or even in your 40s or 50s.

It affects women and men equally, but there may be slight differences in the way it affects them.

• Women with bipolar disorder can have rapid mood swings. If they have four or more episodes of mania or depression in a year, it's called "rapid cycling." Changes in sex hormone and thyroid hormone levels, as well as the higher prevalence of antidepressants in women, may contribute to this "rapid cycling" condition.
• Women may also experience more depressive episodes than men.

How common is bipolar disorder?

Approximately 5.7 million adults in the United States, or 2.6% of the population, have this condition. This condition can also be seen in Sri Lanka.

What are the symptoms of bipolar disorder?

The main symptom of bipolar I disorder is a manic episode that lasts at least a week . People with bipolar II disorder or cyclothymia experience hypomanic episodes.

But many people with bipolar disorder experience both manic/hypomanic and depressive episodes. These mood swings don't always occur in the same pattern. A manic episode doesn't always follow a depressive episode. A person can have the same mood (e.g., mania) multiple times, and can also go from a normal mood (euthymia) to the other side (depression).

These changes in mood can last for weeks, months, or even years.

The important thing is that these mood changes are out of your usual range and that the change lasts for a long time . In mania, it can last for days or weeks, and in depression, it can last for weeks or months.

The severity of depressive and manic episodes can vary from person to person, and even over time in the same person.

Symptoms of Manic Episodes

Some people experience episodes of mania or hypomania several times in their lives. Others experience them very rarely.

Symptoms of a manic episode are:

• Feelings of great joy, hope, and excitement.
• A sudden, severe change in mood. For example, going from being very happy to suddenly becoming angry or hostile.
• Restlessness.
• Rapid talking, racing thoughts.
• Increased energy, decreased need for sleep.
• Increased self-control, making bad decisions. For example, suddenly quitting a job.
• Making big, impossible plans.
• Reckless, risky behavior. For example, drug and alcohol abuse, unsafe sex.
• Feeling unusually important, talented, or powerful.
• Psychosis – Experiencing hallucinations and delusions in the most severe cases of mania.

Often, people who are in a manic state are not aware of the negative consequences of their actions. The risk of suicide is always present in bipolar disorder. Some people are tempted to commit suicide during manic states, not just during depressive states.

If someone is in a severe state of mania, especially if they have hallucinations and delusions, they may need to be hospitalized to protect themselves and others from harm.

Symptoms of Hypomania

Some people experience symptoms that are similar to mania, but milder. This is called hypomania . During this time, you may feel very good and feel like you can get a lot done. People who are in a hypomanic state can usually function well in society or at work.

During a hypomanic episode, you may not feel like anything is wrong. But your family and friends may notice changes in your mood and behavior, and they may think it's unusual for you. You may also experience severe depression after a hypomanic episode.

Symptoms of depressive episodes

The symptoms of depressive episodes in bipolar disorder are similar to those of major depression . They include:

• Feeling unbearable sadness.
• Lack of energy, fatigue.
• Lack of interest in doing anything.
• Despair, feeling worthless.
• Not getting pleasure from things that used to bring joy.
• Difficulty concentrating, making decisions.
• Crying uncontrollably.
• Anger.
• Increased need for sleep.
• Insomnia or excessive sleeping.
• Weight loss or gain due to changes in appetite.
• Thoughts about death or suicide ( Suicidal Ideation ).

If you are having suicidal thoughts, you should seek help immediately. In Sri Lanka, call an organization like Sumithrayo (0112692909), or go to the nearest hospital.

Characteristics of a Mixed Episode

In a mixed episode, both mania and depression symptoms occur together. During this time, you have the negative feelings and thoughts that come with depression, but you also feel anxious, restless, and have a lot of energy.

People who experience mixed episodes often say that it is the worst part of bipolar disorder.

What are the causes of bipolar disorder?

Scientists still don't know exactly what causes this.

But they believe that there is a strong genetic (genetic/inherited) link . Bipolar disorder is one of the most common mental illnesses. More than two-thirds of people with bipolar disorder have a blood relative who also has the condition. But just because a blood relative of yours has bipolar disorder doesn't mean you will develop it.

Other factors that scientists believe contribute to the development of bipolar disorder include:

• Changes in your brain: Researchers have found subtle changes in the normal size or function of some brain structures in people with bipolar disorder. But the disorder cannot be diagnosed with a brain scan.
• Environmental factors, such as trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce, or financial problems, can trigger a manic or depressive episode. Therefore, stress and trauma can also contribute to the development of bipolar disorder.

Scientists are currently researching how these factors are related to bipolar, how they can help prevent the condition, and what their impact is on treatment.

How is bipolar disorder diagnosed?

Your doctor may use several things to diagnose this:

• Physical examination.
• A complete medical history (asking about your symptoms, lifetime experiences, and family history).
• Medical tests,Like blood tests. These are done to check for other conditions that could be causing your symptoms (e.g., hyperthyroidism ).
• A mental health evaluation. Your doctor can do this, or you can refer you to a mental health specialist, such as a psychiatrist.

To be diagnosed with bipolar disorder, you must have experienced at least one manic or hypomanic episode . Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to help determine which type of bipolar disorder you may have.

To determine which type of bipolar you have, your doctor will assess the pattern of your symptoms and how much they affect your life in the worst cases.

People with bipolar disorder are more likely to have these mental health conditions:

• Anxiety.
• Attention-Deficit/Hyperactivity Disorder (ADHD).
• Post-Traumatic Stress Disorder (PTSD).
• Substance Use Disorders.

Because of this, and because people may not remember experiencing it because their memory is impaired during a manic episode, it can sometimes be difficult for doctors to accurately diagnose people with bipolar disorder.

A bipolar patient in a severe manic episode with hallucinations may be misdiagnosed as schizophrenia . It is also possible to be misdiagnosed as borderline personality disorder (BPD) .

Therefore, it is very important to be honest and complete about all your symptoms and experiences when talking to your doctor. It can also be helpful to include a loved one in your discussions with your doctor who can provide additional details about your mental health history.

How is bipolar disorder treated?

Treatment can help many people, even those with the most severe cases of bipolar disorder. A successful treatment plan usually includes a combination of the following:

• Psychotherapy / Talk Therapy.
• Medications.
• Self-management techniques, for example, learning about the disease, recognizing early symptoms of an illness, and identifying triggers.
• Healthy lifestyle habits, such as exercise, yoga, and meditation, can support treatment, but are not a substitute for it.
• Electroconvulsive Therapy (ECT) is used in cases where other treatments do not respond well to medication, or when symptoms need to be controlled quickly to prevent damage.

Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment . It may take months or even years for you and your doctor to find a treatment plan that works for you. Even though this can be frustrating, it is important to continue with treatment.

Manic and depressive episodes recur over time. Most people with bipolar disorder experience a remission of mood swings during episodes, but some may have some residual symptoms. Long-term, ongoing treatment can help manage these symptoms.

If you have other mental health conditions (e.g., anxiety, ADHD) along with bipolar, treating those conditions can be even more difficult. For example, antidepressants for obsessive-compulsive disorder (OCD) and stimulants for ADHD can worsen bipolar symptoms and even trigger manic episodes.

However, while treating these conditions can be difficult, it is not impossible. Be committed to finding a treatment plan that works for you.

What types of therapy are used for bipolar disorder?

Psychotherapy, also known as "talk therapy," can be an important part of the treatment plan for people with bipolar disorder.

Psychotherapy is a variety of treatments that help you identify and change troubling feelings, thoughts, and behaviors. Working with a mental health professional , such as a psychiatrist, can provide you and your family with support, education, and guidance.

Different types of treatments for bipolar disorder:

• Psychoeducation: This is when mental health professionals teach people about their mental health conditions. Because bipolar is a complex condition, learning about it and how it affects your life can help you and your loved ones better manage and cope with it.
• Interpersonal and Social Rhythm Therapy (IPSRT): This therapy is designed to help you understand and work with your biological and social rhythms to improve your mood. IPSRT is an effective treatment for people with bipolar disorder and other mood disorders. It focuses on medication adherence, managing stressful life events, and reducing disruptions to social rhythms (changes in daily routines). IPSRT teaches you skills that can help you avoid future episodes of mania or depression.
• Family-Focused Therapy: This is a treatment for adults and children with bipolar disorder and their caregivers. In this therapy, your loved ones work with you to learn about bipolar, improve communication skills, and practice problem-solving skills.
• Cognitive Behavioral Therapy (CBT): This is a structured, goal-focused type of therapy. Your therapist helps you look deeply into your thoughts and feelings. You will learn how your thoughts influence your actions. Through CBT, you can learn to let go of negative thoughts and behaviors and develop healthier thought patterns and habits.

What medications are used for bipolar disorder?

Some medications can help manage bipolar symptoms. You may need to try several different medications under the guidance of your doctor to find the one that works best for you.

Common medications for bipolar disorder include:

• Mood Stabilizers.
• Second-generation ("atypical") neuroleptics (also called antipsychotics).
• Antidepressants.

If you are taking medication for bipolar disorder, keep these things in mind:

• Talk to your doctor to understand the risks, side effects, and benefits of the medication.
• Tell your doctor about any other medications (prescribed, over-the-counter, or nutritional supplements) you are already taking.
• If you experience any bothersome side effects, tell your doctor right away. They may be able to change the dosage or give you a different medicine.
• Remember that bipolar medication should be taken continuously, as prescribed.

Mood Stabilizers for Bipolar

People with bipolar disorder usually need mood-stabilizing medications to manage manic or hypomanic episodes.

Types of mood stabilizers and their brand names:

• Lithium ( Eskalith®, Lithobid®, Lithonate®)
• Valproic acid (Depakene®)
• Divalproex sodium (Depakote®)
• Carbamazepine (Tegretol®, Equetro®)
• Lamotrigine (Lamictal®)

Lithium is one of the most commonly prescribed and most studied medications for bipolar disorder. Lithium is a naturally occurring salt. It reduces manic symptoms within two weeks of starting treatment, but it can take weeks or months for manic symptoms to be completely controlled. For this reason, doctors often prescribe other medications, such as antipsychotics or antidepressants, to help control symptoms.

Lithium can sometimes cause thyroid and kidney problems . So your doctor will regularly check your thyroid and kidney function, as well as your blood lithium levels, because lithium levels can easily become too high.

Anything that lowers your sodium levels — such as switching to a low-sodium diet, excessive sweating, fever, vomiting, or diarrhea — can cause lithium to build up to toxic levels in your body. Be aware of these conditions if you are taking lithium, and tell your doctor if they occur.

These are symptoms of lithium toxicity/overdose . If you have any of these , call your doctor immediately, or go to the nearest emergency room:

• Blurred vision or double vision.
• Irregular heartbeat.
• Very fast or very slow heartbeat.
• Difficulty breathing.
• Confusion, dizziness.
• Severe tremors or seizures.
• Excessive urination.
• Uncontrollable eye movements.
• Unusual bruising or bleeding.

Neuroleptic medications for bipolar disorder

Doctors often prescribe second-generation or atypical neuroleptics (antipsychotics) along with a mood stabilizer for people with bipolar disorder. These medications help with both manic and depressive episodes.

Only four of these medications are approved by the US Food and Drug Administration (FDA) to treat bipolar depression:

• Cariprazine (Vraylar®)
• Lurasidone (Latuda®)
• Olanzapine-fluoxetine combination (Symbyax®)
• Quetiapine (Seroquel®)

However, other medications such as Olanzapine (Zyprexa®), Risperidone (Risperdal®), and Aripiprazole (Abilify®) are also commonly prescribed.

Antidepressants for bipolar disorder

Doctors sometimes prescribe antidepressants to treat depressive episodes in bipolar disorder. However, to prevent manic episodes, they also prescribe a mood stabilizer along with the antidepressant.

Antidepressants are never used as the only medication for bipolar disorder, as taking an antidepressant alone can cause a manic episode.

What are the side effects of bipolar medication?

Side effects of bipolar medications are common, and they vary from medication to medication. It's important to talk to your doctor about what to expect from the medication you're taking. It's also important to tell them if you're having side effects.

Never stop taking medication unless your doctor tells you to. Stopping medication suddenly can cause serious side effects and lead to serious medical conditions.

The most common side effects of bipolar medications are:

• Weight gain.
• Metabolic dysregulation, including abnormal lipid levels (dyslipidemia) , high blood pressure (hypertension) , and high blood sugar (hyperglycemia) .
• Drowsiness.
• Akathisia – A feeling of restlessness, restlessness, and a strong urge to move, rock, or move around.

What other medical treatments are used for bipolar?

Other treatment options your doctor may consider to treat bipolar disorder include:

• Electroconvulsive Therapy (ECT): This involves sending a short electric current through your scalp to your brain, causing a seizure. This is most often used for people with severe depression. ECT is very safe and effective for depression that doesn't respond to medication or severe, life-threatening mania. It's the best treatment for mania if you're pregnant. ECT is done under general anesthesia, so you're asleep during the entire procedure and won't feel any pain.
• Transcranial Magnetic Stimulation (TMS): This involves sending an electrical current through a short electromagnetic coil to your brain. Doctors sometimes use this to treat depression that doesn't respond to medication. It's an alternative to ECT. TMS is not painful and doesn't require anesthesia.
• Thyroid medications: These medications may act as mood stabilizers. Studies have shown that they are effective in reducing symptoms in women with difficult-to-treat, "rapid-cycling" bipolar disorder.
• Ketamine Treatment: Low doses of the anesthetic ketamine administered intravenously (IV) have been shown to have short-term antidepressant and anti-suicidal effects in people with bipolar disorder.
• Hospitalization: This is an emergency option for bipolar care. It is necessary when someone is in a severe depressive or manic episode and is an immediate threat to themselves or others.

Do lifestyle changes help bipolar?

Your medical team will likely recommend lifestyle changes to help you stop behaviors that make your bipolar symptoms worse. Some of these lifestyle changes include:

• Stop using alcohol, drugs, and tobacco: It is essential to stop using alcohol and drugs (including tobacco) as these can interact with the medications you are taking, worsen your bipolar condition, and increase your risk of developing the condition.
• Keep a daily diary or mood chart: Recording your daily thoughts, feelings, and behaviors can help you see how well your treatment is working and identify triggers that can lead to episodes of mania or depression.
• Maintain a healthy sleep schedule:Bipolar can have a big impact on your sleep patterns, and changes in sleep patterns can lead to illness. Make it a priority to have a regular sleep schedule, such as going to bed and waking up at the same time every day.
• Exercise: Exercise has been shown to improve mood and mental health in general. Therefore, it can also help manage bipolar symptoms. A common side effect of bipolar medications is weight gain. Therefore, exercise can also help manage weight.
• Meditation: Meditation has been shown to be effective in improving depression, which is a part of bipolar disorder.
• Manage stress and maintain healthy relationships: Stress and anxiety can worsen symptoms in many people with bipolar disorder. It's important to manage your stress in a healthy way and eliminate stressors when possible. A big part of this is maintaining healthy relationships with supportive friends and family, and letting go of toxic relationships that add stress to your life.

What is the prognosis of bipolar disorder?

The outlook for bipolar disorder is often poor if not treated properly. However, with proper treatment, many people with bipolar disorder can lead fulfilling, productive lives.

Bipolar disorder shortens life expectancy by about nine years. About one in five people with bipolar disorder commits suicide. It is estimated that about 60% of people with bipolar disorder are addicted to drugs or alcohol.

This is why it is essential for bipolar patients to seek medical advice and commit to treatment.

Regular, consistent medication use can help reduce episodes of mania and depression. If you can identify the symptoms and triggers of these episodes, you have a better chance of finding successful treatments and coping strategies that can prevent prolonged illness, hospitalizations, and suicide.

Can bipolar disorder be prevented?

Unfortunately, because scientists don't know the exact cause of bipolar, there is no known way to prevent it.

However, it is very important to be aware of the symptoms of bipolar disorder and seek medical advice at the earliest stage (Early Intervention) .

When should you see a doctor about bipolar?

If you have been diagnosed with bipolar disorder, you will need to meet with your medical team regularly throughout your life to make sure your treatment is working well for you. This team may include:

• Your primary health care provider.
• Psychiatrist.
• Psychologist or Therapist.
• Neurologist.

When should bipolar patients go to the Emergency Treatment Unit (ETU) ?

If you have situations like this,It is essential to immediately call 1990 (Sri Lanka's emergency ambulance service) or go to the nearest emergency room:

• Thoughts about death or suicide.
• Thoughts or plans to harm oneself or others.
• Experiencing hallucinations and delusions.
• Symptoms of lithium toxicity/overdose , such as severe nausea and vomiting, severe hand tremors, confusion, and vision changes.

Finally, remember (Take-Home Message)

Bipolar disorder is a lifelong illness. But long-term, ongoing treatment, such as medication and talk therapy, can help you manage your symptoms and live a healthy, purposeful life. It's important to meet with your healthcare team regularly to monitor your treatment plan and symptoms. Remember that your doctors and loved ones are there to support you. Don't be afraid to ask for help.

` Bipolar, manic depression, mania, depression, mental health, mood disorders, treatment