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Bipolar Disorders: What Are They?

Updated: Aug 3, 2020

Written by Karen Hernandez and Rida Shehzad

Introduction: Contrary to popular belief, bipolar disorders are not just an “edgy teenager phase”, but mood swings that everybody can have. In fact, bipolar disorder mood swings have a level of severity that is different from regular mood swings. Common misconceptions like these make it difficult for people to understand and give help to those who may be experiencing bipolar disorders. These reasons exhibit the importance to understand what this mental disorder truly is: a mental illness characterized by episodes of extremely exalted moods and depression which can cause impairments to daily habits.

Causes on a Biological Level A majority of researchers agree that there is no single cause for bipolar disorder, but there are some commonalities between those who have bipolar disorder. These similarities can be seen in brain structure and function and genetics. Individuals with bipolar disorder exhibit different brain structures in regions controlling inhibition and emotion as well as greater deficits in the brain’s gray matter compared to those without this disorder. Research has also shown that bipolar disorder is possibly genetic. An individual having a parent or sibling with bipolar disorder may have an increased chance of possessing the disorder. Aside from biological causes, stressful life circumstances tend to result in bipolar disorder as well. Those who encounter stressful events very often are more likely to develop bipolar disorder. Rhythm disruptions may also trigger bipolar disorder as well. Types of Bipolar Disorders There are multiple types of bipolar disorder and some are listed below.

  1. Bipolar I Disorder : Diagnosed when a patient has at least one manic or mixed episode Bipolar II Disorder: Diagnosed when a patient experiences at least one major depressive episode and at least one hypomanic episode. Diagnosis for Bipolar II disorder can not include a history of manic or mixed episodes

  2. Manic Episodes : Shows at least four manic symptoms in addition to an altered mood, persists for a week with detrimental consequences such as causing severe impairments in daily function, hospital admission, or experiencing psychotic symptoms

  3. Mixed Episodes : Portrays mood symptoms lasting for more than a week that meet the criteria for manic symptoms and major depression symptoms for as long as a week occurring at different times or rapidly alternating between.

  4. Major Depressive Episode : More than five depressive symptoms other than those of depressed mood or diminished interest, occurs for at least two weeks on most days causing severe inability to perform functions.

  5. Cyclothymic Disorder: Diagnosed when adults show mood swings that are significantly less severe than depression and mania for two years. For children and adolescents the time frame requirement for diagnosis is 1 year.

Symptoms of Bipolar Disorder According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV) guidelines, exalted moods of bipolar disorder are placed into two categories: manic and hypomanic symptoms. Manic symptoms are characterized by ranges in periods of very high irritability and energy to feelings of hopelessness, commonly known as depressive episodes. Manic symptoms may be so severe that they lead to significant impairments for daily functions and oftentimes causing hospitalization.

Symptoms of manic episodes include:

  • Increased activity to achieve goals

  • Agitated mental activity

  • Lack of need to sleep

  • Too much involvement in pleasurable activities that lead to consequences

  • High self-esteem at the level of grandiosity

  • Increased and pressured speech

  • Racing thoughts

  • Distractibility

Meanwhile, hypomanic symptoms include a less severe variation of manic symptoms, individual function is not significantly impaired and does not involve hospitalization. These symptoms tend to persist for four days and no psychotic symptoms are included.

Individuals with bipolar disorder also experience depressive symptoms which include:

  • Depressed mood

  • Reduced interest in activities

  • Loss or gain of weight

  • Loss or gain of appetite

  • Insomnia or hypersomnia

  • Psychomotor retardation or agitation

  • Fatigue

  • Loss of energy

  • Suicidal thoughts

  • Indecisive

  • Inability to focus

Diagnosis of Bipolar Disorder

Doctors will first perform a physical or a lab examination to determine if the mood swings are caused by any other external factors, such as illnesses or side effects from medication. If not, health professionals will then perform a mental state examination such as a “Mood Disorder Questionnaire” or a “Hypomania Checklist” to assess the presence of any past manic or hypomanic episodes. Then based on the DSM-IV guidelines, doctors will determine if an individual has a bipolar disorder and what type. Treatments for Bipolar Disorder

When working to minimize the symptoms and effects of bipolar disorder, individuals may find some treatment options to work better for them over others. Some of the most common actions used to support those with bipolar disorder include medication, psychotherapy, electroconvulsive therapy, and transcranial magnetic stimulation. Medication Medications used to treat bipolar disorder include mood stabilizers and second-generation antipsychotics. Mood stabilizing medications prevent extreme highs (mania) and lows (depression). Second-generation antipsychotics block certain receptors to alleviate symptoms, although they are known to result in a greater quantity of side effects. They help to keep bipolar disorder from interfering with the day to day activities of individuals. There is no ‘best medicine’ for managing bipolar disorder symptoms. Each medication works differently for each individual.

Those who struggle with bipolar disorder may need to take several medications in order to find the medication optimal for them. People with this disorder must be in constant communication with their healthcare provider. This will allow them to better understand their condition and find the best medication in a short amount of time. Medications for bipolar disorder need to be taken consistently, even when one is feeling well since suddenly stopping a medication suddenly can lead to a worsening of bipolar disorder.

Psychotherapy aka “Talk Therapy” Psychotherapy aims to help individuals identify distressing emotions and behaviors associated with bipolar disorder. This form of support then assists the individuals in changing their actions and thoughts— providing support, guidance, and comfort to those with bipolar disorder along with their families. There are numerous therapies that provide the aforementioned support, including: Cognitive behavioral therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT), and Family Focused Therapy (FFT). Assessing one’s actions and behavioral patterns through these therapies early on may be able limit the extent to which bipolar disorder affects an individual.

Dialectical Behavior therapy (DBT) 

This treatment is a type of psychotherapy that uses a cognitive behavioral approach to treat bipolar disorders. DBT  helps patients understand their strengths so that they can feel more confident, helps patients bring awareness to evasive thoughts that can make them feel powerless. For instance, thoughts like “Getting upset means that I am lazy” can become interpreted as “It is okay and normal to feel down sometimes”. These sessions are usually held on a weekly basis. 

Interpersonal and Social Rhythm Therapy (IPSRT) 

Interpersonal and Social Rhythm Therapy is an evidence based therapy that aims to aid people with bipolar disorder or mood disorders by understanding their biological and social rhythms. This treatment emphasizes on techniques that one can use to manage mood disorders, stressful life events, and social rhythms. Patients who participate in IPSRT learn to monitor their moods by keeping a daily mood journal. They are also taught on how to have productive days in which they can ensure staying active.

The following two treatments are quite invasive so they are rarely used.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a procedure done to reduce the symptoms of those suffering with severe bipolar disorder symptoms. This process is done under anesthesia and is categorized as a brain stimulation procedure. ECT is most effective when medications and therapies are proven ineffective for individuals. Furthermore, ECT is also a solution for those who need a rapid response as in the case for those who may be on suicide watch or catatonia.

Transcranial Magnetic Stimulation

This fairly new development in the world of brain stimulation utilizes magnetic waves to alleviate the symptoms of bipolar disorder. The process of Transcranial Magnetic Stimulation (TMS) takes place on a conscious patient over the course of one month, making it a slow and steady process. Though much study is still to be done, this method proves to be helpful for those possessing various forms of depression. Support for Bipolar Disorder: The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a free national hotline for those who experience or have loved ones that experience the effects of bipolar disorder. If you feel that this is beneficial for you or someone you know, please call 1-800-662-HELP (4357).

To help a loved one with bipolar disorder be sure to:

  • Maintain a positive environment

  • Monitor any mood shifts or disruptive behaviors

  • Remain patient as recovery is a long process

  • Assist them in maintaining a routine, which can be helpful

  • Ensure that they are getting enough exercise and sleep

Check for Understanding!

1. Exalted moods are places in which two categories? a) Manic and Hypertension b) Hypomanic and Depression c) Manic and Hypomanic d) Maniac and Depressive 2. True or False: Loss or gain of weight is a depressive symptom. a. True b. False

3. Which is the best treatment for bipolar disorders? a) Medicine b) There is no best treatment since it all depends upon the patient’s needs c) Psychotherapy

d) Electroconvulsive therapy

4. What is the cause of Bipolar Disorder? a) It is genetic and is only passed on through parents and their offspring b) Brain abnormalities alone result in bipolar disorder c) There is not enough research to pinpoint a single cause but study is ongoing d) Depression results in an individual developing bipolar syndrome

5. True or False: Medication for bipolar disorder should be taken with a personal preference and no consultation from a health care provider

a. True b. False

6. Which bipolar disorder is being described: when a patient experiences at least one major depressive episode and at least one hypomanic episode a) Bipolar I disorder b) Bipolar II disorder c) Cyclothymic disorder d) Major Depressive Episode

7. If a medication is ineffective, what action should be taken by the affected individual? a) Immediately stop using the medication b) Alter the amount of medication being used c) Switch to a different medication without consulting your healthcare provider d) Contact your health care provider to discuss your options

8. Transcranial Magnetic stimulation is...

a) A developing gradual process used to relieve symptom

b) Proven to suppress bipolar disorder symptoms in all patients c) Result in the worsening of existing symptoms d) Immediately relieve the symptoms of those with bipolar disorder Answer Key: 1. C, 2. A, 3. B, 4. C, 5. B, 6. B, 7. D, 8. A Citations

Citations - BD
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