Bipolar disorder is a mood disorder in which the person alternates between periods of really low mood (i.e., depression) and periods of really elevated or irritable mood (e.g., mania). These intense mood fluctuations interfere with the person’s normal everyday functioning.
Are there different types of bipolar disorder?
There are several different types of bipolar disorder, with the main difference being the severity of the manic episode and the speed at which someone cycles between the highs and the lows. Some of the most common are:
- Bipolar I disorder - This is when a person experiences one or more manic episodes. He or she likely will also experience depressive episodes over the course of his or her illness. Mood shifts from manic to normal or depressed mood can happen over the course of days, last for several weeks, or last even longer.
- Bipolar II disorder - This is similar to bipolar I, except that the person experiences hypomanic episodes, instead of manic episodes, and at some point will suffer from a major depressive episode. Hypomania is a less severe form of mania where the person experiences mood disturbances but does not require hospitalization or experience serious impairment to his or her ability to function.
- Cyclothymic disorder - This is when a person chronically cycles between periods of hypomanic symptoms and periods of depressive symptoms. Although the person doesn’t have enough symptoms (or severe enough symptoms) for a manic episode or for a depressive episode, the symptoms experienced cause significant distress or impairment. This cycling is ongoing for at least 2 years.
What are the symptoms of mania & depression?
People experiencing a manic episode may not realize there is a problem, as they may enjoy the excitement and positive feelings that accompany mania. Unfortunately, mania can intensify to a level that impairs the person’s thinking and judgment and they may act in ways that can lead to very negative consequences. Sometimes the mania can be so severe that the person becomes psychotic – losing touch with reality. The symptoms are:
Extremely elevated, euphoric, or irritable mood lasting at least one week.
Other symptoms may include (3-4 are necessary to be diagnosed as having a manic episode):
- excessive confidence or a feeling that you can do anything (even if impossible)
- decreased need for sleep (e.g., feeling rested after only a couple of hours)
- feeling super talkative, like there’s a buildup of words inside you that need to get out
- racing thoughts that jump from one idea to the next without a logical flow
- easily distracted by unimportant or irrelevant details
- increase in purposeful activity or psychomotor agitation
- excessive engaging in risky pleasurable activities (e.g., unprotected sex, shopping sprees, drug use, speeding, risky business investments)
These symptoms are not due to substance use or a general medical condition.
- Everyone feels sad or has a bad day occasionally but when someone has depression, their sad feelings last for long periods of time, often to a point where the person feels hopeless and cannot function. The symptoms are:
- Overwhelmingly depressed/sad/low mood
- Loss of interest in usual activities
- Change of appetite and weight
- Irritable or short tempered
- Loss of energy, fatigue
- Difficulty concentrating
- Guilty feelings
- Sleeping too much or too little
- Low self-esteem
- Loss of pleasure
- Feelings of worthlessness
- Feeling of hopelessness
- Restlessness or lack of movement
- Thoughts of death or suicide
- Suicide attempts
- Bipolar disorder affects approximately 1% of Canadians.
- It typically starts in late adolescence or early adulthood.
- It affects just as many men as women.
- People with bipolar disorder are at higher risk of suicide than the general population.
- It can take years for a person to receive the correct diagnosis of bipolar disorder. In Canada, the average is 4 years.
Bipolar disorder and substance abuse
Some people with bipolar disorder have problems with drugs or alcohol, sometimes in an effort to control their symptoms and sometimes due to difficulties with judgment or self-control. When substance abuse and bipolar disorder happen at the same time, the person will experience even greater difficulties.
How is bipolar disorder treated?
Most people with bipolar disorder respond well to treatment. However, if treatment is stopped, the illness will return. Bipolar disorder is treated primarily with medication and psychotherapy. People with bipolar disorder usually have to take medications continuously. A number of different medications can be used, including:
- Mood stabilizers - Improve and reduce mood swings and treat both depressive and manic symptoms. They also help prevent the illness from returning once the symptoms have lessened.
- Antidepressants - For certain people, antidepressants are used during depressive episodes, but they are not appropriate for everyone.
- Anti-psychotic medications - Help improve psychotic and mood symptoms. Also prevents the illness from returning once the symptoms are lessened.
Psychotherapy is helpful
In addition to medication, psychotherapy and psychoeducation can also be helpful and usually focus on dealing with the associated stressors that result from having bipolar disorder. Psychotherapy used in treatment of bipolar disorder may include:
- Cognitive Behavioral Therapy (CBT) - CBT helps people learn to problem solve and change their negative thoughts and behaviours into more positive ones.
- Family-focused therapy - This therapy helps family members understand the illness and develop healthy coping strategies.
- Psychoeducation - This treatment may be done in a group or with family members and is helpful in teaching individuals how to better understand their illness and manage their symptoms.
How long does treatment last?
There is a good chance that someone with bipolar disorder will always have to be on medication in order to control their symptoms, but the type and amount of medication may change over time. Psychotherapy, however, is not likely to be needed long-term. It only has to last as long as it takes for the necessary skills, coping strategies, and knowledge to be gained. People with bipolar disorder may occasionally need to be hospitalized, if their medications need to be readjusted or they have stopped taking their medication. For people who do not respond well to medication, electroconvulsive therapy (ECT) may be recommended. After a severe manic or depressive episode, a person may need a period of rehabilitation in a day treatment program until they are feeling stronger.
Once an episode of mania or depression has ended (doctors call that “remission”), the next step is to keep another episode from happening again (if that happens it is called “relapse”). There are a number of things that a person with bipolar disorder can do to prevent relapse including:
- Taking medications as prescribed - Stopping medications is the strongest risk factor for relapse. Even though you might feel better, remember that it is the medication that is helping you feel that way.
- Eating health - Watching calories and eating healthy food, especially those rich in omega-3 (found in fish) may be a good idea.
- Avoiding drugs and alcohol - Some people with bipolar disorder may be able to drink small amounts of alcohol, but only after consulting with their doctor.
- Exercising - 30 minutes of good exercise (such as going for a fast walk) at least five days a week is a good.
- Having a regular sleep/wake cycle - Going to bed and waking up around the same time every day is very important.