Bipolar Disorder Explained
Bipolar Disorder I
The more severe disorder in terms of symptoms- with individuals being more likely to experience mania, have more prolonged ‘highs’, be more likely to have psychotic experiences and be more likely to be hospitalized.
Bipolar Disorder II
Is diagnosed when a person experiences the symptoms of a high but with no psychotic experiences. These hypomanic episodes tending to last a few hours or a few days, but longitudinal studies suggest impairment is often as severe as in bipolar I disorder.
The high mood is called mania or hypomania, and the low mood is called depression.
However, it is essential to note that everyone has mood swings from time to time. It is only when this mood becomes extreme and interferes with one’s personal and professional life that bipolar disorder may be present, and a psychiatric assessment may be warranted.
Other Key Points About Bipolar Disorder
- Occasionally people can experience a mixture of both highs and lows at the same time, or switch during the day, giving a mixed picture.
- Some people may only have one episode of mania once a decade while others may have daily mood swings. For each individual, the pattern is quite distinct.
- People with bipolar disorder can experience a “normal mood” in between their swings but the majority experience some low-level symptoms between episodes.
- Women and men develop bipolar I disorder at equal rates, while the rate of bipolar II is somewhat higher in females.
- Bipolar disorder can commence in childhood, but onset is commoner in the teens or early 20s. Some people develop their first episode in mid-to-late adulthood. Many people can go for years before the illness is accurately diagnosed or treated.
- Women with bipolar disorder have a very high chance of a significant mood disturbance both during pregnancy and in the post-partum period – most commonly in the first four weeks. (Most will have a depressive episode, a significant proportion will have highs, and 10% will have mixed highs and lows.)
- With the right treatment, the vast majority of people with bipolar disorder are able to live “normal” and productive lives.
Some people with bipolar disorder can become suicidal. Talk of suicide must be taken seriously and for such people to be treated immediately by a mental health professional or other appropriate people.
Causes of Bipolar Disorder
The causes of bipolar disorder are still unknown. Researchers believe that it appears to have primarily biological underpinnings. Its onset is often linked to a stressful life event.
There are several factors that are believed to play a role, including genetics, brain chemicals, environmental factors and sometimes medical illnesses.
Genetics
Bipolar disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition.
If one parent has bipolar disorder, there is a 10% chance that his or her child will develop the illness. If both parents have bipolar disorder, the likelihood of their child developing the illness rises to 40%.
However, just because one family member has the illness, it is not necessarily the case that other family members will also develop the illness. Other factors also come into play.
Brain Chemicals
A recent theory about the cause of bipolar disorder is that it is related to abnormal serotonin chemistry in the brain. Serotonin is one of the neurotransmitters in the brain, and one that strongly affects a person’s mood. It is thought that abnormal serotonin chemistry causes mood swings because of its feedback effect on other brain chemicals. It is unlikely; however, that serotonin is the only neurotransmitter involved.
Environmental
While the onset of bipolar disorder may be linked to a stressful life event, it is unlikely that stress itself is a cause of bipolar disorder. Notwithstanding this, people who have bipolar disorder often find it beneficial to find ways of managing and reducing stress in their lives (as do people without the disorder!).
Again – while not a cause – seasonal factors appear to play a role in the onset of bipolar disorder, with the chance of emergence increasing in spring. The rapid increase in hours of bright sunshine is thought to trigger depression and mania by affecting the pineal gland.
Medical Illness
Medical illness is not a cause of bipolar disorder, but in some instances, can cause symptoms that could be confused with mania or hypomania.
Some medications and certain illicit stimulant drugs can also cause manic and hypomanic symptoms.
Antidepressants can trigger manic or hypomanic episodes in susceptible people; it is essential to report any unusual symptoms to your prescribing doctor while on these medications.
Pregnancy
For women who are genetically or otherwise biologically predisposed to developing bipolar disorder, the postnatal period can coincide with the first episode of bipolar disorder.
What is the Future for Someone with Bipolar Disorder?
Like any other medical condition, such as heart disease or diabetes, bipolar disorder is an illness that requires careful management.
While there is no known cure for bipolar disorder, the good news is that its severity and the frequency of episodes can be reduced or prevented with medication and other supports, such as psychological therapies.
Treatments for Bipolar Disorder
Conventional Methods of Management and Treatments for Bipolar Disorder
Bipolar disorder involves episodes of depression and episodes of mania or hypomania. Conventional methods of management and treatments for bipolar usually include two parts:
- Treating the current episode of mania or depression, and
- Preventing the long-term recurrence of mania and depression.
Increased Nutrient Management and Treatment
As early as the 1960’s, Dr Linus Pauling, winner of two Nobel Prizes, speculated that some people have a genetically-based need for more vitamins and minerals than others. He thought about the possibilities that mental illness could be the result of failing to meet these additional requirements.
Research is in its infancy on the subject; however, it is now starting to show that this hypothesis may be correct. Dr Bruce Ames, at the University of Berkeley, has been demonstrated that genetic mutations often result in an increased need for nutrients. He also has found that taking additional specific nutrients could correct the deficiencies.
If a man comes to the door of poetry untouched by the madness of the Muses, believing that technique alone will make him a good poet, he and his sane compositions never reach perfection but are utterly eclipsed by the performances of the inspired madman. – PLATO
Had [Winston Churchill] been a stable and equable man, he could never have inspired the nation. In 1940, when all the odds were against Britain, a leader of sober judgment might well have concluded that we were finished. – ANTHONY STORR
Bipolar disorder can be a great teacher. It’s a challenge, but it can set you up to be able to do almost anything else in your life. – CARRIE FISHER
What a creature of strange moods [Winston Churchill] is – always at the top of the wheel of confidence or at the bottom of intense depression. – LORD BEAVERBROOK
Isn’t it nice to think that tomorrow is a new day with no mistakes in it yet? – Montgomery
Pregnancy, Postnatal and Bipolar
Pregnancy, Postnatal, and Bipolar Disorder are severe concerns for women, their partners, and loved ones. Bipolar disorder occurs in childbearing women, and the onset of symptoms may be during pregnancy or after the birth of a baby.
This may be a first episode or the continuation or relapse from an episode before the pregnancy. Symptoms are the same as those that occur with bipolar disorder at other times; however, the treatment required may vary when a woman is pregnant or breastfeeding. The focus of fears and depressive concerns can be the wellbeing of the baby or feelings of inadequacy as a parent.
Women with a history or a family history of bipolar disorder are at increased risk of an episode occurring during pregnancy and after childbirth, and they need to be monitored closely for early symptoms. They also have an increased risk of puerperal psychosis*. Once a woman has experienced one episode of bipolar disorder or a puerperal psychosis* the risk of another episode is as high as 50-90%.
Prevention of relapse is an essential aspect of the antenatal and postnatal care of women. Relapse is common if a woman discontinues her medication without medical advice. If an episode cannot be prevented, then early identification and treatment is desirable to minimize the impact of the disorder on mother and baby.
Bipolar disorder has a genetic component so when one parent has bipolar disorder there is a 10% chance that their child will develop the illness. This possibility rises to 40% if both parents are affected.
*Puerperal (postpartum) psychosis is a very rare, but severe mental health condition that is experienced by one or two in 1,000 women in the weeks after having a baby. Puerperal psychosis is very serious as the mother may be at risk of self-harm and there is risk of potential harm to the baby and/or other children.
Treatment Issues for Bipolar Disorder in Pregnancy and the Postnatal Period
Women who are receiving treatment for bipolar disorder are encouraged to seek a review from their doctor when planning a pregnancy so that ongoing care and a plan regarding medications during the pregnancy and after the birth can be arranged. Women who experience an episode of bipolar disorder during pregnancy or after a birth may require specialist care by a psychiatrist.
Psychologically based therapies play a role in coping with bipolar depression even though the primary causes are biological and may require the use of medication. Practical assistance and increased levels of social support can assist a new mother with the care of her baby when adjusting to, and when undergoing treatment.
The safety and care of mother and baby are of paramount concern and need to be fully assessed on an ongoing basis by all health care professionals involved with ongoing treatment. The availability of family and community supports and local mental health resources will have a bearing on the treatment plan.
Use of Medication/s
Amongst pregnant and breastfeeding women with bipolar disorder, there are particular issues associated with the use of medications and specialist care by a psychiatrist is recommended. The need for effective treatment of the mother using medicine has to be balanced against the risk to the fetus and infant. Electroconvulsive therapy is sometimes used when a woman is pregnant, and certain types of medications are contra-indicated.
Use of mood stabilizers is a vital aspect of treatment for acute episodes and to prevent relapses. The use of medication in pregnancy is very challenging as these medications can cause malformations when used in the first 3-months of pregnancy. Hence, pregnant women should always be under specialist care at this time and discuss the medication options before pregnancy where possible. High-dose folate should be started before becoming pregnant to reduce the risk of malformations.
There may be an argument for being medication-free in the first trimester; however, this can only be decided in consultation with a psychiatrist. If medication is ceased over this period, there is a need for very regular appointments with the psychiatrist and close communication between the family and the treating team to pre-empt a relapse whenever possible.
- If a woman remains off medication throughout her pregnancy, it should usually be recommended immediately postnatally.
Ongoing care
Other things such as minimizing stress, maximizing sleep ( especially in the first 1-2 weeks after baby’s birth ), and where possible staying on the postnatal ward a bit longer to get help in establishing breastfeeding, are essential.
- Close family needs to be aware of the condition and be available to help care for the baby, especially in the first few weeks postnatally.
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