What is Bipolar disorder: Causes, symptoms & disease management

Bipolar disorder (also known as manic-depressive illness) is a brain disorder that cause extreme changes in mood, energy and ability to function.

People feel sometimes high (mania) and sometimes low (depression)


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Bipolar disorder can result in poor job or school performance, damaged relationships and increased risk of suicide. 1 But, a number of effective treatment options are available for bipolar disorder.2

Bipolar disorder are categorized into 4 sub-types1

  1. Bipolar disorder I: This is the severe form of the disorder and lasting at least 2 weeks. It defined b mania or mixed episodes and depressive episodes as well.
  2. Bipolar disorder II: Pattern of depression and hypo-mania.
  3. Bipolar disorder not otherwise specified (BP-NOS): Symptoms are clearly out of the person’s normal range of behavior.
  4. Cyclothymia: It is milder form of bipolar disorder and involves episodes of hypo-mania as well as mild depression for at least 2 years.

How common is bipolar disorder?

  • At present, about 51 million individuals are suffering from bipolar disorder worldwide and in India about 8.7 million people.3
  • It often starts in the late teens or early adult ages. At least half of bipolar disorder cases start before the age of 25. 1

Causes

The exact cause of bipolar disorder is not clear. But, several factors may involve such as:

  1. Genetics: Bipolar disorder tends to run in families. People who had a family history of bipolar disorder are increased risk of developing this illness. 1, 2
  2. Chemical Imbalance: Due to a chemical imbalance in the brain. Normally, these chemicals play a major role in brain functions such as movement, sensation, memory, and emotions. 2, 4
  3. Stress: Stress often causes the symptoms of bipolar disorder. Examples of stressful conditions include 4

Breakdown of any relationship

Physical, sexual or emotional abuse

Death of a loved one or close family member

  1. Drugs: Some drugs may worsen bipolar disorder like,Antidepressants, Appetite suppressants, Caffeine, Corticosteroids, Thyroid drugs, Alcohol

Symptoms to watch out for

People with bipolar disorder may coexist with other health problems such as anxiety disorder and substance abuse. In addition, they also facing a greater risk for thyroid disease, migraine, headaches, heart disease, diabetes, obesity, and other physical illnesses. 1

Symptoms of Mania6

  • Feelings of euphoria (a state of intense excitement and happiness)
  • Extreme irritability
  • An abundance of energy
  • Extremely active
  • Being overly restless
  • Inability to concentrate
  • Racing thoughts
  • Jumping from one idea to another
  • Talking very fast
  • Violent behavior
  • Poor judgment
  • Being confused
  • Sleeping little or not being tired
  • Increased sexual drive
  • Abusing alcohol
  • Abusing drugs

Symptoms of Depression6

  • Feeling intense sadness
  • Feeling lethargic
  • Losing interest in activities that you previously enjoyed
  • Weakness
  • Unable to concentrate
  • Sleeping too much or too little
  • Eating too much or too little
  • Feeling worthless
  • Feeling hopeless
  • Feeling helpless
  • Feeling negative
  • Crying frequently
  • Withdrawing from others
  • Neglecting personal appearance
  • Feeling angry
  • Feeling guilty
  • Unable to think clearly
  • Thinking of death or suicide, or attempting suicide.

How to diagnose bipolar disorder?

A doctor or health care provider should conduct below examinations 1, 7

  • Interview to know about the complete history of the patient and their
  • Physical examination, and
  • Laboratory tests are as follows
  • Blood or urine test
  • Thyroid function test
  • Serum chemistry
  • Electroencephalograms and
  • Functional magnetic resonance imaging (fMRI))

Management of bipolar disorder

The effective treatment for bipolar disorder commonly includes a combination of medication and psychotherapy. 1

Medications

Mood stabilizers (First choice for bipolar disorder)

  • Lithium
  • Valproic acid
  • Carbamazepine
  • Lamotrigine
  • Gabapentin
  • Topiramate
  • Oxcarbazepine

Anti-psychotic agents

  • Olanzapine
  • Aripiprazole
  • Quetiapine
  • Risperidone
  • Ziprasidone

Antidepressants

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Bupropion

Psychotherapy

It gives support, education, and guidance to the patient and their family members. Psychotherapy treatments includes the following therapies: 1

Cognitive behavioral therapy: It teaches the patient how to change harmful or negative thought patterns and behaviors.

Family-focused therapy by family members: It helps in improving family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy improves communication with the family members.

Interpersonal and social rhythm therapy: It improves the patient relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.

Psychoeducation: It teaches the patient about their illness and its treatment.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is also called as “shock therapy”. During ECT, a small electrical current is passed through the brain which in turn causes chemical changes in brain that eventually give relief from severe depression.ECT is safe and effective treatment for patients who are1  pregnant or not responding to medications and psychotherapy

Tips to manage Bipolar Disorder

  • Bipolar disorder can worsen if left undiagnosed and untreated. So, consult a doctor immediately without a delay. 1
  • Discuss with your doctor regularly about treatment options and progress. 1
  • Stay on your medication to control the bipolar disorder. 1
  • Try to control the stress situations.5
  • Make a healthy choices like sleeping, eating and exercising habits to stabilize your moods. 5
  • Keep a track of your mood swings and take a precaution not to behave improper. 5
  • Help to someone who have this illness by friendly talk, encouragement and moral support. 5
  • A list of the doctors or organizations who helps better for your situations: 1
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies

Reference

  • Bipolar Disorder. http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed on November 26, 2015.
  • Patient information: Bipolar disorder (manic depression) (Beyond the Basics).http://www.uptodate.com/contents/bipolar-disorder-manic-depression-beyond-the-basics. Accessed on November 26, 2015.
  • Srinivasan G, Chidambram M, krishnana K et al. Formulation and in-vitro evaluation of lithium carbonate extended release tablet to study the effect of various concentration of hydrophilic and hydrophobic matrix in comparison with innovator’s product. Int J Pharm Pharm Sci. 2002; 4(4):632–634.
  • Bipolar disorder – Causes. http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Causes.aspx. Accessed on November 26, 2015.
  • Bipolar Disorder Signs and Symptoms. http://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.htm#triggers. Accessed on November 26, 2015.
  • Bipolar Disorder and Suicide. http://www.suicide.org/bipolar-disorder-and-suicide.html. Accessed on November 26, 2015.
  • Hilty DM, Brady KT, Hales RE et al. A review of bipolar disorder among adults. Psychiatr Serv. 1999 Feb;50(2):201-13.

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