Bipolar disorder, previously called manic-depression, is a mood disorder characterized by swift mood swings that move between exaggerated mania and episodes of depression.
Patients diagnosed with bipolar disorder have a chemical imbalance in the brain that affects their emotions and actions. In some cases, bipolar individuals are not diagnosed or they may refuse treatment. Without treatment, bipolar disorder leads to dire consequences
Experts worry that many people go undiagnosed. The number of people diagnosed with bipolar disorder remains low, only around 2.6 percent of the U.S. adult population. Around 83 percent of people diagnosed have severe cases. This suggests only people with significant symptoms and dysfunction get a diagnosis.1
Bipolar disorder is very complex and has been subdivided into different categories. Each category is classified according to the pattern and intensity of the symptoms, the University of Maryland Medical Center (UMMC) reports.
- Bipolar Disorder I
Bipolar disorder I
This classification of bipolar disorder describes a patient who has one manic episode or a mixed episode (experiences both mania and depression), followed by one more depressive episode that lasts for at least one week. This type of bipolar disorder is usually more severe than other types. Without treatment, bipolar disorder I patients suffer from four or so emotional cycles per year. Mania can last for weeks to months, followed by depressive episodes that last approximately six to 12 months. With treatment, the length and frequency of these episodes are drastically reduced.
- Bipolar Disorder II
Bipolar disorder II
Bipolar disorder II is signified by a predominance of depressive symptoms sometimes linked to a few days of hypomania, which involves mild manic episodes. Bipolar II patients do not have any true episodes of mania and usually return to a normal emotional status after the depressive episodes. This category of bipolar disorder has a more chronic duration and due to the severe symptoms of depression, patients with bipolar disorder II are often at risk for suicide.
- Cyclothymic Disorder
This classification of bipolar disorder is less severe than bipolar disorder I or II but has a much longer course. These patients, when going through hypomania, often act irritable. Cyclothymic disorder lasts at least two years, with each episode lasting for more than two months. Over time, the disorder can progress to a more severe form of bipolar disorder or continue on as a low-intensity disease.
- Bipolar disorder with rapid cycling
Bipolar disorder with rapid cycling
Patients with this type of bipolar disorder experience four or more manic, hypomanic or depressive symptoms within one year. Rapid cycling may also occur in other forms of bipolar disorder and is usually temporary.
- Bipolar disorder not otherwise specified (NOS)
Bipolar disorder not otherwise specified (NOS)
Some patients present with symptoms of bipolar disorder that do not fit into any established category. These patients are classified as bipolar disorder NOS.
Bipolar disorder is not caused by just one factor. Typically, bipolar disorder is due to a combination of biological, genetic and environmental factors. These factors appear to trigger a variety of chemical imbalances within the brain that are associated with the disorder. Often doctors find it difficult to test for genetic and environmental factors, but there are some specific biological factors that they are able to test for.
Most patients with bipolar disorder have high levels of a stress hormone called cortisol. Cortisol is a hormone produced by the adrenal gland that helps moderate the flight-or-fight response.
Most commonly, it is used to increase blood sugar and aid in the breakdown of fat and other nutrients. Excess cortisol levels often interfere with normal metabolism.
An abnormal influx of calcium into the brain is a characteristic of bipolar disease. Calcium triggers brain cells to activate and can, over time, destroy some of the brain tissue. As calcium levels increase, bipolar patients tend to experience more severe episodes.
During brain imaging, doctors notice that bipolar patients exhibit irregular hyperactivity in parts of the brain linked with emotion and movement coordination. Moreover, bipolar patients have low activity levels in the areas of the brain responsible for concentration, attention, judgment and inhibition. These findings help explain the manic episodes many bipolar patients experience.
Everybody has a biological clock, which regulates the daily release of hormones and other chemicals. The biological clock is located within a tiny cluster of nerves called the suprachiasmatic nucleus (SCN). The SCN is centrally located within the brain and in charge of monitoring the patient’s circadian rhythm and sleep cycle. Bipolar patients are described as having an incredibly fast biological clock that causes a rapid release and absorption of hormones. This causes the patient to undergo frequent cycles of mania then depression.
However, in one study, researchers found a genetic link. 60 to 80 percent of the time an identical twin with a sibling who has bipolar disorder also has the disorder. When the twins are non-identical, the risk drops to 20 percent.2
Patients suffering from bipolar disorder quickly shift from mania to extreme depression and back again, FamilyDoctor.org notes. While experiencing a manic episode, patients feel extremely happy and energetic, as if they can do anything. Often patients will not want to rest while going through mania.
Signs of mania include:
- Easily angered and irritated
- Rapid incomprehensible speech
- Refusal to sleep
- Feeling important and powerful
- Difficulty concentrating
- Abusing alcohol and other drugs
- Spending exorbitant amounts of money
When depressed, bipolar individuals are profoundly sad and unmotivated. They rarely want to do anything and often isolate themselves.
Depression is characterized by:
- Not finding pleasure in previously enjoyable activities
- Feeling numb or empty
- Uncontrollable, irrational crying
- Feeling very slow
- Extremely low self-esteem
- Unintended weight gain and changes in appetite
- Unwilling to make decisions
- Memory problems
- Headaches, backaches, muscle pain or digestive distress
- Constantly thinking about death and suicide
Impact on Families
Bipolar patients often adversely affect their friends and family. Family members may require some form of therapy or education to help them cope with the ongoing effects of bipolar disorder in their loved one.
Before the disease is diagnosed, family members may be confused and hurt by the actions of the bipolar relative. They will not understand why their loved one is seemingly happy one moment and then intensely disturbed the next. Moreover, bipolar patients often say and do things to intentionally hurt their friends and relatives. Even after a diagnosis is made, some family members find it hard to believe that the actions of the bipolar patient are due to a real disease, especially since most bipolar patients are articulate and deliberate in their actions.
Family members may feel guilt and grief because they believe that they are responsible, in some way, for making their loved one bipolar. Most family members will feel a keen sense of sorrow and grief. This is a normal reaction to a serious illness, like bipolar disorder. During manic episodes, friends and relatives will worry about their loved one’s risky behavior; during depressive episodes, they fret about whether the patient will commit suicide.
The family’s daily life is often disrupted due to the need to monitor the bipolar relative. Social engagements are cancelled, and normal activities and chores are postponed. According to an article in Pharmacy and Therapeutics, families with at least one bipolar member face financial problems and an inordinate amount of stress. In time, the family’s social network slowly diminishes, often causing family members to feel isolated and alone.
As the disease progress and remains untreated, family members will continue to suffer. Young children are particularly susceptible to feelings of guilt, sadness and fear. Getting the right treatment is the only way to help alleviate the burden placed upon a bipolar patient’s family.
Self-Medication and Addiction
Bipolar disorder also puts people at greater risk for developing an addiction. Almost two-thirds of sufferers experience a substance use disorder at some point in life. Some people abuse drugs to manage a depressive episode after coming down from the high of a manic episode. Drugs like heroin, prescription painkillers or methamphetamine create a fleeting period of euphoria, a feeling unavailable in the depths of a bipolar depressive cycle.3
The impulsivity of a manic episode also increases a person’s chance of taking high doses of drugs or alcohol. Some sufferers believe taking drugs puts them back in control. Unfortunately, any control is temporary, as substances shift people from one extreme to another.
About 56 percent of individuals with bipolar who participated in a national study had experienced drug or alcohol addiction during their lifetime.
Intervention and Treatment
Treatment for bipolar disorder provides both pharmacological and psychological therapy to the patient. Without treatment, people with bipolar disorder are at a high risk of suicide or developing other co-morbid mental illnesses.
Instead of trying to force your loved one to get treatment, consider hiring a professional interventionist. A well-organized intervention helps people with bipolar disorder accept their affliction. Furthermore, an intervention provides an accessible treatment option for the patient.
Bipolar individuals are often unaware of the severity of their condition. They may chalk up the fluxes in their mood to life events or other rational explanations. As the disease progresses, bipolar patients develop an impaired ability to comprehend information and make decisions. Often, this mental deterioration makes them reluctant to seek treatment.
A good intervention will also provide support to friends and family hurt by bipolar disorder. Before the intervention meeting, team members are given a lot of information on the course and pathology of bipolar disorder. During and after the intervention, team members have access to the interventionist and other healthcare professionals just in case they have any questions and concerns.
If you think your or your loved one may be suffering from multiple cycles of manic-depression, we can help review your options, discuss insurance coverage, and other questions you may have. You don’t have to do this by yourself. We’re serious about helping everyone find solutions no matter where you are in the country. 855-317-8377
1 “Bipolar Disorder Among Adults.” NIMH. 2005. Accessed 26 June 2017.
2 Wein, Harrison, ed. “Major Ups and Downs: Bipolar Disorder Brings Extreme Mood Swings.” NIH News in Health. May 2010. Accessed 26 June 2017.
3 Bauer, M.S., et.al. “Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder.” Journal of Affective Disorders. Vol. 85, No. 3, pp. 301-315, April 2005. Accessed 26 June 2017.