What is Bipolar Disorder?
Once one of the most dreaded and least understood of psychiatric illnesses, bipolar disorder, also known as manic depression, is an illness of the brain that affects moods. Unlike ‘normal’ moodiness, young people and adults with bipolar disorder experience extreme mood fluctuations that range from high-energy euphoria to almost paralyzing depression that render it difficult, if not impossible, for them to function on a day-to-day basis. Children with bipolar disorder can become excessively excited and silly as well as sad and lethargic.
As a result of these symptoms, relationships suffer, grades and behavior in school suffer and work performance suffers. Sadly, according to the National Institute of Health, somewhere between 15 and 25 percent of patients diagnosed with bipolar disorder attempt suicide at least once in their lives. This is especially tragic since the typical onset of the disorder is somewhere between 15 and 25 years of age although it affects younger children as well. However, the good news is that researchers are learning more about the disorder resulting in more effective treatments that enable patients to lead happy and productive lives. Following is a detailed look at bipolar disorder, including symptoms, diagnosis, treatments, causes and even a listing of famous people who suffer from the illness.
In a few words, intensity in behavior and mood – happy or sad—characterize bipolar disorder. But more specifically, its two notable extremes are manifested in manic episodes and depressive episodes. People having a manic episode are overly happy, impulsive and happy. They are in ‘over’ mode – over-spending, over-drinking and just plain over-doing. They need little sleep and may even go days without it and overall, they experience soaring energy levels. On the other hand, a person having a depressive episode has little energy and is alarmingly hopeless or sad. The following chart shows the symptoms of both manic and depressive episodes in adults in more detail.
|Manic Phase(lasts from several days to months)||Depressive Phase|
|Unable to concentrate, easily distracted||Low or sad mood|
|Doesn’t need much sleep||Unable to concentrate|
|Easily angered||Difficulty remembering things|
|Irritable||Can’t make decisions|
|Shows poor judgment||Over- or under-eating; weight loss or gain|
|Reckless||No energy, tired all the time|
|Lack of control and impulsive in drinking, sex, drug use and spending||Feelings of worthlessness, guilt and hopelessness|
|Has racing thoughts||Loss of pleasure in activities previously enjoyed|
|Talks fast and a lot||Loss of confidence and self-esteem|
|Feelings of grandiosity||Thoughts of death or suicide|
|Over commits to activities||Isolating|
|Trouble sleeping or sleeping too much|
Unfortunately, for children and teens the symptoms are disorder is often far worse than in adults with more symptoms, more often and to a more severe degree. Besides difficulties in school, they may also have trouble getting along with friends and family members. Suicide is a risk among young people as well as forms of self-mutilation and injury. The chart below shows symptoms in what’s called early-onset bipolar disorder in more detail.
|Manic Episodes||Depressive Episodes|
|Acts unusually silly||Extreme sadness|
|Happy to an extreme||Complains about physical ailments|
|Short tempered||Too much or too little sleep|
|Rapid and disordered speech||Feels guilty for no reason|
|Trouble sleeping but not tired||Feels worthless and insecure|
|Can’t focus well||Loss of appetite|
|Talks about inappropriate things||Overeating|
|Racing thoughts||No energy|
|Takes excessive risks||No interest in previously enjoyed activities|
|Thoughts of suicide|
Children with bipolar disorder may have other problems as well such as substance abuse, attention deficit hyperactivity disorder or an anxiety disorder.
In addition to classic manic and depressive episodes, the disorder has several other forms. Hypomania is a less severe form of mania where the patient is very productive and functions well overall. There is also a form called a mixed state where the patient experiences mania and depression at the same time. Rapid cycling is another form where the episodes occur in rapid sequence with four or more occurring within a year. For all forms, the risk of suicide for patients with bipolar disorder escalates significantly when alcohol or drugs are brought into the mix. (http://mentalillnesspolicy.org/consequences/suicide.html)
For the sake of treating and diagnosing patients, medical practitioners have developed the following categories of bipolar disorder.
- Bipolar I: Bipolar I is technically the most severe form of the illness. A patient is diagnosed with bipolar I if they have a mixed or manic episode that lasts 7 days and/or that requires hospitalization. Likewise, to be diagnosed bipolar I, they must also have had a depressive episode that was at least 2 weeks long. Patients with bipolar I may also experience hallucinations or delusions
- Bipolar II: Patients diagnosed with bipolar II have had depressive episodes as well as hypomania that does not escalate into a full-blown manic episode. Hypomania can be hard to diagnose because patients perform productively and function well.
- Bipolar NOS: NOS stands for not otherwise specified and these patients have symptoms that don’t fall into either bipolar I or bipolar II but are still out of the normal behavioral range.
- Cyclothymic Disorder: The patient has mild hypomania and mild depression that has lasted at least 2 years.
What are the Causes of Bipolar Disorder?
No one knows for sure what the causes of bipolar disorder are, but research studies have identified trends and similarities among patients. Still, there is a lot scientists don’t understand and much work remains to be done. However, here are some of the possible contributors.
- Genetics: It’s clear that bipolar disorder tends to run in families. For a child in a family where one or both parents or a sibling suffers from the disorder, the chances of that child getting the disease increase as compared to a family where no one has bipolar disorder. However, studies of identical twins have found that despite identical genes, when one twin develops the disorder, it is not necessarily true that the other will develop it. The National Institute of Mental Health has partly funded the Phenome Database that strives to match genes with visible behavioral symptoms to find genetic ‘hot spots’ in seeking the causes mental illnesses, including bipolar disorder.
- Brain structure: Using magnetic resonance imaging (MRI) and positron emission tomography (PET) , scientists have identified some differences in the brain structure of patients with bipolar disorder versus those of healthy people. In addition, studies performed on children show developmental patterns in the brain that overlap those of children with other unstable mood issues. Studies have also determined that the portion of the brain that handles functions such as problem solving and decision making, behaviors impacted by bipolar disorder, do not mature until adolescence, explaining why the illness usually does not manifest until around age 15. (http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml)
What Triggers a Manic Episode?
Although there are no absolutes when it comes to answering the question: what causes a manic episode, there are some factors that have been identified as triggers. These are listed below.
- Childbirth: After a woman has a child, her hormone levels plummet which in turn affects the chemicals in the brain, initiating an episode in susceptible women.
- Some medications: Some antidepressants, diet pills and over-the-counter cold medicine can trigger mania.
- Substance use and abuse
- Not being able to sleep
- Change of seasons
Statistics About Bipolar Disorder in the U.S. (http://www.statisticbrain.com/bipolar-disorder-statistics/)
|Adults with bipolar||5.7 million|
|Total percent of people with Bipolar disorder||5%|
|Average age of onset||15 – 25|
|Likelihood of child getting disorder with 1 BP parent||23%|
|Likelihood of child getting disorder with 2 parents diagnosed||66%|
|Percent of suicides||20%|
|Percent of people who receive correct diagnosis within 3 years||25%|
|Percent of people who are Obese||35%|
|Success rate of lithium in treating||77%|
|Percent of people who receive 1 misdiagnosis||70%|
How is Bipolar Disorder Treated?
Although bipolar disorder is not curable, it is manageable and with ongoing psychiatric support and medication, people can and do live happy and productive lives. The key to this is management of the drastic and potentially dangerous mood swings patients experience. This is done with a combination of the therapies that follow.
The first mode of defense against the destructive symptoms of bipolar disorder is medication. There are a myriad of options that fall within the categories of mood stabilizers, antipsychotics and antidepressants. Finding the right balance, or ‘cocktail’ as it sometimes referred to, is the secret and often takes some trial and error.
In conjunction with medication, psychotherapy gives patients emotional support and education for patients and their families. There are a number of different approaches a psychiatrist can take in working with a bipolar patient including cognitive behavioral therapy (CBT), family-focused therapy and psycho-education. But a warning here: anyone can hang a shingle declaring themselves to be a mental health therapist, so the key is to find a licensed practitioner who is also experienced in bipolar disorders.
Electroconvulsive Therapy (ECT)
A controversial and often a last resort treatment, ECT, once known as ‘shock’ therapy, has improved over the years. Most doctors recommend ECT when medications and other psychotherapy treatments have not worked. It is particularly helpful for patients with severe mania or depression. The once dreaded side effects are only temporary and include confusion, disorientation, and some memory loss.
Even though there is not much data on how effective herbal remedies are in treating bipolar disorder, some people have opted to take the natural route. However, this can be dangerous. One supplement, St. John’s Wort, is advertised as being a natural antidepressant, but in reality, it can trigger mania. In addition, it has been shown to interact negatively with some antidepressant and anticonvulsant medications. Studies are being conducted to test the effectiveness of omega-3 fatty acids as a long term therapy, but so far there has been nothing conclusive in the results. http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Treatments for Children and Teens
Doctors use some of the same treatments for children as they do for adults with bipolar disorder, specifically medication and psychotherapy. However, children’s bodies respond to medication differently than adults’ systems do so the goal is to find the lowest possible dose at which symptoms are managed. As so with all bipolar patients, it’s critical that they stay on their medication. Quickly stopping medication can exacerbate symptoms and set the stage for a potentially dangerous situation.
Having a child with bipolar disorder puts a strain on parents as well as everyone in the family. There are things that can lessen the stress, including learning as much as possible about the illness, joining a family support group, encouraging the bipolar child to partake in fun activities, communicating with the child frequently and helping him or her understand that with treatment, life will become happier.
Famous People with Bipolar Disorder
Bipolar disorder knows no bounds in who it strikes, and it touches celebrities and other famous people to a surprising degree. Many celebrities have made their bipolar struggles public. And some of those are listed below.
- Jim Carey
- Rosemary Clooney
- Robert Downey Jr.
- Patty Duke
- Carrie Fisher
- Margot Kidder
- Kristy McNichols
- Ben Stiller
- Jean-Claude Van Damme
- Robin Williams
- Ludwig Von Beethoven
- Francis Ford Coppola
- George Frederick Handel
- Vincent Van Gogh
- Ted Turner – business mogul
- Buzz Aldrin – astronaut
- Phil Graham – owns Washington Post
- Illie Nastase – tennis player
- Daryl Strawberry – former major league baseball player
- Winston Churchill
- Kitty Dukakis
- Theodore Roosevelt
A Final Note For Parents
Although the most dangerous of mental illnesses because of its high suicide rate, bipolar disorder does not need to be a death knell. There are so many treatments and support systems available today as well as new medications constantly coming on the scene.
If you suspect your child has bipolar disorder, get him or her to a licensed professional who is experienced in dealing with the illness.
Sources: http://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/ https://www.princeton.edu/~achaney/tmve/wiki100k/docs/Hypomania.html http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml