Bipolar disorder, formerly called manic-depressive illness, is one of several disorders known as mood disorders. Mania and depression, alone or in combination, are hallmarks of mood disorders. Mania is characterized by a feeling of euphoria in which the individual has grandiose ideas, exhibits boundless energy, needs little sleep, and exhibits great self-assurance. While in a manic state people’s thoughts race, they talk too fast and demonstrate poor judgment. Maniacs can impulsively spend too much money, commit sexual indiscretions, and alienate people with their irritability and impatience. Hypomania refers to a milder form of mania that is an excessive amount of euphoria but does not significantly affect the individual’s life.
Depression can be characterized by many symptoms, including feelings of worthlessness, guilt, and sadness. When you’re depressed, life seems empty and overwhelming. The depressed individual has difficulty concentrating, is unable to make decisions, lacks confidence, and is unable to enjoy previously pleasurable activities. Physical symptoms may include weight gain or loss, sleeping too much or too little, restlessness, or lethargy. Depressed people may worry about death or suicide. They may believe that they have committed the unforgivable sin and that their loved ones would be better off without them.
Bipolar disorder is so named because sufferers experience both mania and depression, in contrast to those with unipolar disorders, who experience only one extreme, usually depression. Bipolar disorders are classified into two types, Bipolar I and Bipolar II. In Bipolar I the individual experiences both mania and depression; in Bipolar II the individual experiences hypomania and depression. Mania or hypomania is the key to diagnosing bipolar disorder. A person who experiences a manic state even once is presumed to have bipolar disorder. The manic and depressive states may immediately precede or succeed each other, or they may be separated by long intervals of time, and the individual may have more episodes of one pole than the other. Some people, known as speed cyclists, will experience four or more episodes per year.
The age of onset for bipolar disorder is earlier than that for unipolar depression and usually begins in the late teens or early twenties, but rarely begins after age 40. In some cases, it is preceded by a disorder called cyclothymia, which is a milder form of mood disorder. characterized by mood swings and marked mood swings for at least two years. Bipolar disorder is a chronic disorder, and even with treatment, less than half of people who experience it go five years without a manic or depressive episode. People with bipolar disorder are at risk of committing suicide in the depressive phase and are more prone to accidental death in the manic phase due to impulsiveness and poor judgment.
The causes of bipolar disorder are not clear, but it is probably determined by multiple factors. Family and adoption studies have consistently indicated a genetic predisposition toward mood disorders. First-degree relatives of people with bipolar disorder are much more likely than the general population to experience bipolar depression, unipolar depression, and anxiety. At this point, however, there is no clear evidence that any particular gene is linked to the transmission of bipolar disorder; instead, it appears that a family history increases vulnerability to various disorders.
Neurotransmitters in the brain have been extensively investigated and are most likely involved in bipolar disorder, but in complex and interactive ways that are not yet understood. The relationship between neurotransmitters and hormones secreted by the hypothalamus, pituitary, and adrenal glands appears to be significant. There is also speculation that bipolar disorder may be related to circadian rhythms because some people with bipolar disorder are especially sensitive to light and display abnormal sleep patterns, such as entering REM sleep too quickly, dreaming intensely, and missing sleep stages. deeper sleep.
Stressful life events can precipitate episodes of mania or depression, but they do not appear to be the main cause of bipolar disorder. Psychosocial factors such as attributional style, learned helplessness, attitudes, and interpersonal relationships appear to be correlated with bipolar disorder, but have not been identified as causes; they are often the result of having the disorder. It appears that a genetic vulnerability coupled with psychological and sociocultural stressful events can result in bipolar disorder.
Three primary treatment modalities are most commonly used for bipolar disorder. Medication is commonly used, especially lithium. For reasons that are not yet fully understood, lithium reduces the frequency of episodes, and many people with bipolar disorder remain on lithium for long periods of time. Lithium levels must be carefully monitored through blood tests, and there can be side effects such as weight gain, lethargy, and kidney failure. Due to the side effects of the medications and because they lose energy from hypomanic and manic states, people with bipolar disorder may stop their medications. Newer antidepressants that affect serotonin levels are often used, but there is some suspicion that they may contribute to a faster cycle. Anti-seizure medications, such as carbamazepine, are also used.
A second treatment approach that is sometimes used is electroconvulsive therapy (ECT). This approach is used only in severe cases where uncontrollable behavior or the threat of suicide make it impossible to wait the two to three weeks for the medication to take effect. ECT, which is used to treat people who have not responded to other forms of treatment, is often effective but is subject to side effects: temporary short-term memory loss and confusion immediately after treatment.
Psychotherapy is the third treatment approach. While many psychotherapeutic approaches have been tried, cognitive therapy and interpersonal therapy are currently the most popular. Cognitive therapy focuses on identifying and correcting faulty thinking styles and attributions, so that the client can gain cognitive control of emotions. Interpersonal therapy focuses on developing the skills to identify and resolve interpersonal conflicts, which often accompany bipolar disorder. Both psychotherapies are highly structured and short-term. Many people receive a combination of medication and psychotherapy to stabilize them and prevent relapse.
In addition to addressing the possible causes of bipolar disorder, psychotherapists help people deal with a number of issues that come with living with the disorder. One is the difficulty of living with the disruptions in one’s life that manic and depressive states bring. People may be too sick to work or parent and may even be hospitalized. Another problem is undoing or coping with inappropriate behavior that occurred during a manic state, when the individual may have recklessly spent money, made grandiose promises, or said inappropriate things. A third common problem is dealing with negative reactions and mistrust from family, friends, and co-workers who have been affected by the individual’s extreme mood swings. Taking medication regularly is a struggle for some people, a struggle that is compounded by the tendency for people in a manic or hypomanic state to feel like they don’t need medication. People with bipolar disorder deal with constant anxiety that their feelings may get out of control. They often feel helpless and as if their disease is under control and can take over at any time. There is also the question of why God allows people to go through such struggles. People with bipolar disorder need therapists to help them exercise cognitive control over their emotions, recognize when they are getting too high or too low, manage interpersonal relationships, deal with the stresses of life, and understand how to accept and live successfully. with bipolar disorder.