The truth about bipolar disorder

Such open communication should empower others to speak out, but sadly, expressing your experiences with mental health still retains a certain stigma.

Mental health problems can be difficult for anyone to handle but it can be made worse by having to deal with discrimination from others.

The unfortunate truth is that millions of people suffer with bipolar disorder, and this article aims to provide a brief outline of the disorder, related risk factors, and potential management strategies.

Definition of Bipolar Disorder

Bipolar disorder is also referred to as mood disorder, and the term itself is a combination of words - "bi" meaning two and "polar" standing for opposite or extreme sides.

Bipolar disorder causes changes to one's mood, usually consisting of shifts between extreme high and low moods. When an individual's mood switches to an extremely high state, it is called mania, while an extremely low state is called depression. The depression phase of bipolar disorder is characterized by the same symptoms seen in depressive disorders.

The severity of the mania and/or depression varies; as each individual case can be unpredictable. While everyone experiences ups and downs, the shifts that happen in bipolar disorder can have a severe impact on a person's life.

So, what are the warning signs?

Signs of mania are:

• Increased energy
• Excitement
• Impulsive behaviour
• Agitation
• Aggressiveness

Signs of depression are:

• Decreased level of energy
• Feelings of worthlessness
• Feelings of hopelessness
• Difficulty in concentrating on an activity
• Loss of interest in activities
• Low self-esteem and suicidal thoughts

In some cases, a person's mood may shift from mania to hypomania, which is a lesser state than mania. In such a case, a person may feel moderately euphoric, full of energy and/or unusually irritable. 

It is important to note that mania is more severe than hypomania and can cause more noticeable problems at work, school and in engagement in social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalisation at some point in time.

Types of bipolar disorder

Bipolar disorder may take different forms, depending on its severity and rate of occurrence. These types include:

1. Bipolar I: This occurs usually everyday and could last for at least a week. It occurs with one or more manic episodes and one or more major depressive episodes.  Bipolar I disorder is the most severe form of the illness, marked by extreme manic episodes.
2. Bipolar II: This is a milder form of bipolar I disorder, but with a separate diagnosis.  Bipolar II is harder for people to see in themselves, thus it is important that friends or loved ones encourage someone with this type to seek help.
3. Cyclothymic disorder: This is a milder form of bipolar disorder. It has several hypomanic episodes with less severe episodes of depression. A person can often function normally without medication, but with great difficult. There are instances that a person's mood swings may develop into a diagnosis of bipolar II or I.
4. Not otherwise specified: This form of bipolar disorder does not follow any particular pattern and order. A person only has some bipolar symptoms, but not enough for a diagnosis.

Risk Factors

Men and woman stand equal chances of experiencing bipolar disorder. However, women are more likely to receive a diagnosis than men, although the reason for this still remains unclear.

Bipolar disorder can occur at any stage in life, however, it is usually most evident in late adolescence/early adulthood (where it can be misidentified as mood swings).

Although a specific genetic link to bipolar disorder has not been pinpointed, research shows that bipolar disorder tends to run in families.

Bipolar disorder and other mental health problems

Symptoms of bipolar disoder can persist for a long time before appropriate diagnosis is made. Often a misdiagnosis of depression is given. This is because people are more likely to report when they feel down than in the times when they feel high. This is one reason why it may take longer for an actual diagnosis of bipolar disorder to be given.

Bipolar disorder can occur concurrently with other health problems, and some of these conditions can worsen bipolar disorder symptoms or make treatment less successful.  Examples of these conditions include:

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug problems
• Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Seeking help

Treatment of bipolar disorder is highly individualized and based on the types and severity of symptoms a person may be experiencing.

• Bipolar disorder can be treated with either medications or psychotherapy, or a combination of the two.
• Psychiatrist/doctors prescribe medication. It is important that an individual follows the treatment plan prescribed by their psychiatrist or doctor. It's also important to note that the use of antidepressants for conditions of bipolar disorder may trigger more manic symptoms in some individuals while other individuals may respond poorly to it. Discussing any symptoms changes with a psychiatrist/doctor is paramount.
• Talk therapy or psychotherapy is known to be useful. Psychologists and other professionals use a range of therapeutic approaches, such as cognitive behaviour therapy, family therapy and interpersonal therapies to help individuals develop useful strategies to manage their symptoms.

Lifestyle changes or self-management strategies

1. Stop over-drinking and/or taking drugs: The use of alcohol has a tendency to cause changes to one's mood. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behaviour, such as repeated intoxication, extravagant spending and risky sexual behaviour.
2. Seek healthy relationships: It is important a person surrounds themselves with people who are a positive influence. The focus should be centred on building healthy relationships with people.
3. Develop healthy habits: A healthy routine for sleeping, eating and physical activities can help to balance a person's moods.
4. Monitoring mood: Recording daily moods; treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.
5. A full evaluation of symptoms and emotional history is critical in determining a person's treatment needs! 

There are just some long-term, successful strategies to staying well, and liaising with a healthcare professional/team in finding the right treatment to help maintain a balanced mood is crucial!

Finding the right drug combination that works with the person's body is also imperative, as everybody's system is somewhat different.

Living with bipolar disorder can be challenging. It can change the course of one's life, but it doesn't mean that person can't manage their symptoms given the right resources and support.

About the author

Dr Funke Baffour is a Chartered Clinical Psychologist, Nutritional Advisor, and Associate Fellow of the Society, as well as an author, illustrator, and one of the UK's leading contributors to psychology in the media.