Bipolar disorder: everything you need to know

What is bipolar disorder
How widespread is it?
What causes it and who can develop it?
Symptoms: how can I tell if I might have bipolar disorder?
Treatment: how is bipolar disorder treated
What should I do if I have symptoms?
Life with a diagnosis and self-help
Guide for loved ones: what should I do if someone I love has bipolar disorder?

What is bipolar disorder?

The term ‘bipolar’ is often misused to describe a person whose mood and/or emotions can change rapidly within a few moments. This phenomenon is actually called emotional instability, and it is not a mental health disorder, but rather a symptom found in various conditions.

Bipolar disorder, on the other hand, is a mental health condition manifested by episodes of extreme mood, which can be positive (hyperactivity, euphoria), negative (sadness, lethargy) or a combination of both, and is usually accompanied by major changes in energy levels, activity and concentration. These episodes don’t last minutes or hours, but weeks or even months, and can seriously affect a person’s life, in some cases even being fatal. It is important to understand these distinctions so as not to stigmatise those who suffer from this condition, and to detect the signs of a possible mood disorder as quickly as possible.

How widespread is it?

In Romania, a 2009 study (The Romanian Mental Health Survey [1]) showed that the prevalence of bipolar disorder in the general population (the percentage of people suffering from this condition) was 1.4%, a value close to those reported in the UK (2% [2]) or globally (1% [3]). This percentage is equivalent to a population of approximately 280,000 Romanians (at present).

In reality, however, many of those who suffer from bipolar disorder do not receive this diagnosis and are never treated. The same study shows that only 32.5% (nearly a third) of patients receive a diagnosis and start treatment within the first year of the onset of symptoms, and only 63.8% (nearly two-thirds) go through this initial process by the age of 50 [1]. This means that approximately one-third of Romanians with bipolar disorder are never treated.

What causes it and who can develop it?

Two-part image, the first part with a superhero man and the second with the man sinking

https://minddoc.de/magazin/bipolare-stoerung-manische-depression/

Like any complex psychiatric condition, bipolar disorder is caused by a combination of genetic and environmental factors that are not fully understood. Environmental factors include psychological and social factors, such as childhood trauma (abuse, neglect or the loss of a loved one), which is why post-traumatic stress disorder is often encountered concurrently. Both the genetic and environmental components explain the fact that bipolar disorder runs in families (you have an increased risk if someone in your family suffers from this condition), but it can in principle affect anyone.

Bipolar disorder usually appears in adolescence or in early adulthood, and can occur in very rare cases in children as well. Women and men are equally predisposed. Certain triggers are associated with the onset of symptoms, as well as with the onset of extreme episodes:

stress
financial problems, at work or in personal life
stressful events, such as the death of a loved one, physical, sexual or emotional abuse or the end of a relationship
certain physical illnesses
lack of sleep
pregnancy and hormonal changes
the changing of the seasons

Similar symptoms can also be triggered by alcohol, drugs and certain medications, but in these situations it is most likely not bipolar disorder.

The biological mechanism of this condition is not known, but it is believed to involve a disruption in the levels of certain chemical compounds that help the brain function. The theory comes from the fact that the medications used to treat this condition alter the levels of these compounds, and it is considered that they return them to a normal state.

Bipolar disorder is a chronic condition that usually lasts a lifetime, requiring continuous treatment. It is important to point out that bipolar disorder is one of the most serious mental health problems in terms of mortality, as it increases the risk of suicide by 15-20 times compared to the general population [4]. This makes the need for early detection and treatment particularly important!

Symptoms: how can I tell if I might have bipolar disorder?

If you frequently have extreme moods, it is very possible that you suffer from a mood disorder. If these states are always negative (a state of particularly low mood, sadness and lethargy), it is probably depression (also called unipolar depression). On the other hand, if at least part of the extreme states are in the other, positive direction (particularly good mood, hyperactivity and euphoria), it is possible that you suffer from a disorder on the bipolar spectrum.

Bipolar spectrum disorders are of several types:

bipolar I disorder (formerly called “manic-depressive” or “bipolar depression”): this is the classic type, with episodes of mania that alternate (in most patients, but not all) with usually severe episodes of depression
bipolar II disorder: the positive episodes or states are less extreme and are called hypomania, while the episodes of depression can be just as severe
subthreshold bipolar disorder: when the patient presents symptoms of bipolar disorder, but these are not sufficient to define a manic/hypomanic episode
cyclothymia: a less severe variant of bipolar II disorder, in which states of hypomania alternate with less severe depressive states, usually in an oscillatory way

Mood fluctuation in mental disorders such as depression and bipolar disorder

Osmosis

Episodes in which the mood is extremely low are depressive episodes, while those in which the mood is good are divided into very extreme episodes (of mania) or more moderate ones (of hypomania). Depressive and (hypo)manic episodes manifest through the following symptoms (most of which are in contrast):

The depressive episode

you feel sad, emotionally empty, pessimistic or hopeless most of the time
you have no energy, you feel slowed down or, on the contrary, you feel agitated
you speak more slowly
you have lost interest in daily activities, things that you used to enjoy no longer give you pleasure; you no longer have a libido
you have problems with concentration and memory
you have problems with sleep: either you cannot sleep (insomnia), or you sleep too much
you have no appetite and lose weight, or you have an increased appetite and gain weight
it’s hard for you to make decisions
you have feelings of guilt and despair, you feel useless, worthless and you doubt yourself
you have suicidal thoughts

What are the Different Types of Bipolar?

The manic/hypomanic episode

you feel very good, in a state of happiness or euphoria
you have a lot of energy, you are irritable or agitated
you speak very fast and your “ideas are racing” (thoughts pass through your mind very quickly and words cannot keep up)
you have many ideas and plans, you want to do many things at the same time and you get involved in many projects without finishing them; you have an increased libido
you lose your concentration very easily
you don’t feel the need for sleep
you don’t feel the need for food
you make risky decisions that are not characteristic of you or that can put you in danger, such as massive spending on shopping, excessive eating, unprotected sex, alcohol or substance use, or betting and gambling
you feel extreme self-confidence (you feel you can succeed at anything) or grandiosity (you feel you are very important, talented or powerful)
(only in some cases of mania) you suffer from psychosis, which manifests through delusions (you have illogical, meaningless thoughts) or hallucinations (you see or hear unreal things)

What are the Different Types of Bipolar?

Depressive episodes cannot be distinguished from those encountered in major depressive disorder (the clinical name for depression), which is why a large percentage of patients with bipolar disorder are initially misdiagnosed with depression, sometimes never receiving the correct diagnosis, and therefore not being treated correctly.

The way depressive and (hypo)manic episodes manifest differs from person to person. Some people with bipolar I disorder do not suffer from depressive episodes, but only manic ones. Some people have periods of normal mood (euthymia) between manic and depressive episodes, while others pass quickly from one to the other (rapid cycling). In some people, mixed episodes also appear, with a combination of depressive and manic symptoms (for example, hyperactivity with a low mood).

Treatment: how is bipolar disorder treated?

Treatment is essential to prevent episodes of mania and depression, reduce the severity of symptoms and keep them under control. Without treatment, manic episodes can last 3-6 months and depressive ones 6-12 months, the latter of which can lead to suicide. On the other hand, with effective treatment, the person can lead an almost normal life. Bipolar disorder is a recurrent chronic illness, so treatment must usually be followed for a lifetime.

The main goals of treatment are stabilising mood and associated symptoms, identifying triggers, practising a healthy lifestyle and forming an external support system. Different strategies will work for different people, and finding the optimal strategy is done together with a psychiatrist. This strategy may include:

1. Medication: the drugs usually used to reduce symptoms and prevent episodes are mood stabilisers, such as lithium, anticonvulsants (also used in the treatment of epilepsy) and antipsychotics (also used in the treatment of psychosis). Antidepressants may be prescribed as a secondary medication, but are not recommended outside of depressive episodes, as they can trigger and worsen states of mania.

https://www.verywellmind.com/treating-bipolar-disorder-3576129

The dose must be chosen carefully to ensure effectiveness and reduce side effects, which is why monitoring through blood tests and other physical exams must be done regularly in the case of lithium consumption. For the same reason, it is very important that, if you present side effects, you immediately inform your psychiatrist to modify the dose or stop the treatment.

2. Psychotherapy: a form of long-term psychotherapy can be useful alongside medication, especially in the treatment of depressive episodes; the most common forms are cognitive-behavioural therapy (which focuses on changing the way a person perceives a certain situation, with the aim of changing the way they act) or interpersonal therapy (which tries to resolve interpersonal problems)

Discussion between patient and therapist

https://www.verywellmind.com/treating-bipolar-disorder-3576129

3. Psychoeducation and self-help: learning about all aspects of the disorder can help the affected person accept their diagnosis, talk more openly about it and start to detect triggers; also, self-help practices and maintaining a healthy lifestyle help prevent extreme states.

https://www.verywellmind.com/treating-bipolar-disorder-3576129

4. External support: forming a support system greatly helps the affected person lead a normal life; psychoeducation for loved ones and family-focused therapies can help them be more understanding. For support, support groups or group therapy are also options.

What should I do if I have symptoms?

If you feel you have one or more of the symptoms above (including if you received a diagnosis of depression some time ago, but you consider that you present symptoms of mania or hypomania), it is very important to consult your GP as soon as possible. They can issue a referral letter to a psychiatrist. Following a clinical examination, the psychiatrist will establish a diagnosis and advise you on the most suitable course of treatment. This will most likely include medication prescribed by the psychiatrist and potentially the recommendation of a psychologist or a psychotherapist who can support you further. Psychological services can be obtained free of charge based on the referral from psychiatry, if you have medical insurance and the specialist in question has a contract with the insurance house. (See our page for more information regarding available reimbursed psychological services). Ideally, the psychiatrist and the therapist will help you together to find the optimal treatment strategy for you.

If you have the necessary funds, we recommend making an appointment directly with a psychiatrist who practises in a private cabinet or clinic, to benefit from a consultation as quickly as possible. If you feel you are in a serious state, have self-harming or suicidal thoughts, call 112 or one of the TelVerde helplines in Romania (https://mentalhealthforromania.org/ro/call-center). In the case of a serious state, psychotic experiences, or an extremely unstable mood, hospitalisation is also recommended for closer monitoring and access to medication.

Life with a diagnosis and self-help

The memory of someone with bipolar disorder

https://www.bphope.com/wp-content/uploads/2017/01/Mania-Bipolar-Memory.jpg

Living with bipolar disorder can be difficult, and it’s normal to feel as if you’re not in control. The diagnosis itself can be scary, but it is the first step necessary to gain access to treatment. Furthermore, open and honest communication with the psychiatrist and eventual psychotherapist is also essential, as is the regularity of treatment. In addition to medical support, there are a number of self-help strategies you can do yourself to help you cope better:

1. Learn to recognise triggers (for example, a stressful deadline) and warning signs (such as changes in your sleep schedule).

2. Monitor your mood over longer periods of time (you can use a “mood diary”: https://www.bipolaruk.org/FAQs/mood-diary).

3. Take care of your physical health, through regular exercise, a balanced diet and sufficient sleep.

4. Create a routine and stick to it.

5. Try to reduce stress, for example through relaxation exercises, meditation or mindfulness.

6. Make a crisis plan, so you know what to do when you detect warning signs, and inform your friends and family as well.

7. Try to speak openly about your experiences with friends and family.

8. DO NOT consume alcohol or drugs! These are an attractive “coping mechanism”, but in the long term they only do more harm.

Guide for loved ones: what should I do if someone I love has bipolar disorder?

Seeing a loved one go through extreme states can be painful. However, the way you react can make a big difference in how they feel. It is mainly important to be there for them and encourage them to seek help. Always communicate openly about what they need, including a crisis plan so you know how to react and help better. Show understanding towards the extreme states, but if you encounter difficulties when they are going through such states, try to find a moment when they are in a good state to talk to them about it. Learn to predict the triggers and warning signs yourself to avoid and manage them. At the same time, it’s important to take care of yourself and your mental health to ensure you can continue to offer support.

One of the most important things is not to make assumptions about the experiences of people with bipolar disorder, and not to trivialise their experiences. Bipolar disorder is one of the most stigmatised mental health conditions, so it is all the more important to take care not to fall into this trap, whether it’s a loved one or someone less close.

What NOT to say to a person with bipolar disorder:

1.
“I’m also/everyone is a little bipolar sometimes”
2.
“Everyone has good days and bad days”
3.
“You’re exaggerating again, snap out of it”
4.
“I wish I were manic too so I could be productive”
5.
“Have you taken your medication?”
6.
“It’s your fault you’re like this”
7.
“I can’t stand you taking your anger out on me anymore”

What to say instead:

1.
“I’m here for you and I’m listening”
2.
“How can I help you?”
3.
“It’s a medical condition and it’s not your fault”
4.
“The disorder doesn’t define you”
5.
“It must be extremely difficult to go through this, I’m proud of you”
6.
“I might not understand what you’re going through, but I’m here”
7.
“I care about you and you are important to me”