Contents:
- 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 of various conditions.
Bipolar disorder, on the other hand, is a mental disorder manifested by episodes of extreme moods, which can be positive(hyperactivity, euphoria), negative(sadness, lethargy) or a combination of both, and is usually accompanied by major changes in energy, 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 fatally. It’s important to understand these distinctions so as not to stigmatize sufferers, and to spot the signs of a possible mood disorder as early 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%, which is close to the prevalence reported in the UK(2% [2]) or globally(1% [3]). This percentage is equivalent to a population of about 280,000 Romanians (currently).
In reality, however, many people with bipolar disorder are not diagnosed and never get treatment. The same study shows that only 32.5% (almost one third) of patients receive a diagnosis and start treatment within the first year of symptom onset, and only 63.8% (almost two thirds) go through this initial process by the age of 50 [1]. This means that about a third of Romanians with bipolar disorder never seek treatment.
What causes it and who can develop it?
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 loss of a loved one), which is why post-traumatic stress disorder is often co-occurring. Both genetic and environmental components explain why bipolar disorder runs in families (you’re at increased risk if someone in your family suffers from it), but it can affect anyone.
Bipolar disorder usually appears in adolescence or early adulthood, but in very rare cases it can also occur in children. Femeile și bărbații sunt la fel de predispuși. Certain triggers are associated with the onset of symptoms as well as the onset of extreme episodes:
- stress
- financial, work or personal problems
- 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
- changing seasons
Similar symptoms can also be triggered by alcohol, drugs and certain medications, but in these cases it’s most likely not bipolar disorder.
The biological mechanism of the condition is not known, but it is thought to be a disturbance in the levels of certain chemicals that help the brain function. The theory stems from the fact that the drugs used to treat the condition alter the levels of these compounds, which are thought to bring them back to normal.
Bipolar disorder is a chronic, usually lifelong condition that requires ongoing treatment. It is important to note that bipolar disorder is one of the most serious mental health problems in terms of mortality, increasing 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 experience extreme moods, it’s very likely that you have a mood disorder. If these moods are always negative (particularly low mood, sadness and lethargy), it is probably depression (also called unipolar depression). On the other hand, if at least some of your extreme moods are in the other, positive direction(particularly good mood, hyperactivity and euphoria), you may be suffering from a bipolar spectrum disorder.
There are several types of bipolar disorder:
- type I bipolar disorder (formerly called ‘manic-depressive’ or ‘bipolar depression’): this is the classic type, with episodes of mania alternating (in most, but not all, patients) with episodes of usually severe depression
- type II bipolar disorder: the positive episodes or moods are less extreme and are called hypomania, while depressive episodes can be just as severe
- subthreshold bipolar disorder: when the patient has symptoms of bipolar disorder but not enough to define a manic/hypomanic episode
- cyclothymia: a less severe variant of bipolar II disorder, in which hypomanic states alternate with less severe depressive states, usually in an oscillatory fashion
Episodes when mood is extremely bad are episodes of depression, while those when mood is good are divided into very extreme ( manic) or more moderate ( hypomanic) episodes. Depressive and (hypo)manic episodes manifest with 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, feel sluggish or feel restless
- you speak slowly
- you’ve lost interest in everyday activities, you no longer enjoy things you used to enjoy; you no longer have a libido
- you have problems with concentration and memory
- you have sleep problems: either you can’t sleep (insomnia) or you sleep too much
- you have no appetite and lose weight, or have an increased appetite and gain weight
- you find it difficult to make decisions
- you have feelings of guilt and hopelessness, worthlessness, worthlessness and self-doubt
- you have suicidal thoughts
The manic/hypomanic episode
- you feel really good, happy or euphoric
- you have a lot of energy, are irritable or agitated
- you talk very fast and “your ideas run away” (your thoughts go through your head very quickly and your words can’t keep up)
- you have lots of 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 a high libido
- you lose your concentration very easily
- you do not feel the need for sleep
- you don’t feel the need to eat
- you make decisions that are uncharacteristic of you or put you at risk, such as spending heavily on shopping, overeating, unprotected sex, alcohol or substance misuse, or betting and gambling
- you feel extreme self-confidence (feeling that you can do anything) or grandiosity (feeling that you are very important, talented or powerful)
- (only in some cases of mania) you suffer from psychosis, which is manifested by delusions (having illogical, nonsensical thoughts) or hallucinations (seeing or hearing things that make no sense)
Depressive episodes are indistinguishable from those seen 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 in which depressive and (hypo)manic episodes manifest differs from person to person. Some people with type I bipolar disorder don’t have depressive episodes, only manic episodes. Some people have periods of normal mood(euthymia) in between manic and depressive episodes, while otherscycle rapidly between the two. Some people also have mixed episodes, with a combination of depressive and manic symptoms (e.g. hyperactivity with 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 episodes can last 6-12 months; the latter can lead to suicide. However, with effective treatment, the person can lead an almost normal life. Bipolar disorder is a chronic relapsing illness, so treatment is usually lifelong.
The main goals of treatment are to stabilize the mood and the associated symptoms, identify triggers, stimulate a healthy lifestyle and build an external support system. Different strategies will work for different people, and finding the optimal strategy is done together with the psychiatrist. Different strategies may include:
1. Medication: the medications commonly used to reduce symptoms and prevent episodes are mood stabilizers, such as lithium, anticonvulsants (also used to treat epilepsy) and antipsychotics (also used to treat psychosis). Antidepressants can be prescribed as a secondary medication, but are not recommended outside of depressive episodes, as they can trigger and worsen manic states.
The dose needs to be chosen carefully to ensure effectiveness and reduce side effects, which is why monitoring with blood tests and other physical examinations should be done regularly when taking lithium. For the same reason, it is very important that if you experience side effects, you should tell your psychiatrist immediately to change the dose or stop treatment.
2. Psychotherapy: a form of long-term psychotherapy can be useful in addition to medication, especially in the treatment of depressive episodes; the most common forms are cognitive-behavioral therapy (which focuses on changing the way a person perceives a situation, with the aim of changing the way they act) or interpersonal therapy (which attempts to solve interpersonal problems)
3. Psychoeducation and self-help: information about all aspects of the disorder can help the affected person to accept their diagnosis, talk more openly about it and begin to recognize triggers; self-help practices and maintaining a healthy lifestyle also help prevent extreme states.
4. External support: forming a support system greatly helps the affected person to lead a normal life; psychoeducation of loved ones and family-focused therapies can help them to be more understanding. For support, support groups or group therapy are also an option.
What should I do if I have symptoms?
If you feel that you have one or more of the above symptoms (including if you have been diagnosed with depression in the past, but you think you have symptoms of mania or hypomania), it is very important to see your GP (family doctor) as soon as possible. They can issue a referral letter to a psychiatrist. Following a clinical examination, the psychiatrist will make a diagnosis, and advise you on the most appropriate course of treatment. This will most likely include medication prescribed by your psychiatrist and potentially the recommendation of a psychologist or psychotherapist who can support you further. Psychological services can be obtained free of charge on the basis of a psychiatric referral note, if you have health insurance and the specialist in question has a contract with the National Health Insurance House. (See our page for more information about psychological services in Romania). Ideally, your psychiatrist and therapist will work together to help you find the best treatment strategy for you.
If you have the necessary funds, we recommend that you make an appointment directly with a psychiatrist practicing in a private practice or private clinic to get a consultation as quickly as possible. If you feel that you are in a serious state of distress, have self-harming or suicidal thoughts, call 112 or one of the helplines in Romania(https://mentalhealthforromania.org/ro/call-center). In the case of a serious condition, psychotic experiences, or an extremely unstable mood, hospitalization is also recommended for closer monitoring and access to medication.
Life with a diagnosis and self-help
Living with bipolar disorder can be difficult, and it is normal to feel like you are not in control. The diagnosis itself can be scary, but it is the first step needed to get access to treatment. Furthermore, open and honest communication with the psychiatrist and psychotherapist is also essential, as is regular treatment. As well as medical support, there are a number of self-help strategies you can do yourself to help you cope better:
1. Learn to recognize triggers (e.g. a stressful deadline) and alarm signals (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. Look after your physical health with regular exercise, a balanced diet and enough sleep.
4. Make 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 spot warning signs, and let your friends and family know.
7. Try to talk openly about your feelings with friends and family.
8. DO NOT use alcohol or drugs! They are an attractive coping mechanism, but in the long run they only do more harm.
Guide for loved ones: what should I do if someone I love has bipolar disorder?
Watching a loved one go through extreme states can be painful. However, how 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 best to react and help. Show understanding towards their extreme states, but if you have difficulties when they are going through them, try to find a time when they are in a good state to talk to her about them. Learn to predict the triggers and warning signs to avoid and manage them. At the same time, it is important to look after yourself and your mental health to ensure you can continue to provide support.
One of the most important things is not to make assumptions about the experiences of people with bipolar disorder, and not to trivialize their experiences. Bipolar disorder is one of the most stigmatized mental illnesses, so it is all the more important to be careful not to fall into this trap, whether it is someone close to you or someone less close.
What NOT to say to someone with bipolar disorder:
1.
“I am/everyone is a bit bipolar sometimes”
2.
“Everyone has good days and bad days”
3.
“You’re exaggerating again, get over it”
4.
“I wish I was manic so I could be productive”
5.
“Have you taken your medication?”
6.
“It is your fault you are like this”
7.
“I cannot take it anymore when you get on my nerves”
What to say instead:
1.
“I’m with you and I’m listening”
2.
“How can I help you?”
3.
“It is a medical condition and it is not your fault”
4.
“This illness does not define you”
5.
“It must be extremely difficult to go through this, I’m proud of you”
6.
“I may not understand what you’re going through but I’m here”
7.
“I care about you and you are important to me”
Bibliography & resources:
SCIENTIFIC ARTICLES:
[3] Grande et al., Bipolar Disorder. Lancet 2016; 387: 1561–72
RESOURCES IN ENGLISH:
[5] NHS (UK National Health Service)
[6] Mental Health Foundation (UK charity)
[7] Mind (UK mental health charity)
[8] Bipolar UK (charity focusing on bipolar disorder)
[9] NIMH (National Institute of Mental Health in the United States)
RESOURCES IN ROMANIAN:
[10] Bipolar disorder – Regina Maria
[11] Bipolar disorder – “Dr. Victor Babes” Medical Diagnostic and Treatment Center
[12] Bipolar disorder – what it is, how to recognize it and how to cope – Interview
[13] Myths about Bipolar Disorder
EDUCATIONAL RESOURCES ON YOUTUBE:
[14] TED-Ed
[16] Osmosis
