Introduction
Bipolar disorder is a disorder involving significant changes in mood and energy that affect negatively (and in some instances positively) the ability to carry out day to day tasks. A person with bipolar disorder alternates between mania, or hypomania. These consist of periods of change in mood: elevated (very happy, euphoric) and or increased irritability (mild, moderate, extreme). These changes in mood are both accompanied with increased levels of energy above his/her normal usual moods and energy; the same person experiences at other times the other side of the bipolarity, that is he/she experiences episodes of depressions: which are characterized by low moods or loss of interest. Such mood swings and energy are different from the usual “ups” or “downs” a person usually feels. In bipolar disorder, the changes in mood or “mood swing” can last for hours, days, weeks, or even months.
Such disruptive behaviors (whether one is in a manic/hypomanic or a depressed phase) may result in problematic relationships, irregular work or school performance or sometimes self-harming behaviors. If untreated, a person may put himself at high risk where his safety could be seriously jeopardized and in turn interfere with his adaptive functioning and well-being.
Overview and Facts
Bipolar disorder often develops in a person’s late teens or early adult years. At least half of all cases start before age 21. Some have their first symptoms during childhood, while others may develop symptoms late in life.
Bipolar disorder usually begins during a person’s late teen years, although it can sometimes start in early childhood or as late as a person’s 60s or 70s. An equal number of men and women develop this illness, and it affects people of all races, ethnic groups and social classes.
A study was conducted by IDRAAC (Institute for Development, Research, Advocacy and Applied Care) to assess the lifetime prevalence of mental disorders in Lebanon (one meeting criteria for a mental disorder at some point in his life). Results showed that the lifetime prevalence of someone having any type of bipolar disorder was 2.4% (Bipolar I 0.4%, Bipolar II 0.5% and Subthreshold Bipolar 1.5%).
The prevalence is probably higher as we have demonstrated in a landmark study (Karam et al., 2014).
Symptoms
The symptoms of bipolar disorder are divided into manic, hypomanic, depressive and mixed episodes.
For more information, please download the Brochure Available at the bottom of the page.
Causes and Risk Factors
Bipolar disorder is one of the most highly heritable disorders among medical diseases. A large number of studies have shown that bipolar disorder runs in families. Twin studies have clearly shown that bipolar disorder is inherited because of genetic influences.
Some famous people "thought" to have bipolar disorder:
- Actors: Jim Carey, Robert Downey Jr., Ben Stiller, Robin Williams, Mel Gibson, Jean-Claude Van Damme, Tim Burton, Drew Carey, Marilyn Monroe, Catherine Zeta Jones
- Musicians: Ludwig Von Beethoven, Jimi Hendrix, Axl Rose, Kurt Cobain, Ray Davies, Mozart
- General: Vincent Van Gogh, Isaac Newton, Napoleon Bonaparte
- Poets: Charles Baudelaire, William Blake, TS Elliott, Victor Hugo
- Politicians: Winston Churchill, Theodore Roosevelt, Abraham Lincoln
- Writers: Edgar Allen Poe, Mark Twain, Virginia Woolf, Ernest Hemingway, Lord Byron, Ralph Emerson, Hans Christian Anderson, Agatha Christie, Emily Dickinson
Tests and Diagnosis
To be able to diagnose a person with bipolar disorder, the physician needs to assess the symptoms, their length, frequency and severity in order to be able to present a clear diagnosis.
The Bipolar Spectrum includes different types of Bipolar Disorders that differ based on the length, frequency and pattern of the manic and depressive episodes. The bipolar spectrum includes Bipolar I, Bipolar II and Cyclothymia.
- Bipolar I is characterized by periods of full blown mania and could be accompanied with major depressive episodes and/or psychotic symptoms at times (hallucinations hearing and seeing things that are not real, delusions- strongly held false beliefs that are not explained by reason). It is the most severe form of Bipolar Disorder.
- Bipolar II is characterized by hypomanic symptoms which are less severe than manic symptoms and major depressive episodes.
- Cyclothymia is characterized by at least two years of hypomanic and mild depressive symptoms that do not meet criteria for manic or depressive episodes.
Treatment
The treatment of bipolar disorderi ncludes:
- Psycotherapy: There are many types of therapy that can help someone address issues in his life and learn new ways to cope with his illness. An example of an evidence-based approach in treating bipolar disorder is cognitive behavioral therapy (CBT). The focus is on under¬standing the relationships between thoughts, emotions and behaviors and identifying distorted automatic thoughts, dysfunctional core beliefs and assumptions that are as¬sociated with the illness and interfere with the way one views himself, others and his environment.
- Medications for bipolar disorder:
There are specific medications for treating bipolar disorder. They include:
- Mood stabilizers: These medications help regulate mood fluctuations. Some examples are Lithium Carbonate, Valproic Acid (Depakine), Lamotrigine (Lamictal) and Carbamazepine (Tegretol).
Printed brochures on the mood stabilizers Valproic Acid (Depakine) and Lithium are available at M.I.N.D. (Medical Institute for Neuropsychological Disorders) offices if you would like to obtain additional information about them.
- Antipsychotics: They are part of another class of medication but are highly used and recommended in treating symptoms of mania. There are two main categories of antipsychotics (old generation and new generation). The most famous example of the old generation is Haloperidol (Haldol). Some examples of the new generation are Que¬tiapine (Seroquel), Risperidone (Risperdal), Olanzapine (Zyprexa), Ziprasidone (Zel¬dox), Aripiprazole (Abilify) and Paliperidone (Invega).
Lifestyle changes:
A healthy lifestyle is always conducive to better wellbeing. Hence, one can improve his mood by improving his health habits.
- Ensure treatment compliance (medication and/or therapy compliance)
- Maintain a regular sleep schedule.
- Avoid high-stress situations
- Share talking and listening time with a friend often, especially during difficult times.
- Exercise regularly. It helps one relax and reduce stress.
- Take a walk each day.
- Engage attention in pleasant and interesting activities.
- Create a daily planning calendar.
- Limit alcohol and avoid illegal drugs.
- Avoid caffeine and stimulants (ex: energy drinks).
- Try to maintain a calming and safe environment.
Sources and Links
Adapted from National Institute of Mental Health (NIMH), Depression and Bipolar Support Alliance (DBSA), Child and Adolescent Bipolar Foundation, and www.idraac.org.
Angst, J. & Marneros A. (2001). Bipolarity from ancient to modern times: conception, birth and rebirth. Journal of Affective Disorders, 67, 1-3, 3-19.
Barnett, J. & Smoller, J. (2009). The genetics of bipolar disorder. Neuroscience, 164, 1, 331-3439
Karam, E. G., Sampson, N., Itani, L., Andrade, L. H., Borges, G., Chiu, W. T., Akiskal, H. (2014). Under-reporting bipolar disorder in large-scale epidemiologic studies. Journal of Affective Disorders, 159, 147–154.