Bipolar Disorder

Bipolar disorder is a complex mental health condition characterized by significant, often dramatic, shifts in mood, energy, activity levels, and the ability to function daily. The extreme mood changes can profoundly affect a person’s life, relationships, and work, highlighting the critical need for understanding bipolar symptoms and effective bipolar disorder treatment.

Overview

Bipolar disorder is a mental health condition that affects a person’s mood, energy, activity level, and ability to function in daily life. It is a chronic condition characterized by episodes of extreme highs (mania or hypomania) and lows (depression), with periods of stability in between. Bipolar disorder can have a significant impact on a person’s life, relationships, and work.

Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can be different for each person, but they usually fall into two main groups:

Manic or Hypomanic Episodes (High Mood)

• Feeling very happy, excited, or full of energy for no clear reason
• Doing many things at once and working much more than usual
• Sleeping very little but not feeling tired
• Feeling much better or more important than other people
• Thinking and talking very fast, jumping from topic to topic
• Acting without thinking and doing risky things
• Having a much higher interest in sex than normal
• Sometimes seeing or hearing things that aren’t really there

Depressive Episodes (Low Mood)

• Feeling very sad, hopeless, or empty most of the time
• Crying a lot and feeling very tired with no energy
• Big changes in eating habits like eating too much or too little
• Sleeping problems like can’t sleep or sleeping too much
• Losing interest in things that used to be fun
• Having trouble focusing, remembering things, or making decisions
• Moving or talking much slower than usual
• Feeling guilty or worthless about everything
• Having thoughts about death or wanting to hurt yourself

Causes

The causes of bipolar disorder can vary from person to person. Understanding these potential causes is an important part of comprehending bipolar symptoms and the approach to bipolar disorder treatment.

• Family History: If a family member has bipolar disorder, ADHD, or depression, you may have an increased likelihood of developing these conditions as well.
• Neurochemical Imbalances: The brain relies on neurotransmitters to regulate mood and attention. When these chemical systems function improperly, they can contribute to mood fluctuations and concentration difficulties.
• Chronic Stress: Prolonged exposure to stressful situations can precipitate bipolar episodes or exacerbate existing symptoms.
• Sleep Disruption: Insufficient sleep can destabilize mood regulation and serve as a trigger for episodes in individuals predisposed to bipolar disorder.
• Significant Emotional Trauma: Traumatic experiences such as relationship dissolution, childhood abuse, or bereavement can increase risk factors for developing the condition.
• Postpartum Period: Some individuals develop bipolar disorder following childbirth, often in conjunction with postpartum depression or other perinatal mood disorders.
• Comorbid Medical Conditions: Certain medical conditions, particularly thyroid disorders, can sometimes present with symptoms that mimic or contribute to bipolar disorder.

Types of Bipolar Disorder

Bipolar disorder is categorized into different types based on the patterns and severity of bipolar symptoms. Each type requires specific considerations for bipolar disorder treatment.

• 1. Bipolar I Disorder

Characterized by at least one manic episode that lasts for at least one week or is severe enough to require hospitalization. Depressive episodes are also common in Bipolar I, though a depressive episode is not required for diagnosis. Manic episodes can be so intense that they may be difficult to distinguish from certain forms of schizophrenia.

• 2. Bipolar II Disorder

Defined by episodes of major depression and hypomania. Hypomanic episodes are not as intense as full-blown manic episodes and typically don’t cause significant impairment in daily functioning or require hospitalization.

• 3. Cyclothymic Disorder (Cyclothymia)

A milder but more chronic form of bipolar disorder, characterized by numerous periods of hypomanic symptoms and numerous periods of depressive symptoms lasting for at least two years in adults (one year in children and adolescents). The symptoms are less severe than those seen in Bipolar I or Bipolar II, but the mood swings are persistent and noticeable.

• 4. Other Specified and Unspecified Bipolar and Related Disorders

This category includes individuals who experience bipolar symptoms that don’t precisely meet the criteria for Bipolar I, Bipolar II, or cyclothymic disorder. This might be due to mood swings caused by substance use, certain medical conditions, or other specific patterns of symptoms that don’t fit the standard classifications.

When to See a Doctor

If you or someone you know is experiencing symptoms of bipolar disorder, it is important to seek medical attention. A doctor or mental health professional can evaluate the symptoms and provide a proper diagnosis.

When to Get Emergency Help

Emergency medical help should be sought if a person is experiencing severe symptoms of bipolar disorder, such as suicidal thoughts, psychosis, or extreme agitation. If a person is unable to care for themselves or is a danger to themselves or others, they should seek emergency medical help.

Diagnosis

Diagnosis of bipolar disorder is typically made by a mental health professional, such as a psychiatrist. A thorough evaluation is necessary to rule out other conditions and determine the presence of manic or depressive episodes.

Components of the Evaluation

• Psychiatric Evaluation: This is the core of the diagnostic process. It involves detailed interviews with the individual to assess their symptoms, including:
  • Description and duration of mood episodes (manic, hypomanic, depressive, or mixed).
  • Severity of symptoms and their impact on daily functioning (work, relationships, self-care).
  • Thought patterns, energy levels, sleep disturbances, and behavioral changes.
  • Presence of any psychotic symptoms (e.g., hallucinations, delusions).
• Physical Exam: A general physical examination and lab tests may be conducted to rule out any underlying medical conditions that could be contributing to the symptoms.
• Mood charting: In order to track your mood, you might have to keep a daily log of your moods, sleep habits, and other relevant factors. This record helps your healthcare team identify patterns and better understand your condition.

Key Information for Diagnosis

• Personal Medical History: A detailed account of the individual’s past mental and physical health issues, including previous episodes of mood disturbances, treatments, and their responses.
• Family History: Information about mental health conditions, particularly mood disorders like bipolar disorder, in close relatives is highly relevant, as there is a strong genetic component to the illness.

Treatment

Treatment for bipolar disorder usually involves a combination of medication, mental health therapy, and lifestyle changes.

• Psychotherapy: Different therapeutic approaches help individuals develop coping skills, manage stress, identify triggers, and improve interpersonal relationships.
• Lifestyle Changes: Adopting healthy habits, such as regular exercise, a balanced diet, and consistent sleep patterns, can significantly support mood stability and complement other treatments.
• Deep Transcranial Magnetic Stimulation (dTMS): is a non-invasive treatment that uses magnetic fields to stimulate specific brain regions. For bipolar disorder, it is primarily used to target the depressive phase, helping to regulate mood when traditional medications are ineffective. 
• Ongoing Support: Working closely with a mental health professional and potentially engaging with support groups provides essential guidance and a network for managing the long-term aspects of the condition.
• Intensive Outpatient Programs or Hospitalization: For severe episodes, or when there’s a risk of harm, more intensive programs or a hospital stay may be necessary for stabilization and close monitoring of bipolar symptoms and treatment response.

Medicines

Medication is a cornerstone of bipolar disorder treatment, aiming to regulate brain chemistry and stabilize mood. The choice of medication often depends on the predominant bipolar symptoms and individual response. It’s crucial to work closely with a healthcare professional to find the right combination and dosage, and to never stop or alter medication without medical guidance due to the risk of withdrawal or symptom worsening.

• Mood Stabilizers: These are foundational for managing both manic episodes and also might help depressive episodes as well.
  • Examples: Lithium, valproic acid (Depakote), divalproex sodium, carbamazepine (Tegretol, Equetro), and lamotrigine (Lamictal).
• Antipsychotics: Often used for manic or mixed episodes, and sometimes for depressive episodes, many antipsychotics also have mood-stabilizing properties. They can be used alone or with mood stabilizers.
  • Examples: Olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), asenapine (Saphris), lumateperone (Caplyta), and cariprazine (Vraylar).
• Antidepressant-Antipsychotic Combinations: Some medications combine an antidepressant and an antipsychotic, specifically approved for bipolar depression.
  • Example: Symbyax (fluoxetine and olanzapine combination).
• Antidepressants: These may be cautiously added to address depressive bipolar symptoms, but are typically prescribed alongside a mood stabilizer or antipsychotic to prevent triggering a manic or hypomanic episode.
• Antianxiety Medicines (Benzodiazepines): Used short-term to help with anxiety and improve sleep, but generally avoided for long-term use due to potential for dependence.
• Spravato (Esketamine): is a prescription nasal spray used alongside oral antidepressants for treatment-resistant depression in adults. It works by targeting glutamate receptors in the brain to provide rapid symptom relief, but must be administered strictly under medical supervision due to potential side effects like dissociation and increased blood pressure. 

Complication

Untreated or poorly managed bipolar disorder can lead to various complications, impacting many aspects of a person’s life. 

• Physical Health Issues: Higher likelihood of developing conditions such as cardiovascular disease, diabetes, obesity, and chronic headaches.
• Co-occurring Mental Health Conditions: Often accompanied by anxiety disorders, ADHD, or thyroid disease.
• Substance Abuse: Increased risk of developing drug or alcohol addiction as a way to self-medicate or cope with mood swings.
• Legal and Financial Problems: Risky behaviors during manic episodes can lead to legal troubles or significant financial difficulties.
• Relationship Dysfunction: Strained relationships with family and friends due to unpredictable mood changes and associated behaviors.
• Suicidal Ideation and Attempts: A significant risk, particularly during depressive or mixed episodes, making emergency intervention crucial when these bipolar symptoms are present.

Prevention

Early recognition of bipolar symptoms and consistent engagement with bipolar disorder treatment can significantly mitigate its impact and reduce the severity and frequency of episodes. 

• Monitor Warning Signs: Pay close attention to changes in mood, energy levels, and behavior. Learning to identify personal triggers for manic or depressive episodes can help in seeking timely intervention. This includes noticing extremes in happiness or anger, or impulsive, risky behaviors.
• Avoid Substance Use: Alcohol and recreational drugs can exacerbate bipolar symptoms and trigger episodes, making them significant risk factors. Abstinence or careful management of substance use is vital.
• Adhere to Treatment Plans: Consistency with prescribed medications and therapy is crucial. Skipping doses, stopping medication abruptly, or reducing dosages without medical consultation can lead to relapse or worsening of bipolar symptoms.
• Establish a Healthy Routine: Maintaining a regular schedule for sleep, meals, and physical activity helps stabilize mood. Regular exercise, at least 3-4 times a week for 30 minutes, can release endorphins, reduce stress, and promote better sleep.
• Open Communication: Regularly communicate with your healthcare provider about any changes in your bipolar symptoms or concerns about your bipolar disorder treatment. Discuss all medications and supplements you’re taking to avoid potential interactions.
• Mood Charting: Keeping a daily log of your moods, sleep patterns, activities, and feelings can help you and your healthcare team identify patterns, triggers, and the effectiveness of your bipolar disorder treatment.

Quality Care for Bipolar Disorder 

Navigating bipolar symptoms and finding effective bipolar disorder treatment requires specialized care. At Bangkok Mental Health Hospital, we understand the complexities of bipolar disorder and offer a comprehensive approach to help individuals achieve stability and improve their quality of life. 

Our expert team provides integrated outpatient services and inpatient services, including personalized therapy sessions and medication management, all designed to address the unique needs of each patient. We are committed to supporting your journey toward mental wellness. Contact us today, we are here to help.

• Phone: 02-589-1889
• Line: @bmhh
• Mail: [email protected]
• Location: Tiwanon – Pathum Thani road, Tha Sai, Mueang Nonthaburi Nonthaburi 11000

Article By
Assistant Professor Special Prakarn Thomyangkoon, M.D.
Adult Psychiatry
Bangkok Mental Health Hospital (BMHH)