Bipolar disorder refers to a mental health condition belonging to the family of mood disorders, a clinical state involving intense alterations in moods lasting for a long while. A person diagnosed with this condition experiences emotional highs and lows in episodes. The two dominating moods in mood disorders are depression and mania.
Depression makes a person feel dejected and lose interest in their surroundings. Mania on the other hand is often known as exceptional and unreasonable feelings of excitement and general elation in the mood. These disruptions in mood are extreme and persistent enough to cause fatal problems with day-to-day life.
What is Bipolar Disorder?
Among the two types of mood disorders, bipolar disorders are distinguished from unipolar disorders because of the manic and hypomanic episodes, which are almost always followed by episodes of depression. In simpler terms, it can be described as an emotional rollercoaster ride in which a person drops from an emotional high to an emotional low.
The earlier term, manic-depressive insanity, to describe this disorder gave a clear clinical picture of it as well. Kraeplin (German Psychiatrist) introduced the latter-mentioned term and described this disorder as a series of euphoric and depressive outbursts, with periods of normality in between.
The new term ‘Bipolar Disorder’ is an accurate way to describe it as well, if we break down the word ‘bipolar’; we get ‘bi’ meaning two and ‘polar’ meaning something completely opposite, describing the shift of two entirely different emotional states, mania and depression.
Bipolar disorder can further be categorised into two types:
Bipolar Disorder I
In this type of bipolar disorder, a person is considered to have full-blown mania. Individuals might also have mixed episodes in which both, mania and depression, occur either alternatively or simultaneously. The duration or severity of manic episodes might extend for seven days or longer, thereby necessitating immediate medical attention.
Bipolar Disorder II
In this type of bipolar disorder, a person has episodes of hypomania and depression, however, the symptoms do not cross the threshold of full-blown mania. It includes at least one episode each of hypomania lasting at least four days and depression lasting at least two weeks, the depressive episodes here are more intense. Those who experience hypomanic episodes exhibit manic symptoms while maintaining their ability to function.
Is it treatable?
Bipolar disorder is often chronic in nature and therefore ends up becoming a lifelong illness for many people. It however, is not untreatable. There are different treatments, including therapy and medications, to deal with this disorder. A treatment that is long-term and consistent, helps the person suffering from said disorder manage symptoms better and ensure that they lead a healthy life.
The first and foremost step towards treatment is diagnosis. The signs and symptoms of this condition are frequently disregarded and left untreated, which causes problems in a person’s life and in the lives of others around them. This disorder is recurring in nature which is why it demands continuous treatment. A correct diagnosis plays an important role in getting effective treatment.
Most individuals diagnosed with bipolar disorder experience significant impairment in their interpersonal and occupational activities. They face problems in their personal and work relationships on account of these recurring episodes of depression and mania.
There is no exact treatment for bipolar disorder; medications are used for mood stabilisation, and simultaneous therapy is often suggested as well but the chance of “full recovery” from bipolar disorder is depicted as very low.
Family members are suggested to refer to professional resources, particularly those affiliated with mental health advocacy and support groups. Bipolar disorder may seriously impair a person's everyday life and lead to a difficult home environment. These resources can teach families coping mechanisms and how to get involved in the treatment process and get relevant support.
Treatments and Outcomes
There is a great chance of a significant majority of individuals with mania and depression to recover without formal treatment (although temporarily) within a year. However, considering the enormous amount of personal suffering and lost productivity that these individuals endure, and given the wide variety of treatments available today, more and more people are seeking treatment. There is also increased public awareness of the existence of effective treatments nowadays and substantially less stigma associated with experiencing a mood disorder, hence, individuals are more likely to seek out formal treatment.
Antidepressants, mood stabilisers, and antipsychotic drugs are used for this category of treatment. Treatment with antidepressant drugs requires 3 to 5 weeks to take effect. Physicians often try different medications if there is no improvement after 6 weeks. Discontinuing drugs after a course when the symptoms have subsided may lead to relapse as well.
Lithium as a mood stabiliser is prominently used for depressive and manic episodes of bipolar disorders in treatment. They contain antimanic and antidepressant effects which lead to a stabilisation in mood in either direction. These medications often have side effects as well, such as cognitive slowing, insomnia, weight gain and gastrointestinal distress.
Alternative biological Treatments
There are various alternative physiological techniques that are used for treating mood disorders in addition to the use of medication. These methods have recently been the focus of empirical research, and they seem like potential treatment options.
By stimulating the brain, electroconvulsive treatment (ECT) can help treat bipolar disorder's severe symptoms. Typically, ECT is only considered when other therapies, such as medication or psychotherapy, have failed to improve a patient's condition or when an immediate reaction is necessary, such as when a patient is at risk of suicide or is in catatonia (a state of unresponsiveness).
Individuals with refractory depression who have not improved after trying medication, psychotherapy, or ECT are given deep brain stimulation as a treatment option.
It involves placing an electrode in the brain and electrically stimulating that region.
In contrast to ECT, which employs an electrical stimulus to stimulate the brain, transcranial magnetic stimulation (TMS) stimulates the brain using magnetic waves to treat depression over a number of sessions.
TMS is not as effective as ECT, but is less dangerous and doesn't involve general anaesthesia. It also has fewer potential memory or cognitive side effects. Seasonal affective disorder (SAD) is most effectively treated with bright light therapy, and many patients with bipolar illness have a cyclical exacerbation of depression in the winter, often to the point of SAD.
Psychotherapy has been shown to be effective in the treatment and noticeable improvements have been made equivalent to those with the use of medications. There are specialised treatments developed to address the difficulties of people with bipolar disorder and frequently those of their families as well.
Some recommended psychotherapies are as follows:
Cognitive behavioural therapy- It is a thought-based therapy that is frequently patient-tailored and one of the most well-known types of psychotherapy. It makes systematic and highly structured attempts to help people with depression assess their dysfunctional beliefs and negative automatic thoughts.
Behavioural activation therapy -This therapeutic strategy strongly emphasises encouraging patients to interact more actively with their surroundings and other people. These strategies involve planning daily activities and measuring their enjoyment and competence, investigating other behaviours to achieve goals, and role-playing to address particular weaknesses.
Interpersonal therapy and social rhythms - It emphasises the importance of regulating daily social rhythms that, if left unstable, may contribute to the onset of bipolar episodes. Patients learn to identify how interpersonal interactions affect their circadian and social rhythms and how to regulate these rhythms. This treatment is promising as a supplement to medication.
Family and marital therapy - Dealing with unique stressors in a patient's life is crucial in any treatment plan since they might cause the patient's depression to return and lengthen the duration of their treatment. In cases of bipolar disorders, it has been seen that some family interventions aimed at lowering the intensity of expressed emotion or hostility and enhancing the family's knowledge of how to cope with the disorder have been particularly effective in preventing relapse.
As previously indicated, patients with mania and depression may be able to recover from a specific episode in less time than a year without receiving formal therapy. The general outlook of an episode might be favourable for many thanks to the new therapeutic approaches mentioned above, assuming the treatment is administered correctly.
Nonetheless, the diagnosis is crucial because at least half of patients never receive even minimally appropriate treatment. Although relapses and recurrences are common, maintenance therapy, which involves continuing medication and scheduling follow-up therapy sessions on a regular basis, can now frequently prevent or at least reduce the frequency of these events. The assistance of the people in the diagnosed person's life clearly aids in their recovery. There is still a definite need for long-term and even more effective short-term treatments, as well as for research into the risk factors for developing depressive disorders and the application of the findings to early intervention and prevention.
Hooley JM, Butcher J, Nock MK, Mineka, S M. Abnormal Psychology. 17th ed.
Bipolar Disorder: Overview and More (verywellmind.com)
NIMH » Bipolar Disorder (nih.gov)