Bipolar disorder – types, symptoms, risk factors and treatment

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What is bipolar disorder?

Definition: A brain disorder that causes unusual shifts in mood, energy, activity levels, and the inability to carry out daily activities is called bipolar disorder. It is also known as manic-depressive illness or manic depression.

Bipolar disorder causes extreme mood swings in patient because of a simple reason or even without any reason. It brings a change in the patient’s life-style, such as- eating disorder, sleeping disorder, behavioral or thinking disorder may occur. If we analyze the definition of bipolar disorder we can understand that patient feels very happy, energetic and confident one time and after some moment they feel sad, hopeless and sluggish.

Types of bipolar disorder

There are four fundamental types of bipolar disorder all of which involve clear changes in mood, energy, and activity levels. These moods range from manic episodes to depressive episode including hypomanic episode.

Manic episode

Manic episode describes the duration when patient feels overly excited and confident. These feelings also involve irritability and impulsive or reckless decision-making.  Some people can also have delusions (believing things that are not true and that they can’t be talked out of) or hallucinations (seeing or hearing things that are not real) during mania.

Depressive episode

Depressive episode describes the duration when the patient feels depressed. Those symptoms are the same as depression.

Hypomanic episode

Hypomanic episode describes less severe manic periods. In this period, someone does not have delusions or hallucinations, and their high symptoms do not interfere with their daily activities.

Now, I am going to describe the types of bipolar disorder.

  1. Bipolar I Disorder

Bipolar I Disorder is defined by manic episodes. It lasts at least 7 days. If the manic symptoms are so severe the person needs immediate hospital care. Generally, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) may also occur.

  1. Bipolar II Disorder

Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes like bipolar-I disorder.

  • Cyclothymic Disorder

Cyclothymic Disorder is defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years in adult persons but 1 year in children and adolescents. The symptoms of this disorder do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. Cyclothymic Disorder is also called cyclothymia.

  1. Other Disorder

Other Specified and Unspecified Bipolar and Related Disorders are defined by bipolar disorder symptoms that do not match the three types listed above.

Symptoms of bipolar disorder

The dramatic episodes of high and low moods of the patient do not follow a set pattern.  The symptoms differ from person to person and can also change over time, becoming more or less severe.

Symptoms during manic episode Symptoms during depressive episode
Having a lot of energy and less need of sleeping Loss of energy, feeling tired and needs more sleep
Excessive happiness and hopefulness Sadness and hopelessness or worthlessness
Overconfidence Loss of confidence
Abrupt changes from being happy to being irritable, angry, and hostile Eating disorder ( eating too much or too little)
Speedy speech Forgetfulness
Poor concentration Uncontrollable crying
Reckless sex Feeling worried, empty and not enjoying anything
Making grand and unrealistic plans, doing risky works Thoughts of death or suicidal attempts

 

Who are affected by bipolar disorder?

People usually develop bipolar disorder when they’re in late adolescence or young adulthood, although it can also happen earlier in childhood. Some people get bipolar disorder by heredity. Patient seasonal depression and certain anxiety disorders, like post-traumatic stress disorder (PTSD), are also more likely to have bipolar disorder.

Although both men and women are equally likely to get bipolar disorder, women are somewhat more likely than men to get bipolar disorder.

Risk factors of bipolar disorder

Most researchers agree that no single factor causes bipolar disorder. Factors that increase the possibility of getting bipolar disorder are called risk factors of bipolar disorder, such as- brain structure and functioning, genetics and family history.

Brain structure and functioning

Some studies show that the brains of people with bipolar disorder are different from the brains of healthy people or people with other mental disorders. Studying and analyzing more about these differences, along with new information from genetic studies, helps researchers better understand bipolar disorder and predict which types of treatment will work most effectively to cure the diseases.

Genetics

According to some researchers, people with particular genes are more susceptible to develop bipolar disorder than others, although genes are not the only risk factor to develop bipolar disorder.

It has been seen in some studies on identical twins that even if one twin develops bipolar disorder, the other twin does not always develop it, despite the fact that identical twins share all of the same genes.

Family History

One may develop bipolar disorder by heretically as this illness tends to run in families. Children with a parent or sibling who has bipolar disorder are much more susceptible to develop bipolar disorder, compared with children who do not have a family history of this disorder. But it is not right that most people with a family history of bipolar disorder will develop the illness, rather most people do not develop it.

Treatments and therapies for bipolar disorder

Bipolar disorder is a lifelong sickness. Episodes of depression and mania usually come back over time. An effective treatment plan usually consists of a combination of medication and psychotherapy; this is also called “talk therapy”. Between episodes, many people with bipolar disorder feel free of mood changes, but lingering symptoms may be seen in some people. These symptoms can be controlled by long-term, continuous treatment.

Medications

The following medications usually used to treat bipolar disorder include:

  • Mood stabilizers
  • Atypical antipsychotics
  • Antidepressants

Mood stabilizers

Technically, the Food and Drug Administration (FDA) does not categorize medicines as “mood stabilizers.” Rather, doctors and patients use that term informally to mean any medicine that has antidepressant or anti-manic properties and does not cause deteriorating of mood states over time. Medicines that treat and prevent highs (manic or hypomanic episodes) and lows (depressive episodes) are called mood stabilizers.

Not all mood-stabilizing drugs have equal anti-manic and antidepressant properties.  For example, lithium is more effective at treating manias than depressions and lamotrigine is more useful for depression than manic symptoms. Sometimes, the term “mood stabilizer” can be misunderstood. Actually, mood stabilizers have not been studied to treat day-to-day or moment-to-moment mood swings. The primary purpose of mood stabilizer is in treating full episodes of mania/hypomania or depression that each lasts for several days or weeks at a time.

Atypical antipsychotics

Atypical means something that is not typical; atypical antipsychotics work in a manner that is significantly different than the previous class of antipsychotic medications. These medications are very helpful to make mood swings less frequent and less intense.

Here is a list of seven commonly prescribed atypical antipsychotic medications for bipolar disorder:

  1. Abilify (aripiprazole)
  2. Risperdal (risperidone)
  • Zyprexa (olanzapine)
  1. Seroquel (quetiapine)
  2. Geodon (ziprasidone)
  3. Cloazril (clozapine)
  • Symbyax (olanzapine/fluoxetine)

Antidepressants

Bipolar disorder may increase the risk of early death of patient. Antidepressants are frequently prescribed medication to get rid of this illness, but it is not recommended to use antidepressant alone to treat a depressive episode. Here, I have given a list of 6 most effective natural antidepressants with a short description which have a significant positive impact on the functioning of mood and brain and thus help to reduce the symptoms of bipolar mood disorder.

List of 6 antidepressants to cure bipolar disorder

  1. Omega-3 fatty acids
  2. Folate
  3. Choline
  4. Siberian Ginseng
  5. Magnesium
  6. N-acetyl cysteine

 

  1. Omega-3 fatty acids

Omega 3 Fatty Acid is natural antidepressants which have a great potential to stabilize patient’s mood.

Source of omega 3 fatty acid:

Omega 3 fatty acids are found in food sources such as salmon fish, sardine fish, walnuts, beef, soybeans, tofu, shrimp, cauliflower, Brussels sprouts, flux seeds etc. You can also get Omega 3 Fatty acids are also available in capsule supplements.

 

  1. Folate

According to a research of the University of Maryland Medical Center, if one have deficiency of enough dietary folate in his/her body, he/she may suffer from fatigue and irritability.

Folate is vitamin B9 that helps to generate new healthy cells in your body. Converting fats and proteins to their usable forms folate assists with cell growth and development. It is very helpful to maintain proper functioning of your nervous system and brain, and thus it helps to cure bipolar disorder.

Source of folic acid or folate:

Broccoli, asparagus, papaya, orange, grape, strawberries, grape, raspberries,  spinach, collard greens, mustard green, turnip green, romaine lettuce etc. are rich in folate.

 

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  1. Choline

Choline is needed by the brain for functioning of memory; it is useful for learning, and mental alertness, as well as for the manufacture of cell membranes and the neurotransmitter acetylcholine.

Source of choline:

Eggs, livers, peanuts, beets, whets, pasta, dairy foods, rice, broccoli, cauliflower, asparagus, turkey etc. are cholate rich food.

  1. Siberian Ginseng

Siberian ginseng often called adaptogen is one kind of plant grows in Siberia. Its root is used for making medicine. Taking lithium and Siberian ginseng orally for 6 weeks,  that means 42 days is useful to induce a similar response rate and remission rate as taking lithium plus fluoxetine in people with bipolar disorder.

 

 

Caution: People often confuse Siberian ginseng with American or Panax ginseng. So, be careful about this.

  1. Magnesium

Magnesium helps to

  • Maintain a steady heart rhythm
  • Keep muscle and nerve function normal
  • Increases bone-strength and
  • Support a healthy immune system

 

Deficiency of magnesium cause –

  • Muscle spasm or tremors
  • Muscle weakness
  • Sleeplessness or nervousness and confusion
  • Depression
  • Hyperactivity

 

  • High blood pressure
  • Irregular heartbeat
  • Constipation
  • Fits or convulsions
  • Lack of appetite.

Magnesium is very helpful to get recover from bipolar disorder. In a study, it has been seen that some people with bipolar disorder or other psychiatric illnesses had differences in the amounts of magnesium in their blood. Magnesium plays an important role in calming the nervous system because it has the ability to block brain N-methyl D-aspartate receptors (NMDA) and thereby it inhibits excitatory neurotransmission. And this is the reason why magnesium is supportive for good sleep.

Source of magnesium:

There is significant amount of magnesium in soybeans, pumpkins, bananas, nuts, yogurt, beans and lentils, brown rice, avocado, dark chocolate, green leafy vegetables, almond, figs, chard etc.

  1. N-acetyl cysteine

N-acetyl cysteine (NAC) – a modified form of amino acid is becoming popular to treat bipolar disorder problem. It helps the body produce glutathione which is a powerful antioxidant. Glutathione supports liver detoxification and reduces free radicals in the body. Low levels of glutathione in the brain causes psychiatric disorders. It has been shown that NAC is helpful to cross the blood-brain-barrier and raise glutathione levels in the brain. It is available in tablet form in the market

N-acetyl cysteine

 

Caution: Before taking any medication, do not forget to take expert’s suggestion because you do not the perfect dose for you and about the side-effects. If you are pregnant or expecting baby or breastfeeding, if you have diabetes share all of them with the doctor, so that he can prescribe you the right medication, otherwise you may face problem.

Effective psychotherapies for bipolar disorder

Psychotherapy may involve a one-on-one interaction with a therapist or group sessions that include the therapist and other people on similar issues. Certain types of psychotherapies are given to treat bipolar disorder. Actually, the basic treatment of bipolar disorder involves the combination of medication and therapy. Several types of psychotherapy are given to treat bipolar disorder, such as- cognitive behavioral therapy, interpersonal therapy and social rhythm therapy.

Cognitive Behavioral Therapy (CBT)

CBT is a short-term therapy and its primary aim is to help the patient to gain a new outlook on his/her situation. It can be applied by preventing a relapse into those symptoms,  handling the symptoms of mental illnesses, learning effective coping techniques to help control emotions and stress. Its one of the main advantages is that it can be applied as an alternative treatment when medications are not effective or not an option.

During a CBT session you have to co-operate with your therapist to-

  • Identify the problem
  • Identify negative or incorrect thoughts, behaviors, and emotions.
  • Scrutinize the thoughts, behaviors, and emotions related to these problems.
  • Change your reaction in a positive way

Interpersonal and social Rhythm Therapy (IPSRT)

IPSRT is based on the chronobiological model (a specialized area of biology that discuss about the biological rhythms or cycles of all living creatures, and how the sun and moon affect these cycles) of bipolar disorder.  The approach of IPSRT is usually used in conjunction with medication and it is often necessary for anyone with bipolar disorder. IPSRT proposes that disturbed circadian rhythms (internal clock that regulates our sleep-wake cycle) play at least a partial if not major role in bipolar symptoms.

For example,  if you’ve ever been up all night attending to a sick child, or if you have neighbors who were partying all night, you know how much it disturbs your rest and sleep, not only that, because of not enjoying sound and sufficient sleep you also feel awful next day. In-fact, disrupted sleep is not good for anyone’s health, but the results are often much more problematic if you are a patient of bipolar disorder. Your sleep timetable is part of your overall social rhythm, which consists of your day to day routine of eating, sleeping, going to work, exercising and so on.

Interpersonal component of social rhythm therapy uses the principles of traditional interpersonal therapy to identify the impact that relationship issues and problems have on your life.

If you are having a conflict with your, boss, best friend, spouse or anyone else in your life, it can cause anxiety and intensify your stress.  This type of stress can disrupt your normal routine severely.  Working on improving and resolving these issues by therapy helps bipolar patients minimize the stress in their lives – which is very important, since stress can trigger mood episodes – and make it easier for them to return to a healthy routine.

 

 

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