From Causes to Treatment - Understanding Bipolar Disorder

While we all experience mood swings throughout our lives, Bipolar disorder, sometimes referred to as ‘manic depression’ is a severe mental illness that causes unusual and extreme versions of these mood swings. It has an impact on an estimated number of over 40 million individuals's job and school performances, relationships, and overall quality of life. In this article, we will be doing an in-depth explanation of Bipolar disorder and exploring the possible neurological causes of this genetic mystery. 

What is Bipolar Disorder? 

Bipolar disorder is a chronic disorder causing extreme mood swings characterised by periods of emotional highs referred to as ‘mania’ or ‘hypomania’, periods of emotional lows referred to as ‘depressive episodes’ , and ‘mixed’ episodes with both symptoms of manic and depressive episodes. 

Periods of emotional highs lasting longer than a week unless cut short by treatment are known as ‘mania’, causing severe disruption to daily-life, while ‘hypomania’ is known as the less severe version, typically lasting for a few days and manageable to a degree where it doesn’t significantly affect the individual's ability to continue their daily life. 

Symptoms of Bipolar Disorder 

Symptoms typically start appearing during late adolescence (Age 18-24) with over half of all diagnosed cases starting before age 25. These symptoms come in the form of hypomanic/manic, depressive, and ‘mixed’ episodes mentioned previously and typically last one to two weeks or longer in severe cases.  An Individual’s mood usually returns to a healthy baseline in between episodes but episodes don’t always follow a pattern and can happen in any order – for example, an individual can experience more than 1 manic episode in a row (while returning to normal in between) without depressive or ‘mixed’ episodes. 

In periods of emotional highs, an individual displays abnormal elevated levels of physical activity and mental behaviour that is noticeable by other people with symptoms including but not limited to : 

• Excessive appetite for pleasurable and reckless activities from eating to drug and alcohol misuse

• Increased energy and restlessness 

• Racing thoughts and rapid speech

• Feeling unusually important, powerful or talented 

• Impulsivity and poor judgement 

• Experiencing hallucinations and hallucinations (psychosis) 

In depressive episodes, an individual displays significant decreased levels of physical activity and mental behaviour that is noticeable by other people with the same symptoms as those of major depression which include but are not limited to : 

• Trouble falling asleep (Insomnia) or excessive sleep 

• A sudden change in appetite 

• Lack in interest in all activities 

• Low energy and fatigue, unable to do daily tasks 

• Thoughts of death and suicide 

In a ‘mixed’ episode, symptoms of mania and depression could occur simultaneously or one right after the other with no time for recovery where the individual’s mood returns to a healthy baseline in between. For example, an individual experiencing a ‘mixed’ episode could lack an interest in all activities while still having abnormally elevated levels of energy. 

How is it Diagnosed? 

With around 69% of patients with bipolar disorder who participated in a survey by the National Depressive and Manic-Depressive Association being misdiagnosed initially and more than 23% remaining misdiagnosed for another 10+ years, the diagnosis process for bipolar disorder has become an extremely lengthy and strenuous one, on average taking around 3.5 years to confirm a diagnosis. 

Healthcare providers use guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM) to help diagnose bipolar disorder, along with ordering tools such as physical exams, a mental health evaluation, medical tests to rule out other conditions and a thorough record of the individual’s medical history. 

What are the Possible Causes and Risk Factors? 

Although the exact cause of bipolar disorder is still unknown by scientists, there is still a significant amount of research done that points towards several factors that are speculated to contribute to the development of Bipolar disorder. 

1. Genetics 

Genetics plays a huge role in the development of Bipolar disorder as research has suggested that certain genes greatly increase the chance of inheriting the condition with over two-thirds of individuals who have Bipolar disorder having at least one close biological relative that has the condition. However, it has been proven that genetics is not the only risk factor as studies showed that the identical twin of someone with the condition who shares the same genes did not always develop bipolar disorder as well. 

2. Structural brain changes 

There have been multiple imaging studies comparing the difference between the brain structure of individuals with bipolar disorder and healthy individuals and some of their findings have shown that the prefrontal cortex – the part of the brain involved in problem solving and making decisions – tended to be smaller and have reduced function in individuals with bipolar disorder, explaining why symptoms tended to arise during late adolescence as abnormal growth of the prefrontal cortex during adolescence impacts their executive function. 

Treatment for Bipolar Disorder 

Albeit there being no current cure for bipolar disorder, there are many forms of treatment available to individuals that can help even the most severe cases of the condition which include : 

• Various medications such as mood stabilisers and atypical antipsychotics 

• Psychotherapy (Talk Therapy) 

• Other alternative treatments such as electroconvulsive therapy for severe or urgent cases 

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