Understanding Bipolar Disorders

‘Bipolar’ disorder is a mental health concern wherein the mood (that is, their emotional state, and related energy and functionality) seems to shift from relatively low (related to depressive symptoms) and relatively higher (related to manic symptoms) ends of the emotional spectrum.

Such shifts may have an association with something specific such as a stressful event, or one’s family history, but may also be acute (or sudden) their onset. For some, they may also occur rapidly in time, or stretch out over days or weeks so that it is easier to distinguish between pre-morbid functioning (one’s level of functioning before the symptoms showed up) and the impact of symptoms on the individual’s life; the latter may be termed as an ‘episode’ of a mood state. Mental health professionals often need to make note of these distinctions, timelines and histories so that they can determine and provide appropriate treatment and management plans for the individual.

As you can imagine, this disorder can be experienced in many different ways, and is more of an umbrella term rather than one concrete condition. It is also important to note that these shifts are experienced differently than mood swings normally seen in most, in the way they impact a person’s life and ability to cope with and within their mood state. The distress (or suffering) and dysfunction (or the inability to keep up with the usual/normal functioning levels) related to the experience of bipolar disorder is often high, for which they may find it helpful to acknowledge the need for external and/or professional support for their mental health. It may also be helpful to be aware of the symptoms related to both of the ‘poles’ seen in bipolar and related disorders:

Pole 1: Depressive episode: would include five or more of the following symptoms

• Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
• Marked loss of interest or feeling no pleasure in all — or almost all — activities that were enjoyable earlier
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
• Changes in sleeping patters (either sleeping too much or too little)
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Feelings of worthlessness, or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking about, planning or attempting suicide

Pole 2: Manic or Hypomanic episode: both mania and hypomania are related to three or more of the following symptoms, but are considered distinct from one another on the basis of severity (with mania considered more severe in its experience than hypomania)

• Feeling abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees without regard for one’s financial resources, risk-taking behavior that results in harm to self and/or others, etc.

Sometimes people experience both manic and depressive symptoms in the same episode, which is termed as an episode with mixed features. They may then experience feeling very sad, empty, or hopeless, while, at the same, time feeling extremely energized.

On the basis of the above symptoms, a mental health professional may make one of the following diagnoses:

• Bipolar I disorder: this diagnosis is made on experience of at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes
• Bipolar II disorder: this diagnosis is made on experience of at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode.
• Cyclothymic disorder: this diagnosis is made on experience of at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types: Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, a condition which is referred to as “other specified and unspecified bipolar and related disorders.”

The experience of some of the mentioned symptoms can be similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. Experience of these symptoms is further known to be commonly related to certain other mental and physical health conditions, some of which are:

• The experience of bipolar disorder in a more severe form may be related to experience of psychotic symptoms like hallucinations or delusions. The latter tend to match the person’s extreme mood. For example:
  • People having psychotic symptoms during a manic episode may have the belief that they are famous (when they are not), have a lot of money (when in reality they do not), or have special powers (such as being able to hear the thoughts of others).
  • People having psychotic symptoms during a depressive episode may believe they are financially ruined and penniless (even if that is not the case in reality), or have committed a crime (when they have not).
• It is also common for people living with bipolar disorder to also have an anxiety disorder, attention deficit hyperactivity disorder (ADHD), patterns of substance abuse, eating disorders, etc.

While lifestyle factors and related changes such as including exercise in one’s routine is helpful for any person regardless of their health status, dealing with a mental illness may require specialized treatment and support like any other kind of health condition. Such treatment would optimally involve visiting a psychiatrist to seek help by way of prescribed medication, visiting a psychologist or counselor for therapy, or a combination of both.

It is imperative that these treatment plans be designed keeping according to the best interest and choice of the individual experiencing the symptoms and are to begin at their earliest observation. Having a stable routine and adequate social support may help during recovery, even as figuring out this process may take some time. If you or someone you know is experiencing a mental health crisis (such as experiencing a sudden onset of the above symptoms or ideas of self harm or suicide) it is suggested that they reach out to a mental health professional as soon as possible to get the help they need.