Dr. Prakash

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. A person’s mood and emotions can be altered drastically due to bipolar disorder, but they do not have more than one personality. Split personalities problem is more commonly seen in those with personality/dissociative disorders. 

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

1. Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, 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) are also possible.
2. Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
3. Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
4. Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

The disorder has two strong phases: 1) Bipolar Mania and 2) Depression.

Mania-

Mania is a state of heightened energy and euphoria - an elevation of mood. It is in direct contrast to depression. Mania can vary in severity from hypomania, where, in addition to mood and energy elevation, the person shows mild impairment of judgement and insight, to severe mania with delusions and a level of manic excitement that can be so exhausting that hospitalisation is required to control the episode.

The mood, energy and other related symptoms define both mania and hypomania, with psychotic features being an 'add on' component experienced by a sub-set of individuals. 

You have an intense sense of well-being, energy and optimism. It can be so strong that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways.
 
Like depression, it can make it difficult or impossible to deal with day-to-day life. Mania can badly affect both your relationships and your work. When it isn't so extreme, it is called 'hypomania'.
 
If you become manic, you may notice that you are:

Emotional:

• very happy and excited
• irritated with other people who don't share your optimistic outlook
• feeling more important than usual. 

Thinking:

• full of new and exciting ideas
• moving quickly from one idea to another
• hearing voices that other people can't hear.

Physical:

• full of energy
• unable or unwilling to sleep
• more interested in sex.  

Behaviour:

• making plans that are grandiose and unrealistic
• very active, moving around very quickly
• behaving unusually
• talking very quickly - other people may find it hard to understand what you are talking about
• making odd decisions on the spur of the moment, sometimes with disastrous consequences
• recklessly spending your money
• over-familiar or recklessly critical with other people
• less inhibited in general.

If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong – although your friends, family or colleagues will. You may even feel annoyed if someone tries to point this out to you. You increasingly lose touch with day-to-day issues – and with other people's feelings. 

Depression- 

The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives. In clinical depression or bipolar disorder, the feeling of depression is much worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:

Emotional:

• feelings of unhappiness that don't go away
• feeling that you want to burst into tears for no reason
• losing interest in things
• being unable to enjoy things
• feeling restless and agitated
• losing self-confidence
• feeling useless, inadequate and hopeless
• feeling more irritable than usual
• thinking of suicide.  

Thinking:

• can’t think positively or hopefully
• finding it hard to make even simple decisions
• difficulty in concentrating. 

Physical:

• losing appetite and weight
• difficulty in getting to sleep
• waking earlier than usual
• feeling utterly tired
• constipation
• going off sex. 

Behaviour:

• difficulty in starting or completing things – even everyday chores
• crying a lot – or feeling like you want to cry, but not being able to
• avoiding contact with other people.

Causes:

1. Biological Causes: Experts say that patients with bipolar disorder often show physical changes in their brains. Nobody is sure why the changes lead to the disorder.
2. Genetic Traits: Researchers are involved in finding out whether or not the causes of bipolar disorder arise out of genes and other hereditary factors. If you have a first-degree relative or a sibling who is/was affected by this condition, you would probably have it too.
3. Neurotransmitters: Mood swing disorder is caused by an imbalance in brain chemicals known as ‘neurotransmitters’.

Treatment Methods:

1. Initial Treatment: The initial treatment method is to take medications to balance and control the mood swings. After the symptoms are in control, one has to start working with his/her trusted doctor for chalking out an effective and practical long-term treatment procedure.

2. Recovery from substance abuse: Problems related to excessive alcohol and drug abuse are solved by this therapy. Failing this step, this disorder can be unmanageable.

3. Day care treatment: Day care treatment programs can be recommended by your doctor. This treatment method includes counseling and support which keep the bipolar traits under control.

4. Hospitalization: Hospitalization or immediate medical support is recommended in case of suicidal thoughts or when a person starts exhibiting erratic behavior (being psychotic).

5. Medications: Medications include the administration of antipsychotics (such as ziprasidone, olanzapine), antidepressants (usually in combination with a mood stabilizer or an anti-psychotic), mood stabilizers (such as valproic acid, lithium, divalproex sodium) and anti-anxiety medications. If you wish to discuss any specific problem, you can consult a psychiatrist.