Bipolar disorder

Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime. There are four types of mood occurrences in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

Mania Symptoms

In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a recklessly and profligately, scarcely sleep, and are hyperactive.

They may also feel like they’re omnipotent, impregnable, or destined for prominence. Although mania inaugurates with delightful sensations, it has a tendency to spiral out of control. People often Denave uncontrollably aurlng a manic eplsoae: gambling away savlngs, engaging In inappropriate sexual activity, or making irrational business investments, for example. They may also become angry, irritable, and aggressive”picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior. Some even become delusional or start hearing voices.

Depression Symptoms

In the past, bipolar depression was amalgamated in with regular depression. But a mounting reservoir of research suggests that there are significant differences between the two, particularly when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar epression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and speak slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depression”a condition in which theyVe lost contact with reality”and to experience major disability in work and social functioning.

Types

There are several types of bipolar disorder; all involve episodes of depression and mania to a degree. They include bipolar l, bipolar II, cyclothymic disorder, mixed bipolar, and rapid-cycling bipolar disorder.

Bipolar I

Raging bipolar (l) is characterized by at least one full-blown manic episode lasting at least one week or any duration if hospitalization is required. This may include inflated self-esteem or grandiosity, decreased need for sleep, being more loquacious than usual, flight of ideas, distractibility, an increase in goal-oriented activity, and excessive involvement in hazardous activities.

The symptoms are severe enough to disrupt the patient’s ability to work and socialize, and may require hospitalization to prevent harm to themselves or others. The patient may lose touch with reality to the point of being psychotic. The other option for raging bipolar is at least one “mixed” episode on the part of the patient. The DSM-IV is uncharacteristically vague as to what constitutes mixed, an accurate reflection of the confusion within the psychiatric profession. More tellingly, a mixed episode is almost impossible to explain to the public. One is literally “up” and “down” at the same time.

Bipolar II

Swinging bipolar (II) presumes at least one major depressive episode, plus at least one hypomanic episode over at least four days. The same characteristics as mania are evident, with the disturbance of mood observable by others; but, the episode is ot enough to disrupt normal functioning or necessitate hospitalization and there are no psychotic features. Those in a state of hypomania are typically the life of the party, the salesperson of the month and more often than not the best-selling author or Fortune 500 mover and shaker, which is why so many refuse to seek treatment.

But the same condition can also turn on its victim, resulting in bad decision-making, social embarrassments, wrecked relationships and projects left unfinished.

Rapid Cycling

DSM-IV defines rapid cycling as the occurrence of at least 4 major depressive, manic, ypomanlc, or mlxea eplsoaes aurlng tne prevlous year In a patient wltn a Olagnosls of BP I or BP II. These episodes must be demarcated either by a partial or full remission of at least 2 months’ duration or by a switch to an episode of opposite polarity.

Duration criteria for episodes are not waived, which means that each major depressive episode must last at least 2 weeks, each manic or mixed episode must last at least 1 week, and each hypomanic episode must last at least 4 days.

Mixed Bipolar

A mixed episode is not a disorder itself, but rather is a description of a component of a specific type of bipolar disorder. A mixed episode is defined by meeting the diagnostic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.

Like most mental disorders, a mixed episode must be severe enough to cause distress or impairment in social, occupational, education or other important functioning and is not better accounted for by the physiological effects of substance use, or abuse, or a general medical condition.

Cyclothymia

Cyclothymia is a chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania, lasting a few days to a few weeks, eparated by short periods of normal mood.

Individuals with cyclothymia are never liberated of symptoms of either depression or hypomania for more than two months at a time. In 1980 the classification of cyclothymia was changed in the DSM-IV from Personality Disorder to Mood Disorder. Though the above description portrays cyclothymia as a mild disorder, it is so only relative to the severity of Bipolar I and Bipolar II disorders. Cyclothymia can completely disrupt the life of an individual and create personal chaos. In their continual oscillation of mood, they never know from ne day to the next what to expect.

Treatments

Bipolar disorder is being better understood each day. There is also ongoing research into its treatment. But successfully treating bipolar disorder can involve several medication trials, and it can take years to achieve remission. Even if remission is attained, recurrence is the rule ” not the exception. It’s not uncommon for all first- line treatments to be exhausted.

Common Treatments

Lithium and the anticonvulsants lamotrigine and valproate are treatments for bipolar depression. They are mood stabilizers. For severely ill patients, lithium and an ntidepressant are sometimes used.

A mood-stabilizing medication works on improving social interactions, mood, and behavior and is recommended for both treatment and prevention of bipolar mood states that swing from the lows of depression to the highs of hypomania or mania. According to the American Psychiatric Association (APA), lithium, lamotrigine, valproate, carbamazepine, and most atypical antipsychotic medications are approved by the FDA for treating one, or more, phases of bipolar disorder. Treatment Resistance There is no consensus among clinicians and researchers on one definition of reatment resistance.

Generally, patients in an acute state, manic, depressed, or mixed, whose symptoms do not improve after at least two evidence-based medication trlals are conslaerea treatment-reslstant In researcn stu01es. In tne malntenance phase, patients are considered treatment-resistant if they continue cycling despite several adequate medication trials. In some studies additional criteria must be met in order to truly be considered treatment-resistant. These include functional measures of remission.