The Bipolar Disorder

Bipolar disorder can be described as a mental illness that results to extreme shifts in mood, thinking, energy and individuals behaviors. Since 16th century, this illness has been a mystery. This disease can be highly intimidating to individuals who go through it. Individuals with bipolar disorder change their moods instantly, for example, a person can change from being happy to be extremely upset within an extremely short time. This occurs because of the levels of serotonin in a person’s brain.  The major effect of this disease is making individuals experience mood swings, which in most cases have nothing to do with events that occur in their daily lives. Bipolar disorder can also be defined as maniac depression; the name bipolar means 2 poles that  include Mania and depression. When the levels of serotonin are extremely high in a person’s brain, he or she can be said to be Hypomaniac. On the other hand, when serotonin levels become low in a person’s brain, then he or she may be said to be in a depressed state. Individuals with this illness, experience both of these happening at the same time all through their lives, it can even happen many times a day.

It is believed that the in the United States, bipolar disorder affects approximately 1.2 percent of the total population in United States. Also, in the United States, it is believed that bipolar disorder affect 1% adults and up to approximately 4 million people. Statistics reveals bipolar disorder as the fifth cause disability among people worldwide. Also, statistics show that individuals suffering from bipolar disorder may be at extremely high risk of suffering from mental health problems and substance abuse. The bipolar patients depression state may be irritable, restless, decreased sexual activities, change in sleep and appetite patters, slowed thinking, and speech among other issues. On the other hand, people in mania state may experience increased energy or activity, more thoughts, ostentatious thoughts, thinking faster, increased sexual activity, overjoyed mood, decreased sleep, irritable mood among other symptoms.

The effects of bipolar disorder may last for days, weeks or even months. Compared to ordinary mood changes, bipolar disorder can interfere with the person’s ability to function effectively. During mania state, the effects may be extremely serious, for example, in this stage, a person might spontaneously quit job, feel rested after having two hours sleep, or charge exorbitant prices on various products. On the other hand, during depression state, the affected person might feel too tired to wake up, and experience hopelessness over being in debt or unemployed. In many cases, the first incidences of mania and depression occur in the teenage years or early adulthood. The symptoms of bipolar disorder may be extremely confusing and subtle.  Many individuals with this illness are ignored or even misdiagnosed. This subjects such people into unnecessary suffering, but if they can get proper treatment and support, they can live a fulfilling life.

Bipolar patients may try doing things that can harm themselves or even try to commit suicide. Some of these things may include using drugs such as marijuana, drinking alcohol, cutting themselves among other harmful things. In most cases, individuals with this illness use a drug such as marijuana to relieve the symptoms of stress or pain. When bipolar patients get in the manic state, they start thinking in frenzy. As a result, their muscles tense up and their jaws and shoulder blades start aching, their heartbeat increases speed. In addition, the physical activities of these people become effortless; although they feel extremely strong, even ordinary activities like tying their shoe may be difficult to them. These people start to feel fidgety, and they want to move around a lot.

When bipolar patients are in mania they oftenly talk to themselves. Also, in case they are talking to other people, they usually repeat the same thing several times. Regularly, people with this illness over react to various things, and are likely to have short tempers. According to medical practitioners, driving while a person is in mania state can be the most fatal thing for these people to do. This is because these people tend to forget about all the mental pictures of other vehicles on the road and think they are the only people driving on the road.

Even if, things are annoying to other people, bipolar patients in the state of mania continue to do them, for example, ignoring others, poking people, interrupting other people among other irritating things. Additionally, bipolar patients in the state of mania oftenly speed up their speech and they may be incomprehensible to other people. Surprisingly, when bipolar patients are in hypomanic, they may be outstanding at poetry and lyrics, as well as being capable of coming up with songs and other things easily.

Although a person can do many things during hypomanic state, a part from dangerous driving, he or she can still do fatal things, such as committing suicide. Surprisingly, some researches show that more bipolar patients commit suicide when they are in hypomania state rather than depression. This is because these people may think to be on the top of the world and think that nothing can hurt them, while as depression causes people to sulk around.

On the other hand, depression state affects the lives of bipolar patients in various ways. During depression state, bipolar people start losing understanding of the things they are supposed to do next. As a result, these people tend to meander around in shock, and many things remain undone. Additionally, when bipolar person is in the state of depression, even individuals close to him or her at all times make him or her become nervous. They may be able to fight it for some time, but in case, it hits hard, everything turn out to be a burden to do. This can turn out to be a lost battle because these people cannot help it. In many cases, by the time these people understand that they need help, depression has taken over already, and these people may not be able to communicate precisely enough with other individuals to tell them. When bipolar people get in state of depression, they oftenly stay indoors, and they do not leave, even the patterns of their sleep becomes odd.

Additionally, during depression state, the affected individuals stay awake frequently even for 20 or more hours. Also, they become scared of other people that they may even disappear or go driving, sometimes for many hours. The main reason why these people act in that manner is to escape into the places that they feel to be safe and comfortable to escape the terror.

Bipolar disorder takes place when both states of depression and mania get demonstrated in a cycle at the same time. When the episodes take place more than four times in one year, the situation can be referred as rapid episode.  This situation is more common in women, and in many cases, the situation may be resistant to treatment. There are two types of bipolar disorder namely, bipolar I disorder and bipolar II disorder. The major difference between the two types of bipolar disorder is what is characteristically thought of the situation of bipolar disorder, with episodes of serious state of mania and depression. On the other hand, bipolar II disorder may be referred to the situation of bipolar disorder with episodes of depression and hypomania. Although the accurate cause of bipolar disorder is not precise, most probably many factors may contribute to this illness.

       Additionally, the diagnosis of this disease is not exact. Because there is no physiological test for bipolar disorder, an assessment has to be made physiologically. This can be done through the use of basic symptoms, behavioral assessment test, course of illness, use of scales and family history. The diagnosis of this illness can be extremely tricky particularly when it comes to bipolar II disorder. Many bipolar patients may be misdiagnosed with unipolar depression since hypomania may either fail to be recognized or serious psychotic mania gets underestimated. The beginning of bipolar disorder illness happens in the late adolescence or early adulthood, although, it may also be possible for children and adolescents to develop the illness too. This situation may occur when there is a family history for the bipolar disorder. Children affected by this disease oftenly become more irritable and destructive when they get into manic state, and they become more prone to mixed states. It even becomes more problematic to diagnose this disease in children. This is because it may oftenly be confused with other problems that happen at children’s younger age like conduct disorder, deficit disorder, main depression or schizophrenia.

As demonstrated by the National Depressive and Manic Depressive Association (MDMDA), this illness can create considerable family and marital interruptions, developmental delays and financial disasters. Additionally, bipolar disorder plays a part in the loss of jobs and many costs to society. In many cases, bipolar disorder is believed to affect people between the ages 20 and 30 years, the second peak is thought to affect individuals in mid-forties for women. Surprisingly, bipolar patients may get eight to ten episodes throughout their lifetime. However, bipolar patients with rapid cycling can get more episodes of depression and mania that succeed each other progressively without a period of reduction.

The three stages of this disease start with the state of hypomania, in which the affected individuals report being extroverted, energetic and assertive. This state has made various researchers believe that people affected with bipolar disorder are “addicted” to their state of mania. Hypomania state develops into mania state, and the change may be marked by judgment loss. Regularly, at this stage, euphoric grandiose characteristics get exhibited, and irritable or paranoid characteristics start to become evident. The third stage of mania becomes noticeable when bipolar patients get a false impression with paranoid themes. Also, at this stage, person speech becomes rapid and hyperactive behavior becomes evident in some cases linked with violence.

In a situation where the mania and depression symptoms occur at the same time, the situation can be referred as mixed episode. The bipolar patients may be special risk since mixed episode means that there is a combination of agitation, hopelessness and anxiety, which can make people overreact. Various studies show that about 50% of all bipolar patients in the state of mania experience mixture of depressed moods. Affected individuals report feeling unhappy, depressed and feeling dysphoric; yet these people display the energy associated with state of mania.

Rapid cycling mania may be another presentation of bipolar disorder illness. Mania state may be present with four or more different episodes within a period of one year, but no concrete evidence to propose that, at times, rapid cycling may be a passing manifestation of the bipolar disorder. This illness displays more episodes of both mania and depression states than bipolar.

Various causes and symptoms of bipolar disorder

For a long time, where and how bipolar disorder illness may be caused may still be a mystery.  Some information of bipolar disorder may be known, but nothing tangible about this illness. According to medical practitioners, bipolar can possibly be caused by genetic predisposition. Bipolar disorder can be seen in the family of the person affected by this illness. Some medical practitioners have carried out a study on identical twins, to determine if there is a higher possibility of twins with the same genetic structure, to acquire this illness both of them. Surprisingly, the findings revealed that there may be a high possibility of one twin getting the disease if the other twin gets affected, but this may not be certain.

Other researches reveal that, the gene for bipolarity has largely been found to chromosome 18 and some other chromosomes too. Although this gene has been traced to chromosome 18 it is not certain which is responsible since in some cases, the study reveals that this chromosome may not be affected in individuals with bipolar disorder. Most likely, this illness is connected to numerous genes acting together. Therefore, it appears that the genetic predisposition of this illness may be a key factor in causing bipolar disorder, but this does not make it a certainty.

Also, chemical imbalances in a person’s body may also contribute to this illness. This is because, the brain contain a chemical balance which can cause many problems in the person’s body when disrupted. The study show that in looking for primary cause for depression monoamines, it is believed that a class of neurotransmitters may contribute to its cause. Additionally, various studies revealed that the drug reserpine that depletes monoamines resulted to serious depression and other drugs that slow down monoamines break down get used as antidepressants. Specifically, it is revealed that monoamine norepinephrine play a key role in the cause of depression.  As a way of regulating the level of norepinephrine, some drugs get used in blocking the reuptake of the neurotransmitter, and block it in the synapses.

In addition, serotonin may have an effect on depression; this is because, in turn it affects other parts of a person’s brain through its depletion. Also, it is believed that the hypothalamus involved in a person’s sleep and appetite and cortical areas involved in cognition can also be key factors that lead to the cause of depression. Additionally, it is also thought that amygdala which comprise of set of neurons situated in the medial temporal lobe of the person’s brain, and involved in emotions can be a contributing factor to the cause of depression.

There are influences that can affect bipolar disorder, for instance, stress can cause an episode to happen or make the disease to progress. In a person’s brain, the area that deals with stress may be referred as hypothalamic-pituitary-adrenal (HPA) axis. When the body of a person gets exposed any form of stress, HPA usually releases corticotropin-releasing factor (CRF). Corticotropin-releasing factor causes the release of cortisol. CRF can result to decrease of sex, appetite and heightens alertness. On the other hand, Cortisol can lead to an increase in the muscle activity. Also, constant activation of this chain of fluctuations can contribute to the cause of depression; it may also cause mania because of chemical changes it causes in a person’s brain.

It is also thought that sleep and the internal clock, can contribute to the cause of bipolar disorder illness. The circadian clock is situated in the hypothalamus specifically in suprachaismatic nucleus (SCN). This nucleus together with other things plays a part in regulating melatonin. Melatonin can be referred as a hormone involved in the person’s sleep cycle. Bipolar patients experience a lot of complexity in regulating their circadian rhythms between states of depression and mania.

Treatment

Since 1960’s, Lithium has acted as the primary treatment of bipolar disorder. Lithium plays an extremely vital function in stabilizing the cycling characteristic of this disease. According to four controlled researches conducted by F. K. Goodwin together with K. R. Jamison, the total response rate for bipolar subjects treated using Lithium reached 78% in the 1990. Also, Lithium is the main drug used for long-term maintenance of this illness.  In the majority of individuals with bipolar disorder, Lithium reduces the period, severity and frequency of mania and depression episodes.

Unfortunately, approximately 40% of individuals with bipolar disorders are either not responsive to Lithium, or cannot tolerate the side effects of this treatment. Some of the major side effects of lithium treatment include weight gain, diarrhea, thirst, nausea, and edema. Many bipolar patients, who are unresponsive to the treatment using Lithium, are in most cases individuals who experience mixed states, dysphoric mania, or those who experience cycling bipolar disorder.

One of the main problems connected with Lithium treatment is the fact that, long-term Lithium treatment can be connected with a decrease in the functioning of thyroid in bipolar patients. Preliminary evidence proposes that hypothyroidism may lead to rapid-cycling. Also, another problem linked with Lithium treatment is usually experienced by pregnant women. Using Lithium treatment during pregnancy has been associated with various birth defects, specifically Ebstein’s anomaly. With regard to the current data gathered from United States, the risk of a baby with Ebstein's anomaly born to a mother who used Lithium treatment in her first trimester of pregnancy is about 1 in every 8,000, or2.5 times to that of the total population.

In many cases, where the bipolar patient turns out to be unresponsive or cannot tolerate the effects of lithium treatment, other effective treatments for this illness can be used. The guidelines of the American Psychiatric Association propose the next line of bipolar disorder treatment to be Anticonvulsant drugs. These drugs include arbamazepine and valproate can play a significant role as antimanic agents, especially among patients with mixed states.  Both Arbamazepine and valproate can be used in combination with each other, or in combination with lithium. Valproate drug is particularly useful for bipolar patients experiencing rapid-cycling, unresponsive to lithium, or those with comorbid alcohol or drug abuse.

In addition, Neuroleptics like chlorpromazine or haloperidol can also play a vital role in stabilizing manic patients who may be highly agitated or psychotic. Usage of these drugs is regularly essential since their response is fast, but risks involved in their usage are also present.  As a result of serious side effects, Benzodiazepines are regularly used in their place. These chemicals can attain the same results as Neuroleptics for most bipolar patients in terms of quick control of excitement and agitation, without stern side effects.

On the other hand, some doctors have also used antidepressants like amitriptyline and selective serotonin reuptake inhibitors (SSRI's) fluovamine in treating bipolar disorder. According to a research conducted in 1990s by F. Gatti, M. Gasperini among others, it    revealed that amitriptyline and fluvoxamine can be highly effective in treating bipolar patients in depressive episodes. Most medical practitioner can see the significance of antidepressants when used together with mood stabilizing medicines for instance lithium.

Other than the mentioned medical treatments of this illness, various options can also be available to bipolar patients. Most of this treatment gets used in combination with medicine, for example, light therapy. A certain research compared the response to light therapy of individuals with bipolar disorder with that of unipolar patients. The findings revealed that, the patients were free of hypnotic and psychotropic medication for a month before getting treatment. On the other hand, individuals with bipolar disorder in this study displayed an improvement of slightly more than 90 %, in their depressive symptoms, with no occurrence of mania or hypomania.

Another treatment for bipolar patient can be electro-convulsive shock therapy commonly known as ECT. This treatment is the favorite treatment for pregnant patients with severe manic state, and those patients who are psychotic, homicidal, medically compromised, catatonic or severely suicidal. Finally, According to The National Depressive and Manic Depressive Association spokesman, Dr. John Graves, outpatient group psychotherapy can also help in addressing the issues of bipolar disorders.