Bipolar disorder - causes, symptoms, diagnosis and treatment
How to recognise manic and depressive episodes, how bipolar disorder is diagnosed and which treatments keep the illness under control.
Bipolar disorder is a chronic psychiatric condition characterised by the alternation of periods of deep depression and episodes of mania or hypomania. During depressive episodes, individuals can experience feelings of extreme sadness, a loss of interest in everyday activities and difficulty concentrating. In contrast, manic episodes are marked by a state of excessive euphoria, increased energy, a reduced need for sleep and impulsive behaviours. The condition affects a person’s mood, energy and ability to function.
The main characteristics of bipolar disorder include extreme fluctuations of mood and energy.
There are two major types of bipolar disorder: Bipolar I, which is defined by full manic episodes, often accompanied by major depressive episodes, and Bipolar II, characterised by episodes of hypomania (a milder form of mania) and major depressive episodes. People with bipolar disorder can also have periods of normal mood between the episodes of mania and depression, but these periods can vary in duration.
Bipolar disorder and borderline personality disorder share some common symptoms, such as rapid mood changes and impulsive behaviours, but they are distinct conditions. The difference between bipolar disorder and borderline is that bipolar disorder is marked by well defined cycles of mania and depression, while borderline personality disorder involves a persistent pattern of instability in interpersonal relationships, self-image and affects, often linked to an intense fear of abandonment.
Causes and risk factors for bipolar disorder
Bipolar disorder is a complex condition, with multifactorial causes that are not fully understood at present. Even so, research has identified several risk factors and possible causes that can contribute to the development of this disorder. These factors include genetic, biological, environmental and psychological components.
Genetic factors
Studies show that bipolar disorder has a significant genetic component. People who have a first-degree family member (parents, siblings) with bipolar disorder have a higher risk of developing this condition compared with the general population. Although the specific genes responsible have not been fully identified, genetic research suggests the involvement of several genes in combination with environmental factors.
Biological factors
Dysfunctions in brain chemistry, especially in neurotransmitters such as serotonin, dopamine and norepinephrine, play a crucial role in bipolar disorder. These chemicals are essential for regulating mood and emotions. Structural abnormalities of the brain, detected through brain imaging, such as changes in the amygdala and the hippocampus, have also been associated with bipolar disorder.
Environmental factors
Stressful life events, such as emotional trauma, abuse, the loss of a loved one or traumatic experiences in childhood, can trigger episodes of mania or depression in genetically predisposed people. Constant stress and the lack of adequate social support can worsen the symptoms and can contribute to the development of this disorder.
Psychological factors
The individual characteristics of the personality and coping strategies (stress management) can influence the onset and the course of bipolar disorder. People with certain personality traits, such as impulsivity or a tendency to experience intense emotions, can have a higher risk of developing this condition.
Bipolar disorder is therefore the result of a complex interaction between genetic, biological, environmental and psychological factors. Understanding these factors can help with the early identification of people at risk and with the development of more effective prevention and treatment strategies.
The symptoms of bipolar disorder
Bipolar disorder shows itself through a wide range of symptoms, which fall mainly into two categories: episodes of mania/hypomania and episodes of depression. Although the basic symptoms of bipolar disorder are similar in men and women, there are differences in the way they show themselves and are experienced depending on sex.
The symptoms of bipolar disorder in women
Episodes of mania/hypomania:
- Exaggeratedly positive emotions: A state of euphoria or increased irritability.
- Increased energy and activity: Restlessness, hyperactivity, intense participation in social activities.
- Rapid thoughts and accelerated speech: A rapid flow of ideas and fast speech, sometimes difficult to follow.
- Reduced sleep: A reduced need for sleep, but without the feeling of tiredness.
- Risky behaviours: Impulsivity, excessive spending, risky sexual behaviours.
Episodes of depression:
- Deep sadness: Persistent feelings of sadness, emptiness or hopelessness.
- Loss of interest: A lack of interest in activities that used to be enjoyable.
- Tiredness and lack of energy: A constant feeling of tiredness, difficulty getting out of bed.
- Difficulty concentrating: Problems with concentration and with making decisions.
- Changes in appetite and weight: A significant decrease or increase in appetite and weight.
- Thoughts of death or suicide: Recurring thoughts of death, of suicide or suicide attempts.
The symptoms of bipolar disorder in men
Episodes of mania/hypomania:
- Exaggeratedly positive emotions: A state of euphoria or increased irritability.
- Increased energy and activity: Restlessness, hyperactivity, excessive involvement in physical or social activities.
- Rapid thoughts and accelerated speech: A rapid flow of ideas and fast speech, difficult to interrupt.
- Reduced sleep: A reduced need for sleep, but maintaining a high level of energy.
- Risky behaviours: Impulsivity, aggressive behaviours, the use of alcohol or drugs, excessive spending.
Episodes of depression:
- Deep sadness: Persistent feelings of sadness, emptiness or hopelessness.
- Loss of interest: A lack of interest in activities that used to be enjoyable.
- Tiredness and lack of energy: A constant feeling of tiredness, difficulty getting out of bed.
- Difficulty concentrating: Problems with concentration and with making decisions.
- Changes in appetite and weight: A significant decrease or increase in appetite and weight.
- Thoughts of death or suicide: Recurring thoughts of death, of suicide or suicide attempts.
Differences between men and women with bipolar disorder
- The onset and the cycle of the episodes: Women tend to have rapid cycles, with more depressive episodes, while men can experience more manic episodes and are more prone to aggressive behaviours.
- Comorbidities: Women are more prone to anxiety disorders and eating disorders, while men have a higher risk of developing problems related to substance abuse.
- The impact on social and professional life: Women can have greater difficulty managing interpersonal relationships and everyday responsibilities, while men can have greater problems keeping a job because of impulsive and aggressive behaviours.
Although bipolar disorder shows itself through a common range of symptoms, there are notable differences depending on sex in terms of the frequency, the intensity and the impact of these symptoms. These differences underline the importance of a personalised approach in the diagnosis and treatment of bipolar disorder.
Diagnosing bipolarity
Diagnosing bipolar disorder is a complex process that requires a careful and detailed assessment by a mental health professional. Because of the similarities between the symptoms of bipolar disorder and those of other mental conditions, correct diagnosis can sometimes be difficult. It involves a combination of clinical interviews, psychological assessments and the patient’s medical history.
The clinical interview and the medical history
The first step in the diagnosis is a thorough clinical interview, in which the psychiatrist or the psychologist gathers information about the patient’s current symptoms, their duration and severity, as well as about any previous manic, hypomanic or depressive episodes. It is essential to explore the family history as well, given the genetic component of bipolar disorder. A detailed medical history helps identify any other medical or psychiatric conditions that could influence or mimic the symptoms of bipolar disorder.
Psychological assessments and diagnostic instruments
Besides the clinical interview, various psychological tests and standardised questionnaires can be used in order to assess the patient’s mental state and to quantify the symptoms specific to bipolar disorder. Examples of such instruments include the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). These assessments can offer an objective picture of the severity of the symptoms and can help distinguish bipolar disorder from other mood disorders.
The DSM-5 diagnostic criteria
The diagnosis of bipolar disorder is often based on the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
According to the DSM-5, in order to be diagnosed with bipolar I disorder, a person has to have experienced at least one manic episode, which can be preceded or followed by hypomanic or major depressive episodes.
Bipolar II disorder is characterised by the presence of major depressive episodes and at least one hypomanic episode, without full manic episodes. It is important to note that a manic episode is distinguished by an extremely elevated or irritable mood, accompanied by excessive activity and energy for at least one week, while a hypomanic episode has a shorter duration and a lower intensity.
Differential assessment
A crucial aspect of diagnosing bipolar disorder is the differential assessment, in order to rule out other conditions that could present similar symptoms, such as personality disorders, anxiety disorders, autism spectrum disorders or substance abuse disorders. It is also necessary to take into account the medical factors that could influence the symptoms, such as thyroid conditions or the side effects of certain medicines.
Monitoring and adjusting the diagnosis
Diagnosing bipolar disorder is not a static process and can require monitoring and periodic adjustments. The symptoms can develop over time, and the response to treatment can offer additional clues about the exact nature of the disorder. In some cases, reassessments may be needed in order to ensure the accuracy of the diagnosis and the effectiveness of the therapeutic interventions.
It is also a multidimensional process that requires an integrated and collaborative approach. An accurate and complete assessment is essential in order to ensure a suitable treatment plan and to improve the quality of life of the people affected by this disorder.
Treatment options for bipolar disorder
The treatment of bipolar disorder involves a combination of medication, psychological therapy and alternative interventions in order to manage the symptoms and to prevent relapses. It is important for the treatment to be individualised, adapted to the specific needs of each patient.
Medication
- Mood stabilisers: These are used in order to prevent manic and depressive episodes.
- Anticonvulsants: They are often used as mood stabilisers, having a beneficial effect in preventing episodes of mania and depression.
- Antipsychotics: They are used in order to treat severe manic episodes and to stabilise mood.
- Antidepressants: In combination with mood stabilisers, antidepressants can be used in order to treat depressive episodes, although their use requires caution so as to avoid triggering a manic episode.
Psychological therapy
- Cognitive-behavioral therapy (CBT): It helps patients identify and change the patterns of negative thinking and the behaviours that contribute to their symptoms.
- Interpersonal and social rhythm therapy (IPSRT): It focuses on stabilising the daily routine and the circadian rhythms in order to prevent mood changes.
- Family therapy: Involving family members in the treatment helps educate them about bipolar disorder and improves communication and support within the family.
Alternative interventions
- Neurofeedback therapy: Neurofeedback is a non-invasive technique that involves training the brain to self-regulate its activity. The patient is connected to an EEG device that monitors brain activity in real time and offers visual or auditory feedback. Through this process, the patterns of brain activity associated with the symptoms of bipolar disorder are changed.
- Electroconvulsive therapy (ECT): In severe cases or in cases resistant to treatment, ECT can be used in order to relieve the symptoms quickly. It involves applying controlled electric shocks in order to induce a brief seizure.
- Transcranial magnetic stimulation (TMS): TMS is a non-invasive procedure that uses magnetic pulses in order to stimulate certain regions of the brain involved in regulating mood.
The effectiveness and the way neurofeedback works
Neurofeedback has gained interest in treating bipolar disorder thanks to its ability to modulate brain activity directly. Studies suggest that neurofeedback can be effective in reducing the symptoms of depression and mania by training the brain to maintain more stable patterns of activity. Patients learn to self-regulate their brain activity through feedback in real time, which leads to a reduction in mood fluctuations.
The visual or auditory feedback is offered according to the patient’s brain activity, allowing them to observe and consciously adjust the activity of the brain. Through repetition, the brain learns to adopt and maintain patterns of brain activity associated with a stable mood.
Complications associated with a lack of treatment for bipolar disorder
The lack of treatment for bipolar disorder can lead to a series of severe complications that affect the person’s mental and physical health, as well as their interpersonal relationships and their social and professional functioning. These complications can progressively worsen the state of health and can lead to situations of increased risk for the individual’s life.
Psychological and emotional complications
- The severity of the symptoms: Without treatment, the episodes of mania and depression tend to become more frequent and more severe. People can experience extreme mood fluctuations, which can lead to impulsive behaviours and dangerous decisions.
- The risk of suicide: The deep depression associated with bipolar disorder significantly increases the risk of suicide. Without intervention, people can develop persistent suicidal thoughts and can attempt to take their own life.
Physical complications
- Health problems: People with untreated bipolar disorder are more prone to physical health problems, including cardiovascular disease, obesity and diabetes. Manic behaviours, such as lack of sleep, the excessive use of alcohol or drugs, and unhealthy eating contribute to these risks.
- Accidents and injuries: Risky and impulsive behaviours during manic episodes increase the risk of accidents and injuries, both for the person affected and for those around them.
Social and professional complications
- Problems in relationships: Untreated bipolar disorder can lead to major difficulties in interpersonal relationships. Mood fluctuations can cause frequent conflicts with family members, friends and work colleagues.
- Reduced professional performance: People with untreated bipolar disorder can have difficulty keeping a stable job. Episodes of mania and depression can affect the ability to carry out daily tasks, leading to low performance, frequent absences and the loss of the job.
- Social isolation: Because of emotional and behavioural difficulties, those affected can become socially isolated, avoiding social interactions and losing their support network.
Legal and financial complications
- Legal problems: Impulsive and irresponsible behaviours during manic episodes can lead to legal problems, such as breaking the law, arrests and court cases.
- Financial difficulties: Excessive spending and reckless financial decisions can lead to serious economic problems, including large debts and bankruptcy.
The long-term impact
- The progression of the illness: A lack of treatment can progressively worsen bipolar disorder. Every untreated episode can make future episodes more severe and harder to treat.
- Quality of life: Without treatment, the quality of life of people with bipolar disorder can drop dramatically. The constant feeling of emotional instability and the associated difficulties can lead to a life full of suffering and frustration.
Managing this condition properly through a comprehensive treatment plan is essential in order to prevent these complications and to ensure a more stable and healthy life.
If you are dealing with bipolar disorder and you want an innovative and effective therapeutic approach, brain training therapy could be the right solution for you. This unique method combines the advanced technology of neurofeedback with complementary therapies in order to obtain the best and most lasting results. Train your brain to manage the symptoms of bipolar disorder more effectively, gaining control over your emotional and social life. Book a free phone conversation today with a specialist in order to start your journey towards a more balanced and happier life!
References
- Bi, B., Che, D. and Bai, Y. (2022). Neural network of bipolar disorder: Toward integration of neuroimaging and neurocircuit-based treatment strategies. Translational psychiatry, [online] 12(1). doi:https://doi.org/10.1038/s41398-022-01917-x.
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