BIPOLAR DISORDER: Diagnosis and Treatment

Overview

With Kanye West back in the news, we thought it would be an excellent time to discuss Bipolar Disorder. It is a mental disorder characterized by unusual energy levels, mood swings, activity levels, focus, and the capacity to perform daily activities[1].

Key facts about Bipolar disorder

• Worldwide, over 45 million people are affected by bipolar disorder[1].
• It might be challenging to deal with bipolar disorder, but there are actions you can take to help yourself or the patient.
• Go for treatment and adhere to it—improvement isn’t quick or easy. Nevertheless, treatment works.
• Keep all medical and therapy sessions, and discuss drug treatment with your doctor.
• Medications should be taken according to the prescription.
• Be sure to follow a regular eating and sleeping schedule.
• Notice your mood fluctuations and warning signals, such as sleep deprivation.
• It takes time for improvements to take place. However, assistive social networks can be beneficial.
• Drug and alcohol misuse should be avoided.
• Remember that it is a lifelong disease, but continuous therapy can help you overcome your symptoms and maintain a healthy lifestyle

.

It has four main types: high energy, mood changes, activity level changes, and physical symptoms[2]. These moods can fluctuate from very “up” and energized (manic episodes) to extremely “down,” unhappy, or hopeless attitude (depressive episodes).

• Bipolar I Disorder: It is described by manic episodes that could last two weeks or manic episodes that necessitate urgent hospitalization. Common depressive episodes last two weeks or more.
• Bipolar II Disorder: Different from Bipolar I, where mainly manic episodes occur, Bipolar II Disorder is marked by a set of hypomanic and depressive episodes.
• Cyclothymia: As the name suggests, It is characterized by hypomania and anxiety episodes that last for two years. On the other hand, the signs and symptoms do not match those of a major depressive or manic episode.
• Unspecified bipolar disorder: As the name suggests, It is a bipolar disorder not otherwise specified when the symptoms do not match the other three.

Risks Factors/ Causes

Researchers are investigating the causes of bipolar disorder[4]. Thus far, no specific cause has been attributed to bipolar disorder, but several factors contribute to the development of the disease.

• The function of the Human Brain: The brains of individuals with bipolar disorder may function differently from people who do not have the disease. By understanding these differences, scientists understand bipolar disorder better and can determine which remedies are most helpful. In addition, with brain imaging or other diagnostic testing, healthcare practitioners do not have to rely simply on the patient’s symptoms and history to diagnose and plan therapy.
• Genetics: According to some research, it may be more common in persons with particular genes. According to a study, People with bipolar disorder running in the family are more prone to develop the illness themselves, according to research[5]. Multiple genes may be involved, with no single gene responsible for the disease. A better understanding of genotypes’ role in bipolar disorder will lead to novel treatments.

Diagnosis

With the proper diagnosis and treatment, people with bipolar disorder can live healthier and more productive lives. A consultation with a doctor or other healthcare professional should be the first step. They may perform a psychological exam or refer patients to a psychologist[6]. Bipolar disorder is identified by mental health professionals based on signs and symptoms, previous experiences, and family background.

Treatments and Therapies

Treatment can help many people with mild to severe bipolar disorder[7]. Plans that combine medicine and psychotherapy, known as “talk therapy,” are frequently successful.

Lifelong bipolar disorder is a chronic illness. It is common for manic and depressive episodes to recur over time. However, some bipolar people may experience persistent mood changes in between episodes. Continuous, long-term treatment can be beneficial for people with these symptoms

• Pharmacotherapy

Bipolar disorder can be managed with the help of certain medications. However, you may need to work with your healthcare provider and try various medications before settling on the most effective.

Bipolar disorder is typically treated with second-generation antipsychotics and mood stabilizers. Sleeping or anxiety pills may also be included. Antidepressants are frequently used to treat anxiety attacks and mood stabilizers to stop a manic episodes [8]. Talk to your doctor before stopping a medication because Bipolar disorder symptoms may worsen if a medication is suddenly stopped.

• Psychotherapy

People with bipolar disorder may benefit from psychotherapy, also known as “talk therapy.” There are many different types of psychotherapy, but the goal is always to help identify and modify troublesome feelings, ideas, or behaviors. In addition, it can offer family and educational support to patients with bipolar disorder. Several conditions can be treated with psychoeducation and cognitive-behavioral therapy[9].

Family-focused therapy and Interpersonal and social rhythm therapy (IPSRT)  are newer treatments for bipolar disorder. An essential aspect of these therapies is that intensive psychotherapeutic intervention applied at the initial stages can help stop or restrain the onset.

• Other Treatment Options

Other treatments for bipolar disorder may be helpful for some people, including:

• Electroconvulsive therapy (ECT): People with bipolar disorder with severe symptoms may benefit from electroconvulsive therapy (ECT), a brain stimulation technique. Modern ECT typically involves a series of treatment sessions. It helps treat manic and depressive outbreaks when medicine and psychiatry are ineffectual or risky. In addition, ECT is helpful when a rapid reaction is necessary, such as in a suicide attempt[10].
• Transcranial magnetic stimulation (TMS): This newer brain stimulation method uses magnetic waves to stimulate the brain’s neurons. Over one month, the drug is administered to the patient daily. TMS appears valuable for patients with various types of depression[11].

How to Deal with your loved ones with Bipolar disorder?

Living with a loved one with bipolar disorder and providing care and support for that person can be challenging. Likewise, it’s tough to deal with someone suffering from bipolar disorder.

Here are some suggestions for assisting your loved one:

• Spend time with your loved one.
• Answer questions honestly.
• Don’t take any comments personally.
• Allow your loved one to sleep whenever possible.

References:

• GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. DOI:https://doi.org/10.1016/S0140-6736(18)32279-7
• Müller-Oerlinghausen, Bruno, Anne Berghöfer, and Michael Bauer. “Bipolar disorder.” The Lancet 359.9302 (2002): 241-247.
• Craddock, Nick, and Pamela Sklar. “Genetics of bipolar disorder.” The Lancet 381.9878 (2013): 1654-1662.
• Hirschfeld, Robert MA, and Myrna M. Weissman. “Risk factors for major depression and bipolar disorder.” (2002).
• Kakiuchi, Chihiro, et al. “Impaired feedback regulation of XBP1 as a genetic risk factor for bipolar disorder.” Nature genetics 35.2 (2003): 171-175.
• Phillips, Mary L., and David J. Kupfer. “Bipolar disorder diagnosis: challenges and future directions.” The Lancet 381.9878 (2013): 1663-1671.
• Geddes, John R., and David J. Miklowitz. “Treatment of bipolar disorder.” The Lancet 381.9878 (2013): 1672-1682.
• Hirschowitz, Jack, Alexander Kolevzon, and Amir Garakani. “The pharmacological treatment of bipolar disorder: the question of modern advances.” Harvard review of psychiatry 18.5 (2010): 266-278.
• Jones, Steven. “Psychotherapy of bipolar disorder: a review.” Journal of Affective Disorders 80.2-3 (2004): 101-114.
• Valentí, Marc, et al. “Electroconvulsive therapy in the treatment of mixed states in bipolar disorder.” European Psychiatry 23.1 (2008): 53-56.
• Myczkowski, Martin L., et al. “Cognitive outcomes of TMS treatment in bipolar depression: Safety data from a randomized controlled trial.” Journal of affective disorders 235 (2018): 20-26.