Bipolar disorder is a mental illness that alternates between manic and depressive episodes, although mixed states are also possible. The disorder is partly genetic. Terms such as manic-depressive psychosis, manic depression are also often used for bipolar disorder.
What is bipolar disorder?
Infographic on the causes and neural reasons for depression. Click image to enlarge. Because bipolar disorder leads to mood changes that cannot be influenced by the affected person, it is categorized as one of the so-called affective disorders, as are manias and depressions. The manic phases of bipolar disorder are characterized, among other things, by an increased energy level, reduced need for sleep and exaggerated self-confidence. During such episodes, sufferers may be capable of exceptional performance, but may also become delusions of grandeur and enter difficult or dangerous situations. The depressive phases, on the other hand, are characterized by listlessness and dejection – often during this phase, sufferers regret the things they said or did during a previous manic episode. During these depressive phases, people with bipolar disorder are at significantly increased risk for suicide.
Causes
A number of factors are thought to be responsible for bipolar disorder. Because the disorder runs in clusters in some families and altered chromosomes have been found in affected individuals, it must be assumed that bipolar disorder is partly hereditary. Studies from twin research confirm the influence of genes. Often, a drastic life event or stress is the trigger for bipolar disorder to make itself felt for the first time. Later in life, even minor stress can be enough for a sufferer to slip into a manic or depressive episode. The illness usually breaks out relatively early in life, before the personality is sufficiently consolidated. Since this can lead to low self-esteem, there is a possibility that the symptoms of bipolar disorder may be exacerbated by this.
Symptoms, complaints, and signs
The main symptom of bipolar disorder is the chronic and often lifelong fluctuation of mood, drive, and activity. The alternation of depressed and manic moods, interrupted by neutral phases, exceeds the usual level and is clearly distinguishable from normal mood swings that everyone experiences. Further symptoms of the disease are the inevitable social and professional impairment as well as great psychological suffering of the affected persons. The contrasting moods cause the different symptoms of the disease. Depressive phases usually occur more frequently and last for at least two weeks. The main symptoms are a severely depressed mood, reduced drive and lack of interest. These may be supplemented by a loss of positive self-esteem, thoughts of death, suicidal tendencies, sleep disturbances, loss of appetite, or cognitive deficits, such as memory impairment. Symptoms of a manic phase that lasts several days are an increased level of agitation and a noticeably elevated mood. This often seems inappropriate to the situation and can quickly turn into an irritable and aggressive mood. Other symptoms include an increase in drive, loss of social inhibitions, and sexual overactivity. The attitude towards the own person is extremely positive, own abilities are clearly overestimated. The result is risky behavior without recognizing possible risks. Symptomatic of mania are further urge to talk, racing thoughts, ideas of grandeur, impulsivity, little or no need for sleep, decisiveness.
Diagnosis and course
The phases of bipolar disorder are each characterized by very different symptoms. Several of these symptoms must be observed for an extended period of time for the disorder to be correctly diagnosed. In most affected individuals, bipolar disorder first becomes apparent in adolescence or early adulthood. The duration and intensity of manic or depressive episodes can vary widely: Manic phases usually last somewhat shorter; in addition, there may be periods of hypomania, a weakened form of mania.About one third of sufferers experience problems with addictive substances – it can be assumed that this is a form of self-medication. As people age, depressive episodes become more frequent, and about 20 percent of those affected by bipolar disorder commit suicide.
Complications
Complications arising from the manic episodes are most common in bipolar I disorder. In contrast, the hypomanic episodes in bipolar II disorder are milder. During a manic episode, sufferers often tend to engage in risky behavior, feel increased sexual needs, or spend a lot of money. This can lead to conflicts and debts. Suicidality is a serious complication that can occur especially during depressive episodes. Thirty percent of all sufferers commit at least one suicide attempt during the course of their illness. Some people suffering from bipolar disorder also engage in self-injurious behavior. However, this does not necessarily have the goal of ending one’s own life. Wounds and scars can lead to further complications: Inflammation, muscle and nerve damage, and stigmatization are some of them. Outside of depressive episodes, bipolar disorder may also be accompanied by depressed mood or the maintenance of individual depressive symptoms. Circadian disturbances are common: affected individuals typically rise late and feel better in the late evening hours. Sleep disorders or other mental illnesses may develop as a further complication. Severe lifestyle restrictions are possible in a course known as rapid cycling. In this case, the manic and depressive episodes alternate very quickly. The rapid change often poses a challenge for the social environment of the person affected. In addition, there is a risk that the episodes will be downplayed as mood swings.
When should you see a doctor?
A doctor should be consulted when everyday life and togetherness suffer. A distinction must be made between depressive phase and mania. If the sick person is in a high from his point of view (mania), it is hardly possible to get him to go to the doctor. There is usually a complete lack of insight into the illness and the sufferer feels better than ever before. However, a doctor and the police can be called if there is a danger to self or others. This is often the case when the sick person becomes aggressive and makes threats. Unfortunately, in this case we have to speak of helping against his will. It is easier to encourage the sick person to visit a doctor when the depression sets in. He is usually barely able to do everyday things like getting out of bed, doing laundry or shopping. Due to the lack of drive and the gloomy thoughts ranging from self-hatred to suicidal intentions, the sick person will be more willing or even feel the urge to go to the doctor. Many doctors diagnose depression instead of bipolar disorder. Because of this, a good primary care physician or specialist must ask the family members and include them in the treatment. Since psychological causes and/or trauma are the cause of the illness in many cases, an appropriately trained psychologist should definitely be consulted.
Treatment and therapy
The different phases of bipolar disorder can be treated with different medications: Antidepressants are used in the depressive phases, and neuroleptics are used in the manic phases. It is often necessary to combine different medications – especially in those phases in which symptoms of depression and mania occur simultaneously. In addition, it may be useful to carry out talk therapy. The overconfidence in the manic phases usually prevents those affected from reflecting on their own behavior in order to recognize it as harmful or risky, if necessary. To prevent patients from putting themselves or others at risk, such cases may result in forced psychiatric placement. Over time, sufferers can learn to cope with bipolar disorder, but a complete cure is not currently possible.
Outlook and prognosis
Many people with bipolar disorder suffer from recurrent manic and depressive episodes. Rapidly changing episodes are called rapid cycling and occur in 20% of people with the disorder. Women suffer from rapid cycling more often than men.Manic and depressive episodes occur particularly frequently when certain risk factors are present. These risk factors include, for example, mixed episodes (with manic and depressive features simultaneously), young age at onset, critical life events, female gender, and psychotic symptomatology. In addition, the prognosis of bipolar disorder is often unfavorable when medications intended to prevent the manic and depressive episodes do not work reliably in the affected person. 30% of people suffering from bipolar disorder attempt suicide during their lifetime. Furthermore, it is possible that residuals remain after the manic and depressive episodes. Psychology refers to these as residuals. Many bipolars also suffer from single or multiple depressive symptoms outside of the delineable depressive episodes. Some sufferers experience only a few manic and depressive episodes and have little overall restriction in their lifestyle. “Spontaneous recovery” without treatment is possible; however, it usually occurs in younger sufferers and is usually unpredictable. Therefore, early treatment is recommended.
Prevention
Those affected by bipolar disorder can learn over time to watch for certain warning signs that a new manic or depressive episode is approaching. It is important to seek professional help as early as possible – even if symptoms are rather inconspicuous. Even if no cure can be expected, the damage caused by bipolar disorder can be kept to a minimum.
Aftercare
Part of the aftercare of a manic or depressive episode is to prevent further episodes. Various means can be used to do this. After an inpatient stay, it makes sense to continue treatment on an outpatient basis. A psychotherapist supports the patient on a psychological and social level, while a psychiatrist decides together with the patient whether to take medication. Not in every case do people with bipolar disorder need to take psychotropic drugs permanently. However, especially during severe manic and depressive episodes, they can help establish a biochemical balance in the brain. Doctors prescribe certain active ingredients with the aim of reducing the risk of manic-depressive episodes returning. To this end, six agents are approved for bipolar disorder in Germany: Lithium, olanzapine, quetiapine, carbamazepine, lamotrigine and valproic acid. In psychotherapy, patients learn about their individual causes and triggers for bipolar disorder. For follow-up care, it is crucial to reduce these factors as much as possible in order to establish a stable living situation. [[Depressive symptoms often persist after an acute manic or depressive episode, which is why their treatment also plays a role in aftercare. In addition, prevention of suicidal ideation is important in the aftercare of bipolar disorder.
Here’s what you can do yourself
Because bipolar disorder is a serious mental illness, self-help alone is not recommended. In bipolar disorder, the extreme swings in mood and drive should always be treated and monitored by experts. Acute therapy involves the use of mood-stabilizing medications, which are then often given for life as part of phase prophylaxis. In addition to treatment by experts, a healthy lifestyle with a good diet and sufficient exercise is advisable. Good nutrition helps the body to maintain its functions. Sufficient exercise units in everyday life help to reduce stress and ensure an increased release of happiness hormones. This can have a great effect, especially during a depressive phase. Artistic activities such as painting, music and dance also have a positive effect on many patients. Attending self-help groups can also bring comfort to those affected. Among like-minded people, one can discuss one’s complaints and gain more knowledge about one’s illness. By means of mood calendars, sufferers can record the course of their mood swings and thus have good control over the individual course of the disease.The progression of mood in the mood calendar can also provide important insight for the therapist to better tailor treatment interventions to the patient’s individual problem.
