Bipolar Disorder: Multiple Mood Episodes, but where is the Solution?

What Is Bipolar Disorder?

Bipolar disorder was previously called manic-depressive psychosis, or MDP. There has been a paradigm shift in the understanding of this complex brain disorder.

What Are the Inheritance and Perpetuation of Manic Episodes?

Those afflicted with bipolar disorder are prone to a lot of mood changes, sometimes on a day-to-day basis. This disorder runs in families, and research has identified many loci for its inheritance.

The various facets of this disorder include hypomania, mania, and depression. Each of these phases can be debilitating. The majority of those suffering from bipolar disorder spend their time being depressed rather than in mania or hypomania.

• The maximum duration that depression occurs or an episode can last is for 9 to 12 months, while a manic episode will remit within 3 to 6 months. However, this is not the rule in every case, but it is the maximum time period that a mood episode can last. Following this, there will be spontaneous remission, what is called ''the natural course'' of the disorder.

• Spontaneous remission of the mood episode (depression or mania or hypomania) is not seen in all cases, and there are quite a few chronic mania patients as well.

• Rather than the severity or duration of manic symptoms, factors associated with chronicity in mania are the presence of psychotic symptoms and issues related to social and occupational functioning.

What Are Behavioral Disturbances?

Mood episodes are intense, and people are prone to have behavioral disturbances during such episodes. It is imperative to seek professional help from a psychiatrist.

If left untreated, there will be serious socioeconomic implications with resultant loss of functioning capacity, quality of life, pay, and absence from work.

What Are the Symptoms of People with a Manic Episode?

• They may feel very ''up'' or ''high'', feel ''jumpy'' or ''wired''.

• They talk really fast with difficulty in interrupting them.

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• They will be agitated and restless.

• They are unable to sit in one place, indulge in high-risk behaviors like having reckless and unprotected sex or spend a lot of money.

• Their sleep goes for a toss, and they will be found to be pacing in their homes, right through the night. Even with such little sleep, they will feel refreshed and display high energy levels.

What Are the Symptoms of People with a Depressive Spell?

On the other hand, those having a depressive spell will experience symptoms that are poles apart from that of a manic episode.

• Depressed individuals will feel ''down'', worry a lot, and cannot concentrate on things at hand.

• They keep forgetting a lot of stuff.

• They become disinterested in day-to-day living.

• They experience difficulty in falling asleep.

• They keep getting thoughts about death and suicide.

• Coupled with this, they also experience a lot of fatigue and become less active.

What Are the Risk Factors of Bipolar Disorder?

Factors increasing the risk of developing bipolar disorders are,

• A first-degree relative (parent or sibling) with bipolar disorder.

• High stress due to a traumatic event or the death of a loved one.

• Drug abuse or alcohol abuse.

What Are the Complications of Bipolar Disorder?

When bipolar disorder is left untreated, it can result in serious problems affecting every day of your life, such as:

• Issues of drug and alcohol abuse.

• Unable to concentrate on studies.

• Suicide attempts.

• Financial problems.

• Trouble maintaining a stable relationship.

• Poor work performance.

How Is Bipolar Disorder Diagnosed?

• Bipolar disorder is diagnosed using criteria, either from the Diagnostic and Statistical Manual-5 (DSM-5) or the International Classification of Diseases (ICD-10). More often than not, it is common for clinicians to miss a previous mood episode which altogether changes the diagnosis.

• Bipolar disorder is a clinical diagnosis, and there is no investigation that will effectively point to the diagnosis as of now.

• Research is going on to find reliable biomarkers, as in the case of cancer, for the diagnosis of bipolar disorder.

How Is Bipolar Disorder Prevented?

Bipolar disorder cannot be prevented. But getting treatment at the earliest can help prevent bipolar disorder or any other mental health conditions from getting worsened.

When you have been diagnosed with bipolar disorder, following some strategies can help to prevent minor symptoms from becoming full-blown episodes. They are,

• Paying Attention To Warning Signs - When we address the symptoms earlier, one can prevent episodes from getting worse because the pattern of bipolar episodes and its triggering factors can be identified. Reach the doctor when you feel falling into an episode of mania or depression. Also, involve your family or friends to watch for warning signs.

• Avoid Drugs and Alcohol - Recreational drugs or alcohol consumption can worsen the symptoms and make them more likely to return.

• Take the Medications As Directed - Do not stop the medication or reduce the dose on your own because it may cause withdrawal effects or the symptoms may worsen or recur.

How Is Bipolar Disorder Treated?

A host of options exist for the treatment of bipolar disorders. The current philosophy of treating bipolar disorder lies in symptom control and prophylaxis.

Risk for recurrent episodes exists throughout one's life, and one school of thought says that prophylaxis should be for a lifetime. Again, there are differing schools of thought, as there is none to fit all treatment.

Medication:

These are referred to as mood stabilizers. Those with euphoric (intense sense of happiness) mania are treated with Lithium, and those with dysphoric or irritable mania are treated with Valproate.

Those who have a preponderance of repeated depressive spells in their course of this disorder are treated with Olanzapine-Fluoxetine combination, Quetiapine, or Lamotrigine. All atypical antipsychotics serve as antimanic agents.

Therapy:

''Talk'' therapy can help clients change their behavior and manage their lives. Therapy should also include family members, and they should be educated about the illness, its natural course, prognosis, and treatment options.

A specialized form of therapy, called Interpersonal and Social Rhythm Therapy (IPSRT), exists for clients with bipolar disorder. All psychiatrists undergo training to administer this form of therapy.