Also called manic-depressive illness, bipolar disorder is defined by the United States’ National Institute of Mental Health as a mental disease that “causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” The Public Health Agency of Canada specifies that it is a bio-chemical condition that provokes intense mood swings. These can last for “days, weeks or even months” and can range from mild to severe.
These distinct emotional states are called mood episodes. The “overly joyful” or manic state is called called a manic episode, while the “extremely sad or hopeless state” is called a depressive episode. A mixed state is one that includes both manic and depressive symptoms.
While the disorder typically lasts a person’s whole life, the episodes can be spaced out by a long time during which the affected person experiences no symptoms. Furthermore, mood is not the only thing affected—a person’s energy levels, sleep pattern, and behaviour can also see drastic changes.
Some people can inadvertently experience a milder form of mania, known as hypomania. Hypomanic episodes can make you feel very good and productive, and may be easily confused with just having a “good day.” However, if these episodes go unchecked, hypomania can eventually lead to more severe manic and depressive episodes.
Mixed states are characterized by the experience of mania and depression at the same time. This can cause someone to feel agitated, have trouble sleeping, go through major changes in appetite, and have suicidal thoughts.
More severe manic or depressive episodes can lead to psychotic symptoms as well, like hallucinations and delusions, in keeping with their extreme emotional state. For this reason, bipolar disorder is sometimes confused with schizophrenia.
“For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime.”
Like other mental illnesses, bipolar disorder tends to run in families, but environmental factors are also believed to come into play. One MRI study found that the brain’s prefrontal cortex in people with bipolar disorder tends to be smaller and function differently when compared to those of adults who don’t have the disorder. Having said that, scientists are still discovering how the regions of the brain are interconnected. More research is needed in both genetics and neurological connections to pinpoint an exact cause.
Diagnosis usually follows a physical exam, an interview, and lab tests, and typically falls into one of these four categories:
- Bipolar I Disorder—manic or mixed episodes that last at least seven days, or severe manic symptoms that require immediate hospital care; depressive episodes can occur as well, lasting at least 2 weeks.
- Bipolar II Disorder—pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
- Bipolar Disorder Not Otherwise Specified (BP-NOS)—symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II.
- Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder that includes hypomanic and mild-depressive symptoms.
A severe form of the disorder is called Rapid-cycling Bipolar Disorder, which occurs when four or more episodes all happen within a year. It seems to be more common among younger people and women, and can come and go.
Treatment usually takes the form of medication (mood stabilizers), and sometimes antidepressants. These can be combined with psychotherapy, which provides support, education, and guidance to those affected and their families.
The Centre for Addiction and Mental Health (CAMH) is a great resource if you need help with bipolar disorder. It offers a Mood and Anxiety Program that provides a variety of services, including excellent inpatient care.
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