【Neuro】Bipolar disorder

Bipolar disorder

• formerly called manic depression
• a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
• Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Content:

1. Type

2. Difference between the types

3. Symptoms

4. Cause

5. Risk factors

6. Treatment

7. Prevention

8. Reference

1. Type

Bipolar I disorder. 

• at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. 
• In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. 

• at least one major depressive episode 
• at least one hypomanic episode
• never had a manic episode.

Cyclothymic disorder

• at least two years 
• eg, one year in children and teenagers 
• of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types 

bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

**Bipolar II disorder is not a milder form of bipolar I disorder

Manic episodes of bipolar I disorder: severe and dangerous

Depressed bipolar II disorder: can be depressed for longer periods

Note: Major depression

• also known as unipolar or major depressive disorder (MDD)
• is characterized by a persistent feeling of sadness or a lack of interest in outside stimuli.
• Only experienced negative emotions and symptoms

2. Difference between the types

y-axis: mood, with mania and depression being on the far ends of the axis
x-axis: time

Average healthy individual: Normal ups and downs

Unipolar depression: might have normal highs, but also have crushing lows (may not have an obvious trigger) that last for a long period of time 

Bipolar 1: Major lows (>2 weeks) & major highs (>1 week or require hospitalization). Untreated manic episodes can last as long as 3-6 months

Bipolar-2: similar lows, and has additional highs called “hypomania”. Hypomanic states need to last at least four days. These symptoms generally last a few weeks to a few months.

Cyclothymia / Cyclothymic disorder: Milder lows & milder highs or “hypomania”. Cycle back and forth between these two over a period lasting at least 2 years. 

3. Symptoms

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time. 

Beside, it’s also worth mentioning that people with bipolar disorder often have other disorders, such as

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug problems
• Physical health problems, such as heart disease, thyroid problems, headaches or obesity

a. Mania and hypomania

Mania 

• severe than hypomania 
• causes more noticeable problems at work, school and social activities, as well as relationship difficulties.
• may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
• Delusions of grandeura — for example,  personal mission from god, have supernatural power.

b. Major depressive episode

noticeable difficulty in day-to-day activities

includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
• Marked loss of interest or feeling no pleasure in all — or almost all — activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
• Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking about, planning or attempting suicide

c. Others symptoms

i. Mixed episodes: experiencing symptoms of both depression and mania at the same time
ii. Rapid cycling: has 4 or more episodes of depression or mania within a given year.

4. Cause

a. Genetic and environmental factors

• Genetics: Family with Bipolar disease → 10X more likely get

b. Drugs and medications 

• some drugs and medications can trigger manic episodes, eg, serotonin reuptake inhibitors (SSRIs)

More about SSRIs: 【Pharmacology】Antidepressants 4a. Selective serotonin reuptake inhibitors (SSRIs)

5. Risk factors

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

6. Treatment

No cure.

• Lithium salts-----mood stabilizer
• Antidepressant----trigger manic episodes
• Antipsychotics
• Anticonvulsants
• Benzodiazepines

**All have side effects that can be severe and lead to non-adherence which can be dangerous 

Related link: 【Pharmacology】Antidepressants

7. Prevention

Psychological interventions

• helpful tools to help individuals with bipolar disorder (especially after a manic episode has ended) handle stressful situations
• prevent a potential manic episode

8. Reference

https://www.psycom.net/depression.central.major.html

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

https://youtu.be/KSvk8LLBo2g

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