Bipolar Disorder: Understanding the Ups and Downs!

Bipolar Disorder Explained: How to Cope and Feel Better

Bipolar disorder is a mental health condition where a person experiences extreme mood swings. These swings can range from periods of feeling overly happy and energized (called mania) to feeling very sad and low (called depression). Managing bipolar disorder can be difficult, but there are many treatments and strategies that can help.

Bipolar disorder is not rare. In fact, about 1% of adults in India, which is roughly 13 million people, are estimated to have bipolar disorder, according to the Indian Psychiatric Society. In the past, bipolar disorder was known as “manic depression” or “bipolar disease.”

Main Symptoms of Bipolar Disorder:

• Mania: Feeling extremely happy, energetic, or irritable for a long time.
• Depression: Feeling very sad, hopeless, or tired.

These mood episodes can last from a few days to weeks or even longer.

If you have bipolar disorder, the right treatment can help you manage these mood swings and improve your quality of life. Common treatments include:

• Medication
• Therapy
• Lifestyle changes (like regular sleep and exercise)

With the right help, living with bipolar disorder can become more manageable.

Types of Bipolar Disorder

There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is when someone has at least one period of very high energy or mood (called mania). They might also have periods of lower mood (depression) or less severe highs (hypomania) before or after the manic episode. Sometimes, they can have long periods where they feel normal in between these episodes. This type of bipolar disorder affects everyone equally, regardless of gender.

Bipolar II

People with bipolar II experience at least one major depressive episode that lasts for at least 2 weeks. They also have at least one shorter period of high energy or mood (hypomania) that lasts about 4 days. This type may be more common in females.

Cyclothymia

Cyclothymia involves having some symptoms of high and low moods, but not as intense or long-lasting as those in bipolar I or II. People with cyclothymia may have shorter periods of mood swings and often feel normal for 1 to 2 months at a time. Nowadays we are seeing the cyclothymia disorder in young children also. 

Other Types

Sometimes, people might have mood symptoms that don’t fit exactly into these categories. In such cases, they might be diagnosed with:

• Other specified bipolar and related disorders
• Unspecified bipolar and related disorders

Understanding Bipolar Disorder Symptoms

Bipolar I Disorder

To be diagnosed with bipolar I disorder, a person needs:

• Manic Episodes: Feeling extremely happy or irritable with lots of energy and making impulsive decisions.
• Depressive Episodes: Feeling very sad, losing interest in things, and being unusually tired.
• Mixed Features: Experiencing both manic and depressive symptoms at the same time.
• Psychotic Symptoms: Having false beliefs or seeing things that aren’t there in severe cases.

People with bipolar I may also experience depressive episodes or symptoms of psychosis (seeing or hearing things that aren’t there). It’s important to get help if these symptoms occur. 

Bipolar II Disorder

For bipolar II disorder, a person needs:

• Hypomanic Episodes: Feeling very upbeat or energetic, but not as extreme as full mania.
• Major Depressive Episodes: Feeling deeply sad, uninterested in things, and very tired.
• No Full Mania: No severe manic episodes like those in Bipolar I.
• Possible Psychosis: Seeing or believing things that aren’t real during depressive times.

People with bipolar II do not have full-blown mania but have hypomania and depression.

Cyclothymia

Cyclothymia involves:

• Periods of hypomanic and depressive symptoms for at least two years (one year for children and teens)
• Symptoms that don’t fully meet the criteria for hypomania or depression
• Symptoms present for at least half of the time, with no break longer than two months
• Symptoms that cause significant distress and affect daily life

Cyclothymia features mood swings that are less severe than bipolar I or II but last longer. 

What is Mania and Hypomania?

Mania and hypomania are periods of unusually high energy and emotions.

Mania is when you feel extremely excited, impulsive, or euphoric, almost like you are on a high. Your thoughts might race, and you could feel overly confident, like nothing can stop you. Some people may also experience hallucinations or symptoms of psychosis, which means they might see or hear things that aren’t real.

During a manic episode, you might act impulsively, doing things without thinking about the consequences. For example, you might:

• Have unprotected sex
• Misuse alcohol or drugs
• Spend a lot of money on things you don’t need

Impulsiveness during mania can also show up in other ways, such as:

• Quitting your job suddenly
• Taking an unplanned road trip without telling anyone
• Making big investments without much thought
• Driving recklessly or way over the speed limit
• Trying extreme sports you wouldn’t normally try

What’s important to remember is that these behaviors happen because of the manic episode, not because it’s something you would normally do when you are feeling stable.

Hypomania, usually linked to bipolar II disorder, is a milder form of mania. The symptoms are similar, but less intense. You might still feel very energized and productive, but you won’t experience hallucinations or psychosis. Hypomania also doesn’t typically cause major problems at work, school, or in relationships.

Unlike mania, hypomanic episodes are shorter and usually don’t require hospitalization. While you might feel extra productive, you may not realize your mood has changed, but close friends or family are likely to notice.

Major Depressive Episodes in Bipolar Disorder

When you experience a “down” mood shift in bipolar disorder, you may feel tired, unmotivated, and deeply sad. This is called a major depressive episode, and it includes several symptoms. You might feel constantly sad or empty, lose energy, and have trouble enjoying things you once loved. Some people may sleep too much or too little, feel guilty or worthless, and find it hard to concentrate or make decisions. 

Others may experience changes in appetite, either eating more or less, and in some cases, have thoughts of death or suicide. Not everyone with bipolar disorder goes through major depressive episodes, but many do. Sometimes, a person may only have a few symptoms of depression rather than the full range.

It’s also important to note that while mania can feel exciting at times, once treated, the balanced mood might feel like a “down” or depressed state, rather than a normal mood. A key difference between bipolar disorder and depression is that bipolar disorder causes both high and low mood swings, while depression leaves you feeling low consistently until you receive treatment.

The Bipolar Disorder in Children and Teenagers

Diagnosing bipolar disorder in children can be tricky because they don’t always show the same symptoms as adults. Their mood changes and behavior might not match the usual signs doctors look for in adults. Many symptoms of bipolar disorder in children also look like symptoms of other conditions, like ADHD (Attention Deficit Hyperactivity Disorder), which makes it harder to diagnose.

Just like adults, kids with bipolar disorder have big mood swings. They might be extremely happy and full of energy one minute, then very sad, tearful, or easily irritated the next. All kids go through mood changes, but bipolar disorder makes these mood swings much more extreme and noticeable than usual.

A Look at Manic Symptoms in Children

Children with bipolar disorder can show signs of mania, which may appear differently compared to adults. These symptoms include:

• Acting overly silly or too happy: A child might seem much more excited and giggly than usual, even when there’s no clear reason. 
• Talking too fast and jumping between topics: They may speak so quickly that it’s hard to follow, switching topics without finishing their thoughts.
• Difficulty focusing or paying attention: Children might struggle to concentrate on tasks, especially schoolwork, and seem easily distracted. 
• Taking risky actions: Kids may engage in dangerous or harmful behaviors, like jumping from high places or acting without thinking about consequences. 
• Quick temper and sudden outbursts: Children can get angry very fast, often over minor things, leading to temper tantrums or fights. Source: National Alliance on Mental Illness
• Not needing much sleep: They may have trouble falling asleep or wake up early but still seem full of energy, without feeling tired. 

Depressive Symptoms in Children

Children with bipolar disorder also go through depressive episodes. Some common signs include:

• Acting sad, moping, or crying a lot: A child might seem sad most of the time and cry often, even if there’s no clear reason. 
• Sleeping too much or too little: Some children might sleep all the time, while others struggle to sleep at all. 
• Low energy or no interest in usual activities: A child may seem tired or bored and lose interest in things they used to enjoy, like playing or hanging out with friends. 
• Complaining of not feeling well: They may frequently say they have headaches, stomachaches, or other pains, even when there’s no physical cause. Source: Child Mind Institute
• Feeling guilty or worthless: A child might say things like they feel useless or can’t do anything right. 
• Eating too much or too little: Some children may eat a lot more than usual, while others lose their appetite. 
• Thoughts of death or suicide: In more serious cases, a child might talk about death or have suicidal thoughts, which requires immediate professional help.

Other Possible Diagnoses

Some of the symptoms you notice in your child could be caused by other conditions, like ADHD or depression. Sometimes, children with bipolar disorder may also have other mental health issues. Your child’s doctor can help monitor these behaviors to make the correct diagnosis, which is key to finding the right treatment. Getting the right treatment can make a big difference in your child’s well-being and quality of life. 

What are the Treatment Options for Bipolar Disorder?

Managing bipolar disorder involves several types of treatments, including medications, therapy, lifestyle changes, and sometimes natural remedies. Here’s a closer look at what can help:

Medications

1. Mood Stabilizers: Medications like lithium (Lithobid) are commonly used to help keep mood swings in check and prevent episodes. 
2. Antipsychotics: Drugs like olanzapine (Zyprexa) can help control symptoms during manic episodes. 
3. Antidepressant-Antipsychotics: Combinations like fluoxetine-olanzapine (Symbyax) may be effective for people experiencing depressive episodes. 
4. Benzodiazepines: These anti-anxiety medications can provide short-term relief for anxiety symptoms but are not meant for long-term use. 

Psychotherapy

1. Cognitive Behavioral Therapy (CBT): This type of talk therapy helps individuals identify negative thoughts and change harmful behaviors, providing strategies to manage mood swings. 
2. Psychoeducation: This approach teaches individuals and their families about bipolar disorder, which helps them recognize early symptoms and manage them better. 
3. Interpersonal and Social Rhythm Therapy: This therapy focuses on maintaining regular daily routines, like sleep and meals, to help stabilize mood. 
4. Online Therapy Options: For those who prefer remote support, many platforms offer professional therapy online. 

Other Treatment Options

1. Electroconvulsive Therapy (ECT): This treatment can be effective for severe cases when other treatments haven’t worked. 
2. Sleep Medications: Doctors may prescribe medications to help regulate sleep if sleep issues are a problem. 
3. Supplements: Some people use supplements like omega-3 fatty acids, which may help with mood stabilization, but these should be discussed with a doctor first. 
4. Acupuncture: Some studies suggest acupuncture may help reduce symptoms of anxiety and depression. 

Natural Remedies

Natural remedies might help alongside traditional treatments, but always consult a doctor before trying them:

• Omega-3: Some studies suggest omega-3 supplements may help with bipolar symptoms, but results vary. 
• Rhodiola Rosea: This herb might help with moderate depression, but more research is needed for its effects on bipolar disorder. 
• S-adenosylmethionine (SAMe): This supplement may help with depressive symptoms but can also trigger mania, so caution is advised. 

Lifestyle Changes

Making healthy lifestyle choices can help manage bipolar disorder:

• Balanced Diet: Eating a healthy diet supports overall mental health.
• Regular Exercise: Getting at least 150 minutes of exercise each week can improve mood and reduce symptoms. 
• Weight Management: Keeping a healthy weight can influence mood stability. 
• Counseling or Therapy: Regular therapy can provide ongoing support and coping strategies.

Sum up,

While lifestyle changes can be beneficial, they usually work best when combined with other treatments, as studies indicate that lifestyle changes alone may not be enough to manage bipolar disorder. If you or someone you know is dealing with bipolar disorder, it’s important to talk to a healthcare professional to create a personalized treatment plan.