Brain Chemistry And Biology
Bipolar disorder also has a neurological component.
Neurotransmitters are chemical messengers in the brain. They help relay messages between nerve cells throughout the body. These chemicals play an essential role in healthy brain function. Some of them even help regulate mood and behavior.
Older links three main neurotransmitters to bipolar disorder:
Imbalances of these brain chemicals may prompt manic, depressive, or hypomanic mood episodes. This is particularly the case when environmental triggers or other factors come into play.
Reducing The Risk Of Misdiagnosis
Clinicians can take several steps to ensure they are making an accurate diagnosis. The risk of misdiagnosis is still present, but it can be reduced. If you are working with a doctor or mental health professional, there are a few approaches to your assessment they may use to help them provide the most accurate diagnosis possible.
Can Depression Turn Into Bipolar Disorder
While an episode of clinical depression can be a feature of bipolar disorder or unipolar depression , it is not always easy to predict if the episode indicates the presence of bipolar disorder. Ongoing treatment and re-assessment is necessary before a determination can be made.
It can be difficult to cope with a new or unexpected diagnosis, but having an accurate diagnosis is necessary to ensure the condition is treated properly.
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Key Diagnostic Criteria Distinguishing Bipolar I Disorder From Bipolar Ii Disorder
Manic episode 2
Distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least 1 wk .
Must be accompanied by at least three of the following symptoms : Inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased involvement in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities with a high potential for painful consequences.
Symptoms do not meet criteria for a mixed episode.
Disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization, or it is characterized by the presence of psychotic features.
Symptoms not due to direct physiologic effect of medication, general medication condition, or substance abuse, although if they persist after a direct condition is addressed, a primary bipolar condition should be considered.
Jahangir Moini, … Anthony LoGalbo, in, 2021
What Are The Symptoms Of Mood Disorders
Depending on age and the type of mood disorder, a person may have different symptoms of depression. The following are the most common symptoms of a mood disorder:
Ongoing sad, anxious, or empty mood
Feeling hopeless or helpless
Feeling inadequate or worthless
Repeating thoughts of death or suicide, wishing to die, or attempting suicide
Loss of interest in usual activities or activities that were once enjoyed, including sex
Trouble sleeping or sleeping too much
Changes in appetite and/or weight
A decrease in the ability to make decisions
Frequent physical complaints that dont get better with treatment
Running away or threats of running away from home
Very sensitive to failure or rejection
Irritability, hostility, or aggression
In mood disorders, these feelings are more intense than what a person may normally feel from time to time. Its also of concern if these feelings continue over time, or interfere with one’s interest in family, friends, community, or work. Any person who expresses thoughts of suicide should get medical help right away.
The symptoms of mood disorders may look like other conditions or mental health problems. Always talk with a healthcare provider for a diagnosis.
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Who Is At Risk For Mood Disorders
Anyone can feel sad or depressed at times. However, mood disorders are more intense and harder to manage than normal feelings of sadness. Children, teens, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or worsen feelings of sadness or depression. This makes the feelings harder to manage.
Sometimes, life’s problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage.
The risk of depression in women is nearly twice as high as it is for men. Once a person in the family has this diagnosis, their brothers, sisters, or children have a higher chance of the same diagnosis. In addition, relatives of people with depression are also at increased risk for bipolar disorder .
Once a person in the family has a diagnosis of bipolar disorder, the chance for their brothers, sisters, or children to have the same diagnosis is increased. Relatives of people with bipolar are also at increased risk for depression.
Types Of Bipolar Disorders:
- Bipolar I: At least one manic episode that lasts for at least seven days or requires hospitalization
- Bipolar II: Alternating depressive and hypomanic episodes
- Cyclothymic disorder: Alternating periods of hypomania and depression mixed with normal moods
- Unspecified bipolar disorder: Periods of elevated moods that don’t fit in with the other types of bipolar disorders
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Who Is At Risk From Developing A Mental Disorder
At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances including poverty, violence,disability, and inequality are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influencedthrough changes in brain structure and/or function.
When To Seek Help
If friends and family are voicing concerns about a personâs mental health, it is a good idea to speak with a mental healthcare professional. Doing this is particularly important during the COVID-19 pandemic, when it may be even more important to keep potential physical and mental health problems from getting out of control.
Before seeking help, it is useful to know as much as possible about an individualâs physical and mental health history. This information can help guide treatment.
Research shows that the children of people with bipolar disorder are at higher risk of developing the condition or other mental health issues, such as depression, anxiety, or substance abuse.
It is time to seek help if a person exhibits any of the following signs of a manic episode, and they last for a few days or more:
- talking a lot more than normal in an unusually excited way
- not being able to sleep, or thinking that sleep is unnecessary
- racing thoughts
- overconfidence and euphoria
- behaving impulsively and recklessly
Similarly, if an individual exhibits any of the following signs of a depressive episode for a few days or more, it is time to seek help:
- feelings of hopelessness and despair
- lack of interest in things that they previously enjoyed
- an inability to focus their thoughts or concentrate
- changes in sleeping, eating, or bathing habits
- feelings of worthlessness
If a person is having thoughts of suicide, it is important that they get immediate help.
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Bipolar Disorder: A Background
Bipolar disorder, a severe and chronic mental illness with a lifetime prevalence of ~1.0%,1 is characterized by alternating episodes of depressed and elevated mood.2 Regarded as the sixth leading cause of disability internationally,3 bipolar disorder is associated with standard mortality rates ranging from 1.9 to 2.1,4 resulting from cardiovascular disease , diabetes mellitus, pneumonia, influenza, chronic pulmonary obstructive disease, and suicide, among other factors.5 Research indicates that > 50% of bipolar patients experience one or more medical comorbidities associated with poor health behaviors , side effects from pharmacological treatments , and nonadherence to established treatment regimens.6 Many bipolar patients also suffer from comorbid psychiatric conditions such as anxiety disorders and substance-use disorders.1,7 In addition to increasing mortality risk, such comorbidities result in reduced quality of life and overall poor mental health, thus contributing to continued mood symptoms and a worsened course of bipolar illness.1,4,6,8
Mood Disorders: Bipolar Disorders
Bipolar disorders have been effectively treated with medication for nearly 50 years. People with bipolar disorder experience alternating periods of depression and mania. Lithium is the most common psychopharmacological treatment, but other drugs have also been found useful. Lithium is effective in approximately 7080% of patients presenting with acute mania. The mechanism by which lithium exerts its therapeutic effect is not yet clear, but possibly it enhances the activity of the 5-HT system. Some evidence shows that lithium increases the release of NE but also reduces its postsynaptic receptor sensitivity. However, since lithium affects most NT systems and signal transduction pathways, conclusions cannot yet be drawn as to its mechanism of action. Lithium appears to block an enzyme of the intracellular second-messenger system , resulting in a reduced responsiveness in those neurons that depend on such second-messenger linkages .
Lithium’s side-effects include confusion and memory problems and loss of some motor coordination and development of a slight tremor. It can also induce hypothyroidism. It must be noted that lithium has a small therapeutic window, with high serum levels causing neurotoxicity. Symptoms of lithium’s neurotoxic effects include delirium, ataxia, and seizures. Toxicity can be fatal if not treated immediately. Lithium is also teratogenic, so should be used in pregnant women with extreme care.
E. Hollander, … S.Y. Berkson, in, 2012
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Prognosis For Bipolar Disorder
Prognosis for adolescents with bipolar disorder varies but worsens with each recurrence. Factors that increase risk of recurrence include early age of onset, severity, family psychopathology, and lack of, and/or poor adherence to, treatment . Those who have mild to moderate symptoms, who have a good response to treatment, and who remain adherent and cooperative with treatment have an excellent prognosis. However, treatment response is often incomplete, and adolescents are notoriously nonadherent to drug regimens. For such adolescents, the long-term prognosis is not as good.
Little is known about the long-term prognosis of prepubertal children diagnosed with bipolar disorder based on highly unstable and intense moods.
Risk Factors For Bipolar Disorders
It’s not possible to predict who might develop bipolar disorders. People who experience the following have an increased risk:Substance abuse: Misusing drugs or alcohol can trigger a manic or depressive episode. This can also make the symptoms of the episode worse. Certain prescription medications can have a similar effect.
- Trauma: Abuse may increase your chances of developing bipolar disorders. That’s the case even if the event happened when you were a child. Stressful situations and lack of sleep can cause a manic episode.
- Gender: Equal numbers of men and women have bipolar disorders. Women are more likely to be rapid cyclers. They often have more depressive episodes than men. Rapid cycling means a person experiences four or more manic, hypomanic or depressive episodes in a year.
- Family history: Bipolar disorders appear to run in families. A person with a parent or sibling who has a bipolar disorder may be more likely to develop it. Most people with a family history of bipolar disorder never show signs of the illness.
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Is This The Same As Paradoxical Laughter
Short answer: Theyre similar, as both are indications of humor that tend to be unwarranted by circumstantial events, but they arent the same.
- inappropriate laughter
- pathological laughter
This is where it can get confusing. Manic laughter is usually inopportune and referred to as inappropriate laughter, but its not a type of PBA.
PBA is also called inappropriate laughter, but its different from mania. Its a feature of neurological impairment, not a mental disorder.
The symptom of inappropriate laughter is common to both, but theyre different.
If symptoms like manic laughter cause interpersonal issues in the above areas, you might want to take accountability for actions that may embarrass, offend, or hurt those you care about.
What Is A Major Depressive Episode
People with this disorder may also experience periods of depression. During a major depressive episode, a person may feel sad, helpless, or hopeless and lose interest in activities.
Bouts of depression alter a persons thoughts, feelings, and behaviors, and may be short or long term. During a depressive episode, a persons thoughts may become overwhelmingly sparse or slow to process. Other symptoms may include:
- Losing interest in enjoyable activities.
- Excessive feelings of worthlessness, guilt, or helplessness, or feeling overwhelmed.
- Slowed thinking or fewer thoughts than usual.
- Difficulty concentrating, remembering, or making decisions.
- Changes in eating patterns, including reduced appetite and weight loss or increased cravings for food and weight gain.
- Changes in sleep, such as sleeping too much or too little, or insomnia.
- Loss of interest in sex.
- Thinking about, planning, or attempting suicide.
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Most Common Bipolar Disorder Treatment Options
There are many high-quality bipolar disorder treatment options available beyond just medication for bipolar disorder. While medication may be right for some, some medications can come with challenging side effects.
Research shows that adding therapy to a bipolar disorder treatment plan can have an even greater impact than medication alone. Some common therapeutic techniques used to treat bipolar disorder include:
Cognitive Behavioral Therapy – Cognitive Behavioral Therapy, or CBT, is a therapeutic technique that helps re-work the relationship between your cognitions and your behavior. CBT is a therapy that has a strong evidence base and has been used to treat mood disorders for many years. Researchers have found that CBT is an effective bipolar disorder treatment option, whether on its own or in conjunction with medication.
Dialectical Behavioral Therapy – Dialectical Behavioral Therapy, or DBT, is closely related to CBT, but has a stronger focus on emotions. DBT can help you to build skills like mindfulness, distress tolerance, and emotion regulation. DBT can be used while working one-on-one with a therapist or in group therapy. Research has shown that DBT can help increase coping skills and psychological well-being for people with bipolar disorder. DBT is also an impactful treatment for bipolar disorder in teens, with one study finding that DBT reduced depressive symptoms and suicidal thoughts in teens with bipolar disorder.
When Should I See My Healthcare Provider About A Mood Disorder
If you or your child are experiencing symptoms of a mood disorder, talk to a healthcare provider.
If youve been diagnosed with a mood disorder, youll likely need to see your provider and/or mental health professional regularly to make sure your treatment plan is working.
Discuss any concerns you have about changing or stopping medications with your provider or another health professional. Ask them whether you might need to try a different medication or have the dosage adjusted if the one youre taking isnt working or causes unpleasant side effects.
A note from Cleveland Clinic
Its important to remember that mood disorders are mental health conditions. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your symptoms.
Last reviewed by a Cleveland Clinic medical professional on 08/04/2022.
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Symptoms Of Bipolar Disorder
In bipolar disorder, the person alternates between periods of depression, mania and hypomania. The durations of the periods often vary. The manic episode usually lasts at least a week, while the periods of depression are longer. Between the episodes, the person can be completely healthy or only suffer mild symptoms.
In a manic episode, the persons mood, activity and confidence are abnormally elevated. A manic episode also often involves irritability. The persons need for sleep and ability to focus are reduced and they are prone to taking risks unreservedly. The symptoms of hypomania are similar to those of mania but are significantly milder.
There are two types of bipolar disorder. If the persons mood is clearly manic during at least one episode, they suffer from bipolar I disorder. If the episode is hypomanic, in other words mildly manic, the person suffers from bipolar II disorder. A mixed episode refers to a state where symptoms of both depression and mania occur during the same episode.
Brightquest Levels Of Care For Bipolar Disorder And Anxiety
Men and women who struggle with co-occurring anxiety and bipolar disorder carry a significant burden. Family members do their best to help, but overcoming these conditions requires professional intervention.
Many of our clients spend a year or more in treatment, based on their pace of recovery. BrightQuest treatment plans are intensive and truly transformative. Our levels of care include:
- 24-Hour Residential
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How Do Medications Factor In
Treating bipolar disorder with medication can be something of a delicate balance. Antidepressants that help ease depressive episodes can sometimes trigger manic episodes.
If your healthcare provider recommends medication, they might prescribe an antimanic medication such as lithium along with an antidepressant. These medications can help prevent a manic episode.
As you work to develop a treatment plan with your care provider, let them know about any medications you take. Some medications can make both depressive and manic episodes more severe.
Also tell your care provider about any substance use, including alcohol and caffeine, since they can sometimes lead to mood episodes.
Some substances, including cocaine, ecstasy, and amphetamines, can produce a high that resembles a manic episode. Medications that might have a similar effect include:
- high doses of appetite suppressants and cold medications
- prednisone and other steroids
- thyroid medication
If you believe youre experiencing a mood episode or other symptoms of bipolar disorder, its always a good idea to connect with your healthcare provider as soon as possible.