The Brain And Bipolar Disorder
Experts believe bipolar disorder is partly caused by an underlying problem with specific brain circuits and the functioning of brain chemicals called neurotransmitters.
Three brain chemicals — norepinephrine , serotonin, and dopamine — are involved in both brain and bodily functions. Norepinephrine and serotonin have been consistently linked to psychiatric mood disorders such as depression and bipolar disorder. Nerve pathways within areas of the brain that regulate pleasure and emotional reward are regulated by dopamine. Disruption of circuits that communicate using dopamine in other brain areas appears connected to psychosis and schizophrenia, a severe mental disorder characterized by distortions in reality and illogical thought patterns and behaviors.
The brain chemical serotonin is connected to many body functions such as sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory. Researchers believe that abnormal functioning of brain circuits that involve serotonin as a chemical messenger contribute to mood disorders .
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:
- serotonin
- dopamine
- norepinephrine
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.
They Miss Perceiving The World As They Did Prior To The Disorder
Depression and mania can cause ones perception of the world to change dramatically. This can be both exhausting and frustrating. When the medications start to balance out and things begin to stabilize, the individual may again see things through a more normal lens. This can be a great feeling, but it can also be frightening because its unclear if this will last.
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What Is Rapid Cycling
Some people with bipolar disorder develop rapid cycling where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.
The different faces of bipolar disorder
Bipolar I Disorder This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usuallybut not alwaysBipolar I Disorder also involves at least one episode of depression.
Bipolar II Disorder In Bipolar II disorder, you dont experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.
Cyclothymia Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.
Diagnosing Bipolar Disorder In Older Adults
It was once believed that bipolar disorder burns out over the course of ones life. This belief was likely caused by the prevalence of bipolar disorder diagnoses in teens and young adults. More than half of bipolar disorder cases begin before age 25, according to NAMI.
Numerous studies have debunked the myth that bipolar disorder only affects young people. In recent years, theres been increased research on late onset bipolar disorder . A 2015 report stated that nearly 25 percent of people with bipolar disorder are at least 60 years old.
Most research considers bipolar disorder that begins at 50 years old or later to be LOBD. Between 5 and 10 percent of people with bipolar disorder will be at least 50 when they first show symptoms of mania or hypomania.
It can be difficult to correctly diagnose bipolar disorder symptoms in older adults. The symptoms are often confused with other conditions. Symptoms such as psychosis, sleep disturbance, and aggressiveness can be confused with dementia or depressive disorder, according to an article in Primary Psychiatry. The article also suggests that late onset manic episodes can be more closely associated with stroke, dementia, or hyperthyroidism.
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What Are The Signs And Symptoms
A person with bipolar disorder will go through episodes of mania and at other times experience episodes of depression . These aren’t the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.
Symptoms of mania include:
- anger, worry, and anxiety
- thoughts of death or suicide
In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day.
Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.
Between episodes, someone with bipolar disorder usually returns to normal functioning. For some people, though, there is little or no “break period” between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.
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They Enjoy Parts Of Mania But Ultimately Feel Exhausted By Them
There are parts of mania which are exciting and fun. Colors are more vibrant and individuals often feel incredibly empowered however, every episode of mania comes with a deep slide into depression. The obsession and highs of mania take incredible amounts of energy and ultimately wear the individual out.
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Bipolar Disorder Requires Routines A Strict Rhythm
Your average person has a pretty variable rhythm. People get less sleep on weekdays, go out to a party now and then, not getting to sleep until 2AM, sleep in on weekends, sometimes skip breakfast, drink more and less coffee, work more or less hours and exercise at different times during the day. This is not generally a big deal for people. Thats just part of life.
The problem is that for a bipolar, its a very detrimental part of life.
Many of us with bipolar, not to mention the people around us, have noticed that breaks in rhythm result in bipolar episodes. Most noticeable is changes in sleep, life changes and stress leading to episodes. Studies have borne out this observation. A change in life routine does, in fact, often precede an episode like hypomania or mania. A therapy was designed to address just these points.
What Have You Learned As A Result Of Your Experiences
Living with bipolar, often for years, teaches you a lot about yourself, about mental health services, about medicationand sadly often about stigma, shame, and discrimination.
Id say for me it was a key driver for learning about mebut also a red herring as I feel I vested too much of my own identity in clinging to the life-raft of the diagnosis as an explanation of my life in my early 20sagain though, there are a range of perspectives:
Brian talks of the possibility of recovery:
Despite what others may tell you, or what you might believe, recovery is possible. I never thought I could be a worthwhile human being and have something meaningful to offer.
That’s just illness speak and the effects of learned stigma. It doesn’t need to be that way.
Anna points to learning about what is important in life:
I have learnt that I am more resilient than I could have ever imagined. I have discovered that there is more to life than getting a degree or a good job. I have learnt that I have amazing friends who never stopped believing in me, even when I couldn’t believe in myself.
Hannah draws on a theme park analogy to talk about assembling your team of helpers:
I feel like I’m riding a constant rollercoaster of moods. There are people who are too scared to come to the theme park, those that will hop on rides with you and those that watch sensibly in awe and sickness from a distance minding your bags.
All of those people have a valid and useful part to play in your life.
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Take Care Of Yourself
In order to help your loved one, youll first you have to take care of yourself. If youre worn thin and running on empty, you wont have any reserves left to offer. Make sure to tend to your own needs for example, if your loved ones erratic behaviors have made friends start to keep their distance, find time to see them on your own. Dont forget about hobbies or neglect your usual healthy habits.
What Are The Different Types Of Bipolar Disorder
There are different types of bipolar disorder.
What is bipolar disorder I disorder?
A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. You may also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.
What is bipolar II disorder?
A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania.
What is bipolar I or II disorder with mixed features?
You will experience symptoms of mania or hypomania and depression at the same time. You may hear this being called mixed bipolar state. You may feel very sad and hopeless at the same time as feeling restlessness and being overactive.
What is bipolar I or II disorder with rapid cycling?
Rapid cycling means you have had 4 or more depressive, manic or hypomanic episodes in a 12-month period.
What is bipolar I or II with seasonal pattern?
Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by the seasons. For example, you may find that each winter you have a depressive episode, but your mania doesnt regularly follow a pattern.
There can be some similarities between bipolar I or II with seasonal pattern and another conditional called seasonal affective disorder.
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What Are The Signs And Symptoms Of Bipolar Disorder
This disorder is characterized by shifts in a persons mood for definable periods of time. People with the disorder may experience periods of mania or hypomania, a less extreme form of mania. Periods of depression may also occur. These periods may last a short time or persist over the long term.
These unpredictable mood swings or episodes can be difficult to manage, and they can affect a persons thoughts and behaviors. Mood swings may occur rarely or several times a year. Symptoms can vary from person to person and change over time. Its important to discuss changes in mood, thinking, or behavior with your doctor.
Symptoms Of Bipolar Disorder
Bipolar disorder is a mental disorder in which a person experiences alternating periods of depression with symptoms similar to unipolar depression and periods of mania. Periods of mania are defined by elevated mood and high energy.
While in a manic state, a person can feel very good. Compared to feelings of depression, manic symptoms may not be especially troubling. Manic episodes can also be infrequent, with gaps as long as several years occurring in between them. When symptoms do occur, they can be mild.
Symptoms of mania may include:
- Feeling restless, increased activity or energy
- Euphoria, excitement, “big” ideas
- Having trouble focusing, getting distracted, thinking about many different things
- Aggression, getting angry or irritated easily
- Increased sex drive
- Delusions, hallucinations
In some cases, a person with bipolar depression may not mention manic symptoms to a doctor or therapist unless, or until, they become severe.
Types of Bipolar
It’s important to know that there are two types of bipolar disorder: bipolar 1 and bipolar 2. While the symptoms of each type are similar, they differ in frequency and duration.
Bipolar 1 disorder typically involves at least one major depressive episode. How it’s different from depression is that people with bipolar disorder have also experienced at least one manic episode. In bipolar 1, people may alternate between periods of depression and mania.
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Lack Of Impulse Control
Impulse control. If I see something and I want it, I just get it, regardless if it was in my budget or not. Hannah G.
I think the worst one would be the impulsivity control: always either doing something and regretting it or not doing something and also regretting it Emily E.
Impulses. They are so so bad. I cant tell you the amount of debt Ive gotten myself into because of it. I learned too little, too late that credit cards are one of the biggest mistakes someone with bipolar disorder can make. Cristi B.
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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How To Increase The Chance Of Getting The Correct Diagnosis
- Use an online screening tool that is written in plain language. The mood disorder questionnaire and the bipolar spectrum disorder scale can be found easily online for example, here and here. They can correctly identify about 75% of people who do have bipolar disorder. They can misidentify 10 to 15% of people who screen positive but turn out not to have bipolar disorder upon further investigation. Bring this screen to your doctor to encourage them to take a more thorough history that can steer them toward the correct diagnosis.
- Include partners, family members, or close friends in your evaluation with your doctor. While people with undiagnosed bipolar disorder can easily identify depressive moods, family and friends are more likely to recognize the manic symptoms such as increased energy and activity.
- If you have been diagnosed with depression, ask your doctor to screen for bipolar with every new episode and with every anti-depressant failure. One screening for bipolar is not enough. Every episode of depression can increase the risk for a switch into mania or hypomania.
In her book, Prozac Monologues , Willa Goodfellow tells her personal story and shares her road to recovery. She also lists books, articles, and organizations she found most helpful along the way. She is a wonderful example of how people can educate themselves and become full partners in their own treatment.
How To Support Someone With Bipolar Disorder
Bipolar disorder is a mental health condition in which people experience abnormally high or irritable moods. These are typically followed by periods of depression. A person with bipolar disorder may show signs of psychosis, such as hallucinations or delusions.
It is relatively common for people to have mixed episodes when both the mania and depressive symptoms are present at the same time. The causes of bipolar disorder are not known, but possible factors are that its due to a combination of genetic factors and environmental influences. Treatment for this condition includes medication, counseling, and lifestyle changes.
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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.
What Can I Do To Manage My Symptoms
You can learn to manage your symptoms by looking after yourself. Selfcare is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.
What lifestyle changes can I make?
Making small lifestyle changes can improve your wellbeing and can help your recovery.
Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week.
Your healthcare professionals should offer you a combined healthy eating, exercise and sleep programme.
You can find more information about wellbeing any physical health at:www.rethink.org/advice-and-information/living-with-mental-illness/wellbeing-physical-health/.
What are support groups?
You could join a support group. A support group is where people come together to share information, experiences and give each other support.
You might be able to find a local group by searching online. The charity Bipolar UK have an online support group. They also have face to face support groups in some areas of the country. Their contact details are in the Useful contacts at the bottom of this page.
What are recovery colleges?
Unfortunately, recovery colleges arent available in all areas. To see if there is a recovery college in your area you can use a search engine such as Google.
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