Who Experiences Bipolar Disorder
Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder . Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.
While bipolar disorder occurs equally in women and men, women are more likely to meet criteria for bipolar II disorder. Women with bipolar disorder may switch moods more quickly this is called “rapid cycling.” Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.
An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder .
Breaking Down The Vicious Cycles Of Bipolar Disorder
Bipolar disorder, also known as manic depressive illness, is a mental disorder characterized by extreme unusual shifts in energy, mood, and activity levels, impacting the ability to carry out day-to-day tasks. Although it is not a neurodegenerative disease like other previous topics discussed, bipolar disorder is neuroprogressive. Tissue damage and structural changes occur in areas involved in mood regulation increase the risk of recurrence of episodes and reduce the effectiveness of treatment. Several factors have been identified to contribute to the neuroprogression in BPD. First, lets break down the symptoms and diagnosis of this disorder.
Neuroprogression of Bipolar Disorder
Types Of Bipolar Episodes
The main difference between bipolar disorder and conditions such as depression is the possibility of experiencing the overly excited state called mania, says Amit Anand, MD, a professor of medicine at the Lerner College of Medicine, vice-chair for research for the Center for Behavioral Health, and the director of the Mood and Emotional Disorders Across the Life Span program, all at the Cleveland Clinic in Ohio. People who are manic are unusually outgoing or happy. In some cases, mania also causes intense irritability and restlessness. During depressive episodes, intense sadness or hopelessness may lead to fatigue, trouble concentrating, and thoughts of suicide.
But bipolar mood swings are not always extreme, Dr. Anand notes. For instance, some people experience a less severe form of mania, known as hypomania. Those who are hypomanic may not feel anything is wrong, making diagnosis more difficult, he adds.
Complicating matters is that its possible to experience both mania and depression at the same time, known as mixed features. When this happens, you may feel overly energized yet be extremely irritated, sad, hopeless, or empty.
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How Does It Affect People
Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.
Recent research suggests that kids and teens with bipolar disorder don’t always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.
Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just “snap out of it,” as if a person who is sick can become well simply by wanting to.
Bipolar disorder isn’t a sign of weakness or a character flaw it’s a serious medical condition that requires treatment, just like any other condition.
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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Types Of Rapid Cycling
Rapid cycling may also have subtypes categorized based on the frequency of the episodes.
- Ultra-rapid cycling is the rapid change of moods within weeks or several days, as opposed to months. The patient will probably experience more than one episode in one month.
- Ultradian rapid cycling is a pattern in which rapid cycling occurs within a day or 24 hours.
However, there is a difference of opinion on whether these are distinct patterns of rapid cycling or just unstable mood changes associated with the disorder.
What Does A Mood Episode Looks Like With Bipolar Disorder
Those with bipolar disorder experience periods of unusually intense emotions, per the NIMH. These periods are known as “mood episodes”typically categorized as manic episodes or depressive episodes. The mood episodes can last as long as several days to a few weeks, with symptoms presenting every day for most of the day.
Manic episodes specifically can make a person feel “up” or “high,” per the NIMH. When in a manic episode, a person may also feel a decreased need for sleep they may start talking too fast or they may feel distracted, agitated, or engage in risky behavior, Ashraf Elmashat, MD, a psychiatrist with Keck Medicine of USC, tells Health. Technically speaking, “to be considered mania, symptoms need to last for at least seven days,” says Dr. Elmashat.
When a person is experiencing a depressive episode, they may feel “down,” or hopeless, the NIMH says. Depressive episodes can also impact a person’s behavior, causing changes in sleep, appetite, and loss of enjoyment in normal activities.
It’s also possible for a person with bipolar disorder to experience both manic and depressive feelings in the same episodethat’s known as an episode with mixed features. People going through this type of episode “may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized,” the NIMH says.
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Treatment Of Rapid Cycling Bipolar Disorder
People who experience rapid cycling bipolar are hospitalized more often and their symptoms are usually more difficult to control over the long term.
Rapid cycling is more common in people with type 2 bipolar disorder and people with bipolar 2 have been shown to spend 35 times more time depressed than hypomanic. Because of this, rapid cycling treatment tends to be focused around relieving the depression.
While antidepressants would seem to be the logical choice for treatment of a depressive episode, antidepressants can often make rapid cycling worse. Antidepressants for bipolar depression can induce cycling, create more rapid cycling or even induce a manic episode.
Mood stabilizers are the preferred treatment for rapid cycling bipolar disorder with the aim to stop the cycling and then bring the mood up if needed. Common mood stabilizers used in the treatment of rapid cycling bipolar disorder include:3
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.
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The Stress Of A Bad Breakup Or Failed Marriage
A number of people with bipolar disorder especially those with a history of severe manic episodes have failed marriages. If youre going through a divorce, working with your therapist through what is often a drawn-out and extremely stressful process can help.
You might consider a durable power of attorney that allows someone else to make major decisions for you, such as financial ones, when you are going through an episode of depression or mania in relation to or during a breakup.
In fact, assigning a durable power of attorney could be useful for anyone who might be experiencing an episode of bipolar disorder.
Patterns Of Depression And Mania
If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa.
Between episodes of depression and mania, you may sometimes have periods where you have a “normal” mood.
The patterns are not always the same and some people may experience:
- rapid cycling where a person with bipolar disorder repeatedly swings from a high to a low phase quickly without having a “normal” period in between
- mixed state where a person with bipolar disorder experiences symptoms of depression and mania together for example, overactivity with a depressed mood
If your mood swings last a long time but are not severe enough to be classed as bipolar disorder, you may be diagnosed with a mild form of bipolar disorder called cyclothymia.
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Mood Cycle Patterns In Bipolar Disorder
Now, in all this cycling, there might be a pattern. Tracking your mood/symptoms is an excellent way to find the patterns to your own moods. For example some people do experience certain moods in certain seasons, quite reliably. You may see patterns that happen monthly or on other timetables.
You might also notice patterns within mood episodes. For example, you may be in a depressive episode but your mood still cycles within that depressive episode through various severities of depression/euthymia . This is what happens to me.
Heres The Good Newsyes There Is Good News
Bipolar disorder is an episodic illness. We have all of our symptoms while in a mood swing. This means we are STABLE when we are not in a mood swing. The symptoms I list above usually go away when the illness is successfully managed. It can take regular monitoring for those of us who have daily symptoms. Others who have long breaks between mood swings may even forget the symptoms even existed. This is why we must have a management plan that can recognize the dangerous, aggressive, and violent behavior psychosis and cognitive impairment as soon as they begin.
I know we want to protect our reputation around this illness. We dont want to be seen as different or freaks. But I ask that within our community, we get brutally honest about what really happens to those of us with the illness. Its the ONLY way to stop the symptoms and make them stay away forever!
Originally posted January 29, 2015.
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Cognitive Impairment In Bipolar Disorder
Many people find this scary. We already have bipolar, does this mean we have memory problems as well? Maybe. Cognitive impairment from memory lapses, forgetting appointments, being unable to remember information, and experiencing brain fog during certain episodes is common! If you have bipolar, youve probably felt the sluggish brain that comes with depression. If you have mania, you have probably tripped over your words, said things you didnt mean, and had trouble thinking thoughts in order.
My cognitive symptoms visit me daily. Im not able to remember dates and numbers, and I need help with calendars and appointments. Mine got worse after intense therapy I had for severe depression. Its something I find distressing, but its easy to manage.
I want us to be open about cognitive issues. This is the only way we can get help! My cognitive symptoms tend to linger all of the time, but they get worse with mood swings. A perfect example of this: I was supposed to submit this blog by midnight. Yesterday, I reminded myself all day to submit it, but I still managed to go to sleep without sharing it on time. I have to live with these symptoms, and even though a few things slip through, I do control the majority of my minor memory problems with a good support system!
Myth: Marijuana Can Help People With Bipolar
There is no research that shows marijuana is a treatment for bipolar disorder. There is research that shows that marijuana can greatly increase the risk of psychosis in people with bipolar due to the high levels of THC found in the most popular strains of the plant.
This often difficult for those of us with bipolar to accept. We want relief and cannabis is marketed as a miracle cure for many ailments. The main problem is THC, which is the stimulating, hallucinogenic chemical responsible for getting people high it’s present in trace amounts in all marijuana-based products. This includes products that claim to contain only cannabidiol , the non-psychoactive substance that some people use for other conditions like anxiety or sleep issues.
No matter what benefits marijuana might have in the medical world, in our bipolar world, it greatly increases our chance of mania and psychosis, and in my decades of personal and professional experience, greatly increases our rate of dysphoric mania.
It’s suggested that people with bipolar avoid marijuana products until the THC can be removed completely. This process is difficult to do at this time. If you struggle with cannabis use, please speak with a professional who can help you manage the symptoms created by the substance.
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Myth: Its Safe To Use Ssris As A Treatment For Bipolar Depression
This is such a misunderstood topic, I asked my coauthor John Preston, Psy.D., to share his opinion along with the latest research. Dr. Preston is a neuro-psychopharmacologist and is the lead author of The Handbook of Clinical Psychopharmacology for Therapists now in its 8th printing. Dr. Preston notes:
“SSRI antidepressants are not recommended for people with bipolar I at all as they can trigger mania,” he says. “In people with bipolar II, SSRIs plus a mood stabilizer should only be used if all other forms of depression management have failed. But even then only about 25% of people will benefit. Too many prescribers hear the word depression and start to use these drugs. They need to hear the words bipolar depression and follow the correct protocol.
Who Is At Risk
Rapid cycling is seen to affect women more than men. Around 10-20% of BP patients experience rapid cycling, and 70-90% are women. The chances increase when genetics come into play.
It has also been observed that rapid cycling more commonly appears:
- In people who have had BP for a longer time
- In people who were diagnosed with BP at a young age
- Along with suicidal thoughts
- Along with substance and alcohol abuse
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Myth: Bipolar Depression Is Weepy Sad And Hopeless
It can be! But for many of us with the bipolar disorder, depression is mean, nasty, negative, and aggressive. I call this irritated depression. Symptoms include restlessness the feeling that nothing is ever good enough trouble sleeping and waking up too early anxiety hopelessness about the world in general snappiness yelling isolation and having a very short fuse even for the people you love. This is combined with a feeling of gloom and the pointlessness of life.
People in this episode will not weep, they will rant and rage. The mean streak that comes with irritated depression greatly affects relationships. Please note that this is not dysphoric mania as there is not a decreased need for sleep or an increase in energy. People with irritated depression have trouble staying asleep, but they need the sleep and get very tired from the disruption. As with all mood swings, irritated bipolar depression will be episodic. When at baseline, the person is not mean and nasty.
Rapid Cycling Bipolar Disorder: Symptoms Treatment Effects
Rapid cycling bipolar disorder can be a dangerous condition and carries a high risk of suicide. When a person with bipolar experiences four or more manic, hypomanic, or depressive episodes in any 12-month period, it’s defined as rapid cycling bipolar. While the term rapid cycling may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Because of the rapid mood swings associated with this type of bipolar disorder, the individual may feel as if they’re on an emotional roller coaster swinging from the highs of mania to the depths of depression — all in the course of a few days or even hours.
Any type of bipolar disorder can be rapid cycling. It is thought between 10% -20% of people with bipolar disorder rapid cycle.2
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