Bipolar disorder 

By Gio Chang 

Bipolar disorder is a condition which all of us have probably heard about but don’t understand very much about. Many people think of them simply as mood swings that we experience in our day to day lives. However, it is a type of mental illness that, surprisingly, impacts quite a large portion of populations. In fact, around 2.8% of the American adult population has been diagnosed with this illness.¹ Like many other mental illnesses, there are many misconceptions surrounding this disease. This article aims to demystify these and build a better understanding of bipolar disorders. 

When explained in the simplest form, bipolar disorder is a condition which causes patients to undergo extreme mood swings from manic emotional states to depressive ones.^{1, 2} Manic states refer to elevated moods, while symptoms of manic episodes include euphoria, racing thoughts, aggressive activity, and impulsive behaviour.¹ Depressive states refer to the opposite of this and symptoms include persistent sadness and hopelessness, intense fatigue, apathy, and irritability.¹  However, symptoms do vary from person to person, and the symptoms shown by one individual may even change over time.² Moreover, some people may only experience shifts in their mood very rarely while others may experience multiple of these over a year.² Bipolar disorders are typically diagnosed in teenage years or in the early twenties but symptoms can appear at any age.² Unfortunately, although there are a few treatment methods which may help relieve and manage the symptoms, bipolar disorder is an incurable lifelong condition.² Current treatment often involves a combination of different treatments and therapies such as medication, counselling, physical interventions, and lifestyle remedies.³  

As mentioned, a variety of symptoms can be seen by individuals with bipolar disorders. Quite unexpectedly, symptoms of this type of condition also include psychosis, which is when individuals lose touch with reality and find it difficult to differentiate between fantasy and reality and can be brought about when individuals experience an especially intense manic or depressive episode.³ The psychotic symptoms shown during euphoria include hallucinations, which is when individuals can see or hear things that are not there, and certain types of delusions, such as grandiose delusions, which is when individuals believe that they are famous.^3, 4 During a ‘low’ episode, individuals may experience different types of delusions, such as believing that they have committed a crime.³ 

Something else in which a lot of people are not aware of is that, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are four types of bipolar disorders. These are bipolar I, bipolar II, cyclothymic disorder, and unspecified bipolar disorder.  Bipolar I is the most common form and involves one or more manic episodes but may not involve depressive episodes.¹ Bipolar II involves shifts between depressive episodes and hypomanic episodes, which are less severe forms of manic episodes, and to be diagnosed with this type of bipolar disorder, individuals would never have experience manic episodes.^{1, 2} It is important to note that there are significant differences between these two types of bipolar disorders, and that bipolar II disorder is not simply a more manageable form of bipolar I disorder. This is because, although the manic episodes shown in bipolar I disorder may cause critical effects, prolonged depressive episodes are also associated with high severity.² Cyclothymic disorder, which is also known as cyclothymia, involve repeated occurrences of the depressive and hypomanic episodes, but may also involve periods of normal mood of up to eight weeks.¹ Unspecified bipolar disorder is a type of disorder in which individuals exhibit unusual manic episodes which do not specifically fit into the three categories explained above.¹ 

There seems to be a few factors that play a part in causing bipolar disorders and may even be caused by a combination of factors. The first, and the most apparent factor is genetics which has been found to cause around 60 to 80 percent of bipolar disorder cases.^3,5 Bipolar disorder can also be caused by biological factors, specifically by an imbalance of certain neurotransmitters or hormones that may affect the brain.³ These neurotransmitters include dopamine, norepinephrine, serotonin, gamma-aminobutyrate (GABA), glutamate and acetylcholine.⁶ The imbalance of different neurotransmitters in the brain brings about the variety of symptoms shown by individuals with this disorder. The final factor is environmental factors. Individuals who have gone through traumatic events, such as abuse, a significant loss, or severe mental stress may develop such disorders. These events can be the initial trigger of an episode.³ 

Bipolar disorder is a real condition that affects a large portion of people worldwide. There are many types of bipolar disorders, and certainly a large variety of symptoms that individuals may show. Learning more about bipolar disorder, and in fact about any mental disorder, helps to remove the stigma that surrounds it. This can help create an environment where patients do not need to hide or feel ashamed of their conditions.  

References:

1. Ashley Everything for Recovery. 4 Types of Bipolar Disorder. Available from: https://www.ashleytreatment.org/4-types-of-bipolar-disorder/ [Accessed 17^th October 2021] 

2. Mayo Clinic. Bipolar disorder. Available from: https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955 [Accessed 17th October 2021]  

3. Medical News Today. What to know about bipolar disorder. Available from: https://www.medicalnewstoday.com/articles/37010#symptoms [Accessed 17^th October 2021] 

4. Cleveland Clinic. Delusional Disorder. Available from: https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder [Accessed 17^th October 2021] 

5. Berit Kerner. Genetics of bipolar disorder. Dovepress. 2014; 7: 33-42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966627/ 

6. Nemade R, Dombeck M. Bipolar Disorder and Neurochemistry. Available from: https://www.gracepointwellness.org/4-bipolar-disorder/article/11204-neurochemistry-and-endocrinology-in-bipolar-disorder#:~:text=The%20neurotransmitters%20that%20are%20suspected,)%2C%20glutamate%2C%20and%20acetylcholine [Accessed 17^th October 2021]