The Bipolar Swing

“Bipolar” is a word applicable to a handful of objects. Our planet is bipolar (hey, Santa!) A magnet is bipolar. Humans, too, can have a bipolar mood disorder. We use the term “bipolar” in society too loosely and, frankly, insensitively. Someone has a mood swing, and we label them bipolar. If you do this, please rethink your quickness to label or to joke about it. Bipolar disorder, or BD, is a serious and life-altering mental and emotional illness that requires consistent treatment with medication and counseling. And, no, mood swings aren’t always indicative of bipolar disorder. The mood swings of BD last longer than 15 minutes or 2 hours; rather they last days and can significantly affect one week to a few months of someone’s life. There are a few different types of bipolar disorder, and diagnosing the type can be difficult and, frustratingly for the patient/family, take months to years to obtain. BD often has similar characteristics and symptoms of ADD/ADHD, major depression, and anxiety; many patients feel discouraged when their prescribed treatments don’t quite manage their fluctuating moods when they are misdiagnosed as one of the former listed conditions. They feel lost in how to live with their symptoms and eventually give up all together in seeking help. But if the diagnosis is made properly from the beginning of symptom presentation, a life of stability can be attempted, and with patience, accomplished.

Let’s break down what bipolar disorder is. Bipolar disorder is defined as having episodes of mania, hypomania, and major depression. What is mania and hypomania? Well, they’re fascinating phenomena and they differ in length of days. Mania is at least 7 days. Hypomania is less (normally around 4). Regardless, the feeling is one of euphoria, feeling on top of the world, and even intense optimism. Manic phases often involve frivolous spending and impulsive actions without regard to risk (“I’m going to drop everything and fly to Jamaica today by myself even though I’ll have to max out my credit cards and I have a job to attend tomorrow but I don’t care!”) People in manic phases don’t require much sleep for days—they can feel raring to go after 3 hours of shut-eye. Their speech is often “pressured” like they can’t get their words out fast enough or with enough “oomph.” A manic individual may maddeningly clean their homes from top to bottom twice over, then move on to the next item of their extensive to-do list—again, without sleeping. This is called “goal-directed activity.” Sometimes it’s difficult to diagnose this because often, a patient sitting in front of you isn’t in a manic phase the day of the appointment. This is why a good question-and-answer session is important. Often, the patient’s friend or spouse will comment on aforementioned behaviors and sound the alarm to me at the beginning of the visit—then the examples pour out. 

The “depression” part of BD isn’t just “sadness.” It’s maybe zero motivation to even leave your bed. It’s sometimes zero interest in self-care, eating, attending normal activities/work/school, or extreme fatigue. The person who experiences a depression like this feels unlike themselves and simply very down. They may cry more than usual during this time, also. 

Again, here is the breakdown of each type of BD: Bipolar I and Bipolar II have distinct differences. 
Bipolar I patients have manic episodes (at least 7 days) and depressive episodes (normally around 2 weeks or more). 
Bipolar II patients have hypomania with depressive episodes. 

Patients who fall in between these diagnoses will have episodes of both, but they may not fit exactly in the defined parameters of mania/depression; these patients have what’s called Cyclothymia disorder. 

Are genetics involved in BD? You bet. The child of a bipolar parent has a ten-fold higher risk of bipolar disorder than the average bear (Craddock and Sklar, 2013). Other factors, too, influence the diagnosis. Childhood adversity and a history of substance abuse can even affect disorder likelihood. Researchers are constantly trying to identify the specific genetic mutations involved in BD, but 100% certainty hasn’t yet been reached. Sure, we know some quality information—but we have miles to go in this subject. It is no secret that the medications available to treat BP aren’t perfect. Once the genetic story of BD is better understood, treatments can improve and diagnostic approaches can be refined. 

The structure of bipolar patients’ brains have actually proven to look a specific way on imaging. The volume of specific parts of the brain are less in BD folks than in individuals without BD. Functional MRIs (think of watching a live improv show) in BD patients helped researchers confirm some excessive activity in parts of the brain that were already hypothesized to be involved (cortico-striatal-limbic systems). Post-mortem brains of patients diagnosed with BD while alive showed a decrease in a biomarker called BDNF (Sigitova E, 2017). With this knowledge, researchers found that BDNF levels in the blood change during manic and depressive episodes versus the levels found when the patient is “euthymic” or more so “balanced” in their mood. What I’ve mentioned here is seriously just the tip of the iceberg when it comes to research findings related to BD. Neurobiologists are looking at numerous possibilities and promising leads to explain the cause and pathophysiology of BD. Research that continues to enlighten the field on the origins of BD is exciting to those hoping for lasting solutions. 

A bipolar individual will begin showing signs in teenage years or early adulthood. Diagnosis date, however, depends on recognizing the signs and getting a thorough examination from a mental health specialist. What always breaks my heart is when a patient states they just stopped trying to go to a clinician because they didn’t feel heard or taken seriously. It’s especially frustrating for the individual when medications don’t work (the prescription choice usually initially misses the mark like I said before). The person then stops taking the medication, or, even more concerning, they’re noncompliant from day to day and only take it occasionally. In the instance, not only is the patient suffering from bipolar mood changes, but the partial medication compliance causes an entirely different nightmare. This and the misunderstanding in the general population regarding bipolar disorder can lead to a stigma that is unfortunate. The person stops trying to get help, and the suffering and life-altering moods continue for sometimes decades. But when a patient is open, and most importantly, not ashamed, of their symptoms, diagnosis and treatment can be liberating. Once the proper diagnosis is made, a life of balance and stability can be a reality rather than an impractical dream. 

If you feel that you or someone close to you may have bipolar disorder, seek support from a clinician who will listen and who can help to not only diagnose the condition but also to lead you to a solid plan of action. 

References:

Craddock N., Sklar P. Genetics of bipolar disorder. Lancet. 2013;381:1654–1662.

Harrison et al. The Emerging Neurobiology of Bipolar Disorder. Trends Neurosci. 2018; 41(1): 18-30. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755726/ 

National Institute of Public Health. Bipolar Disorder. 2020. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145404. 

Psych Central. Manic Episode Symptoms. 2019. Retrieved from https://psychcentral.com/disorders/manic-episode/. 

Sigitova E et al. Biological Hypotheses and biomarkers for bipolar disorder. Psychiatry and Clinical Neurosciences. 2017; 71: 77-103. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/pcn.12476. 

Featured image: https://www.verywellmind.com/what-is-manic-depression-3875261