By John Aziz, MD
Psychiatry, Psychiatric Center of Northwest Ohio
Bipolar disorder is a chronic mood disorder that affects about 1% of the U.S. population. Although bipolar disorder is highly genetic, there is no specific mode of inheritance of the disorder from an affected parent to their children. That means if the father or the mother has bipolar disorder, the children might have a higher risk of having bipolar disorder, but it doesn’t necessarily mean that any of them will definitely have the disorder at some point in their lives.
As the name “bipolar” implies, there are two ends of the “pole”: the higher end and the lower end.
The lower end means depression, which means the bipolar disorder patient is not very different from somebody who has major depression disorder. The high end of the pole is either mania or hypomania. The main difference is based on the severity and duration of symptoms. There are several types of bipolar disorder, including type I, type II, and another type that is not specified.
Bipolar Type I has mania and is more severe than type II, which has hypomania. The main differences between the two are how severe the symptoms are and how negatively the patient’s life is affected. Manic and hypomanic episodes usually consist of a distinct period of time, usually lasting from a few days to weeks, when the patient is not depressed, but instead, he/she will be either euphoric or dysphoric.
Euphoric means that the patient feels so elated and happy, being on top of the world. When a patient feels dysphoric, they will feel very uncomfortable, irritable, anxious, and sometimes agitated. Euphoria is not very common in bipolar; rather, dysphoria is much more common.
One of the most common misconceptions of bipolar disorder is that people believe mania means extreme happiness, which will occur every time the patient is manic. In the manic phase, the patient’s sleep is very disrupted. Patients will usually stay up all night, sometimes for several nights in a row, without feeling tired at all. The patient usually describes having high energy and being anxious. Sometimes, the patient may sleep for a short period, anywhere from 30 to 60 minutes, then wake up refreshed and energetic.
Additionally, the patient will experience impulsive behaviors such as excessive spending of money, unusual increases in sexual activities, as well as impulsive and risky decisions, in addition to other symptoms.
When the manic or hypomanic episode is over, the patient goes into a depressive state, during which they usually feel very depressed. That lasts for a much longer time, depending on each case.
It is very crucial to distinguish bipolar disorder from depression, especially since most patients with bipolar disorder would present to the physician when they are depressed. The treatment for bipolar and depression is very different. If bipolar disorder is treated with an antidepressant alone, the condition will not improve, and more than 20% of patients may encounter severe irritability, agitation, or a full manic episode while being on antidepressants alone.
The cornerstone for treatment of bipolar disorder is a mood stabilizer. Whether or not the patient may need to be on an antidepressant, the bipolar patient must be on a mood stabilizer first and foremost.
There are many medications that are being used as mood stabilizers, including anticonvulsants and antipsychotics, as well as others. The main difference between medications is that some are more effective than others in the manic phase, depressed phase, or the mixed phase. Based on the clinical scenario and based on each patient’s need, the physician might choose a specific medicine based on the side effect profile that suits the specific patient.
If a patient is diagnosed with bipolar disorder at an early age and continues a successful treatment for a long enough time, it is possible that the patient might have a full recovery. However, if the patient has multiple episodes, the likelihood of experiencing another episode increases every time they experience one.
By the time the patient has a fourth or fifth episode, the likelihood of having another episode will be close to 100%. In this case, the patient will need to take medications indefinitely to prevent any future episodes.
There are some myths about bipolar disorder. The most common is equating mood swings to bipolar disorder. Mood swings mean the patient can experience different moods at the same time or during the same day, which range from feeling happy, feeling normal, feeling sad or irritable, etc. Mood swings can happen in healthy people or in patients with depression or anxiety, as well as other mental disorders.
The mood swings that occur with bipolar disorder are usually severe and persistent for a longer period of time, but more importantly, they are only one symptom of a whole array of symptoms, as explained above.
