Understanding Bipolar Disorder

Written by: Katie Leboeuf, MA
CIGNA Behavioral Health

Everyone has heard life described as a roller coaster ride. We all will experience some intense highs and some incredible lows, but we expect this, for none of us thought living was an easy and predictable road. For many people though, the roller-coaster cliché describes a much more terrifying experience; an inner turmoil called bipolar disorder that can bring emotional, physical, and psychological pains far worse than anything most people could ever imagine. More than 2 million American adults or about 1 percent of the population age 18 and older in any given year, have bipolar disorder (Spearing, 2001). Until recently, bipolar disorder was known as manic depression. The word bipolar is now used to indicate the two poles, or extremes, that characterize the disorder. Bipolar disorder is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news; bipolar disorder can be treated and people with this illness can lead full and productive lives.

Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, while others may develop them late in life. It is often not recognized as an illness; many people with bipolar may not even know they have it. Some do not seek treatment because they are ashamed of what they feel, while others are incorrectly diagnosed with other illnesses, such as depression, anxiety, or schizophrenia. Sadly, because of this, people may suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar is a long-term illness that must be carefully managed throughout a person's life (Bipolar.com, 2004). Education and awareness are keys to better understanding this dynamic and tragic illness. Once armed with the proper knowledge and tools, bipolar disorder can be successfully managed and a person can live a healthy and fulfilling life.

As mentioned earlier, bipolar disorder causes dramatic mood swings — from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. To illustrate another way, if you picture a globe, the North Pole would be mania, and the South Pole would be depression. Every time you experience symptoms at one pole for at least 1 week, it is called an episode. As defined by the American Psyhiatric Association (APA) (2000), bipolar disorder includes 4 main mood episodes — Mania, Hypomania, Depression, and Mixed Mood.

Types of Mood Episodes Associated with Bipolar Disorder (APA, 2000).

Manic Episode (Mania) is a distinct period during which there is an abnormally and constantly elevated, expansive, or irritable mood, lasting at least 1 week.

Hypomanic Episode (Hypomania) is a milder form of mania that lasts at least 4 days.

Major Depressive Episode (Depression) is a period during which there is either depressed mood or the loss of interest or pleasure in nearly all activities, lasting for at least 2 weeks.

Mixed Episode is a period of time during which a person experiences both manic and major depressive symptoms nearly every day for at least 1 week.

It is imperative to be able to recognize the signs and symptoms that go along with these episodes. Knowing what to look for can better allow you or your family member to manage, treat, and receive proper care for the illness.

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness.
• Excessively "high," overly good, euphoric mood.
• Extreme irritability.
• Racing thoughts and talking very fast, jumping from one idea to another.
• Distractibility, can't concentrate very well.
• Little sleep needed.
• Unrealistic beliefs in one's abilities and powers.
• Poor judgment.
• Spending sprees.
• A lasting period of behavior that is different from usual.
• Increased sexual drive.
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications.
• Provocative, intrusive, or aggressive behavior.
• Denial that anything is wrong.

Signs and symptoms of depression (or depressive episode) include:

• Lasting sad, anxious, or empty mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in activities once enjoyed, including sex.
• Decreased energy, a feeling of fatigue or of being "slowed down."
• Difficulty concentrating, remembering, making decisions.
• Restlessness or irritability.
• Sleeping too much, or can't sleep at all.
• Change in appetite and/or unintended weight loss or gain.
• Chronic pain or other persistent bodily symptoms that are not caused by physical injury or illness.
• Thoughts of death or suicide, or suicide attempts.

While scary to realize and difficult to discuss, it is important to understand that some people with bipolar disorder do become suicidal. The stress of the illness and the intensity of the depressive episodes can become too much for some to handle. Anyone thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

• Talking about feeling suicidal or wanting to die.
• Feeling hopeless, that nothing will ever change or get better.
• Feeling helpless, that nothing one does makes any difference.
• Feeling like a burden to family and friends.
• Abusing alcohol or drugs.
• Putting affairs in order (e.g. organizing finances or giving away possessions to prepare for one's death).
• Writing a suicide note.
• Putting oneself in harm's way, or in situations where there is a danger of being killed.

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome (Spearing, 2000).

If you are feeling suicidal or know someone who is:

• Call a doctor, emergency room, or 911 right away to get immediate help.
• Make sure you, or the suicidal person are not left alone.
• Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm.

Remembering that some suicide attempts are impulsive acts that have not been well thought out. This final point, (preventing access to methods of self-harm) may be a valuable long-term strategy for people with bipolar disorder.

Most people with bipolar disorder — even those with the most severe forms — can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always necessary. A treatment strategy that combines medication and psychosocial treatment — including certain forms of psychotherapy (or "talk therapy") — is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous rather than intermittent. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness (Spearing, 2001). With bipolar disorder, mood changes often occur, even when there have been no breaks in treatment. These should be reported to your doctor immediately. He/she may be able to prevent a full-blown episode just by making adjustments in the treatment plan. In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This daily chart can also help the doctor track and treat the illness most effectively.

Even though episodes of mania and depression naturally come and go, it is important to recognize that bipolar disorder is a long-term illness that currently has no cure. Staying on course with treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes. Living with bipolar disorder is much like living with any chronic illness. With proper medication, education, and support (therapy, support groups, coaching, family and friends), bipolar disorder can be treated effectively (Kahn, Ross, Printz, Sachs, 2000).

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:

• University — or medical school — affiliated programs.
• Hospital departments of psychiatry.
• Private psychiatric offices and clinics.
• Health maintenance organizations (HMOs) or mental health insurance companies such as CIGNA Behavioral Health.
• Offices of family physicians, internists, and pediatricians.
• Public community mental health centers.

For the person with Bipolar Disorder
While the day-to-day job of managing bipolar disorder ultimately belongs to you, this does not mean you are alone. You will need to work closely with your doctor and other health care professionals and in doing so you will develop relationships with people who can offer you knowledge and care as you learn to live with your condition. You will learn how to ask for and receive the right kind of help from family and friends. Support groups for bipolar disorder offer valuable first-hand information from others who also live with the disorder. Support can also be found in the local community or even on the Internet.

For the Family and Friends of people with Bipolar Disorder
Family and friends of patients with bipolar disorder may face unique challenges. Often people with bipolar disorder may need help to get help. The bipolar patient may not realize at times how impaired they are, or they may blame their problems on some cause other than mental illness. Thus a person with bipolar may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referrals to the proper mental health professionals. Bipolar disorder is hard on spouses, family members, friends, and employers. It can be extremely trying to have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, but ongoing encouragement and support, however hard to give at times, are necessary in order for the bipolar person to find stability and thus strength to battle this trying disease. Remember: as a family member or friend of a bipolar person, it is not your responsibility to make someone well. Your support is just one aspect of the person's treatment. For the family members and friends coping, the most important thing to do is learn everything you can about bipolar disorder then get in contact with your local mental health center and join a support group for families and friends of bipolar patients (Bipolar.com, 2004).

There will be many obstacles when dealing with bipolar disorder. It will not be an easy journey, but with proper care and treatment it can become manageable. With time, support, education, awareness, and determination it becomes easier to understand that life is a ride worth holding onto with all you've got. Get help now to be able to begin leading the fuller, happier, more productive life you deserve.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Bipolar.com. (2004). What is bipolar? Retrieved October 11, 2004, from Bipolar.com.
Website: http://www.bipolar.com/whatis/bipolar-disorder.htm.

Bipolar.com (2004). Living with bipolar disorder. Retrieved October 11, 2004, from Bipolar.com.
Website: http://www.bipolar.com/living/living.htm

Kahn, D., Ross, R., Printz, D., & Sachs, G. (2000). Treatment of bipolar disorder: A guide for patients and families. Postgrad Med Special Report: 97-104.

Spearing, M. (2001). Bipolar disorder. Retrieved October 11, 2004 from the National Institute of Mental Health. Text revision.
Website: http://www.nimh.gov/publicat/bipolar.cfm.

Information in this document is taken from the resources cited and developed for use by the general public. It is not intended as medical/clinical advice or treatment. Only a healthcare provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your healthcare identification card.