Bipolar disorder is a type of psychological disorder or mood disorder characterized by severe feelings of sadness, loss, failure, hopelessness, and rejection. People suffering from this disorder are often seen to swing back and forth between phases of irritability and good moods. The movement from mania to depression can be very fast, with interspersed periods of normal behavior lasting for a long time (Glass, Lynm &Torpy, 2003).
Persons diagnosed with a mood disorder can be categorized as having type I, II, or Cyclothymia bipolar disorders. Type I bipolar disorder patients will have had no less than one episode of manic depression and many episodes of serious depressions. Those with type II have never had a period of full mania but have had periods of impulsiveness and elevated energy levels, although not as high as type I (Altamura et al., 2011).
These periods are called hypomania and alternate with depressive episodes. Cyclothymia is a mild type of bipolar disorder with gentle mood swings. Patients suffering from this type of disorder will alternate between mild depression and hypomania.
There is no clear cause for bipolar disorder, but most depressive episodes are triggered by medications like antidepressants, sleeplessness, reaction to drugs, and extreme life changes. Psychologists suggest that depression occurs in people who have been denied emotional support from others who, for a long time, provided them with self-esteem. Another theory is that depression occurs from learned helplessness, as individuals gain knowledge that their actions are useless in producing positive results (Glass, Lynm & Torpy, 2003). Additionally, genetic factors have been linked to causing depression.
The main symptoms associated with the manic phase include sleeplessness, distraction, poor judgment, reckless behavior, being very upset, too involved in activities, poor control of tempers, and elevated moods. These symptoms may last for a few days to several months. It is noted that mania symptoms are common for both bipolar type I and II, but for type II they are less severe. During the depressed phase, symptoms for type I and II are similar.
These include a low daily mood, difficulty in remembering and concentrating, eating disorder, fatigue, feelings of hopelessness, guilt and worthlessness, trouble getting sleep, loss of interest in activities, low self-esteem, sleeping too much, thoughts of death, and pulling away from friends. There are times when symptoms for manic and depression overlap. A person with severe bipolar disorder is at a high threat of committing suicide and will show suicidal behaviors (Altamura et al., 2011). Additionally, symptoms associated with this disorder can be made worse by the use of alcohol and other substances.
The diagnosis of this disorder requires the examination of a patient’s medical history. This history should look into the possibility of the existence of a family member who may have suffered from bipolar disorder. Diagnosis should also look into recent mood swings and behavior patterns of the patient from their experience and that of their family. Laboratory tests can also be carried out to examine the thyroid gland for problems and check for drug levels in the body (Glass, Lynm & Torpy, 2003). Lastly, observation of the patients behaviour is necessary before determining their level of manic or depression.
The management of depression or manic is aimed at preventing the patient from moving from phase to phase. Management also prevents the need for hospital stay and assists the patient function well between episodes. Moreover, it assists in the prevention of self injury or cases of suicide and reduces the frequency and severity of the episodes (Giese, 2009). Treatment and management of bipolar disorder makes use of clinical as well as affective methods.
In order to avoid the use of psychiatric and emergency hospitalization, psychologists recommend therapy and affective approaches. Affective approaches include support and therapy programs, which combine educational and therapeutic programs on bipolar disorder. In these programs families and the community are trained to cope and reduce the symptoms of the disorder from returning (Giese, 2009).
Programs also involve community support and outreach programs that assist those patients that do not have any family support system. These programs promote the importance of coping with symptoms which can exist even when patients are on medication, living a healthy lifestyle and the use of correct medication. Generally, psychotherapy programs are geared towards the treatment of behavioural, emotional, psychiatric and personality problems present during bipolar disorder.
Psychiatric hospitalization uses such support programs in combination with medications. Medications used for the treatment of bipolar disorders are mood stabilizers including Lamotrigine, Lithium, Carbamazepine and Valproate or Valproic acid (Giese, 2009). Additionally, medications can include drugs like antipsychotic and anti-anxiety drugs to deal with mood problems and antidepressant drugs deal with depression episodes. It is noted that those with this disorder will most likely suffer from hypomanic or manic episodes from taking antidepressants; therefore, antidepressants are given to those taking mood stabilizers.
Evidence from medicine show that depression is associated with deficiencies in serotonin and norepinephrine neurotransmitters, where the reduction of these leads to depression. Therefore, antidepressants are used to increase the levels of these neurotransmitters to reduce depression levels (Altamura et al., 2011). Bipolar symptoms are also created by hyper activity of dopamine. Neuroleptics are used in treatment to reduce dopamine activity and prevention of overstimulation of the nerve cells to create antipsychotic effects. Drugs like benzodiazepines and neuroleptics are used to promote sleep and create a tranquilizing effect.
Major depression is treated with electroconvulsive therapy or ECT. ECT is often used in cases where the depressive or manic episode refuses to respond to medication. This method of treatment utilises electrical current to create a small seizure while the person is under anaesthesia (Glass, Lynm & Torpy, 2003). The method has been proven to be very effective in the treatment of bipolar disorder that does not respond to regular medications. Another therapy used for severe bipolar disorder is Transcranial magnetic stimulation or the TMS. This utilizes a magnetic pulse at high frequency to target parts of the brain that have been affected. This method is used after ECT has failed or following the ECT method.
Since severe bipolar disorder requires prolonged treatment, patients find it difficult to continue with medication especially when they start feeling well or go through manic. A halt in medication can lead to serious problems and cause symptoms to return (Altamura et al., 2011). Complications associated with stopping medication include drug and alcohol abuse, relationship, work and finances problems and suicidal tendencies. Apart from compilations in symptoms, long term medication can cause kidney, liver and thyroid problems. Even when the patient is doing well with treatment, depression can occur and is handled by increasing the dosage of their mood stabilizers. However, severe depression is managed with a 2nd mood stabilizer or the drug Symbyax (Altamura et al., 2011).
Since depression and mood disorders are common occurrences in today’s society, lifestyle changes are recommended for prevention and treatment of depression. These changes include getting enough sleep, joining support groups, family support and therapy sessions which reduce symptoms of depression and mania. However, for severe manic and depression cases, medication and psychiatric treatment is recommended.
References
Altamura, A.C., Albano, A., Angst, J., Buoli, M., Dell’osso, B., Colombo, F., & Pozzoli, S. (2011). The Impact of Brief Depressive Episodes on the Outcome of Bipolar Disorder and Major Depressive Disorder: A 1-Year Prospective Study. Journal of Affective Disorders, 134(1-3), 133-137.
Giese, A.A. (2009). Closing the Gap between Guidelines for Bipolar Disorder Treatment and Clinical Practice. American Journal of Psychiatry, 166(11), 1205-1206.
Glass, R.M., Lynm, C. & Torpy, J.M. (2003). Depression. Journal of the American Medical Association, 289(23), 3198.