Bipolar disorder in adults

This article discusses bipolar disorder in adults. About 3 million people in the United States, or 1% of the entire U.S. population, have the disorder, with similar rates worldwide. The disorder affects men and women equally. It most often develops between the ages of 15 and 24.

What is bipolar disorder?

Bipolar disorder is a disease that causes sudden mood swings, such as an extremely elevated state of mania that suddenly turns into a severe state of depression. This disease has another disease - manic-depressive syndrome.

Bipolar disorder affects your mood so much that you cannot fully perform your duties at work, behave adequately in your family or in relation to others. Some people with this disease become suicidal.

This disease can make the person with it feel helpless and hopeless. However, the person with it is not alone. If he attends a support group and talks with people like himself, he will understand that there is hope for a better life. And treatment will help him regain control over his mood.

Relatives of the patient also feel helpless. If there is a person in your family suffering from bipolar disorder, you yourself should attend psychotherapy sessions. Psychotherapy sessions will also help a child whose parents are sick with this disease.

Causes of bipolar disorder in adults

To date, scientists cannot say for sure what causes bipolar disorder. It is only known for sure that this disease is hereditary. It can also develop due to environmental or family problems. One of the most common causes is considered to be an imbalance of chemical elements in the brain.

Although the causes of bipolar disorder are still unknown, there is evidence that the condition runs in families. Family problems or environmental influences can also trigger the condition. In addition, episodes of mania or depression can be caused by imbalances in brain chemicals such as neurotransmitters.

Antidepressants can trigger a manic episode in a patient with bipolar disorder. This can happen even before the patient is diagnosed with bipolar disorder, while he or she is being treated for depression.

Sleep disturbances, alcohol abuse, or excessive use of stimulants such as caffeine can also trigger an episode of mania in a person with this disorder.

Provoking factors

Bipolar disorder is hereditary. If you have a family history of bipolar disorder, your chances of developing the disease are increased.

If you suffer from bipolar disorder, changes in your sleep schedule or daily routine can lead to the development of a manic attack. Antidepressants can also cause a manic attack. But this may be discovered after the mania has developed, when trying to cure an attack of depression.

Stressful situations in life can cause both mania and depression.

Your chances of developing a manic or depressive episode are increased if you do not follow your doctor's instructions and do not take your medications regularly. Very often during a manic episode, when the patient feels good, he stops taking medications. Even if you feel better, do not stop taking medications, this will help you control your condition.

Abusing alcohol, drugs, or experiencing violence increases your chances of relapse.

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Symptoms of bipolar disorder in adults

The symptoms of the disease depend on what mood phase you are in. For example, if you are manic, you will feel extremely energetic, happy, and sexually aroused. You will feel like you don’t want to sleep at all. You will feel overly self-confident. Some people spend too much money or engage in life-threatening behavior during periods of mania.

After the manic phase, you may return to normal or, on the contrary, fall into the opposite feelings of sadness, depression and helplessness. Being in a depressed mood, you will have difficulty making decisions and thinking clearly. Memory problems may arise. You may lose interest in once-favoured activities. You may also have thoughts of committing suicide.

Mood swings in bipolar disorder can range from mild to severe. An attack may begin slowly over a period of days or weeks, or develop suddenly within a few hours. An attack may last from a few hours to several months.

Bipolar disorder causes extreme mood swings, with the sufferer feeling energized one moment and then feeling depressed and powerless the next.

During an attack of mania, the patient:

• Feels extremely happy or very irritable.
• Has an overly high self-esteem.
• Does not need sleep as much as usual (feels rested after three hours of sleep).
• Becomes overly talkative.
• More active than usual.
• Cannot concentrate on one thing because he has too many ideas at the same time (wandering thoughts).
• Easily distracted by sounds or images.
• Behaves impulsively or irresponsibly, such as spending large amounts of money, driving recklessly, engaging in questionable transactions, and becoming promiscuous, leading to unprotected sex.

During depression, the patient may:

• Being depressed or worried about something most of the time.
• Feeling pessimistic or hopeless.
• To suffer from slowness of movement or speech due to loss of strength.
• Have difficulty concentrating, remembering, or making decisions.
• Experiencing changes in appetite or sleep disturbances, resulting in excessive overeating or increased sleepiness, or vice versa.
• Experiencing indifference to once-favorite activities, including sex.
• Have suicidal thoughts.
• Don't rejoice in those things that caused positive emotions in the past.

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Stages

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Bipolar disorder I

This type is considered the classic form of bipolar disorder and causes episodes of both mania and depression. The depressive episode may last for a short period of time or for months. After this, the patient may either return to normal or go straight into the manic phase.

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Bipolar disorder type II

In this form of the disease, the patient experiences an attack of depression, just as in bipolar disorder of the first degree, but the attacks of mania occur in a milder form, the so-called attacks of hypomania. In the second degree of bipolar disorder, patients more often experience attacks of depression than hypomania.

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Bipolar disorder of cyclical form

In this form of the disease, the patient experiences at least 4 attacks of mania, depression, or a combination of both over the course of one year. Most often, the attacks often replace each other, moving from one mood phase to another. Sometimes the patient may not be in a normal state for long between attacks. Attacks of mania and depression occur in the same way as in other types of this disease, but the frequency with which they replace each other indicates the cyclical nature of bipolar disorder.

Sometimes patients with this disease may have mixed symptoms, meaning that symptoms of mania and depression occur simultaneously. These symptoms include feelings of sadness, euphoria, and irritability. They may also include agitation, lack of need to sleep, changes in appetite, and possibly suicidal thoughts. This course of the disease makes the treatment process very difficult and makes the patient's life more difficult.

In addition to mood swings, some people with bipolar disorder may have symptoms of anxiety, panic attacks, or symptoms of psychosis.

Symptoms of bipolar disorder in children can be completely different from those of adults and are often mistaken for other childhood mental illnesses, such as ADHD or depression. Bipolar disorder in children affects their performance in school and their ability to socialize with friends and family.

There are some illnesses whose symptoms at first glance are similar to those of bipolar disorder, such as depression, schizophrenia, and attention deficit hyperactivity disorder.

People diagnosed with bipolar disorder are more likely to abuse alcohol and drugs, with men more likely to abuse these substances than women. Alcohol or drug use can affect the effectiveness of treatment and medications. Bipolar disorder can lead to illnesses such as:

• Obsessive-compulsive disorder
• Panic disorder or panic attacks

These diseases need to be treated together.

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Complications and consequences

In bipolar disorder, the patient fluctuates between bouts of mania and depression. Between bouts, the patient may either return to normal or have only minor symptoms. Mood swings may begin suddenly or gradually.

During a manic episode, the sufferer feels extremely happy and energetic or very irritable for a week or more. The sufferer also becomes overly productive and creative. He feels powerful and seductive and believes that he can achieve any goal. However, as the episode progresses, the sufferer begins to behave unbridled and irrationally. He begins to spend large sums of money, gets involved in dubious deals, and sleeps very little. During this time, he experiences difficulties at work and in communicating with loved ones.

After the manic episode subsides, the sufferer may return to normal or immediately switch to the opposite mood, feeling useless, hopeless and sad. During a depressive episode, the sufferer has difficulty concentrating, becomes forgetful and cannot make decisions on his own. His appetite changes and his sleep is disturbed. He loses interest in once-favoured activities. Some people may commit suicide or deliberately injure themselves during this period. Others feel that they cannot move, think or take care of themselves.

Men are more prone to bouts of mania, while women are more likely to experience bouts of depression.

The cause of the development of an attack of mania or depression can be experienced stress. But as the disease develops, these attacks can appear without any reason. Without proper treatment, bipolar disorder will intensify, and will lead to the fact that attacks of mania and depression will be repeated very often.

People with this condition become prone to diseases such as heart disease, obesity, high blood pressure and diabetes. If you are undergoing treatment, your doctor will monitor your health.

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Diagnostics of bipolar disorder in adults

Bipolar disorder is a very difficult condition to diagnose. Unfortunately, there are no specific lab tests that can diagnose the condition. Instead, your doctor will ask you a lot of questions about your symptoms, their intensity, and how long they've been going on. To be diagnosed with bipolar I disorder, a person must have been in a manic episode for at least a week (or less if they've been hospitalized). During that time, the person must have three or more symptoms of mania, such as decreased need for sleep, increased talkativeness, irresponsible behavior, or a feeling of confusion. To be diagnosed with bipolar II disorder, the manic episode may be shorter and milder.

Also, during the diagnostic process, the doctor must prescribe blood and urine tests to rule out other diseases that cause similar symptoms.

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Tests

There are no specific lab tests that can diagnose bipolar disorder. Instead, your doctor will ask detailed questions about your symptoms, including how long they last and how often they occur. Your doctor will discuss your family history and provide a mental health assessment.

A mental health report allows your doctor to evaluate your emotional functioning, ability to think, remember, and reason. This report consists of an interview with a psychiatrist, a physical examination, and written or oral tests. During the interview, the psychiatrist will evaluate your appearance, mood, behavior, your thoughts, your ability to reason, your memory, your ability to express yourself, and your ability to maintain relationships.

Blood and urine tests will also be performed to rule out other conditions that could be causing the symptoms, such as thyroid dysfunction. Blood tests will also be performed to check for the presence of drugs.

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Early diagnosis

The sooner bipolar disorder is diagnosed and treated, the sooner you can regain control of your mood. Early diagnosis can also help avoid consequences of the disease such as alcohol or drug abuse or suicide.

About 10-15% of patients with bipolar disorder die as a result of suicide. About 60% of patients have alcohol or drug addiction, which affects the effectiveness of treatment.

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Treatment of bipolar disorder in adults

The sooner you diagnose bipolar disorder and begin treatment, the better your chances of regaining control over your mood. One of the most important aspects of treating bipolar mania is recognizing its early signs, which will give you the opportunity to begin treatment as early as possible with medications that should alleviate the mania itself.

There are many medications used to treat bipolar disorder. You may need to try several different medications before you find the one that works for you.

• Most patients with this condition must take medications called mood stabilizers every day.
• Medicines called antipsychotics help quickly cope with an attack of mania.
• In some cases, antidepressants are used to treat an attack of depression, but this must be done with great caution, as they can cause an attack of mania.

Regular visits to your doctor will help you quickly find the right medicine for you.

Psychotherapy also plays an important role in treatment, and not only patients but also their relatives should attend sessions. Psychotherapy will help the patient cope with some problems that may arise at work or at home due to his illness.

Keeping a mood diary will help you learn to recognize the slightest changes and notice symptoms faster. Write down your feelings and the reasons that caused them. If you understand what exactly causes you to have mood swings, over time you will learn to avoid them.

Very often during mania, when the patient feels very well, he stops taking the medicine. But you shouldn't do that. You should take the medicine constantly, even if you feel healthy.

Although bipolar disorder is not a curable illness, it can be treated with a combination of medications and psychotherapy sessions. You may need to try several different medications before your doctor can prescribe the right medication for you.

Initial treatment

Typically, the first treatment is prescribed in the acute phase of bipolar disorder, when the patient experiences his first attack of mania. In the acute phase of the disease, the patient may be in a psychopathic state, be prone to suicide, or cannot think clearly enough to harm himself. In such cases, the doctor may prescribe hospitalization in order to protect the patient from rash actions.

In the acute phase of the disease, the following medications can be used:

• Mood stabilizers, such as lithium carbonate. Experts believe that lithium affects certain brain chemicals (neurotransmitters) that cause mood changes. However, how this drug works is unknown.
• Anticonvulsant mood stabilizers, such as sodium valproate, divalproex, and carbamazepine. Valproate and divalproex are used to treat episodes of mania. The anticonvulsant lamotrigine has been approved for long-term use and is used to treat bipolar I disorder or depressive episodes. These drugs have also been shown to be effective in treating difficult-to-treat bipolar disorder. Combinations of anticonvulsants and mood stabilizers are often used to treat acute episodes of mania.
• Antipsychotics, such as olanzapine, risperidone, quetiapine, and arapiprazole. These help relieve symptoms of both mania and depression. They can be used in combination with mood stabilizers and anticonvulsants.
• Benzodiazepines, such as diazepam (Valium), are used instead of neuroleptics or as an adjunct in the treatment of manic episodes.

Supportive care

Maintenance treatment for bipolar disorder involves going to therapy and taking medications to avoid recurring episodes of mania or depression. It may take months for symptoms to ease and for you to return to your normal life.

Mood stabilizers are usually prescribed for long-term use. However, despite taking them, you may experience repeated bouts of mania or depression. In such cases, your doctor will prescribe additional medications. If you have had several bouts of mania or one acute attack, you will need to take medications for the rest of your life. Psychotherapy can help you restore your relationships and return to work.

Atypical anticonvulsants are currently used for maintenance treatment, but their effectiveness has not been proven.

Antidepressants, including fluoxetine, which are used to treat depressive episodes, need to be used with caution because they can trigger a manic episode. Experts now advise that antidepressants should be used for short periods of time, only during acute episodes of depression, and in combination with mood stabilizers.

Treatment when the disease worsens

In some cases, electroconvulsive therapy is used. During this procedure, a controlled electrical charge is passed through electrodes that are attached to the patient's skull. This charge is intended to cause a minor seizure in the brain, which can balance the brain's chemicals.

If you have symptoms of anxiety disorder in addition to bipolar disorder, such as restlessness and loss of sleep, panic attacks, or signs of psychosis, you may need to take additional medications.

Food for thought

When discussing a medication with your doctor, consider whether your lifestyle will allow you to take the medication at the same time every day. If you have trouble remembering to take your medication, you may want to ask your doctor for a once-daily medication.

You should also remember about the side effects of medications. You may not be able to cope with some side effects. Before you start taking medications, be sure to discuss all side effects with your doctor, this may affect the choice of drug.

It has been proven that the use of antidepressants as independent drugs in the treatment of bipolar depression can cause an attack of mania. Therefore, the use of antidepressants should be under the supervision of a doctor.

Unfortunately, many people do not seek medical attention for bipolar disorder symptoms. This is because the person thinks that they can manage the symptoms on their own. However, this is not the case.

Timely diagnosis of the disease and its effective treatment will help you avoid unpleasant and life-threatening consequences.

Precautionary measures

Unfortunately, bipolar disorder cannot be prevented, but with medication, mood swings can be controlled.

One in three patients will be completely cured of bipolar disorder symptoms if they take mood stabilizers such as carbamazepine or lithium for life.

To prevent an attack of mania or depression, you can:

• Eat a well-balanced diet.
• Do physical exercise every day.
• Avoid traveling to other time zones.
• Try to go to bed and wake up at the same time every day.
• Avoid alcohol and drugs.
• Reduce stressful situations at work and at home.
• Reduce caffeine and nicotine intake.
• Begin treatment as soon as you notice symptoms of a manic or depressive episode.

Changes in your normal sleep schedule can trigger episodes of mania or depression. If you are planning to travel to another time zone, consult your doctor beforehand. Ask him or her if you should change the dosage of your medication and what to do if you have an episode while away from home.

Treatment at home

Home treatment plays an important role in the overall treatment of bipolar disorder. To help you manage your mood, you can:

• Take the medicine every day as prescribed by your doctor.
• Exercise. You can do light exercise for 30 minutes every day. This includes walking.
• Watch your sleep. Keep your bedroom quiet and dark and try to go to bed at the same time.
• Eat a healthy, balanced diet. By a balanced diet, we mean a variety of foods from different food groups, such as whole grains, dairy, fruits and vegetables, and protein. Eat foods from each food group (e.g. eat a variety of fruits, not just apples). This will help you get all the nutrients you need from food, since one type of food will not provide them. Eat a little of everything, but do not overeat. A healthy diet can include foods from all food groups, as long as you practice moderation.
• Manage stressful situations in your life. Organize your time and responsibilities, create a strong social support network, develop effective stress management techniques, and lead a healthy lifestyle. Stress reduction techniques include physical activity and exercise, breathing exercises, muscle relaxation techniques, and massage.
• Avoid alcohol and drugs.
• During a manic episode, reduce your caffeine and nicotine intake.
• Learn to recognize the early signs of manic or depressive episodes.
• Ask family or friends to help you through difficult times. For example, if you are depressed, you may need help with homework or need supervision during a manic episode.

Family members often feel helpless when a loved one is experiencing mania or depression. But relatives and friends can help the sufferer by:

• Support and encourage medication taking, even if the patient feels well.
• Be able to recognize signs of suicide, which include:
  • Excessive alcohol or drug abuse.
  • Talking, writing, or drawing about death. Including writing suicide notes.
  • Talking about things that can be used to cause harm, such as pills, guns, or knives.
  • Spending a lot of time alone.
  • Giving away your own things.
  • Aggressive behavior or sudden calmness.
• Recognizing the early signs of a manic or depressive episode and encouraging immediate treatment.
• Give your loved one enough time to return to everyday life after the attack.
• Know the difference between simply being in a good mood and being in a hypomanic state. Hypomania is an elevated or irritable mood that is very different from simply being in a good mood and can last for a week or longer.
• Encourage the patient to attend psychotherapy sessions and support groups, as well as attend a support group himself, if necessary.

Medicines

Medications can help control mood swings when taken regularly and as prescribed. Although your family doctor may prescribe medication for bipolar disorder, he or she will likely refer you to a therapist who has experience treating the disorder.

Mood stabilizers, such as lithium, are the first drugs prescribed to treat an episode of mania, and later as drugs to prevent episodes of mania and depression. To fully control your illness, you may need to take medications for many years or even for life. To help you better control your symptoms, your doctor may prescribe additional medications - usually anticonvulsants.

Depending on your symptoms, the type of disease and your response to medications, your doctor will select an individual dose of drugs and their combination for you.

Choice of medications

There are several types of medications used to treat bipolar disorder. You may need to try several medications before you find the right one and dose for you. The most common medications include:

• Mood stabilizers, such as lithium carbonate. Experts believe that lithium affects certain brain chemicals (neurotransmitters) that cause mood changes. However, the mechanism by which this drug works is unknown. To treat the acute phase of a manic episode, doctors recommend taking mood stabilizers in combination with antipsychotics. Drugs such as sodium valproate, divalproex, and carbamazepine are also considered mood stabilizers. Valproate and divalproex are used to treat manic episodes. The anticonvulsant lamotrigine has been approved for long-term use and is used to treat bipolar disorder or depressive episodes. These drugs have also been shown to be effective in treating difficult-to-treat bipolar disorder.
• Antipsychotics, such as olanzapine, risperidone, quetiapine, and arapiprazole. Antipsychotics relieve symptoms of mania. Olanzapine may be used in combination with mood stabilizers and anticonvulsants.
• Benzodiazepines, such as diazepam (Valium), are used instead of neuroleptics or as an adjunct in the treatment of manic episodes.

Food for thought

Antidepressants, including fluoxetine, which are used to treat depressive episodes, need to be used with caution because they can trigger a manic episode. Experts now advise that antidepressants should be used for short periods of time, only during acute episodes of depression, and in combination with mood stabilizers.

If you are prescribed lithium, valproate, or carbamazepine, you will need to have regular blood tests to monitor the levels of these drugs in your blood. Exceeding the permissible level of lithium in your blood can lead to serious side effects. While taking these drugs, your doctor will also monitor their effects on your liver, kidney, and thyroid function, and will measure the number of red blood cells in your body.

When you visit your doctor, don’t forget to ask him:

• About the side effects of each medication.
• How often should you take the medicine?
• How these drugs may interact with other medications you take.
• How important is it to take your medications at the same time every day?

If you take medications for bipolar disorder while you are pregnant, it may increase the risk of birth defects in your baby. If you are pregnant or planning to become pregnant, be sure to tell your doctor. If your condition is severe, you may need to continue taking your medications. Your doctor will help you weigh the risks of treatment against the risk of harming your baby.

The Food and Drug Administration advises the following:

• Be aware that antidepressants increase the risk of suicide. The FDA does not recommend that people stop taking these medications. Instead, people taking antidepressants should be monitored for signs of suicidal behavior, especially when starting medications or changing their dosage.
• Be aware that anticonvulsants increase the risk of suicide. The FDA does not recommend that people stop taking these medications. Instead, people taking anticonvulsants should be monitored for signs of suicidal behavior. If you are taking anticonvulsants and are concerned about this side effect, talk to your doctor.

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Alternative treatments

Most people with this disease require medication. But psychotherapy sessions also play an important role in the treatment process, as they help you cope with the problems at work and at home caused by your illness.

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Other treatment methods

Types of psychotherapy used to treat bipolar disorder include:

• Cognitive behavioral therapy, which focuses on changing specific behavior patterns and thinking patterns to help you feel better. It is based on the theory that thoughts and behaviors can affect a patient’s symptoms and become a barrier to recovery.
• Interpersonal therapy that focuses on the patient's personal and social relationships and the problems associated with them. During sessions, the patient discusses his or her problems, the reasons for their occurrence, and ways to resolve them.
• Problem-solving therapy, a simplified version of cognitive therapy that has been used in the past to treat depression, focuses on the problem and helps the patient find an immediate solution.
• Family therapy, therapy that helps relatives and family members cope with a stressful situation or a major life event. During sessions, family members can express their concerns about how the illness will affect the patient and the entire family.

In some cases, electroconvulsive therapy is used. During this procedure, a controlled electrical charge is passed through electrodes that are attached to the patient's skull. This charge is intended to cause a minor seizure in the brain, which can balance the brain's chemicals.

Complementary therapy

Omega-3 fatty acids found in fish oil may be used as an adjunct to the main course of treatment for bipolar disorder. However, this dietary supplement requires additional research on its effectiveness in treating children and adolescents.

Food for thought

Establish a long-term, trusting relationship with your therapist. They can help you see changes in behavior and personality that may indicate that you are beginning to experience mania or depression. Treating the episode early can help you overcome it faster.

Bipolar disorder affects not only the patient, but also all members of his family. They must understand what kind of illness it is and know how to help their loved one.

Bipolar Disorder: When to See a Doctor?

If you have bipolar disorder, call your doctor or emergency services immediately if:

• You believe that you cannot protect yourself from harming yourself or other people.
• You hear voices you've never heard before or they upset you more than usual.
• Do you want to commit suicide or know someone who is planning to do so?

Signs of suicide include:

• Excessive use of alcohol or drugs.
• Talking, drawing, or writing about death, including writing suicide notes or talking about objects that can be used to harm oneself, such as pills, guns, or knives.
• The desire to be left alone.
• Giving away your own things.
• Aggressive behavior or sudden state of calm.

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Waiting and watching

Monitoring the patient's condition will be sufficient if he is at the beginning of an attack and takes medication regularly. If the symptoms of the attack have not improved within 2 weeks, consult a doctor.

If your loved one is suffering from a manic episode and is behaving irrationally, help them seek professional help.

Who should I contact?

Bipolar disorder is a complex and difficult to diagnose illness because it has many different phases and symptoms. It is sometimes confused with depression, because it is during periods of depression that patients most often seek help.

Once a diagnosis is made, it is important for the patient to develop a long-term, trusting relationship with the doctor. This will help the doctor choose the most effective medication and the best dose.

Although the diagnosis may be made by different doctors, you will be advised to see a psychiatrist with experience in treating similar diseases and the right to prescribe medications.

Doctors who can diagnose bipolar disorder include:

• Family doctors.
• Interns.
• Psychiatric nurse practitioners.

Support from relatives

If you have a family member or loved one who has bipolar disorder, it would be a good idea to seek help from a psychiatrist as well. This will help you understand how your loved one's illness will affect your life as well.

Also, psychotherapy sessions will help the child to cope with the parents' illness. A change in the parent's mood can cause tears, anger, depression or disobedience in the child.