Bipolar Disorder

March 30 is celebrated worldwide as World Bipolar Day.

About Bipolar Disorder

• Bipolar disorder (manic depression) is a psychiatric disorder characterised by a pathological alteration in one’s mood, energy, and activity levels.
  • These mood alterations are not transient but last for weeks, months or longer and impair one’s socio-occupational functioning.
• Types: Here, negative life events are associated with depressive relapses while goal-attainment life events are associated with manic relapses.
  • Major Depressive Disorder: It is characterised by a persistent and pervasive sadness of mood, anhedonia (disinterestedness in activities that were pleasurable before the onset of the affliction), easy fatigability, cognitive difficulties, hopelessness, worthlessness, inappropriate guilt, and crying spells. 
    • More Severe Forms: These include suicidal ideas, slowness of bodily movements and thinking, delusions, and hallucinations.
  • Mania: It is characterised by,
    • Elevated, expansive or irritable mood, higher energy levels, inflated self-esteem, decreased need for sleep, pressured speech, subjective experience that thoughts are racing (‘flight of ideas’), being easily distracted, increased goal-directed activity, unrestrained buying sprees, and sexual indiscretions.
• Clinical Onset: Bipolar disorder generally has its clinical onset between the ages of 15 and 30 years.
• Symptoms: Early-onset of multiple brief periods of depression; a family history of bipolar disorder; attention deficit and hyperactivity disorder; substance misuse; abrupt onset and offset of depression; Non response to antidepressants.
• Cause: Psychiatric disorders are inherently complex, polygenic, and multifactorial.
  • Genetically Inherited: Approx. 60-85% of the affliction can be attributed to genetic factors however, no single candidate gene has been identified in the causation of psychiatric disorders.
  • Brain Chemistry: Imbalances in neurotransmitters, such as norepinephrine and serotonin, may play a role in the development of bipolar disorder.
  • Circadian Functioning: It is characterised by marked disturbances in circadian rhythms  including body temperature and melatonin secretion
  • Sleep Disturbances: Sleep Disturbances such as insomnia or irregular sleep patterns, can trigger or worsen bipolar symptoms.
  • Environmental Factors: A person’s early childhood experiences, developmental history, stressors, and life events are the critical windows during development that act as triggers and maintaining factors for mood disorders.
  • Stressors: 
    • Proximal stressors: It include adverse childhood experiences such as abuse, loss, neglect, and domestic violence.
    • Distal Stressors: It is seen in adulthood includes a life-threatening illness, financial difficulties, unemployment, bereavement, violence, and trauma. 
  • Chronic Stress: It is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis disrupting the negative feedback loop rendering a chronic low-grade inflammatory state in the brain and the body.
  • Childhood Maltreatment: Studies have even shown abnormalities in the spermatozoa of victims of childhood maltreatment.
• Diagnosis: The average time from the onset of symptoms to the first diagnosis of bipolar disorder ranges from six to 10 years.
  • It begins with periods of depression before the onset of hypomanic or manic episodes.
• Treatment: It involves a combination of medication and Psychotherapy
  • Mood Stabilizers: Medications, like lithium, valproic acid, and carbamazepine, help control manic or hypomanic episodes and may also help with depressive episodes.
  • Antidepressants: While sometimes used, antidepressants are usually not used alone for bipolar disorder due to the risk of triggering mania or rapid cycling.
  • Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change unhealthy thought patterns and behaviors, and develop coping strategies. 
  • Interpersonal and Social Rhythm Therapy (IPSRT): This therapy focuses on establishing consistent daily routines like regular exercise, a balanced diet, and sufficient sleep,which can help stabilize moods. 
  • Electroconvulsive Therapy (ECT): ECT, a medical procedure involving a brief electrical stimulation of the brain, may be considered in severe cases where other treatments have not been effective.