Bipolar Affective Disorder

All we need to know about Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorder or Bipolar affective disorder is primarily a disorder of mood which can swing from one extreme to another. It is characterized by episodes of mania (patient feel very high with cheerfulness, increased activity level), depression (feeling low, sad) or mixed episodes (mix of mania and depression symptoms). Besides mood swings there are number of other associated symptoms. The high and low phases of illness are severe enough to interfere with everyday life. Bipolar disorder is relatively common condition. It affects around 3.5-4% of general population. The disorder usually starts in between 18-24 years age, though it can affect a person at any age.

What are the common Symptoms and signs of Bipolar Disorder?

The mood swings of Bipolar disorder can range from extreme happiness (mania) to extreme sadness (depression). Episodes of mania and depression can last for several weeks or more.

Manic episode-

Undue elevation of mood or persistent irritability

  • Feeling of excessive energy in oneself

  • Increased talking

  • Big & tall claims without sufficient basis

  • Increased self esteem

  • Increased activity levels

  • Excessive spending

  • Decreased need for sleep & erratic appetite

  • Having illogical thinking, delusions, hallucinations 

Depressive episode

  • Low mood throughout the day

  • Decreased energy

  • Difficulty concentrating and remembering

  • Feelings of emptiness or worthlessness

  • Negative thoughts for self, future & the world

  • Desire to end ones own life

  • Easy fatigue & lack of interest in most activities

  • Decreased sleep and appetite

  • Mixed episode

    • Occurs with admixture of the symptoms of the above two types

    What causes Bipolar Disorder?

    The exact cause of Bipolar Disorder is not fully understood but there are many factors which act together to cause the disorder. These could be complex mix of biological, psychological and social factors. Biological factors include genetic factors with increased vulnerability among individuals with family history of Bipolar disorder in either the immediate family or close relatives; changes in brain neurotransmitters like Dopamine, Nor-epinephrine, serotonin which are chemicals used by brain for transmitting information from one brain cell to another. A stressful or traumatic event can sometimes trigger the illness in particularly vulnerable individuals.

    How to recognize Bipolar Disorder?

    The diagnosis can be made easily by consulting your health care provider. No laboratory tests exist for diagnosing this disorder. It is necessary to consult a doctor or psychiatrist if any of the symptoms suggestive of mania or depression are observed.

    What are the treatment options?

    The majority of patients with Bipolar disorder can be treated using combination of different treatments like medicines to treat symptoms of mania, depression as and when they occur, medicines to prevent these episodes (mood stabilizers).

    Mood stabilizing medications include lithium carbonate, anti-convulsant medications like Valproate, Carbamazepine, Lamatrigine. These medicines are either used as single medicine or in cases not responding to single medicine a combination can be used. These medicines require monitoring periodically to check if the blood levels are appropriate and not too high or too low.

    Antipsychotic medicines are sometimes prescribed to treat episodes of maia or hypomania (less severe mania). In cases of Bipolar depression Antidepressant medicines are used. Different types of antipsychotic and antidepressant  medicines are available and a particular drug is chosen based on various factors including the type of symptomatology, treatment response in past if any, side effect profile, age of patient, associated physical comorbidities, etc. The antipsychotic or antidepressant medications as the case may be are used in combination with Mood stabilizers and are used only for adequate control of episodes.   

    Besides medicines the other useful interventions include psychosocial treatments focusing on enhancing socio-occupational functioning of the patient and helping patient to understand the illness.  Learning to recognize triggers that are associated with these episodes and learning the early signs of an approaching episode enable patient to get help in time.

    Does Bipolar Disorder recover completely?

    Bipolar disorder is classically described as an episodic disorder with episodes of mania, depression & mixed episodes. If the person is under treatment most of them would recover & be able to function to their optimal capacities.

    If left untreated, episodes of bipolar depression or mania can last for 6-12 months. But those with no treatment or inadequate treatment the recurrence of episodes is common. Some patients may experience rapid cycling Bipolar disorder i.e. quick episodes of high and low mood without any a normal period in between.  This condition may require combination of mood stabilizers for effective control.

    Like many other medical disorders such as Diabetes Mellitus, Hypertension, Bipolar disorder requires long term treatment. However with continued Drug treatment, recurrence of episodes can be prevented.  

    What is the role of family?

    During the episodes of mania particularly,  patient may lose touch with reality and may not recognize his behaviour as changed or odd. The patient’s ability to take rationale decisions for oneself including seeking treatment may also be impaired. Thus the patients mainly rely on family for their care and support. The understanding and attitude of family towards illness also influence the outcome. The family thus needs to understand the illness, understand the ways of coping with the illness, and need for medications and continuation of treatment.

    The family also needs to be alert for possible complications or crisis situations that may arise during the course of illness such as severe aggression, violence during manic state, or suicidal ideas or behaviour during depressive state. In case of any of such crisis the family should immediately report it to the doctor as this requires emergency intervention and/or hospitalization. 

    Can Bipolar Disorder be prevented?

    There are no known ways to prevent development of the disorder. However early detection of illness and early intervention can be greatly beneficial. Adopting healthy lifestyle, avoiding stressful situations, effective use of stress reduction strategies help manage the condition more effectively.

    What are the Rehabilitation options for patients with chronic Bipolar disorder?

    Overall prognosis of Bipolar disorder is good with majority of patients showing complete inter episodic recovery and are able to function at optimal level. However a small proportion of patients may show poor response to treatment, have chronic course with poor inter episodic recovery or rapid cycling course. In such cases rehabilitation may be necessary. The options include use of psychosocial therapies which include a variety of methods to increase social abilities, self-sufficiency, practical skills etc. The goal is to enable persons who are severely ill to develop social and vocational skills for independent living.

    Living with Bipolar Disorder- What can you do or help your patient do?

    • Recognize the illness in its early stage

    • Consult the doctor immediately

    • Discuss the treatment options with your doctor.

    • Avoid self medicating.

    • Take medications as prescribed. Continuing medications will help prevent relapse or recurrence.

    • Follow up with your doctor regularly. Regular contact with doctor and timely review are helpful.

    • Avoid excess tea, coffee, nicotine,  drugs like cannabis, Alcohol.

    • Eat and sleep well. Exercise regularly.

    ( This document is compilation of information from Web and Print Media for purpose of making the scientific educative material easily available for patients and families)