Beginner's Guide to Bipolar Disorder

Bipolar disorder is a mental health diagnosis that affect approximately 1% of the world population and 4.4% of US citizens. Its name, however, has been reduced to a colloquial among the public since its become better known universally to describe a person experiencing mood swings and generally lacking emotionally stability. With World Bipolar Awareness day just over a month away, its a good time to familiarize ourselves with an accurate description of this disorder. So what is bipolar disorder? Where does it come from? What are the major brain differences observed in those with it, and what treatments are available today to cope with this disorder?

What is bipolar disorder?

Bipolar disorder is classified as a mood disorder under the DSM 5. Its one of several disorders, which also include depression, seasonal affective disorder, dysthymia, that affect a person's mood and ability to regulate their emotions. In bipolar disorder, the patient experiences persistent and dramatic spikes and lapses in moods that typically last for periods of a week or more.

When is it first discovered in 1851, French psychiatrist Jean-Pierre Falret named it, "la folie circulaire," which translates to circular insanity. During the 20th century, it was referred to as manic depression or manic depressive illness first, then manic depressive disorder, until 1957 when German psychiatrist Karl Leonhard first used the term bipolar disorder; "bipolar" meaning "two poles" to represent each opposite end of mood.

Mania, Hypomania, and Depression

These period of spikes and lapses are known as mania, hypomania, and depression. Mania is the highest of spikes in mood. There are two types of mania. More common is the euphoric type, which is a period of elevated mood that lasts from weeks to months. Symptoms of euphoric mania include:

• increased energy
• increased risk taking
• feelings of euphoria
• increased talking speed
• racing thoughts
• decreased need for sleep
• increased anxiety
• increased distractedness
• heightened sense of self

Mania may also present as an agitated state. This type has similar symptoms, but differs in that the increase in energy is works to increase levels of irritability rather than elevate mood and sense of self. For an episode to qualify as manic, the euphoric type requires at least 3 symptoms present in the patient, while in the agitated type, at least 4 symptoms must present. This works to more definitively distinguish this period from one

of major depression.

Hypomania is similar to mania, as it has many of the same symptoms and can lean in the direction of either type as well. However, in hypomania, these symptoms effects are less severe and hypomanic episodes are not as long. They usually last approximately a week.

Periods of severe depression also present in those with bipolar disorder. A major depressive episode is characterized by at least 2 weeks of pervasive low mood. During periods of depression, the individual may experience symptoms like

• decreased talking speed
• decreased energy
• loss of interest
• feelings of sadness
• anxiety, agitation, or restlessness
• unexplained physical symptoms like back pain or headaches
• change in appetite
• sleep disturbances like insomnia or sleeping too much
• increased agitation
• slowed thinking and movements

It's not unusual for life's circumstances to cause periods of low mood, which can even span long enough to qualify as a period of depression. However, in a clinical diagnosis of bipolar disorder or major depressive disorder for that matter, these symptoms must not be directly correlated to specific circumstances.

Bipolar 1 and Bipolar 2

There are two types of bipolar disorder. Of these, bipolar 1 is less common. In it, the individual experiences all three periods: depression, hypomania, and at least one period of mania. This type is generally viewed as more severe because of the lack of control characteristic of mania.

The second type is bipolar 2 disorder, which is also known as bipolar depression. In this type, the patient still experiences these spikes and lapses in mood but the spikes never reach high enough to qualify as manic. So, patients with bipolar 2 disorder are limited to periods of depression and hypomanic episodes.

Then, there's cyclomania. It's very similar to bipolar 2 disorder, and may even be best explained on its spectrum. It is also categorized by persistent drops and elevations of mood. These patient's ups and downs, however, are comparatively less volatile than those with bipolar disorder-with their highs and lows never quite reaching the standards to qualify as depression and/ or hypomania.

Where does it come from?

This disorder was first diagnosed in 1851 by French psychiatrist Jean-Pierre Falret, who named it "la folie circulaire," which translated to circular insanity.

As all mood disorders are, bipolar disorder's origin lies in the individual's genetics as well as in brain abnormalities.

Major Brain Differences

Differences in the brain of those with bipolar disorder are both anatomical and chemical in nature and are responsible for the changes in mood and cognition of those affected by it.

Some areas of the brain that differ physically in those with bipolar disorder include:

• the prefrontal cortex-which is the area most responsible for cognitive and executive function including attention, impulse control, and moral judgment
• the hippocampus-which is located in the temporal lobe and plays a vital role in processing long-term memory and emotional responses
• the gray matter-which is the outermost layer of the brain-in areas controlling movement, information processing and awareness of bodily states.

When comparing brain functions of those with bipolar disorder to those without, a chemical imbalance is seen in patients with bipolar disorder. This is predominantly seen in their neurotransmitters, which function to move information throughout the brain.

The neurotransmitters believed to be affected by this disorder are norepinephron-which works closely with adrenaline to regulate the body's "fight or flight" response, dopamine-which is most closely associated to the brain's reward center, and serotonin-which plays a vital role in bodily functions like mood, regulating anxiety, sleep, and digestion.

Periods of mania heighten norepinephron and dopamine levels in the brain, resulting in symptoms like increased mood, anxiety, and sense of self. In contrast, during depressive episodes, it's believed that serotonin, dopamine, and norepinephron level are decreased which may lead to symptoms like loss of interest, feelings of sadness, and sleep disturbances to name a few.

It's unclear whether these brain abnormalities cause or are caused by the onset of bipolar disorder, and can be improved upon with due diligence, but are believed to be irreversible, requiring lifelong treatment of those with this disorder.

Treatments Available Today

If you or a loved one have this disorder-don’t fret! Plenty of people live relatively normal lives with bipolar disorder while in treatment. Most often, when patients are diagnosed with this disorder, the recommended course of treatment is regular therapy paired with an assortment of medications.

This assortment usually includes a mood stabilizer like lithium, paired with antidepressant and/ or antianxiety medications like zoloft or xanax, and a sleep inhibitor- with the types and dosages depending on the patient's symptoms and their severity.

This assortment usually requires adjusting, which is why regularly seeing a professional while perfecting them is essential. Once achieved, the correct combination of medication can help the patient to improve upon their symptoms and significantly improve their life.