Healthy Living

Bipolar Disorder: The Top 10 Questions

  • Many studies on patients diagnosed with bipolar disorder have revealed that this condition tends to run in families. 
  • Other studies have also shown that environmental and lifestyle factors have a great impact on bipolar disorder, making its etiology multifactorial.
  • Bipolar depression is often misdiagnosed as regular (unipolar) depression. The distinction is crucial because bipolar depression is not treated with antidepressants. 

Is Bipolar Genetic?

The real cause of bipolar disorder is not known until today, although many factors seem to play a role in its development. Bipolar disorder seems to run in families, for which many consider bipolar disorder an inherited medical disease. However, other studies have also shown that environmental and lifestyle factors have a great impact on bipolar disorder, making its etiology multifactorial.

Many studies on patients diagnosed with bipolar disorder have revealed that this condition tends to run in families. According to Johns Hopkins University study on first-degree relatives diagnosed with bipolar disorder type I and bipolar disorder type II, the bipolar II is more likely to run in families.

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A Stanford University study revealed that having a parent with bipolar disorder increases the risk of developing bipolar disorder at some point in time.

Recent studies on bipolar disorder have revealed that there might be more genes involved than scientists had initially thought.

However, it is generally agreed that certain environmental and lifestyle factors can trigger bipolar disorder among people who have a genetic predisposition for this neurological disease.

What Is Bipolar Depression?

Bipolar disorder is a neurological disorder characterized by mood disturbances that swing from depression to mania and vice versa. Shifts between states can occur a couple of times a week, sometimes a couple of times a year.

The real cause of bipolar disorder is not known. However, certain factors such as genetics, neurotransmitters, and biological differences have been linked to bipolar disorder.

Bipolar depression is depression in people with bipolar disorder and can last for days, weeks, or months. Common signs and symptoms of depression include:

  • Low energy
  • Sadness
  • Loneliness
  • Feelings of guilt
  • Feelings of worthlessness
  • Feelings of hopelessness
  • Loss of interest 
  • Insomnia
  • Oversleeping
  • Changes in appetite
  • Weight gain or weight loss
  • Difficulties in concentrating
  • Low libido
  • Suicidal thoughts
  • Suicide attempts

Bipolar depression is often misdiagnosed as regular (unipolar) depression. However, there are some clear differences between these two types of depression, especially when it comes to treatment. The distinction is crucial because bipolar depression is not treated with antidepressants. 

Bipolar depression is also often associated with unpredictable mood swings, irritability, feelings of guilt, and restlessness, although many signs and symptoms are similar to those of regular depression.

Is a Person Born With Bipolar Disorder?

It is difficult to give a categorical answer when it comes to whether a person is born with bipolar disorder. We are all born with certain genetic predispositions and risks of certain diseases, including mental illnesses like bipolar disorder. Genetics seems to play an important role in bipolar disorder. However, scientists have revealed that lifestyle and environmental factors trigger the onset and development of bipolar disorder.

An average person who does not have anyone in the family diagnosed with bipolar disorder has a 1% risk of getting diagnosed with this mental illness. However, the probability increases when there is a genetic predisposition and when there is a family member already diagnosed with this condition. If only one parent has bipolar disorder, there is a 30 to 35% risk of being diagnosed with bipolar disorder. If both parents have bipolar disorder, the numbers go up to 70 to 75%. Having a fraternal twin with bipolar disorder puts you at about a 14% risk of having bipolar disorder, while the risk for identical twins is greater than 65%.

The signs and symptoms of bipolar disorder become noticeable in adulthood, rarely starting in adolescence or childhood. Life is unpredictable for all.

 Is Bipolar Disorder a Chemical Imbalance in the Brain?

Bipolar disorder can sometimes be caused by chemical imbalances in the brain, but not all cases of the condition can be attributed to this cause. The exact cause of bipolar disorder is still unknown until today, even though several theories attempt to explain its occurrence. The most popular cause is linked to genetics, being that between 4% and 15% of children with one bipolar parent get the disease. The chances are 3.5 times higher if both parents are bipolar. Children whose parents aren’t bipolar have about a 2% chance of developing the disorder.

Even today, not a single gene has been identified as the cause of bipolar disorder, which means that genetics may only predispose a child to the condition. With no gene having been identified thus far comes the greater probability that external triggers spark bipolar syndrome. Among the triggering factors that have been identified are drug use, changes in sleeping habits, traumatic events, and even disease. Such triggers cause an imbalance in noradrenaline, serotonin, and dopamine levels, creating the classic symptoms of bipolar disorder. These neurotransmitters normally control emotions, and their imbalance causes emotions to become erratic and out of whack – the bipolar condition.

How Is Bipolar Disorder Diagnosed?

Once bipolar disorder is suspected, a physical examination and other tests are performed. Through these, your doctor is able to eliminate other problems and check for possible complications.

A complete physical examination is necessary as it gives the doctor information about the patient's overall health and also helps the doctor identify any signs and symptoms occurring due to other medical problems and not just from bipolar disorder.

A psychological evaluation is perhaps the most important part of diagnosing bipolar disorder. The doctor talks to the patient about his or her thoughts, feelings, and behavior. Sometimes, a questionnaire is filled out.

Mood charting also helps the doctor identify the signs and symptoms of bipolar disorder through your keeping track of and recording your daily sleep patterns, mood changes, and other important factors.

All the information gathered is fully assessed using the criteria of the Diagnostic and Statistical Manual published by the American Psychiatric Association.

What Is a Mood Stabilizer?

A mood stabilizer is a drug used to treat and prevent depressive episodes as well as manic or hypomanic episodes in patients diagnosed with bipolar disorder. Mood stabilizers help minimize the negative effects of these mood changes, making it possible for the suffering person to function normally in life.

As bipolar disorder is a chronic medical condition, the medications should be taken for the rest of one's life, just like medications used for diabetes, heart problems, etc. Quitting these medications contrary to or without the doctor's advice will just make your condition worse. Mood stabilizers should be taken exactly as your doctor has prescribed them, daily and in the correct dosage.

Mood stabilizers used for the treatment of bipolar depression are classified into these categories:

  • Mineral – such as lithium
  • Anticonvulsant – such as Lamotrigine, Carbamazepine, Valproic acid, Oxycarbazepine, etc.
  • Antipsychotic – such as Lurasidone, Asenapine, Risperidone, etc.

These medications tend to balance the neurotransmitters that control behavior and emotions. Some of these medications are used during acute episodes of depression or mania, while others are used during periods of remission, preventing manic or depressive episodes from reoccurring. Often, these medications are taken in combination for better results.

Just like any other medication, mood stabilizers have their own possible side effects. Medications should always be taken as prescribed and if side effects occur, your doctor will likely lower the dosage or possibly switch to another similar medication. These medications should not be stopped abruptly unless your doctor tells you to do so.

In cases of hives, rashes, difficulties breathing, or swelling of the lips, tongue, throat, or face, you should immediately call for help as these are signs of an allergic reaction. If you are allergic to a certain medication, you should no longer take it. Your doctor will prescribe you an alternative mood stabilizer for the treatment of bipolar disorder.

What Medications Are Used in Treating Bipolar Disorder?

Once diagnosed with bipolar disorder, a person will need lifelong treatment. The medication should be used even when the person feels fine and there are no noticeable signs and symptoms. As persons with bipolar disorder are more vulnerable to triggers than the general population, regular medication is used in order to prevent recurrence.

Bipolar disorder medications include:

  • Anticonvulsants
  • Antidepressants
  • Antipsychotics
  • Benzodiazepines
  • Supplements

Is There a Cure for Bipolar Disorder?

Bipolar disorder is a mental illness whose onset usually comes in a person's early 20s. Rarely is bipolar disorder diagnosed during childhood. Living with bipolar disorder is not an easy thing, both for the person suffering from this condition as well as for their family members. Constant mood changes ranging from manic episodes followed by episodes of depression greatly interfere with a person’s life, often making it impossible for him or her to function normally.

In general, once a person is diagnosed with bipolar disorder, mood stabilizer medications have to be taken for the rest of one's life, just like medications for other chronic medical conditions such as cardiovascular diseases, diabetes, etc. Some medications are used only during acute phases of the disease, while others are used during remission in order to prevent further mood changes in the future. But is there a cure for bipolar disorder?

No, there is no cure for bipolar disorder. However, the severity of signs and symptoms and frequency of changes in mood vary from patient to patient. In some cases, these mood changes from mania to depression occur a couple of times a week, while in other cases they occur only a couple of times a year. Some patients have long periods of remission where there are no signs and symptoms at all, making it possible for them to function normally. However, as life is never predictable, these people are still more vulnerable to the progression of the disease and mood changes triggered by stressful situations in life.

Usually, medication and avoiding the triggers of manic or depressive episodes help prevent the recurrence of bipolar disorder symptoms.

Can Bipolar Disorder Go Away?

Bipolar disorder never permanently goes away. It is a lifelong condition. However, with proper treatment, the condition can go into remission where all the episodes and symptoms are not displayed for a long period of time. Even then, the individual is still vulnerable to the return of episodes, especially during stressful periods. For this reason, people diagnosed with bipolar disorder once should always receive medical treatment.

Treatment involves a combination of medication and psychotherapy. Additional medications are recommended for severe episodes of the bipolar syndrome involving manic or depressive episodes where the individual places him- or herself at risk. For the short-term treatment of severe symptoms, carbamazepine, valproate, and antipsychotics are given. For the long-term treatment of bipolar disorder, lithium is still the preferred drug in combination with other mood stabilizers.

For less severe symptoms, therapeutic measures can be taken to identify the triggers of bipolar episodes. The individual is also taught to better manage their emotions, and their family members are also trained in handling and helping the affected family member. All these measures help prevent a downward spiral into frequent, severe bipolar episodes. Therapeutic measures are usually combined with medications to ensure the individual is well-rounded and able to cope with all situations.

Does Bipolar Disorder Get Worse?

Yes, it does, if it is not properly managed as soon as it is diagnosed. Symptoms of bipolar disorder are usually identified during adolescence and early adulthood, although their onset can begin at any age. The initial symptoms and presentations are usually mild and few and far between, which often causes the parents, friends, and co-workers to assume that what they see are personality traits. However, as the chemical imbalance in the brain worsens, bipolar episodes become increasingly severe and regular. This is why diagnosis takes between 5 and 10 years from the time the initial symptoms are noticed.

The 6th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-VI) clearly indicates the symptoms of bipolar disorder, but these symptoms are similar to those of other mental health conditions. To rule out these as well as other physical illnesses, a differential diagnosis is necessary. A further analysis of a patient's medical records is made and a physical examination is done to ensure there aren’t any other possible causes of the symptoms.

Once the diagnosis is made, proper medications are given to manage and keep the signs and symptoms of bipolar disorder under control. The earlier the treatment starts, the sooner the symptoms are curbed. Misdiagnoses and inappropriate treatment only make the symptoms get worse as time passes.