As a mental health professional, I have noticed that in daily life people use terms like “I’m OCD” or I’m depressed” or “I’m bipolar” more often than it is really the case. Although for me as a professional it raises a red flag, I find that people use these terms as an exaggeration of their current emotions and not really mean them rather use them in general speech.

However, the pain and struggle that people suffering from these disorders feel is real and deserves a proper acknowledgement. While depression and OCD (obsessive-compulsive disorder) are somewhat better known, bipolar disorder is not often talked about and as 30th of March is World Bipolar day, it seems appropriate to address it.

The term bipolar suggests that there are two poles, two opposites that meet in one person, but these opposites are unable to provide a balance.

 

What is a bipolar disorder?

 

Bipolar disorder was formerly called manic-depression because the mental health professionals of the time noticed that people who suffer from it have manic states (hyper-energetic, elated state) or depressed episodes (low-energy, sad, hopelessness).

The history of bipolar disorder is quite a dynamic one, as it was first mentioned by Hippocrates around 400 B.C. who documented that there were people who reported feeling to extremes of the mood known at the time as melancholia and mania. Even though it has been later described by other physicians, it continued to excite health professionals throughout history but it was not until mid-19th century when a French physician Jean-Pierre Falret suggested that these states could be parts of the same disorder which he named “folie circulaire” (circular madness) as he saw depressive and manic states as cycles with a “normal” cycle in between them. Similarly, his colleague Jules Baillarger at around the same time suggested that there is no cycle in between and gave it a different name- “folie à double forme”( two-form madness). Bipolar disorder further continued to entertain the attention of physicians of different countries and eras and changed its names several times until 1980 when it finally got the name and the form that we know today in Diagnostic Statistic Manual (DSM) III. This was the first time this condition was separated from generalized depressive disorder and characterized as a mood disorder.

As a mood disorder, bipolar disorder affects mood, energy and activity levels. The waves of mood are extremely high (elated, irritable, high energy) in a manic episode or extremely low (sad, indifferent, hopeless) in a depressive one.

 

Types of bipolar disorder

 

We distinguish 4 types of bipolar disorder and they all involve significant changes in mood, energy and activity levels.

  1. Bipolar I: Having one or more episodes of mania lasting for at least 7 days. A depressive episode may or may not occur. Manic episodes can be often severe and require hospitalization.
  2. Bipolar II: Having depressive episodes alternating with somewhat manic episodes, but not full manic episodes (hypomanic).
  3. Cyclothymic disorder: Switching between depressive and manic states for at least 2 years, with periods of normal mood lasting less than 8 weeks.
  4. Unspecified bipolar disorder: When a person does not meet any of the above descriptions but has had significant mood elevation.

Typically diagnosed during late adolescence or early childhood, some occurrence in children and during or post-pregnancy. Bipolar disorder affects people on many levels as handling intense emotions, changes in sleep patterns, activity levels which are extreme and out of character are difficult to handle both for the person and their environment.

Having a manic episode may mean that the person affected feels very “high”, irritable, restless, gets little or no sleep, eats excessively, talks very fast or “rambles”, tries to multitask or have racing thoughts. Manic episodes also tend to put people in risky situations, like gambling all their savings, having reckless or risky sexual encounters or using drugs. The feelings of grandiosity or greater importance are also not unusual.

On the other side, when the same person enters the depressive episode, they become almost unrecognizable as they suddenly feel sad, empty, worried, hopeless, lose interest in food, sex or almost any activities as they feel unable to experience pleasure (“anhedonia”). They feel slowed down, sleep most of the time, get forgetful, have trouble concentrating and get unable to do simple things. Their entire existence gets a completely different dimension as they feel worthless and hopeless, think about death and suicide.

 

Diagnosis and treatment

 

It is important to say that sometimes these signs and symptoms are not as easy to distinguish, but possible to recognize by family or friends who notice behaviour that seems out of character.  A proper and timely diagnosis and treatment by a mental health professional is important so that the person suffering from bipolar disorder can live with and handle their condition in the best way possible.  Taking into consideration that people with bipolar disorder are more likely to seek help when they are in a depressive episode than when they are in a manic one, mental health professionals have to take various aspects into account like family history and relatedness with other disorders on top of the signs and symptoms. Bipolar disorder usually requires a life-long treatment which is a combination of psychotherapy and medication and sometimes crisis -intervention such as ECT (electroconvulsive therapy) which provides fast relief from severe symptoms or new treatments like TMS (transcranial magnetic stimulation) which tackles the depressive episode.

 

Living with bipolar

 

Movies and television often portray people with bipolar disorder that fit certain stereotypes, but for real people living with it, their lives do not always resemble these stereotypes. Living with bipolar can be difficult as the mood changes are not always predictable. Fortunately, a lot can be done by educating patients and presenting them with ways of coping in daily life. It is important to say that even with proper treatment the mood changes can occur but this is where psychotherapy can offer coping skills. Psychotherapy provides therapy sheets that allow patients to record their own warning signs for a manic or depressive episode and encourage them to write a journal or a mood log which will help them understand how they are feeling and maybe predict what could happen next. Patients suffering from bipolar disorder are also encouraged to exercise regularly and take up jogging, brisk walking or swimming which can help regulate the moods better and can improve eating and sleeping patterns. It must be emphasized that bipolar disorder requires life-long treatment which is why structuring and learning about personal triggers and signs is important.

People suffering from bipolar disorder report having difficult periods in life, suicidal thoughts and attempts, fears of having children, fears of their own reactions, loss of control over their body and mind, struggles that they would never be able to feel stability. At the same time, some people can experience exalting creativity and be incredibly prolific in their work, art or science. For instance, people like Van Gogh, Ernest Hemingway or Isaac Newton suffered from bipolar disorder and even though it did not end well for them, they left behind incredible pieces of art and science produced in manic phases of their lives.

However, bipolar disorder does not only affect the person who suffers from it, but it also affects their family and close friends, so it is paramount to know how to deal with the signs and symptoms related. Dealing with frequent mood changes can be challenging as it may disrupt relationships and different aspects of family life. Patience, support and understanding can play a significant role in the patient’s recovery. Educating themselves about bipolar disorder can help family members recognize signs and symptoms in due time and get the appropriate help for their loved one. Showing patience, acceptance, empathy and understanding seem like great skills to have in these circumstances as those patients who have support from their family members appear to stabilize and recover better or their symptoms become milder with time. Apart from the emotional support, it is important to encourage the patient to see a doctor and follow treatments and procedures. Family members of people suffering from bipolar disorder can also suffer personal psychological issues related to this difficult role, so it is paramount for them to ask for help and support, set personal boundaries, focus on their own lives and also know what to in emergency situations.

As living with bipolar disorder is a constant struggle, and no real conclusion is to be expected, I felt it would be appropriate to end this article with a quote from Carrie Fisher, instead of a conclusion:  “Bipolar disorder can be a great teacher. It’s a challenge, but it can set you up to be able to do almost anything else in your life.”

If you or someone close to you is suicidal or violent, do not try to handle the situation alone, call your local emergency line, or police if you feel in danger. If your loved one is suicidal, do not leave them alone and get help as soon as possible.

References

Jeanne Segal, Ph.D. and Melinda Smith, M.A. Helping someone with bipolar disorder
https://www.helpguide.org/articles/bipolar-disorder/helping-someone-with-bipolar-disorder.htm

Wikipedia article List of people with bipolar disorder
https://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder

Tessa Miller, SELF, This is what it’s actually like to live with bipolar disorder

https://www.self.com/story/this-is-what-its-actually-like-to-live-with-bipolar-disorder

Mayo clinic, Bipolar disorder
https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

National Institute for Mental Health, Bipolar disorder

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

The History of Bipolar Disorder, Reviewed by Smitha Bhandari, MD on August 28, 2020
https://www.webmd.com/bipolar-disorder/history-bipolar#:~:text=The%20earliest%20mentions%20of%20bipolar,depression)%20and%20feeling%20extremely%20energized