Bipolar disorder: Causes and symptoms
Bipolar disorder is a serious condition that involves severe changes in mood.
Depression is part of bipolar disorder.
Scientists do not have a clear idea of what causes bipolar disorder. A number of factors are possible.
There is a strong pattern of genetic inheritance, meaning that it can run in families. Evidence also suggests that two chemicals in the brain, serotonin and norepinephrine, become disordered in people with bipolar.
People usually develop bipolar disorder between adolescence and their 30s. The condition usually lasts for life.
For people with bipolar disorder, episodes of depression and mania tend to cycle from one to the other.
A person with this condition may experience episodes of feeling severely down, followed by episodes of feeling extremely up. The episodes of illness are usually separated by periods when symptoms go away.
Most people with bipolar disorder usually experience either symptoms of depression or symptoms of mania. However, some people may experience "mixed" episodes in which symptoms of depression and mania occur at the same time.
A manic episode usually lasts at least 7 days. This can be shorter if the person's symptoms are so severe that they have to go to the hospital.
These symptoms include:
- High mood
- High energy, more goal-driven activity
- High self-esteem
- Reduced sleep
- Talking a lot more than usual
- Rapid flow of speech and racing thoughts
- Easily distracted
- Tetchy, irritable
- Impulse for pleasurable risk-taking without thinking of the consequences
Some people can also experience psychosis during either a manic or depressive episode. Psychosis means having strange, delusional ideas or, sometimes, hallucinations.
A milder form of these manic symptoms may happen during a manic episode. This is known as hypomania.
During the depressive episodes of bipolar disorder, a person may experience a severe form of depression that is similar to major depression.
Depression: Causes and symptoms
Lasting depression does not have a known cause. Similarly to bipolar disorder, depression has hereditary factors. Twins, for example, are more likely to have the condition together.
The two core symptoms of depression are:
- Feeling very down or low for most of the day
- Having a loss of interest or pleasure in things for most of the day
Other symptoms of depression can include:
- Feeling hopeless
- Inappropriate feelings of guilt, worthlessness, or helplessness
- Loss of energy
- Difficulty concentrating or deciding on things
- Difficulty sleeping, oversleeping, or waking early in the morning
- Loss of appetite, weight loss
- Suicidal thoughts or attempts
- Restlessness and irritability
- Slowed down movements and speech
Life events can trigger severe depression. Unlike bipolar disorder, depression usually resolves over time.
Doctors classify two forms of bipolar disorder:
- Bipolar I disorder: The person has had at least one majorly disruptive manic episode, lasting at least 7 days, or less if it is so severe that the person needs to go to the hospital.
- Bipolar II disorder: The person experiences major depressive episodes, with the mania being less disruptive. The person has at least one episode of hypomania, but not the full mania of bipolar I.
Other forms include "unspecified" disorder, when the features are not clearly either bipolar I or II.
Cyclothymic disorder shows hypomania and depression that are less severe and last for less time. Some people with cyclothymic disorder show mania and depressive symptoms at the same time. The symptoms may be mild enough to avoid the attention of a doctor. As a result, diagnosis may be missed altogether.
There are no medical tests for the condition. In order to diagnose bipolar disorder, a doctor relies on observation and evaluation of the symptoms described by the individual and the people around them.
The same is true of depression. Doctors will "take a history" of the person's symptoms to decide whether they have bipolar disorder or severe or "major" depression. This condition is also known as clinical depression and unipolar depression.
For a doctor to diagnose "major" depression, the person must experience appropriate symptoms nearly every day for at least 2 weeks. The symptoms need to include low mood and loss of interest, plus at least five of the other features listed above. People who have unipolar depression do not experience mania.
What's the difference between bipolar disorder and depression?
The key differences that separate bipolar disorder from major depression are:
With bipolar disorder, low moods will alternate with "highs."
- People with a bipolar disorder must have at least one manic or hypomanic episode
- People with major depression do not experience any very elevated feelings
Bipolar disorder is not always easy to diagnose. People may go to their doctor for the first time when they have a depressive episode, rather than when they are on a "high."
It may take some time for a doctor to make a definite diagnosis. The person may be seen by their doctor for a number of months or even years before being diagnosed with bipolar disorder.
In some cases, people with severe mania may be admitted to the hospital because of dangerous behavior. A doctor may diagnose bipolar disorder at this point.
Depression and bipolar disorder can be easily confused. Before making a diagnosis, a doctor needs to rule out other mental and medical conditions, such as anxiety, substance abuse, and thyroid disease.
Another difference between bipolar disorder and depression is how doctors treat the conditions.
Treatments for both bipolar disorder and depression include drug and talking therapies.
Talking, psychological therapies, or psychotherapies include talking to counselors or other health professionals on a one-to-one basis or in a group situation. A person seeking help can choose from a range of options, including cognitive-behavioral therapy (CBT), which helps with thinking patterns.
Lithium is a drug used in the treatment of bipolar disorder, but it is not generally used in the treatment of major depression. The same is true of other mood stabilizers, which are used for bipolar disorder. These drugs include carbamazepine, lamotrigine, and valproate.
People who have major depression may be prescribed drugs, known as selective serotonin reuptake inhibitors (SSRIs). People usually take these alongside their talking therapy.
People with bipolar disorder will typically need help and support for life. For those with major depression, the support may be long term.
An early diagnosis of bipolar disorder or depression offers the best hope of improved daily life.
Help is available for both depression and bipolar disorder.
Good medical management of the condition helps reduce the worst effects and opens up access to wider support. Doctors and other healthcare professionals should help with treating the "psychosocial" effects and not just symptoms.
This means that they may be able to help people with this condition to access group therapies, or help them get assistance in their workplace, and so on.
Some people find that taking part in a support group with others experiencing the same condition is very helpful and supportive. Others find these groups help reduce some of the isolating effects caused by such severe mental health disorders.
The challenges of mental health can also affect those people close to the person with the condition. The challenges of living with a very depressed person, or managing the consequences of manic behavior, can be very difficult. Sometimes, it is family members that seek medical care first.
The effects on the daily life of a person with a mental health condition are highly individual. Not everyone experiences changes to their life and relationships in the same way.
Some people may experience positive effects of their condition, and severe mental illness does not necessarily mean failure or an inability to achieve.
During hypomania, for example, high energy, creativity, and confidence are symptoms that some people would find very useful.