I have never actually blogged on the subject of Bipolar Disorder in and of itself. I have written numerous posts about how I feel about it, or how it is affecting me and others on any given day. So, here goes. Most of this information comes from the National Institute for Mental Health. I am going to break this into pieces as it became something of a dissertation on Bipolar Disorder in all of its lovely forms.
What exactly is Bipolar Disorder?
Also known as manic-depressive illness, Bipolar disorder is mental disorder belonging to the DSM category Mood Disorders. It is characterized by unusual shifts in mood, energy levels, activity levels, and the ability to carry out day to day tasks. The symptoms of Bipolar can range from mild to severe. The symptoms of Bipolar Disorder vary greatly from the experience of “normal” moods. They are far different than the usual ups and downs that most people experience from time to time. The symptoms of Bipolar Disorder can interfere with relationships causing sometimes irreparable damage; they can cause poor school or work performance, and even, at its most extreme, suicide. People with Bipolar have a high rate of death by suicide. I do not know the exact statistics, but they are higher than those of Major Depressive Disorder and other mood disorders, and even Schizophrenia. The good news is that Bipolar disorder can be successfully treated so that people who have the disorder can lead full and productive lives. This is not to say that a “treated” bipolar is not going to experience the world the same way as a person without the disorder, they will still experience “bipolar moments” from time to time. However, the episodes tend not to last as long, and seem to be less detrimental. Many people with manic-depressive illness may go for months without an episode if properly treated with a combination of medication and therapy. It is important to remember this is a lifelong illness. It may go into a “remission” of sorts, but it is still there, and people will still experience episodes from time to time.
While there is no general consensus on what causes Bipolar disorder, scientists do believe there are a number of factors that work together to produce the illness or increase the chances that a person will develop the disorder. First, we will look at role that genetics plays in the onset of the illness.
It has been determined through self-report and the organizing of family mental health “pedigrees” (a chart of all relatives who either have problems with depression or have the illness itself), that Bipolar disorder has a strong genetic tie. Some research has determined that people with a certain gene are more at risk for developing the disorder than others. The NMIH literature states that children with a parent or sibling with the illness are more likely to develop manic-depression than those who do not have a close relative with the disorder. However, most children with a close relative with the disorder will not develop it.
An aside on the genetics model, I believe that Bipolar disorder can skip generations as long as one or both parents carry the gene predisposing one to manic-depression. The reason for my hypothesis is that my Father’s mother (my paternal grandmother) had untreated Bipolar disorder (Lithium didn’t come into play until the 1970’s). As far as I know there are no other close or immediate family members on his side of the family that have Bipolar disorder although I know very little about that side of my family.
Researchers are also pursuing illnesses with similar symptoms such as depression and schizophrenia to identify possible genetic differences that may increase the risk of a person developing Bipolar disorder. However, genetics may not be the only cause. A combination of predisposition and environment has been posited as creating a risk factor. Scientists do not fully understand the duality of genetics and environment in the risk for developing the disorder.
Brain Structure and Functioning
Some imaging studies using MRI’s and PET images have shown possible differences in the actual structure of the bipolar brain. One MRI study found that the pre-frontal cortex in people with Bipolar disorder may be smaller than that of people without the disorder. This is the “decision” making and problem-solving part of the brain. It is linked to other parts of the brain which come to full development in adolescence which may be why most people will present with manic-depression in their teens or early 20’s. Scientists are still working on how these brain structures combined with genetics may predispose a person to develop Bipolar. With more research, scientists may be able to better “predict” what types of treatment will be most successful.
Signs and Symptoms
People with manic-depression experience intense emotional states that are called “episodes.” An episode has to be a drastic change in the person’s normal mood and/or behavior. A “depressive” episode is pretty self-explanatory if you have ever experienced any form of depression. It is just a more intense form of depression and can last a very long time with detrimental effect. A “manic” episode is a different animal altogether. Manic episodes are characterized by abnormally high energy levels, lack of a need to sleep or no sleep at all, “flight of ideas” (a state where your mind is so active, even the Bipolar can’t keep up, it’s like ADD on steroids), pressured speech (an extreme need to speak), and eventually irritability and even psychosis due to the lack of sleep. There is also the “mixed state” which is what I usually present with. It isn’t exactly depression in the classical sense nor is it mania in the classic sense. It is both at the same time. I describe it as being the most unmotivated manic person, and the most motivated depressed person. It sucks. People with manic-depression can be very irritable and explosive while experiencing an episode be it depressive, manic, or mixed (which I have heard is the most dangerous of the mood episodes). Psychosis can appear in all mood episodes which frequently leads to a misdiagnosis of schizophrenia. I, myself have Bipolar disorder Type I with Psychotic Features which means I periodically (usually while depressed experience a break from reality). I do not think I will go into all of the symptoms and resulting behaviors because I have pretty much covered them.