by Emily Durbin
& Sherry Walling
We all go through periods of excitement and the lulls of routine, but these changes in mood can be recognized as part of a dynamic life full of new and differing experiences. When severe, unanticipated changes in mood occur, it may be time to look for another explanation. Bipolar disorder, formerly manic-depression, is a mood disorder affecting about two percent of the population. Episodes of extreme highs and lows can take their toll when desperate cries to ‘just snap out of it’ go unanswered. Periods of euphoria, lethargy, and normalcy can alternate unexpectedly, vary in duration and intensity, and totally impair someone’s work or home life. Often times, it feels like an out of control roller coaster for both the sufferer and their loved ones; but with knowledge, power truly lies.
What to Expect
Characteristics of a bipolar diagnosis come two fold. While mania could be seen as the explosive energy of a race horse right out of the gate, depression would be embodied by a carnival pony slowly moving in circles toward no obvious end.
Symptoms of mania can be summed up as the exaggerated belief that the world is ripe for the taking. People in the midst of a manic episode experience tirelessness, a desire for action and a sense of constant elation. A mild manic experience may seem attractive; those characteristics may even be something that we strive for from time to time. However, with the increase in productivity and creativity found in mania, also come some heavy consequences. Racing thoughts lead to impulsivity and an inability to deal with obstacles that stand in the way of an idea or desired action. Sufferers may stay awake for days at a time and have a hard time sitting down long enough to even eat a meal. Irritability and frustration can follow and the once seemingly harmless drive to produce can become a dangerous building of risk taking and irrationality.
A depressive episode essentially consists of the opposite behaviors. Social withdrawal, a sense of hopelessness and a decrease in desire to participate in activities that used to give pleasure are key indicators that depression may be a factor.
Though there is still much debate about when and why bipolar symptoms develop, clinicians and researchers have identified five areas of study that offer at least part of the picture. From a biological perspective, it would appear that disorders like Bipolar have a genetic component. A predisposition or susceptibility for bipolar may run in families and a diagnosis in a close family member does seem to increase one’s chances of also struggling with the disorder.
Abnormal levels of certain neurotransmitters in the brain seem to also contribute. Specifically, depressed individuals have low levels of the neurotransmitters serotonin and norepinephrine. And manic individuals have low levels of serotonin and high levels norepinephrine.
Cognitive theorists such as Martin Seligman would point out that the roots of depression are in learned helplessness. When people draw global conclusions about their abilities from one time setbacks, a skewed view of their own abilities develops. Aaron Beck’s cognitive triad is a cycle of maladaptive thinking that can contribute to depression. When someone continually views their experiences, themselves and their future in a negative way a cycle of depression is created.
Neo-Freudians attribute depression to grave symbolic loss. Naturally when a loved one is lost we grieve, but when a loss is more abstract (such as an unfulfilled desire be a rock star) our unconscious still grieves.
Behaviorists would credit poor social skills with hindering exposure to good reinforcement. When we don’t learn how to cope, the energy can come out as dysfunction.
Whatever the cause, the course of action is fundamentally the same.
Diagnosis and Treatment Options
While Bipolar Disorder can appear across the lifespan, the most common age of onset is in someone’s 20’s. Bipolar also seems to span many cultures and communities and afflict men and women equally.
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, separates a diagnosis of Bipolar into two categories. An indication of Bipolar I is marked by a history of at least one full manic episode (persistent abnormal symptoms for at least 1 week) and at least one episode of major depression (at least 2 weeks of continued impairment due to depressed mood). A Bipolar II diagnosis is indicated if a history of hypomania (a mild manic state lasting at least 4 days) and at least one major depressive episode is seen. Another mood disorder called Cyclothymic Disorder may also be found if over a span of two years, a cycle of hypomania and mild depression repeats itself.
Treatment should focus first on stabilization and then on maintenance. As mentioned before, there is a biochemical component to Bipolar Disorder. The neurotransmitter serotonin acts as a neuromodulaor (a natural mood stabilizer). Medications that aim to affect serotonin have had great success in curbing the extreme mood swings characteristic of bipolar. While these medications may take time and careful supervision by a doctor they are highly effective.
In order to maintain normality, a drug regimen, the support of family and friends, and talk therapy is usually required. Medications continue to stabilize brain chemistry, while loved ones provide encouragement, pick up slack where needed and ensure that the sufferer doesn’t feel isolated and alone. Therapy can be an important place to educate patients about expectations and their responsibility for getting better and a place to learn new coping styles to deal with the impact of bipolar symptoms.
Why is Getting Help So Important
It is vital for someone suffering from bipolar symptoms to get the help they need. Not only can the highs and lows of bipolar interfere with daily work or home routines, but significant strain on relationships brought on by the sufferer’s unpredictable behavior can have devastating effects. Bipolar symptoms can be confusing for both the afflicted and their loved ones. This added stress contributes to feelings of isolation and uneasiness. Some 60% of bipolar sufferers use drugs or alcohol in order to combat uncomfortable feelings. And individuals diagnosed with bipolar are 10 times more likely to commit suicide than someone without this disorder.
An unmanaged case of bipolar will only get worse over time. It is crucial to recognize signs of major depression and mania in order to promptly find help for yourself or a loved one. Identifying severe pattern shifts in mood is the first step in the healing process.
Some Advice for Family and Friends
There are five ways to come alongside your loved one who suffers from Bipolar Disorder.
1) Educate Yourself: The first thing you need to know about bipolar disorder is that there is no set course for the illness to take. The more information you can gather whether in general or by talking to your loved one about their own experience the better prepared you will be for the unexpected–which will come up.
2) Offer Support and Encouragement to Get Help: The earlier bipolar symptoms are recognized the better the prognosis will be. Bipolar Disorder is a real medical illness and needs the expertise of a doctor in order to manage symptoms in the long term.
3) Keep Communication Lines Open: Make an effort to truly listen to the feelings and experiences of your loved one. You may not understand or agree with everything they say, but just validating their feelings as real will go a long way in showing that you care and want to be there for them. Also make sure if you have questions or concerns, to voice them in a loving way.
4) Partner in the Treatment Plan: It’s important not to blame them for the disorder–Bipolar isn’t a question of self-control or willpower. But you also have to realize that all the love of a family won’t cure them. Find a balance of involvement that’s comfortable for all involved and stick to a routine of support and accountability as bipolar disorder is a lifelong illness with a lifelong process to overcome.
5) Pay Attention to Changes in Symptoms: Be prepared for the unpredictability of mania and the funk of depression. Be aware of upward and downward swings. Getting better takes time and resistance to a treatment plan is greatest when the patient can’t yet see the results. You can be their voice of reason.
Family doctors are an excellent resource to go to if you have questions about bipolar disorder. They can provide you literature or even a referral to another professional. Also, an internet search using reputable cites or a trip to your local library or book store will yield many results. And keep lines of communication between friends and family open to share new research and discuss options together.
For a first hand look at bipolar disorder, check out KRL’s interview with New York Times best selling author Terri Cheney.