Understanding the ‘Rollercoaster’ Known as Bipolar Disorder

Millions of Americans have the mood disorder, yet it is often misunderstood and misdiagnosed.

Indiscriminate. Wild. Exhausting. That’s how Brad Shreve describes bipolar disorder, a mental illness that causes dramatic shifts in mood and energy. Millions of Americans like Shreve have this chronic condition, which can disrupt lives, damage relationships, and make even routine tasks a challenge.

Bipolar disorder, also known as manic depression, is characterized by extreme energy and profound euphoria or mania alternating with bouts of depression – something Shreve describes as a “rollercoaster” on his blog.

The symptoms of a manic episode may include an elated mood, irritability, insomnia, and impulsivity. Depressive episodes are characterized by feelings of sadness and hopelessness, social isolation, and a loss of interest in activities that were once enjoyable. These cycles of high and low moods follow irregular patterns, and mood episodes may mix symptoms of mania and depression.

“When [the depression] hits, I shut the blinds. I don’t shower, shave, or clean up. I don’t go outside,” Shreve says. Other times, “I want to do everything at once…but in the end I get nothing done because it goes way beyond what one person can do in a day.”

Men and women are equally affected by bipolar disorder. According to the National Alliance on Mental Illness (NAMI), more than half of all cases start between 15 and 25 years of age, though symptoms can appear in younger children or later in life.

There are different categories of bipolar disorder, based on symptom patterns and intensity. As defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, types of bipolar disorder include:

Bipolar I consists of manic episodes lasting at least a week and major depressive episodes lasting two weeks or more.

Bipolar II is characterized by milder hypomanic episodes, which are less severe than manic ones, and periods of depression that are usually more frequent and last longer than those that occur in bipolar I.

Cyclothymic disorder or cyclothymia is a milder form of bipolar disorder with periods of hypomanic and depressive symptoms. “It can turn into bipolar I or bipolar II,” says Melissa DelBello, MD, co-medical director of the Mood Disorders Center at the University of Cincinnati Medical Center. “It depends on the degree of functional impairment.”

There is no lab test for bipolar disorder, so diagnosis is based on a patient’s physical examination, medical history, and psychological evaluation. Bipolar disorder is frequently misdiagnosed because its symptoms overlap with other illnesses. Shreve, for instance, was incorrectly diagnosed with depression for most of his life. In many cases, a person with bipolar disease may not realize they have a problem or refuse to see a doctor, which delays treatment and can result in serious physical, emotional, and personal problems.

The exact cause of bipolar disorder is unclear, though it’s most likely a combination of factors. “We know it’s genetic because it runs in families, but environmental stressors can precipitate its onset,” according to DelBello. Studies suggest that differences in brain structure and an imbalance of brain chemicals known as neurotransmitters play a role.

Certain triggers such as stress, lack of sleep, and substance abuse can set off a manic or depressive episode. Shreve recognizes that his depression is sometimes brought on by feeling overwhelmed. “If I have a busy day, it’s the next day that I really crash,” he says. “If I go to a party or work with people on a project, it can set it off because it’s more than I can handle.”

While bipolar disorder is not curable, its symptoms can be treated with medication and psychotherapy. David Miklowitz, PhD, director of the child and adolescent mood disorders program at the UCLA Semel Institute for Neuroscience and Human Behavior, stresses the importance of involving loved ones in a patient’s treatment.

“It’s helpful to bring family members into therapy and educate them about what bipolar is, how do you cope with it as a family, how do you recognize it as being out of hand, what’s effective communication in this context and what isn’t,” he says. “In these family therapy programs, if given with medication, the patients tend to do much better.”

Connecting with others who are living with bipolar disorder can provide emotional support and access to practical information and resources. NAMI and theDepression and Bipolar Support Alliance offer education programs as well as online and in-person support groups.

“Many people go on to live very successful lives with bipolar disorder,” DelBello says. “If you stay on your medication, monitor yourself for stressors, maintain a normal sleep pattern, and stay away from drugs and alcohol, it’s very possible.”

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