More on Bipolar Disorder
By: Beth McHugh 2006
Bipolar Disorder is a major mood disorder in which both manic and depressive
episodes alternate over time. The sufferer may exhibit elated, manic-type
behavior for up to several months at a time, and then descend into a
major depressive episode.
In recent years, bipolar disorder has been classified into additional subcategories: bipolar I, bipolar II, unipolar disorder, and cyclothymic disorder. Bipolar I represents the classic bipolar category type with periods of true mania alternating with periods of major depression. Bipolar II is similar to Bipolar I, where major depressive episodes alternate with hypomanic episodes rather than full-blown mania.
Mania is characterized by a variety of symptoms including inappropriate elation, impulsiveness, extreme hyperactivity, and excessively rapid thought and speech. By contrast, hypomania is essentially a scaled-down version of the above behaviors. The person is noticeably “up”, but can function well while in this mood state. Unipolar disorder involves recurrent episodes of mania without the appearance of the depressive phase observed in classic bipolar disorder. And cyclothymic disorder is diagnosed when hypomanic symptoms alternate with depressive symptoms that do not meet the criteria for major depressive episode, i.e. the depression experienced is less intense, but the essential cyclic nature of mood swings from high to low still remains.
The average age of onset for bipolar I is about 18, and for bipolar II about 22 years of age, although there are recorded instances of bipolar symptoms appearing in childhood. The onset of bipolar is often preceded by minor mood swings which will then often acutely change to a full-blown mania phase if bipolar I is apparent, or marked, long-term mood swings for bipolar II be diagnosed.
During mania and hypomania, sufferers typically deny there is a problem, and persuading them to seek professional help or take medication can be extremely difficult. It is not uncommon for sufferers to stop taking their medication during periods of stress or unhappiness in an attempt to bring on a manic episode which, for them, is far more pleasurable than depression. The characteristic behaviors of the manic patient—the overspending, the rampant promiscuity, the grandiose schemes which consume every waking moment—none are seen as abnormal or out of character to them while in the throes of an episode.
Lithium is the drug of choice for controlling the excessive mood swings associated with bipolar disorder. Despite its use for many decades, researchers have yet to discover just why it has beneficial effects, although it is believed to be associated with dopamine and norepinephrine levels in the brain. More recently, anticonvulsive medications such epilim have been used to help modify the characteristic mood swings from high to low. By far the greatest problem with a drug regimen is compliance, as sufferers will abandon medication in order to achieve the elated high that, for them, is so preferable to the depressive phase of the illness.
Unfortunately, the chronic and unpredictable nature of these mood disorders can make for a disruptive home life and career. The person with bipolar I needs particular assistance from family and friends to cope with e disorder, and family therapy is advisable to that the sufferer and his or her family can learn to understand the condition, and set reasonable boundaries regarding what behavior will and won’t be tolerated, including going off medication. This therapy must, of course, be conducted when the patient is in a receptive and calm state. Provisions for respite for the family must also be considered. With the less disruptive conditions such as bipolar II, and cyclothymic disorders, less intervention is needed.
Major mental disorders such as bipolar require great personal strength on the part of the sufferer to endure the chronic and despairing nature of the illness, as well as unconditional love, acceptance, and compassion on the part of the family. Further education about mental illness in general is essential so that both sufferers and their families can obtain assistance from the wider community. Improving community understanding and support would go a long way to reducing the stress levels of both sufferer and carer, and ironically reduce the number of acute episodes suffered during the course of the illness.
In further articles, we will be looking at how to help loved ones who suffer from a mental illness.