Improving Outcomes in Bipolar Disorder

What does the word bipolar mean? A man named Gary R. VandenBos, PhD defines bipolar as something with two opposites or extremities. Bipolar disorder is an episodic illness (Yatham & Malhi, 2011, p. 5), where people who are diagnosed with it will experience two kinds of episodes: manic/hypomanic episodes and major depressive episodes (VandenBos, 2013, p. 76). Manic episodes and major depressive episodes are polar opposites of each other. Manic episodes can last up to one week (VandenBos, 2013, p. 341). A manic episode can be identified by an increase in activitytalkativenessracing thoughtsinflated self-esteema decreased need for sleepinvolvement in pleasurable activities that are likely to have unfortunate consequences (VandenBos, 2013, p. 341). Hypomanic episodes have the same characteristics as a manic episode, but with less intensity (Yatham & Malhi, 2011, p. 11). A major depressive episode can last up to two weeks (VandenBos, 2013, p. 341). A major depressive episode can be identified by poor or increased appetite with significant weight loss or gaininsomnia or excessive sleeploss of energy with fatiguefeelings of worthlessnessreduced ability to concentrate or make decisionsrecurrent thoughts of death (VandenBos, 2013, p. 339). Depressive episodes tend to be more common than manic episodes (Yatham & Malhi, 2011, p. 5). Manic episodes can be triggered by anything that causes one to lose sleep (Leibenluft). Major depressive episodes can be triggered by any stressor such as a breakup, grief, or anything upsetting for the person (Leibenluft). It is possible for people with bipolar disorder to have symptoms of other illnesses as well (Bipolar Disorder). Doctors who are diagnosing people with bipolar disorder may find symptoms of psychosis, anxiety, ADHD, substance abuse, or eating disorders, making it very possible for doctors to misdiagnose a patient (Bipolar Disorder).

There is a spectrum of bipolar disorders: bipolar I disorder, bipolar II disorder, cyclothymic disorder (cyclothymia), and other disorders with symptoms related to bipolar disorder (Bipolar Disorder). Bipolar I disorder is where one may experience one or more manic episodes and usually one or more major depressive episodes (VandenBos, 2013, p. 76). Bipolar II disorder is where one may experience one or more major depressive episodes and at least one hypomanic episode (VandenBos, 2013, p. 76). Cyclothymic disorder is where one will have periods where they experience symptoms of hypomanic and major depressive episodes for about two years, but the symptoms aren't strong enough to give a full-on diagnosis of bipolar I or bipolar II disorder (Bipolar Disorder).

Bipolar disorder has been around for a long time. Descriptions of bipolar disorder have been found in ancient Greek and Persian texts (Yatham & Malhi, 2011, p. 1). Around 2,000 years ago, a man in Rome named Aretaeus of Cappadocia acknowledged that mania and depression are part of the human condition (Yatham & Malhi, 2011, p. 1). He described different emotional states and kept track of long-term mood changes (Yatham & Malhi, 2011, p. 1). He described people being sad and gloomy without a particular cause, and he described the same people being talkative with inflated confidence and lots of energy (Yatham & Malhi, 2011, p. 1). He was the first to realize that there is a connection between mania and depression (Yatham & Malhi, 2011, p. 1). It was many years after Aretaeus' descriptions that bipolar disorder would be acknowledged again (Yatham & Malhi, 2011, p. 1). In the 19th century, Jean Pierre Falret and Jules Baillarger proposed that it was possible for one illness to have symptoms of both mania and depression (Yatham & Malhi, 2011, p. 1). This proposition was described by Falret as 'circular insanity' (Yatham & Malhi, 2011, p. 1). Falret and Baillarger created a foundation, and the observations of a man named Emil Kraepelin combined with the foundation created what was called 'manic depressive insanity' (Yatham & Malhi, 2011, p. 1). During the 20th century is when the concept of bipolarity began to emerge again, thus furthering the evolution of bipolar disorder (Yatham & Malhi, 2011, p. 2).

There is no single cause of bipolar disorder, as there are multiple ways one can get bipolar disorder (Bipolar Disorder). Family history of bipolar disorder can determine one's chances at getting bipolar disorder since it is one of the most commonly inherited psychiatric disorders (Yatham & Malhi, 2011, p. 21). Environmental factors such as one's experiences of trauma and/or abuse can contribute to the emergence of bipolar disorder (Yatham & Malhi, 2011, p. 23). Much research has been conducted to determine neurobiological causes of bipolar disorder, but no significant breakthroughs have been found (Yatham & Malhi, 2011, p. 24).

Only one percent of the population worldwide are affected specifically by bipolar I and bipolar II disorder (Yatham & Malhi, 2011, p. 17). Around two to five percent of people worldwide have symptoms that are on the bipolar spectrum, which adds up to a total of around four to seven percent of the world population that are on the bipolar spectrum (Yatham & Malhi, 2011, p. 17). Bipolar disorder is equally as common with males as it is with females (Yatham & Malhi, 2011, p. 18). Bipolar disorder typically emerges in people from ages 12 to 20 (Yatham & Malhi, 2011, p. 18). One's ethnicity doesn't have an effect on whether they are prone to bipolar disorder or not (Yatham & Malhi, 2011, p. 18).

Thankfully, there are plenty of methods of treatment that have been discovered over the years. Lithium, a salt that is naturally found in the earth, is considered the most effective treatment for bipolar disorder by scientists (Aiken & Phelps, 2017, pp. 156-158). It's been used as a treatment for bipolar disorder since 1949 (Aiken & Phelps, 2017, p. 158). Medications that stabilize mood such as carbamazepine, oxcarbazepine, valproate, quetiapine (Seroquel), lurasidone (Latuda), olanzapine (Zyprexa), and olanzapine-fluoxetine combination (Symbyax) are commonly used to treat bipolar disorder (Aiken & Phelps, 2017, pp. 164-168). Often times people with bipolar disorder will need treatment for other conditions they suffer from that happen outside of mania and depression (Aiken & Phelps, 2017, p. 188). Bipolar disorder most commonly contributes to anxiety, ADHD, eating disorders, OCD, Bulimia, and addictions (Aiken & Phelps, 2017, p. 188). People with bipolar disorder who suffer from anxiety can be treated with medications such as gabapentin (Neurontin), Pregabalin (Lyrica), propranolol (Inderal), buspirone (Buspar), benzodiazepines, any kind of natural treatments, and any other mood stabilizers that were previously described (Aiken & Phelps, 2017, pp. 189-190). People with bipolar disorder who suffer from ADHD can be treated with modafinil (Provigil), arModafinil (Nuvigil), clonidine (Kapvay), VayaRin, and EMPowerplus (Aiken & Phelps, 2017, p. 192). People with bipolar disorder who suffer from eating disorders can be treated with topiramate (Topamax), zonisamide (Zonegran), ondansetron (Zofran), inositol, and chromium picolinate (Aiken & Phelps, 2017, p. 196). People with bipolar disorder who suffer from OCD can be treated with topiramate (Topamax), ondansetron (Zofran), granisetron (Kytril), n-acetylcysteine (Namenda), and atypical antipsychotics (Aiken & Phelps, 2017, p. 191). People with bipolar disorder who suffer from any kind of addiction are most commonly treated with therapy but can be treated with medications such as acamprosate (Campral), naltrexone (Revia), topiramate (Topamax), gabapentin (Neurontin), and zonisamide (Zonegram) (Aiken & Phelps, 2017, p. 196). Therapy is also used to help treat bipolar disorder (Rivas-Vazquez, Johnson, Rey, Blais, &Rivas-Vazquez, 2002). Different kinds of therapy such as cognitive-behavioral, psychoeducational, family, and interpersonal therapies have been developed to help treat bipolar disorder (Rivas-Vazquez et al., 2002). Family therapy is focused on developing communication skills between family members, problem-solving skills, and informing the family about bipolar disorder (Rivas-Vazquez et all., 2002). Group therapy is focused on creating personalized goals for patients through a structure program that meets on a regular basis (Rivas-Vazquez et all., 2002). Interpersonal therapy is focused on addressing the patient's internal and personal issues (Rivas-Vazquez et all., 2002). Cognitive-behavioral therapy is focused on identifying stressors that can trigger episodes, and identifying any results or effects that are related to the medications the patient is taking (Rivas-Vazquez et all., 2002).

Despite the many complications that come from having bipolar disorder, the extensive research that has been conducted over the years has been proven to improve the lives of those struggling with it.

References

Aiken, C., MD, & Phelps, J., MD. (2017). Bipolar, not so much: Understanding your mood swings and depression. New York, New York: W.W. Norton & Company.

Bipolar Disorder. (n.d.). Retrieved October 1, 2018, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.

Leibenluft, E., MD. (n.d.). Re: Environmental Influences in Bipolar Disorder [Video blog comment]. Retrieved October 1, 2018, from https://www.dnalc.org/view/2349-Environmental-Influences-in-Bipolar-Disorder.html.

Rivas-Vazquez, R. A., Johnson, S. L., Rey, G. J., Blais, M. A., & Rivas-Vazquez, A. (2002). Current treatments for bipolar disorder: A review and update for psychologists. Professional Psychology: Research and Practice,33(2), 212-223. doi:10.1037/0735-7028.33.2.212.

VandenBos, G. R., PhD. (2013). APA Dictionary of Clinical Psychology. Washington, DC: American Psychological Association.

Yatham, L. N., & Malhi, G. S. (2011). Bipolar disorder. Oxford University Press.

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