The bipolar disorders are characterized by cycling mood changes. The affected individual alternates between severe highs (manic or hypomanic episodes) and severe lows (major depressive episodes), often with periods of normal mood in between. The mood changes can be rapid but most often occur gradually.
A manic episode is a distinct period of increased energy and abnormally elated, irritable, or euphoric mood that is present for most of the day, nearly every day, for at least one week. During the episode, three or more of the following symptoms must also be present: higher than usual self-esteem, significantly reduced need for sleep, an increase in talkativeness, racing thoughts, distractibility, an increase in goal-directed behavior, psychomotor agitation, and excessive involvement in pleasurable activities that are risky or self-destructive. Mania, left untreated, may worsen to a psychotic state.
A hypomanic episode is less intense and of shorter duration than a full manic episode. The most important difference between mania and hypomania is that the latter is not severe enough to cause marked impairment in daily functioning, or to require hospitalization, and no psychotic features are present.
MAJOR DEPRESSIVE EPISODES
A major depressive episode is characterized by a persistent depressed mood or loss of interest or pleasure in daily activities over at least a two week period. Four or more of the following symptoms must also be present: significant weight change or change in appetite, sleeping too much or not being able to sleep at all, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, an inability to concentrate or indecisiveness, and recurrent suicidal thoughts.
Types of Bipolar Disorder
BIPOLAR I DISORDER
Bipolar I Disorder is characterized by a manic episode severe enough to cause marked impairment in daily functions or leads to hospitalization to prevent harm to self or others. Major depressive episodes may also occur.
BIPOLAR II DISORDER
Bipolar II Disorder is characterized by a pattern of hypomanic and major depressive episodes. The hypomanic episode is associated with a clear change in daily functioning that is uncharacteristic of the individual.
CYCLOTHYMIC DISORDER (CYCLOTHYMIA)
Cyclothymic Disorder (Cyclothymia) is a milder form of bipolar disorder. Cyclothymic disorder is characterized by at least 2 years of periodic hypomanic and depressive symptoms.
Prevalence and Age of Onset
The lifetime prevalence of the bipolar disorders in the United States is estimated to be 1.8% for both bipolar I disorder and bipolar II disorder, and 0.4%-1% for cyclothymic disorder. Bipolar I disorder and cyclothymia affect men and women equally, while bipolar II disorder is more common in women. The age of onset for the first manic, hypomanic, or major depressive episode is usually late adolescence/early adulthood but can occur at any age. The first episode in men tends to be mania or hypomania while the first episode in women is most often depression. Some individuals experience rapid-cycling between manic and depressive states, experiencing four or more episodes of major depression, mania, or hypomania within a year. Rapid-cycling is more common in women than men.
Treatment & Support
Lithium carbonate is a salt and does not have a specific receptor to which it binds in the brain. Rather, after administration lithium is widely distributed throughout the central nervous system where it is transported into the brain’s cells (neurons) through sodium channels in the cell membranes. Lithium appears to have a neuroprotective action by reestablishing chemical balance (homeostasis) in the neurons and decreasing their susceptibility to damage from both internal and external stimuli. This medication, while highly effective, has serious side effects, due to the small range between an effective dose and a toxic dose.
Medications originally developed to treat seizure disorders have also been found to have mood-stabilizing affects and appear to exert their mood-stabilizing affects through a neuroprotective action similar to lithium. Anticonvulsant medications are most often used in combination with lithium, antidepressants or atypical antipsychotics in the treatment of bipolar spectrum disorders.
Atypical antipsychotics modify the functioning of both dopamine and serotonin in the brain. These medications have been shown to have mood-stabilizing affects and are particularly useful for treating acute mania with or without psychotic symptoms.
Patients receive assistance from another individual in understanding and resolving problems that may be contributing to their disorder. Therapy sessions focus on a number of issues, including unlearning behavioral patterns that contribute to or result from their disorder, mending disrupted personal relationships, changing negative thinking styles, and/or resolving conflicted feelings and emotions.
- Unlearning behavioral patterns that contribute to or result from their disorder
- Mending disrupted personal relationships
- Changing negative thinking styles
- Resolving conflicted feelings and emotions
A Spiritual Perspective
The bipolar disorders are destructive. They destroy the mind of the one afflicted, and they also destroy their relationships and family. Watching a loved one suffer with bipolar disorder makes it difficult to believe in God, let alone trust Him.
As finite beings, we are limited in our ability to grasp the broader meanings and purposes of trials and suffering in our lives. However, we lean not on our own understanding, but rest in God’s understanding and know he is fully in control. We know that God is both sovereign and good because He created and sustains all things (Deuteronomy 4:39; Daniel 4:34–35; Colossians 1:16–17). Without Him there is nothing, and nothing occurs apart from His divine will. Recognizing God’s sovereignty and goodness helps us navigate through difficult times, as we cry out with the psalmist: “But as for me, I trust in You, O Lord, I say, ‘You are my God.’ My times are in Your hand” (Psalm 31:14–15). We may never understand why our loved one is suffering, but we can be assured that God is in control and ready to provide sustaining grace to all those who seek Him (2 Corinthians 12:9).