Bipolar disorder is a class of mood disorders that is marked by certain dramatic changes in behavior, energy as well as mood. The basic characteristics of bipolar disorder are that people tend to alternate between episodes of mania such as extreme elevated mood and depression such as extreme sadness. However, such episodes may last from hours to several months depending on different factors.
The mood disorders or extreme disturbances may lead to severe impairment that disrupts a person’s functioning. The experience of manic episode is not pleasing as it frightens most patients. In most cases manic mood has been reported to cause impulsive behavior that may lead to serious consequences to the subject as well as his/her family. In addition, it becomes difficult or impossible for an individual to function properly in their daily life once they get a depressive episode. Recent study has distinguished persons in how often they experience either episodes of mania and depression. In general, mood disturbances with bipolar disorder usually occur gradually (Mansell & Pedley, 2008).
Mood disorders can be usefully visualized not only to distinguish different mood disorders from one another but also to summarize the course of illness for individual patients by showing them their disorders mapped onto a mood map. Thus, mood ranges from hypomania to mania at the top, to euthymia (or normal mood) in the middle, to dysthymia and depression at the bottom. Major depression is the most common mood disorder and is defined by the occurrence of at least a single major depressive episode, although most patients will experience recurrent episodes. Dysthymia is a less severe but often longer-lasting form of depression.
Such patients with unremitting dysthymia who also experience the superimposition of one or more major depressive episodes may be described as having double depression. This is also a form of recurrent major depressive episodes with poor inter-episode recovery.
In some cases, some people may experience periods of wellness between the different moods of episodes (Angst & Selloro, 2000). In addition, some individuals experience multiple episodes within a year period, a week or even a single day a situation referred to as ‘rapid cycling’. Moreover, a severity of a mood may also range from mild to severe. The establishment of a particular type of bipolar disorder can be helpful in determining the best type of medications to manage the symptoms.
Characteristics of bipolar disorder Bipolar disorder are generally characterized by four types of illness episodes: manic, major depressive, hypomanic, and mixed. A patient may have any combination of these episodes over the course of illness; subsyndromal manic or depressive episodes also occur during the course of illness, in which case there are not enough symptoms or the symptoms are not severe enough to meet the diagnostic criteria for one of these episodes. Types of bipolar disorder
Types of bipolar disorder are based on the severity and duration of the distorted mood. These include; bipolar I, bipolar II as well as cyclothymic disorder. Bipolar I is typified by one mania episode or a range of episodes and one or more depressive episodes. These kind of episodes usually last for about a week but may also continue for a few months. However, bipolar I is the most severe form of the illness.
Secondly, bipolar II disorders are characterized by primarily depressive episodes accompanied by usual hypomaniac episodes. Symptoms of hypomaniac episodes are typically mild than maniac episodes but reported cases have shown that they impair normal functions. However, in between the episodes, there are normal functioning. Many suicide cases have been reported for bipolar II disorder. Thirdly, cyclothymic disorder is generally characterized by chronic fluctuating moods that involves periods of depression and hypomania. The periods of both episodes are usually shorter and with low severity.
However, the periods are separated by periods of normal mood. Cyclothymic disorder can impair an individual’s life since the patient may feel on top of the world and depressed the following day. Some with cyclothymic may people develop a more severe condition of bipolar whereas for other, it continues as a chronic condition. Some people may experience some maniac symptoms and a major depressive episode although their symptoms do not feet in the three described disorders. This class is referred to as ‘bipolar disorder not otherwise specified’. For instance, a person with rapid cycling between manic and depressive episodes may be diagnosed as having this type of disorder. Just like the other three types of disorder, ‘bipolar disorder not otherwise specified’ is treatable.
Bipolar disorder is a long term condition or illness that most often requires management throughout an individual’s life. However, medication is the fundamental form of treatment that helps to control moods and reduce the lows and highs associated with mood swings. Since people are different, each person needs to try a number of different medications before he/she finds the right one to use. In addition, it is recommended to stay on the treatment the doctor prescribes even if you are feeling better. Drugs act as preventive measure and if stopped there is a high chance of relapse (Mackin & Young, 2004). The most common used medications to treat bipolar disorder typically falls in three different categories namely antidepressants, mood stabilizers as well as medications for other kinds of problem linked with bipolar disorder.
This group of medication is usually administered to help control mood swings. Range mood stabilizers are available in the market. One example of mood stabilizer commonly prescribed for persons with bipolar disorder is Lithium. Recent research has confirmed that Lithium is helpful in controlling mood swings in both directions, for instance, from depression to mania and from mania to depression.
The symptoms of mania are usually reduced in the first two weeks of starting therapy although it generally takes weeks to months before the condition is completely managed. However, people respond differently while using Lithium. Another group used in substitution of Lithium is anticonvulsant or anti-seizure therapy. These kinds of drugs were developed for patients with epilepsy but were later found to have high efficacy in persons with “difficult to treat” bipolar disorder. Antidepressant medication
These kinds of medications are usually combined with mood stabilizing drugs to control and manage the depression of bipolar disorder. Antidepressants can trigger maniac episode and therefore they should be used with care. During administration of antidepressants, they may be tapered and discontinued after the mood has stabilized (Gunderson & Elliott, 1985). A person taking antidepressant should be cautious as these types of drugs may push bipolar condition to manic state.
These kinds of drugs are mostly prescribed as supplements to other mood stabilizers. Patients with hallucinations and delusions such as severe mania or psychotic depression are recommended these medications. In some cases, they are used to control manic symptoms during the early treatment of bipolar disorder before Lithium medications can have effect. Anti-sychotics are divided into two groups namely; typical (the older generations) and the atypical (newer generation).
Typical groups of medication are less often prescribed because they tend to cause abnormal involuntary movements, a neurological condition referred to as tardive dyskinesia. On the other hand, atypical group have reduced neurological side effects, although they also posses some side effects. However, many researchers have described them as very effective in controlling manic symptoms (Depp & Jeste, 2004).
Medications such as anti-anxiety are helpful in calming or sedating a person and are quick in relieving mood disturbances. Usually they are combined with mood stabilizers to improve their efficacy. Anti-anxiety treats symptoms such as irritability, over activity and insomnia. In order to effectively treat a bipolar condition, most medications are prescribed together with psychotherapy. The mental heath facilities help patients to connect with other programs that educate you about the illness. It is believed that, learning how to manage your illness is the key to staying well. Recovery
In most cases, during an acute phase of mania most patients are in denial. It is therefore important to draw a network of family members or friends you trust who can tell you if you are unwell. Like other chronic diseases such as diabetes and hypertension, bipolar disorder can be effectively controlled and managed through a combination of treatment and a healthy lifestyle. Sticking to your treatment plan, learning how to recognize early signs of possible manic episode and managing triggers such as stresses can greatly aid in your recovery (Depp & Jeste, 2004).
It can be concluded that, treating and managing mood disorders can lead to effective health lives. If a person is not treated, the condition deteriorates and over time, the person suffer more frequent and have intense episodes. Therefore medications can help to reduce both frequencies and severity of symptoms and help in maintaining a good quality of life.
Angst, J. & Selloro, R. (2000). Historical perspectives and natural history of bipolar disorder. Biological Psychiatry 48 (6), 445–457.
Depp, C. & Jeste, D. (2004). Bipolar disorder in older adults: a critical review. Bipolar Disorder, 6(5), 343-67.
Gunderson, G. & Elliott, G. R. (1985). The interface between borderline personality disorder and affective disorder. American Journal of Psychiatry 142, 277–288.
Mansell, W. & Pedley, R. (2008). The ascent into mania: A review of psychological processes associated with the development of manic symptoms. Clinical Psychology, 28(3), 494-520.
Mackin, P. & Young, A. (2004). Rapid cycling bipolar disorder: historical overview and focus on emerging treatments. Bipolar Disorders, 6(6), 523–529.