More than seventeen million people in the United States and 264 million people worldwide live with depression1. Making it one of the most common mental health concerns, depression may be a misdiagnosis for a more specific kind of depression, called Bipolar Disorder. The disorder is among the most misunderstood, feared, and stigmatized mental health diagnoses. Many of us may know someone affected by BD and have seen firsthand how the symptoms of this illness can impact a loved one’s life.
While normal moods fluctuate regularly, some suffer from a form of extreme swings in mood, highs, and lows, called Bipolar Disorder (or BD), formerly known as Manic/Depressive disorder. About 1% of the US population or 2.3 million people suffer from BD. Often those suffering from Bipolar Disorder also simultaneously suffer from an Anxiety Disorder as well, a phenomenon called comorbidity.
There are two main types of Bipolar Disorders, Type I and Type II.
Type I Bipolar Disorder
Type I is characterized by the occurrence of at least one manic episode lasting, at minimum, one week. A manic episode is characterized by “abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy.”2 There must be an impairment socially, professionally, or an instance of hospitalization to keep the patient or others safe from harm.
What may commonly be considered the corresponding depressive episode is not necessary for the diagnosis of Type I. This type is generally considered the more severe of the two, although the opinions of experts vary.
Type II Bipolar Disorder
The diagnostic parameters of Bipolar II include the occurrence of a hypomanic episode (a manic episode lasting at least four days) and a major depressive episode2. The major depressive episode must last two weeks and there be a severe impairment on social, professional, and other necessary modes of functioning.
The mania experienced may not be as severe as in Type I. Yet, the depressive episodes may be more severe5.
A mental illness associated with BD is Cyclothymic disorder. In this case, there have been two years (one year in young people) in which many periods of hypomania, as well as periods of depression, have occurred. However, these periods not as long as in either BD type18.
What Does Bipolar Disorder Look Like?
Symptoms of Bipolar disorder may appear as feeling super happy for long periods of time, talking fast, extreme restlessness or impulsiveness, overconfidence in abilities, and engaging in risky behavior.3 This behavior may be gambling away large sums of money, impulsive sex, or making large, extravagant purchases.
Those who experience BD report the benefits to the mania experienced in higher levels of creativity, energy, and confidence. The experience can give such high levels of confidence initiating the beliefs of literally being the best in the world at a task in one moment and not worthy of life in the next.
It may be difficult to identify bouts of mania in those closest to us. It may simply seem like extreme happiness4. Those who suffer from the disorder report trouble trusting their feelings6.
There is no cure for Bipolar Disorder. Most patients deal with symptoms for most of their lives7. To illustrate its severity, consider the following. Sufferers of BD have a 10-25 year shorter life expectancy than most9. The reasons for this are many including reckless behavior, medication side effects, and suicide. Treatment outcomes strongly hinge on the attitude, hopefulness, and self-esteem of the sufferer. And so, a strong support network is important to a positive outcome. With proper treatment, it is possible to live a normal, healthy life10
If a member of your family has BD, you are 4-6 times more likely to experience the disorder11.To add insult to injury, more than 60% of those suffering from BD experience a substance abuse disorder12.
Many of those who suffer from Bipolar Disorder are disheartened because most relationships fail due to the illness13. Even more so than other mental illnesses. However, on a hopeful note, with proper relational and support tools14, successful relationships can be had.
Biology of the Disorder
There is no certainty around what causes BD. Recent research has discovered a link between calcium imbalance and the severity of BD. Vitamin D may also play a crucial role8.
A strong genetic component influences BD’s prevalence. There are structural and neurochemical differences in those who suffer from BD. The hormone Noradrenaline and the neurotransmitter serotonin seem to play a crucial role. Too much of either is related to the mania associated with the disorder. Conversely, too little seems to be causal to the depressive episodes that follow11.
Additionally, patients with BD have cortical thinning15, the thinning of the grey matter in parts of the brain16. The areas in which thinning occurs are those associated with impulse control, informational processing, and motor control. Also, BD seems to correlate with a smaller hippocampus, the brain structure responsible for emotional responses and memory processing17.
Externally, traumas such as abuse, extreme loss, or mental stress may be causal to the disorder18.
The FDA has recently stated that psilocybin is a “breakthrough therapy” for those suffering from depression18. MDMA (methylenedioxy-methamphetamine), known as “ecstasy” or “molly”, has been shown to reduce symptoms of PTSD. Currently, Ketamine (a drug used as an anesthetic) is in trials to treat BD. When properly used in a clinical setting, ketamine creates new neural pathways in the brain around trauma, pain, and depression.
While these treatments are controversial, they hold the promise of effectiveness in helping BD suffers lead more normal lives, free from symptoms.
The stigma around mental health continues in our culture. Yet, as I see it, there is progress. This is evidenced in Armchair Expert, Dax Shepard’s podcast, in which the topic is often mental health. I see it in Oprah’s new project, The Me You Can’t See., where the focus is 100% on mental health and its prevalence. Yet, us boots on the ground should do more. This begins with how we react and treat those in our proximity with mental illness. It begins with how we talk to ourselves about it.
BD symptoms are beyond the suffers control. At some point in our evolutionary history, perhaps there was a function for the symptoms of BD. For example, a reaction to a perceived threat may have evolutionarily developed (in certain genetic lines), causing the manic reaction indicative of BD. The manic belief that one is extraordinary may simply be what was needed to survive—the cost of this experience – the low – triggered by the spent hormones and neurochemicals.
Truthfully, there is no way we can know for certain. But without open discussion, the problem perpetuates.
This is where you come in. Listen to those in your bubble, your network. Often, talking and discussing the problem with others can help more than pharmacological intervention can.
Bipolar Disorder is a significant Mental Health concern. Without proper treatment, BD may have a severe outcome. Researchers estimate between 25%-60% of BD sufferers will attempt suicide during their lifetimes, and 4%-19% actually will19.
Warning signs of suicide include talking about suicide, talking or thinking about death often, expressing hopelessness, helplessness, or worthlessness, losing interest in things one used to care about, or putting affairs in order, tying up loose ends20.
*If you or someone you know is going to hurt themselves, dial 911.
Be open to talking about mental health, rethinking your positions, and asking questions. This is the path to destigmatizing mental health.
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