BIPOLAR DISORDER

We all experience changes in mood in response to life’s ups and downs. However, sometimes these mood changes can happen more frequently, and in more intense ways. This is the case for people who experience bipolar disorder, previously called manic depression. In bipolar disorder, people can experience both extreme highs (mania) and lows (depression), which can be out of context to what is actually going on in life. These extreme mood changes can be very disruptive and can seriously interfere with daily life.

TYPES OF BIPOLAR DISORDER

The experience of bipolar disorder varies from person to person. The pattern of mood swings can vary in intensity and in duration. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; p. 123 [1]) classifies three major forms of bipolar disorders: 

Bipolar I Disorder

• At least one episode of mania

• Experiences of depression are common, however not necessary for this diagnosis

Bipolar II Disorder

• At least one episode of hypomania (a less severe form of mania)

• At least one episode of major depression

Cyclothymic Disorder

• At least one episode of hypomania

• At least one period of depressive symptoms

• Occurs over a period of at least two years

Importantly, even though symptoms vary in severity between these disorders, all three can have an equally serious impact on daily functioning.

RECOGNISING CHANGES IN MOOD

While all of us have experienced highs and lows, it is important to be able to notice the signs when these mood swings might be a sign of more extreme changes in mood.  Below we take a closer look at what episodes of mania and depression might look like.

Mania

Manic Episode. A manic episode is at least one week of abnormally elevated, expansive, or irritable mood and increased energy or goal-directed activity.

Hypomanic Episode. A hypomanic episode is a more moderate form of elevated mood, that lasts for at least four days. Importantly, it is very easy to move from hypomania in to mania.

During periods of mania or hypomania, three or more of the following are present:

• Inflated self-esteem or grandiosity

• Decreased need for sleep

• Rapid or pressured speech

• Racing thoughts

• Distractibility

• Increased goal-directed activity or restlessness

• Excessive involvement in unsafe or reckless behaviours (e.g. overspending or unsafe sexual activity).

Depression

Depressive episode: A major depressive episode involves at least two weeks where most of the day, nearly every day, the person experiences a depressed mood or a loss of pleasure or interest in usual activities. This is accompanied by at least four of the following:

• Significant weight loss or gain

• Increased or decreased need for sleep

• Restlessness or feeling slowed down

• Fatigue or loss of energy

• Feelings of worthlessness or excessive guilt

• Difficulty concentrating or making decisions

• Recurring thoughts of death or suicide

You can learn more about how to recognise a Major Depressive episode here.

bipolar disorder SYMPTOMS

There are three main categories of symptoms to consider – cognitive, physical, and behavioural. These follow different patterns, depending on whether the person is in a manic or depressive state [2]. Here’s what they might look like:

COGNITIVE SYMPTOMS OF bipolar disorder

Mania or hypomania. The most common symptom during mania is the development of an extremely positive view of the self, the world, and the future. This can vary from becoming very goal focused with a heightened number of plans and projects on the boil, or even progress to the point that the person becomes delusional about their abilities, or they may significantly discount the negative consequences of their actions.

Depression. In contrast to this, during periods of depression thinking patterns tend to be negative. These negative thoughts centre about the self, the world, and the future.

A critical point may occur in the transition from a manic/hypomanic phase into one of low mood. Plans made during a period of high energy aren’t likely to be achieved when energy and mood are low, and if this lack of achievement is seen as personal failure it may then exacerbate the low mood.

PHYSICAL SYMPTOMS OF bipolar disorder

Mania or hypomania. One of the hallmark characteristics of mania is the increased level of energy. During periods of mania and hypomania, it is also common for people to report a decreased need for sleep (distinct from insomnia in that they still feel refreshed upon waking), excessive energy experienced as restlessness, or an increased sexual drive.

Depression. There are several distinctive physical symptoms that can occur during depressive episodes. These include changes to sleep patterns, changes in appetite (and subsequently weight), a reduction in sexual drive, and decreased energy levels.

Have a look at our blog post on why sleep is so important for our mood.

BEHAVIOURAL SYMPTOMS OF bipolar disorder

Mania or hypomania. As energy levels increase, it is common for individuals in a manic or hypomanic episode to become over-active and engage in reckless or risky behaviours they otherwise would not do. This pattern of increased activity usually begins slowly, however often increases over time, and can itself escalate the experience of mania. Examples of such behaviours may include:

• Going out walking in the middle of the night because of being unable to sleep.

• Taking fewer safety precautions when dating.

• Emptying the bank account with potentially painful financial consequences, often to buy things that aren’t necessary, to drastically change one’s appearance, or even gambling.

Depression. Behavioural changes are also common during the depressive episodes. This typically centres around a decrease in activity and may include socially withdrawing, stopping previously enjoyable activities and hobbies, and no longer going out. As with mania, these changes to behaviour often tend to make depression worse.

TREATMENT FOR bipolar disorder

• PSYCHOPHARMACOLOGY. When considering potential treatments for Bipolar Disorder it is critical to seek advice from a GP or psychiatrist regarding medication. There are different types medication that may be of help - mood stabilisers, antipsychotic medication, and anti-depressants, and it is vital to seek medical advice regarding the correct medication (dosage and combination).

•  COGNITIVE BEHAVIOURAL THERAPY (CBT) is helpful as an adjunct to medication in the treatment of Bipolar Disorder [3]. Here, the focus is on learning monitor the ups and downs of manic and depressive episodes and to examine and shift unhelpful thinking and behaviour patterns that exacerbate the extremes of mood. In addition, CBT focusses on identifying early warning signs of changes in mood and developing structured daily routines.

If you think Bipolar Disorder may be impacting you, why not Contact Us for a tailored approach?

REFERENCES

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.

[2] Jones, S., Lam, D., & Tyler, E. (2014). Bipolar disorder. In A. Carr & M. McNulty (Eds)The Handbook of Adult Clinical Psychology (2nd ed, pp. 607-634). New York: Routledge.

[3] Szentagotai, A., & David, D. (2010). The efficacy of cognitive-behavioral therapy in bipolar disorder: A quantitative meta-analysis. The Journal of clinical psychiatry. doi: 10.4088/JCP.08r04559yel