Bipolar Disorder Manifests Itself In Episodes Of Mania, Hypomania, And Depression

Bipolar disorder is a long-term mental health disorder. The disease is characterized by periodic mood changes, between which there can be long symptom-free periods. Here, we will try to discuss the typical features of episodes of bipolar disorder, i.e. mania, hypomania and depression. The text also tells about the medication for the disease and other possible treatment methods.

Getting sick with a mental health disorder is never the sufferer's own fault. You don't have to stay alone with the disease, but you should seek help to manage it.

What Is Bipolar Disorder?

Bipolar disorder is a long-term mental health disorder. In bipolar disorder, mood changes occur in episodes: episodes of elevated mood and activity, episodes of depression, and combinations of these vary.

Episodes don't always appear one after the other, but the sufferer can have, for example, several depressive episodes in a row. There may also be asymptomatic phases between episodes.

In connection with bipolar disorder, abundant comorbidities are common and the risk of suicide is higher than usual. More than half of the patients also have another psychiatric illness, such as an anxiety disorder, or a somatic illness, such as type 2 diabetes.

How Are Moods And Emotions Different?

Mood is the internal, long-lasting emotional climate of the human mind, in which changes can occur over a longer period of time. Emotions, on the other hand, vary according to the situation and are therefore momentary reactions.

Compared to emotions, mood is a more permanent concept, while emotions can change more quickly. A mood disorder can occur when the change in mood is exceptionally large and atypical. Mood disorders include both bipolar and depressive disorders.

What Causes Bipolar Disorder?

Bipolar disorder usually begins in young adulthood, but it can also strike as a child, middle-aged or elderly person.

The causes affecting the onset of bipolar disorder are both hereditary and developmental, but more detailed information about the causes of the disease is lacking. The onset of the disease is often associated with youth and stressful life situations.

Hereditary factors play a significant role in the development of bipolar disorder: heredity may explain up to 70-90 percent of the prevalence of type 1 bipolar disorder in the population.

Several gene variants are known to predispose to the onset of the disorder. Type 1 disorder differs from type 2 disorder, among other things, in that in type 1 disorder, episodes of elevated mood are stronger.

Bipolar Disorder - Symptoms

The symptoms of bipolar disorder consist of periods of depression and varying degrees of mania, i.e. periods of elevated mood. Episodes can also combine features of manic and depressive episodes, although usually the episode is dominated by either manic or depressive features. 

Usually, there are more episodes of depression than episodes of mania. There may be asymptomatic intermediate phases between episodes, which can last up to several years.

A mixed episode is when the manic and depressive features are equally strong and they occur simultaneously or rapidly change, but during the same episode. During a mixed period, short-term but strong mood swings can also occur.

The number of episodes varies individually from a few episodes to tens of episodes during life. Rapidly fluctuating bipolar disorder is when there are separate episodes more than four times a year. This is also called dense periodicity.

There are two different types of bipolar disorder, both of which have episodes of depression. Instead, episodes of elevated mood and activity occur at different levels: in type 1 disorder, manic episodes occur, while in type 2 disorder, the sufferer has hypomanias, i.e. milder manic episodes. In type 2 bipolar disorder, depressive episodes are more frequent and longer lasting compared to type 1 disorder.

The patient may have difficulties related to memory, executive control, attention and processing speed, which may have a debilitating effect on the ability to function and work. Anxiety, melancholic features, and mood reactivity, obesity or weight gain, and other atypical depressive symptoms can also be associated with bipolar disorder.

Mania

Mania refers to a state in which the person's mood and level of activity have clearly increased. During a manic episode, a person's self-esteem usually rises and delusions of grandeur are common, but mania can also manifest as a decrease in self-esteem.

A manic person is more talkative than usual, clearly needs less sleep than normal, is agitated and can act recklessly, for example in financial matters and interpersonal relationships. Sexual desire increases. 

Careless substance use and traffic behavior can also be part of mania. Irritability can occur alongside the elevation of mood, but on the other hand, during mania, the mood can also be only irritable. A mania lasts at least a week, but usually lasts from two weeks to five months.

Manic episodes can sometimes also be accompanied by psychotic symptoms, which are usually mood-related delusions. A person can imagine, for example, that he is exceptionally important or that he has exceptional abilities.

Hypomania

Hypomania is a milder period of elevated mood and activity than mania. The symptoms of hypomania are clearly milder than mania, and thus do not hinder the ability to function as much as in mania. Activity and talkativeness increase and the need for sleep decreases. Difficulty concentrating and sexual desire may increase.

It can sometimes be difficult to distinguish between a hypomanic episode and personality-specific exhilaration. Unlike the exhilaration characteristic of the personality, hypomania can also be accompanied by irritability, insomnia, short-temperedness, and difficulty concentrating. No psychotic symptoms occur. The duration of the hypomania is at least four days.

A Depressive Episode

During a depressive episode, a person's level of alertness, activity level and self-confidence decrease. Things that were previously perceived as interesting and brought pleasure are no longer interesting in the same way. 

Self-blame, repeated thoughts of death, difficulty concentrating, sleep disturbances and changes in appetite are associated with a depressive episode.

The symptoms of a depressive episode are similar to those of normal depressive states, although the depressive episodes of bipolar mood may last for a shorter period of time. The duration of a depressive episode is two weeks at the shortest, but six months on average. 

Compared to normal depressive states, psychotic symptoms, hyperactivity, slowing down of thinking and movements, and weight gain are more typically present in the depressive episode of bipolar disorder. The proportion of depressive episodes in symptoms increases with age.

How Is Bipolar Disorder Diagnosed?

To be diagnosed with bipolar disorder, a person must have had at least one hypomanic, manic or mixed episode in addition to a depressive episode.

The disease is often diagnosed with a delay, on average eight years after the onset of symptoms. The delay in diagnosis is partly due to the fact that symptoms usually begin during a depressive episode, and the diagnosis cannot be made until the first manic or hypomanic episode occurs.

Treatment And Medication For Bipolar Disorder

The treatment of bipolar disorder mainly consists of medication and psychosocial treatment, which aim to prevent episodes from recurring.

The patient's functional capacity is assessed immediately after diagnosis and at different stages of the disorder. The treatment and rehabilitation plan is drawn up based on the assessment of functional capacity.

The treatment and rehabilitation plan takes into account the different stages of the disease, as treatment needs change according to the different stages. Good cooperation and the transfer of information between different care agencies is important for successful treatment.

Medication

Medication is at the center of treatment for bipolar disorder. Mood-stabilizing drugs are used in combination with drug-free treatments.

Mood stabilizers and antipsychotics, which are used according to the stage of the disease, play a central role in the treatment of bipolar disorder. The most suitable medication is chosen based on the benefit-risk ratio.

It would be important for the patient to try to accept the possibility of recurring episodes. However, the recurrence of disease episodes can be significantly reduced in most cases by committing to medical treatment and managing lifestyles.

Therefore, long-term continuation of drug treatment is of paramount importance in terms of successful treatment.

Psychosocial Treatments

Psychosocial treatment methods aim to learn disease management. The methods are used alongside medical treatment. Psychosocial therapy can be individual, group or family therapy, such as cognitive-behavioral therapy or psychoeducational group therapy.

Depending on the life situation, the patient may also benefit from psychodynamic individual therapy or couple therapy.

It is important for the sick person and his family members to share information about the disease and to teach them to recognize the first symptoms of an illness episode, which makes it easier to manage the episode.

Primary symptoms are, for example, changes in mood, ability to concentrate and the need for sleep. Initial symptoms may appear for a few days or weeks before the actual illness begins. Keeping a mood diary is a method that can help identify mood changes and other first symptoms. 

Taking care of a regular sleep rhythm is important, because lack of sleep can trigger both mania and depression episodes. Stressful events may also predispose a new episode to begin.

In the treatment, a regular daily rhythm, abstinence from intoxicants and learning of stress management methods are encouraged .

When To Seek Help?

If you suffer from or suspect that you suffer from bipolar disorder, feel free to contact a psychiatric specialist. Seeking help is important in order to support a balanced life with the help of medication and psychosocial treatments. 

With appropriate treatment, episodes of illness can be controlled and their recurrence can be significantly prevented. Getting sick with a mental health disorder is never the patient's own fault, and you don't have to be alone with the illness.