The history of bipolar disorder itself is over 2000 years old. "Bipolar Illness, or manic depressive disorder, is an ancient disease with descriptions appearing in the biblical Old Testament and in writings from ancient Greece"(El-Mallakh 775). In the last few years, doctors find the probable cause of bipolar disorder is an inherited lack of stability in nerve impulse transmission in the brain. This biochemical brain problem causes people with bipolar disorder to be more susceptible to physical and emotional stresses. Researchers have found several genes that could be linked to the disorder. This may explain why bipolar disorder seems to run in families.
Bipolar itself means "two poles" as it is characterized by mood swings. The manic episode begins with increased energy, creativity, and social ease that can easily go into uncontrollable anger, agitation, and feelings of being irritable. The other side of the pole, depression, is a lack of energy, feeling sad, worthlessness, and thoughts of suicide. These mood swings are totally unrelated to things going on in the person’s life.
Bipolar disorder affects close to 1% of the population of the United States. "As many as one-fifth of the 3 million people in the United States who develop bipolar disorder eventually find the emotional ride intolerable and kill themselves" (Bower 232). "Suicide is, in fact, the second major cause of death worldwide in women between the ages of 15 and 44. Almost all of these suicides are connected to mental illness, and most mental illnesses are treatable" (Jamison 80).
People with bipolar disorder experience depressive episodes consisting of sadness, low energy, worthlessness, and suicidal thoughts alternating with manic episodes of euphoria, inflated self-esteem, and high energy levels. This disorder with its mood swings can permanently disable people, and without treatment, one out of five commit suicide. Many people with bipolar disorder are very intelligent, creative, and talented. With this creativity comes madness, they are very emotionally sensitive; they lack confidence in themselves and their relationships, and in the working world. Many have learned to overcome the madness and manage the disorder; they are successful artist, actors, poets, writers, and college graduates. Their success is due to drug therapy, psychotherapy, and behavior management. Once you understand the causes and symptoms of the illness itself, you will be able to take control of your treatment and learn to manage it.
You ask yourself, what causes bipolar disorder? Most doctors believe that bipolar disorder is primarily biological rather than psychological. A number of genes have been identified that may be related to the disorder. Bipolar disorder seems to run in families. Dr. John Nurnberger, a recognized authority and researcher on the disorder stated, "If a first-degree relative is affected with bipolar illness, one’s risk is 25 percent, as compared with about 7 percent in the general population. For a child with two affected parents, it’s 50 percent. If one’s identical twin is affected, the risk is about 65%" ("Post…" 271). If you have a number of relatives with the bipolar disorder or depression, the chance may be greater.
There is no one proven cause of bipolar disorder. Medical research is trying to find a connection between the illness and chemical deficits with the brain cells. It suggests that bipolar disorder is most likely an inherited problem somehow related to a lack of stability in the transmission of nerve impulses in the brain due to chemical deficits. Serotonin is the most common believed deficit, two others are norephinephrine and dopamine. This biochemical imbalance makes those with bipolar disorder more susceptible to physical and emotional stress. If there is some kind of trauma, lack of sleep, substance use, or some other over stimulation, the normal brain function for restoring calm don’t always work right. "Additionally, medical conditions such as strokes, hyperthyroidism, encephalitis, seizure disorders, and tumors can bring about the mania associated with bipolar disorder. Certain drugs may have the same effect" ("Bipolar…" 2).
"Both magnetic resonance imaging and positron emission tomographic scans show structural abnormalities called hyperintensities, referred to as unidentified bright objects (UBOs), in the brains of many manic-depressives" (Leutwyler 47). It is only a matter of time before researchers know more. Researchers know chemical deficiencies in the brain cause certain types of physical symptoms and that is why they feel it is related to the symptoms of bipolar disorder.
What are the symptoms of bipolar disorder? Bipolar disorder is identified by highs and lows in moods. There are actually four different types of mood episodes namely manic, hypomanic, depression, and mixed. Each episode has it’s own distinct set of symptoms.
Mania (manic episode) can start out with the person feeling energetic, creative, and socially at ease, but can quickly escalate into anger, agitation, and aggression. During the manic stage a person may have trouble functioning in a normal way. Usually at least four of the following symptoms are present:
Feeling euphoric (high) or dysphoric (irritable).
Requiring very little sleep yet having large amounts of energy.
Thoughts racing through your mind.
Talking so rapidly that others can’t follow what you are saying.
Your mind is distracted and jumping from thought to thought.
Delusions of grandeur (feeling powerful and important).
Doing reckless things without worrying or being concerned about the consequences, such as spending too much money or inappropriate sexual activity.
There may also be psychotic symptoms such as delusions (believing things that aren’t true) and hallucinations (seeing or hearing things that aren’t there).
Hypomania is similar to mania but with less severe symptoms. It is characterized as feeling better than usual, elevated mood, and feeling productive. Many people with bipolar disorder like this feeling and sometimes will even quit taking their medication just to attain it. Hypomania doesn’t last and soon they are either become manic or crash into depression.
Depression has the following symptoms that can last for at least two weeks and can interfere with functioning. The symptoms are feeling blue, sad, or losing interest in things you normally enjoy. Having at least four of the following symptoms is another sigh of depression:
Trouble sleeping or sleeping too much.
Eating too much or too little.
Having trouble making decisions or concentrating.
Feeling slowed down or feeling too agitated to sit still.
Having low self-esteem or feeling worthless.
Loss of energy or feeling tired all the time.
Thoughts of suicide or death.
There may also be hallucinations or delusions.
Mixed episodes can be the most disabling of all. This episode has both symptoms of mania and depression at the same time or alternating back and forth during the day. You may feel excitable and agitated as in mania, but also feel depressed and irritable. I have actually alternated between laughing and crying several times in just a minute or two. Since I also had racing thoughts at the same time and was talking about five subjects at the same time, the person I was talking to couldn’t understand me. Mixed episodes are more common in women, and the causes do make sense.
Are there gender differences in the symptoms or episodes? Yes, there are. "Three possible gender differences in the course of bipolar disorder have been suggested. (1) The prevalence of rapid-cycling bipolar disorder is higher among bipolar women than among bipolar men. (2) Bipolar women may be at a higher risk for depressive episodes, and at a lower risk for manic episodes, than bipolar men. (3) Bipolar women may be more likely than bipolar men to have mixed, as opposed to pure, mania "(Leibenluft 6).
These differences may be caused by the hypothyroidism, which is more common in women and gonadal steroids (hormones and menstrual cycles). Also there is a high chance of depression during the postpartum period. Since women have a higher chance of depression, then some rapid cycling and mixed states could be due to the medications treating the depression.
The symptoms of the different types of episodes help the doctor to diagnose what type of bipolar disorder you have. There are four types, and they are bipolar type I, bipolar type II, rapid cycling, and schizoaffective.
Bipolar type I is characterized by manic or mixed episodes and usually depressions. You can be diagnosed bipolar I even after just one manic episode. It is very likely you will have depressive episodes in the future as well as more mania, if left untreated.
Bipolar type II is characterized as hypomanic episodes and depressive episodes only. This type is very hard to diagnose as you avoid getting into trouble, are very happy and have a lot of energy. Most of the time you have depression and are treated with only an anti-depressant, causing the medication to trigger mania or set off more frequent cycles.
Rapid cycling bipolar disorder occurs when you have at least four episodes per year. This can be any combination of manic, hypomanic, depressive or mixed. "This course pattern is seen in approximately 5-15% of patients with bipolar disorder"(Kahn 82). One cause maybe from taking anti-depressants, which can trigger mania, followed by a crash back to depression. This causes a continual roller coaster of ups and downs.
Schizoaffective disorder is a condition that overlaps bipolar disorder. In bipolar disorder psychotic symptoms may occur during a severe manic or depressive episode but disappear as after the episode. With schizoaffective disorder, the psychotic symptoms, such as hallucinations and delusions persist even when the mood symptoms are under control.
Dual diagnosis occurs when you have bipolar disorder and another mental disorder such as an addiction (substance abuse), personality disorders, attention deficit disorder, obsessive-compulsive disorder, and anxiety disorders. Having one or more additional disorders makes diagnosis and treatment of bipolar disorder more difficult. Substance abuse history lowers the chances of remission from acute mania. Patients with bipolar disorder with histories of substance abuse were most likely males not taking their medications and having suicidal ideations. "Patients with mixed mania were more likely than those with pure mania to abuse alcohol, hallucinogens, amphetamines/stimulants, or sedative/hypnotics" ("Prior…" 5).
No matter what type of bipolar, treatment is not easy. You must work with your psychiatrist and therapist to be able to manage it.
How is bipolar disorder treated? Bipolar disorder can be treated in a combination of ways. There is medication for the acute manic episode and preventative treatment, psychotherapy, behavior modification and electroshock therapy. According to psychologist Kay Redfield Jamison who also struggles with bipolar disorder, "Lithium (one of the most used medications)…makes psychotherapy possible…but ineffably, psychotherapy heals" (Bower 233). This means to me that medication and psychotherapy go hand in hand.
The two most important medications used to control the symptoms of bipolar disorder are mood stabilizers and antidepressants. Other medications that may be prescribed are sleepaids, anti-anxieties, or anti-psychotic medications.
For acute manic, hypomanic, mixed episodes, and occasionally depression, mood stabilizers are used. In the United States the most commonly used mood stabilizers are Lithium, Valproate (Depakote), and Carbamazepine (Tegretol). Lithium is used for patients with more euphoric moods, Depakote or Tegretol if your mood is mixed or irritable or rapid cycling. Depakote and Tegretol are anti-epileptic medications that work on calming the brain. Researchers aren’t sure how Lithium works.
"Lithium is eliminated by the kidney and the primary elimination route for the older anti-epileptic agents (Depakote and Tegretol) is liver metabolism" (Lam 1). Blood tests are performed to determine the correct dosage and also to watch for any problems with liver function with the use of Depakote and thyroid function with the use of Lithium. Each person reacts differently to the medications, so if one does not work for you or if there are side effects that don’t subside, your doctor can suggest another. A newer mood stabilizer that is being used is Neurontin. Neurontin does not need to be followed by blood tests, has very few side effects, and is virtually impossible to overdose on.
Depression is treated with anti-depressants, but they are usually used with a mood stabilizer. An anti-depressant without a mood stabilizer can cause you to go into a manic episode. Some of the most common anti-depressants are Prozac, Paxil, Wellbutrin, and Effexor. Most of these medications increase the re-uptake of serotonin, a needed chemical in the brain. Anti-depressants can take several weeks to start working, so sometimes your doctor may order something to help you with agitation, anxiety or sleep in the meantime. Even though the first drug given to you usually works, it is common to go through several anti-depressants before finding the one that works best for you.
Why is it so hard to stay on your medications? "No matter what the drug, treatment for bipolar disorder is no easy thing. Patients often have difficulty accepting what is essentially a permanent change in their lifestyles. They also may resent ending or limiting manic episodes, since they regard them as wonderful periods of positive energy rather than as symptoms. These beliefs may be so strong that patients refuse to take their medication" ("Bipolar…" 3).
Stopping your medications will eventually cause you to drop into the depths of depression or go over the edge in mania. "As many as one-fifth of the estimated three million people in the United States who develop bipolar disorder eventually find the emotional ride intolerable and kill themselves…Repeated forays into both mania and depression, however, lay waste to marriages, friendships, and other social ties" (Bower 233).
If medications are not working fast enough for you, your doctor may recommend ECT (electroconvulsive therapy). For psychotic depression it is most often the most safest and effective treatment. It is also used for medication resistant depressions. It is has improved over the years and is very safe. I actually know a few people with bipolar disorder that have tried it and recommend it. There is some short-term memory loss lasting a few weeks.
Medications are the most important treatment in bipolar disorder, but in order to heal the damage done during the depression and mania, psychotherapy must come into play.
What is psychotherapy and do I need it? Once you begin taking medication, the next step is psychotherapy (remember psychotherapy heals). Psychotherapy usually starts one on one with a psychiatrist or a therapist. Different techniques such as meditation and relaxation can help you to cope with the mood changes, and help you deal with stress. "Counseling sessions also focus on how emotional turmoil in relationships can disrupt a person’s daily routines and bring on a bout of mania or depression. Bipolar patients then learn to plan and hold to a daily routine, adhere to prescribed medication doses and work on relationship problems as they arise" (Bower 234).
The therapist usually works with your psychiatrist so that your concerns can be voiced to your doctor in case a medication change needs to be made.
Psychotherapy in a group setting with or without family members is another treatment. "Support groups for unipolar and bipolar illness offer a major source of help for patients and families, as attested by the expanding NDMDA and its network of nationwide chapters" (Wetzel 81). Most people with bipolar disorder that attend the meetings have been hospitalized at least once and were seeing a psychiatrist. The topics discussed at meetings were medication side effects, issues of daily life, crisis situations, suicide, legal or criminal matters, and just the sharing of experiences.
Five things were stressed at every group meeting I attended, and I can attest to the fact that not doing three of them did contribute to my last hospitalization. Those five things are: taking my medication, getting six to eight hours of sleep, eating three meals per day, drinking plenty of fluids, and exercising. Doing these five things on a daily basis will help you to remain stable with this disorder. Two other methods of psychotherapy that can help manage this disorder are behavior modification and thought stopping.
What is behavior modification? It is another form of help or treatment. Cognitive behavior therapy (CBT) is one method that works as well as medication in acute cases of depressions, but not so well on chronic depression. "…the depressed individual can be taught to substitute positive thoughts for negative thoughts in response to cues that trigger symptoms of depression." (Sundel 225). Negative cognitions (beliefs, thoughts, attitudes, or emotions) can be the most common symptoms of depression. CBT works best if you are willing to work at it. "Because CBT emphasizes the acquisition of emotional problem-solving skills, it is quite labour-intensive and requires that patients possess insight, motivation, and the capacity to concentrate. This may limit its applicability to a more heterogeneous bipolar population"(Zaretsy 494). The last psychotherapy I am going to write about is called thought stopping.
Thought stopping is a method I use frequently. It is a covert technique used to decrease recurring self-defeating or negative thoughts. Thought stopping can start out as overt when you voice a negative thought and the therapist calls out "stop". Then the therapist has the patient say "stop" first out loud and then to him or herself. This technique works well on low self worth, thoughts of death, overeating and losing control. During the manic stage when the person’s mind is racing, thought stopping can be helpful.
I have also used it when I was ruminating (thinking the same thought over and over), or when I would have two voices (both mine) battling inside my head. One was vindictive and angry and the other one calm and logical. Thought stopping also works well for suicidal ideations or thoughts, or thinking about something in the past or future. When these negative unwanted thoughts would fill my mind, I would yell "stop" in my head and then clear my mind and replace it with music or think something positive. The main thing is to first be aware of your thoughts or actions, and then to use the technique.
Sometimes people with bipolar disorder will use alternative treatments, self treatments not prescribed by your doctor or psychiatrist.
Are there dangerous self-treatments? The most dangerous self-treatment is not taking your medications. Several others are sleep deprivation and St. John’s Wort. Sleep deprivation and disruptions in sleep can be very dangerous to a person with bipolar disorder. According to Dr. Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh Medical Center’s Western psychiatric Institute and Clinic, "For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms" ("Sleep…" 1). Caution must be used with sleep deprivation therapy, because manic episodes often follow the end of a depressive episode. "Extensive literature indicates that sleep deprivation can precipitate an antidepressant response in depressed patients, and a manic episode in bipolar patients" (Leibenluft 9).
St. John’s Wort is a popular over the counter herbal remedy for depression. It can be very dangerous if you have bipolar disorder. Using any type of herbs or medications that are anti-depressants can increase your chances of having a manic episode. Mood stabilizers must always be used with antidepressants.
There are many treatments for bipolar disorder, yet not one single treatment is a cure for this disorder. Many people with bipolar disorder are known to be creative, artistic, and intelligent. Along with this creativity is madness.
How is creativity and bipolar disorder related? According to Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University School of Medicine, who is has bipolar disorder, "The incidence among creative people is 10 to 20 times greater than that of the general population" (Lewis 1). "And several recent studies, including Jamison’s own survey of 47 British writers and artists, support her hypothesis that creative individuals are especially subject to mood disorders and suicide" ("Even…" 22). "Jamison’s work suggests that periods of creative productivity are preceded by an elevated mood. It is as if certain types of moods open up thought, allowing for greater creativity" (Neihart 49).
One article written in Harvard Business Review stated "In our consulting experience during the last decade, we have found manic depressive executives at the top of some of the most successful U.S. companies as chairmen, CEOs, and senior VPs. They are also represented among the ranks of the United States’ most brilliant entrepreneurs. They are risk takers. They build empires. And they often become wealthy. High political office has always attracted its share of manic-depressive leaders, including Winston Churchill, Theodore Roosevelt, and Abraham Lincoln" (Lieblich 4).
Some well known writers/artists in our past with probable mood disorders are Vincent Van Gogh, Michaelangelo, Leo Tolstoy, Edgar Allen Poe, F. Scott Fitzgerald and Charles Dickens to name a few. Here are the names of famous people today with bipolar disorder: Patty Duke (actress), Kay Redfield Jamison (psychiatrist), Buzz Aldrin (astronaut), Francis Ford Coppola (director), Thomas Eagleton (lawyer, former U.S. Senator), Carrie Fisher (actress), Sol Wachter (Judge), Robert Schumann (composer), Jean Claude Van Damme (martial arts, actor), and many others. This disorder did not stop them from attaining success in their lives. Their treatment is the basically the same as ours (medication and therapy) and yet they succeed. I think we can look to them for the inspiration we need in our own lives.
I would like to conclude by saying that bipolar disorder can be a very disabling illness caused by an inherited chemical imbalance of the brain. The extreme mood swings between mania and depression can interrupt a person’s life and their immediate family’s life. The mania or depression of bipolar disorder is treatable once stabilized with medications. Individual therapy, group therapy and behavior modification can also be helpful in maintaining stability in this disorder. Five things you must do daily that can help you maintain and remain stable in this disorder are: take your medication, get six to eight hours of sleep, eat three meals per day, drink plenty of fluids, and exercise. Many people with bipolar disorder are creative artist, actors and writers. Along with this creativity and genius there is madness, yet they find away to manage their disorder.
By reading this paper, you are closer to managing your own bipolar disorder. It is important that you continue to learn all you can about the disorder. The National Depressive and Manic-Depressive Association (NDMDA) and the National Alliance for the Mentally Ill (NAMI) are two excellent resources. You can also check out my bipolar disorder page at http://www.skzdalimit.com/teenascorner/bipolar.html for links to support groups and other information on bipolar disorder. Here is a poem I wrote about seeking knowledge.
Eagle’s Conquest
Soaring like an eagle in the azure sky
Floating through wispy clouds
A flicker of light catches my keen eye
Cutting the wind with a cry so loud
Something curious to the eagles mind
Swooping in low to investigate
After seconds or minutes of time
The claw grabs and manipulates
Take it back up to the sky
Massive wings cutting the air
Up to the cliff I must fly
Under the skies so fair
I searched for knowledge
And conquered and won
Upon the majestic cliff's ledge
Flickering metal in the sun
(7-16-99)
With more knowledge about bipolar disorder, I hope to see you make the choices in your life to accomplish any goal you wish. It is possible to be a CEO in a corporation, an actor/actress, a psychiatrist, astronaut, producer, artist, writer, college graduate or even a computer programmer. The sky is the limit and the only one stopping you is you.
©copyright and written in 2000 by
Teena K. Johnson
page maybe copied but you must include my name as the author and the Works Cited
below.
Works Cited
"Bipolar Disorder: A Treatable Illness." Psychopharmacology Update 5 #11 (Nov 94): 2-4
Bower, Bruce. "Pushing the Mood Swings." Science News 157 #15 (Apr 2000): 232-234
El-Mallakh, Rif S. "Bipolar Illness." Southern Medical Journal 90 #8 (Aug 97): 775-780
"Even Geniuses Get the Blues." Civilization 2 #3 (May/June 95): 22-23
Jamison, Kay Redfield. "A World Apart." Newsweek Special Edition (Spring/Summer99): 79-80
Kahn, David A., Ruth Ross, A. John Rush, and Susan Panico. "Expert Consensus Treatment Guidelines for
Bipolar Disorder: A Guide for Patients and Families." Journal of Clinical Psychiatry 57 #12A (1996)
Lam, Y.W. Francis. "Gabapentin, Lithium Coadministration May Alter Drug
Clearance." Psychopharmacology
Update 10 #8 (Aug 99): 1-2
Leibenluft, Ellen. "Women and Bipolar Disorder: An Update." Bulletin
of the Menninger Clinic 64 #1
(Winter2000): 5-18
Leutwyler, Kristin. "Coming Through Madness." Scientific American 273 #5 (Nov 95): 44-47
Lewis, Ricki. "Evening out the Ups and Downs of Manic Depressive Illness." FDA Consumer (June 1996)
Lieblich, Julia – Harvard Business Review. "Managing a Manic
Depressive." Harvard Business Review (May
1994): 20
Neihart, Maureen. "Creativity, The Arts, and Madness." Roeper Review 21 #1 (Sep 98): 47-51
"Post Update the Genetics of Bipolar Disorder." Saturday Evening Post 271 (Jan 99)
"Prior Substance Abuse May Hinder Treatment For Bipolar Disorder." Outcomes
& Accountability Alert 5 #2
(Feb 2000): 5-6
"Sleep Loss Can Trigger Mania." Reuters http://users.wantree.com.au/~fractal/fsleep.htm
Sundel, Martin and Sandra S. "Cognitive Restructuring" Behavior
Change in the Human Services fourth edition
(l999): 225
Wetzel, Mary C. "Strengths and Limits: Report by a Bipolar/Unipolar Self-Help Group." Psychosocial
Rehabilitation Journal 14 #4 (Apr 91): 81-86
Zaretsy, Ari E., Zindel V. Segal, and Michael Gemar. "Cognitive Therapy for Bipolar Depression: A Pilot
Study." Canadian Journal of Psychiatry 44 #5 (Jun 99): 491-494
This research paper and web page is
copyright © by Teena K. Johnson
Page last updated
04/02/09