By: Kerry Moran
According to the World Health Organization (WHO), 1 in 8 people in the world currently live with a mental health disorder. This equals out to 970 million people. As of 2019, of those 970 million people in the world, 40 million had bipolar disorder.
Bipolar disorder is a mental health disorder characterized by extreme highs and lows (it was previously known as manic-depressive disorder). These highs and lows often come in cycles of depression or mania, though sometimes can be seen as a “mixed state” in which symptoms of both are present. Mania in adults is characterized by high, euphoric moods, increases in energy, decreases in appetite and sleep, and can sometimes also include thoughts of grandeur, delusions, and at the most extreme, hallucinations. Children are more likely to exhibit irritability and emotional outbursts than these more well-known highs. Hypomania is a less severe form of mania that can affect many people with bipolar disorder. Depression in bipolar individuals can be seen as very low mood, low energy, and feelings of hopelessness. Bipolar disorder has a high rate of suicide completion, with one in every five people with the disorder completing suicide, which highlights the importance of treatment for individuals with this disorder.
The misdiagnosis rate is unfortunately high, which delays proper treatment. Women and female presenting persons are more likely to be misdiagnosed with depression and men and male presenting persons are more likely to be misdiagnosed with schizophrenia. Bipolar affects these groups in equal rates.
Typical onset of this disorder is found in adulthood, however it can occur in adolescence and early childhood. There does seem to be a genetic component to this disorder, as it is more common in individuals who have at least one parent with unipolar depression (major depressive disorder) or bipolar disorder. Individuals with an immediate family member who has bipolar disorder are also more likely to develop it sooner in life.
Bipolar types
There are three types of bipolar disorder based on how cycles present. No type is more or less “severe” than the other in terms of the challenges someone may face and the types are not determined by impact on a person’s life but on types of symptoms.
Bipolar I typically presents with manic symptoms that last at least a week. These manic symptoms can also result in the need for emergency care depending on severity. Depression in bipolar I typically lasts at least two weeks.
Bipolar II is characterized by episodes of hypomania and depression. These hypomanic episodes can be less severe than traditional mania and usually do not require emergency medical attention. Depressive cycles tend to be more common with bipolar II.
Cyclothemia, or cyclothemic disorder, is a disorder that involves cycling between hypomania and depressive episodes. These episodes are usually shorter than in bipolar I or II.
Treatment
Typically, we see the use of mood stabilizers and anti-depressants used as the first line treatment for this disorder. Lithium is the most well-known mood stabilizer and was the first one developed as an effective treatment for bipolar. However, many more are now available. SSRI’s and SNRI’s are also commonly used in combination with mood stabilizers. Atypical antipsychotics are often used along with these other medications. According to WHO, 9 in 10 patients are happy with their treatment plan and medications.
Therapy is also part of an effective treatment plan for bipolar. Through therapy, clients are able to learn how to address troubling thoughts, identify potential triggers for cycling and signs a depressive or manic cycle may be coming, and how to change their behaviors. Therapy can also be a way of providing support and education to bipolar clients and their families.
My story
I was diagnosed with bipolar II when I was 12 years old, though it’s very likely I developed it much earlier. Bipolar is considered a progressive disorder and developing it so early meant it was likely my symptoms would be severe. Progression is associated with more frequent episodes, more difficulty in treatment, more severe episodes, and a higher likelihood of suicide attempt and completion.
Treatment was difficult at first for me. I tried many medications that did not work well for my case. My age was a complicating factor in this, of course, as many medications at the time (2002) were not approved for use in children. I reacted poorly to the medications that were available to me and eventually I stopped treatment.
My adolescence was, understandably, difficult. I often experienced rapid cycling, which is categorized as four or more cycles within a year. My depressive symptoms were very severe, resulting often in difficulty in functioning socially and in school.
According to all odds, it was likely only going to get worse. Many bipolar patients experience disability from their disorder. However, in my early 20’s, I went back to trying medications. It took a few years to find an effective treatment regimen. Some medications had side effects I couldn’t tolerate and others didn’t make a difference in my depressive symptoms. After some time I was able to find something that worked for me.
Combining an effective medication schedule with therapy allowed me to gain the skills I needed to achieve a normal level of functioning. These skills were recognizing when a cycle may be coming so that I could take steps to try and prevent it from being too severe, learning how to combat the thoughts and feelings that came with depression and could sometimes lengthen my depressive cycles, and learning when to reach out for more help. Learning when a medication had reached its limit to help me and I needed more support in that area was crucial for my treatment success.
Despite the odds stacked against me with my early onset and severity of symptoms, I was able to achieve a level of functioning that has allowed me to thrive as an adult. I was able to continue working and then eventually attended college and am on my way to a graduate program. Bipolar disorder can be a scary diagnosis, but with proper treatment and education on the disorder, it is possible to have a high quality of life and, more importantly, a full life that is characterized by achieving one’s goals, having good friends, and seeing one’s dreams through.