What Is Bipolar Disorder and How Do People Get It?
Living With Bipolar Disorder
A friend sat in my office one day and recounted the following story:
“Last night, my daughter showed up at my house off her medications (probably doing drugs again), broke in, stole several items, then attacked me with a bat when I confronted her. I have a restraining order against her. She has bipolar disorder and sometimes self-medicates with drugs.” End story.
My friend—a good Christian man who raised his children with church morals and ideals—had seen this behavior before. His wife—who eventually committed suicide—also suffered from this disorder. It was his story that inspired me to write this article. Hopefully, it will help someone out there who is suffering.
Everyone knows about depression. Bipolar disorder is different. Being bipolar is like having two captains of a ship, and every day, they fight over who is going to drive the ship. The passengers have no say-so. One is steering toward the sun, while the other is headed straight for a storm.
One of the things we all take for granted is the ability to control own actions. Oftentimes, the minds of people with bipolar disorder race with unrealistic ideas. They act on an impulse that is unrelenting. Even if they recognize the manic episode, they are helpless to change it's course.
It’s my mission to share this with the world and to let them know that there is life on the other side of those dark times that seem so hopeless and helpless. I want to show the world that there is life — surprising, wonderful and unexpected life after diagnosis.— Demi Lovato
What Is Bipolar Disorder?
According to the diagnostic criteria outlined in the American Psychiatric Association (APA) DSM-IV-TR, bipolar disorder is a cyclic mood disorder characterized by at least one manic episode in a lifetime. However, patients may also exhibit any of the following six types of episodes:
- Acute mania
- Delirious mania
- Depressive episodes
- Mixed-manic episodes
The behaviors involved in bipolar fluctuate between depression and mania. The two ends of the spectrum are often over dramatized in the media to make it seem as though people with this disorder are rapidly and frequently fluctuating between severe depression and an out-of-control high. While that is true for some people, milder presentations of the disorder are more prevalent in society.
A person may not have peaks and valleys that are intense enough for them to even realize something is wrong. One of the diagnostic criteria is that there is not an environmental reason for the mood changes. Obviously, if a person experiences a great loss or has a lot of life stress, depression can become a factor. The difference for people with bipolar disorder is that they may become depressed for prolonged periods of time without cause.
By the same token, the onset of mania can happen at a moment’s notice. People with a mild case may go through life without even realizing they have the disorder.
What Causes Bipolar Disorder?
It’s interesting to note that the first studies of bipolar disorder date back to Ancient Greece, yet still today, little is known about the causes. It has been recorded that 40-65% of bipolar patients live a sedentary lifestyle (Melo et al. 2016). A sedentary lifestyle is known to lead to other health issues that can exacerbate preexisting symptoms.
The Influence of Hormones
The onset often begins during puberty, which validates the connection to hormonal issues. Research conducted by Meinhard, Kessing, and Vinberg (2014) connected bipolar disorder to pregnancy and fluctuation of estrogen.
The use of birth control pills has also been linked to symptoms of bipolar disorder, which makes sense because birth control pills alter estrogen and progesterone levels. In fact, women are advised to contact their doctor if symptoms appear after the use of birth control. The doctor may then suggest alternative birth control methods. Currently, there is no evidence that a hysterectomy can alleviate bipolar symptoms, but it isn't hard to imagine the possibility if the cause is even partially hormone-related.
The Influence of Genetics
Another possible cause is genetics. The National Institute of Mental Health (NIMH) states that genetics may play a roll in the development of bipolar disorder (2015). In my friend's case, it seems as though the disorder could be handed down. A recent study suggests that unlike schizophrenia, there isn’t a single gene that can be isolated as a bipolar predictor (Phelps, J. 2014). According to Phelps, there are several genes that can influence propensity to develop bipolar disorder, and they are not always the same.
"I'm not the kind of person who likes to shout out my personal issues from the rooftops, but with my bipolar becoming public, I hope fellow sufferers will know it's completely controllable. I hope I can help remove any stigma attached to it, and that those who don't have it under control will seek help with all that is available to treat it."— Catherine Zeta-Jones
In recent years, studies have shown the positive effects of physical activity for people with bipolar disorder. In a study of over 15,000 bipolar patients, increased physical activity had a positive effect on depressive symptoms, quality of life, and sleep (Melo et al. 2016). The study also suggested a possible connection between mania and excessive exercise.
Lithium Is the Standard Treatment
The current pharmaceutical treatment for bipolar disorder is lithium. Lithium, in its purest form, is a mineral. Research conducted at the University of Wisconsin found that lithium stabilizes neurotransmitter release in the brain (Purse, M. 2018). However, opinions on the effectiveness of lithium still vary among mental health professionals. No matter our opinion, it is important to note that no one should ever quit a medication for mental illness without first consulting their health care professional.
Vitamins May Also Help
Dr. Patric Darby states that vitamin B6 and zinc are natural treatment alternatives for bipolar disorder. He also abdicates the use of essential fatty acids (EFA) in the treatment bipolar. As Dr. Darby points out, these treatments have been shown to relieve symptoms, allowing patients to wean off their medications.
Remember that treatments vary in effectiveness and should be examined case by case.
Bipolar disorder presents specific issues in terms of diagnosis. One of the reasons it's so hard to diagnose the disorder is because self-reporting is often the main method used to diagnose psychological disorders. People with bipolar disorder are sometimes an unreliable source of information when it comes to their episodes—even when they want help. They may not see their manic episodes as a problem, and therefore, may not report them.
Misdiagnoses Are Common
Patients are often mistakenly diagnosed with depression or schizophrenia due to the lack of patient history. Another issue is that people often try to hide their symptoms to avoid excessive treatments, such as being committed to a mental institution, which is a rare event. It is more likely for a bipolar patient to end up in jail or prison from not taking their medications or stopping treatment.
Brain Imaging Technology Offers More Definitive Results
Today, it is possible to use magnetic resonance imaging (MRI) to diagnose mental disorders. The scans above show the subtle differences between normal brain activity and brain activity in disordered patients. The warm colors (i.e. red, orange, and yellow) represent areas of higher activity, with red being the highest activity. The cool colors (i.e. violet, blue, and green) represent lower activity areas, with violet being the lowest. The brain scan of the bipolar patient shows intense brain activity that is consistent with the high or manic episodes associated with the disorder.
Understanding How the Brain Is Affected Will Inform More Effective Treatments
I also found it interesting that the brain shapes of people with mental illness are very different from that of the healthy brain. Florida State University (2017) found that shrinking of the prefrontal-temporal cortices is associated with certain disorders. Another study by the Norwegian Center for Mental Disorders Research at the University of Oslo (2017) showed that the cortices in the bipolar brain are not as thick as those in a healthy brain. As researchers learn more about how the brain functions, new methods for diagnosis will hopefully become available to doctors.
It was really unusual in boys, quite embarrassing. But I found it euphoric.— Russell Brand
The Silver Lining
I’m going to choose my words very carefully and try not to convey the wrong message. People with bipolar disorder can be difficult to deal with when they refuse treatment or spontaneously go off their medication. The reality is that every person is different, and people with bipolar disorder tend to have a talent and drive that is unrivaled—in everything from music to science.
People who live normal lives will never know the joy of coming up with an original, outrageous idea and having it work out to be genius. If there is a silver lining to bipolar disorder, it’s that it has created some of the most brilliant people of our time. Beethoven, Churchill, and even Sir Issac Newton were said to have suffered from bipolar disorder.
People should get treatment for bipolar disorder, but they shouldn’t be ashamed, and they should learn to love the person they are inside.
Berglan, C. (2 May 2017). New MRI Study Leads to Roadmap of Bipolar Brains. Psychology Today.
Darby, P., M.D. (2018). Causes and Natural Treatments for Bipolar Disorder. A Guide to Alternative Mental Health.
Meinhard N, Kessing, LV, Vinberg M. The role of estrogen in bipolar disorder, a review. Nordic Journal of Psychiatry 68(2): 81-7, 2014. doi: 10.3109/08039488.2013.775341.
Melo, MCA, Daher, EF, Alburquerque, SGC, de Bruin, VMS. Exercise in bipolar patients: A systematic review. Journal of Affective Disorders 198: 32-38, 2016. https://doi.org/10.1016/j.jad.2016.03.004
National Institute of Mental Health. (November 2015). Bipolar Disorder. National Institute of Health. Publication Number TR 15-3679.
Riccelli, R., Toschi, N., Nigro, S., Terracciano, A., Passamonti, L. Surface-based morphometry reveals the neuroanatomical basis of the five-factor model of personality. Social Cognitive and Affective Neuroscience 12(4): 671-684, 2017. doi: 10.1093/scan/nsw175
Phelps, J., M.D. (December 2014). The Genetic Basis of Bipolar Disorder. PsychEducation.org.
Purse, M. (30 June, 2018). Lithium: The First Mood Stabilizer. VeryWellMind.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 MD Jackson MSIOP