Bipolar Disorder

Bipolar disorder is a serious mood disorder with a genetic component1. It should not be confused with personality disorders. Bipolar disorder is characterised by both extremes of emotions and huge jumps between mania, an extreme state of elation, and depression. Both states can be life threatening with around 15% of sufferers dying by suicide1. Symptoms of mania include rapid speaking, flight of ideas, excessive spending, an elevated mood, decreased need for sleep, delusions of grandeur and in some cases excessive promiscuity. At its extreme the diseases can induce periods of psychosis with episodes of hallucinations and delusions.  Of the 1-2% 1of the population thought to suffer from bipolar disorder many will never be diagnosed. A person can have their first bipolar episode at any age. Mixed episodes are when people experience symptoms of mania and depression at the same time.

 

All genetic studies show that bipolar disorder has a significant genetic component. This has been seen in both sexes as well as in twin and adoption studies1. It is generally thought to not be due to one gene but the result of a complex genetic pathway.

 

Treatments, with variable degrees of efficacy are available for both the manic and depressed phases of the disorder. There have not been huge advances in treatment over the last few decades as a result of a poor understanding of the mechanism of how the disease works2. Acute episodes can be reduced using a variety of mood stabilisers while antipsychotics are more effective for acute mania than depression2, though many have unpleasant side effects.

 

Bipolar is sometimes and loosely classified into two types:

  • Type 1 where patients display extremely clear manic episodes.
  • Type 2 where a lesser form of mania, referred to as hypomania, is the norm

 

The drug which has shown to prevent relapses consistently over the longer term is Lithium, which was first used in 1949 by John Cade2. It is the only one for which there is proof of it working well over many years if long-term medical support is needed. Unfortunately it can have serious side effects on renal function in some patients; some people can take it without problems for a lifetime while others will have to stop taking it to avoid serious kidney damage. It is essentially a chemical lottery.  It can be particularly useful for reducing suicidal thinking.

 

Psychological treatment on top of medication can improve outcomes, stabilise moods and reduce the risk of relapses. To work effectively with a psychologist is it important to feel comfortable with them and have a connection that will allow you to talk openly with them, never feel bad for stopping with one to find someone who is a better fit for you.

 

The majority of people who have bipolar disorder are in a depressive state the majority of the time2 which can result in excessive fatigue, difficulty sleeping, weight changes, loss of interest in doing things, seeing people, suicidal ideation, sadness and reduced libido. Unfortunately most patients will live a third of their life with depression whether they are actively in a bipolar episode or not and relapse rates are high2: 37% within a year and 60% within 2 years. Treating depression in bipolar disorder is extremely difficult, with their being few proven treatments and the use of antidepressants is not straightforward as they appear to trigger enhanced fluctuations of mood in many people. Many drugs are totally ineffective and patients need to find other ways of managing their depression over the long term. For this seeing a psychologist can be invaluable.

 

Modern society for the large parts remains fearful of mental illness and it is rarely discussed and remains largely hidden. Feelings of stigma are normal as is fear of admitting to having a serious psychiatric illness, it is definitely a time when you learn who your friends are. People who are particularly affected will struggle to lead what society terms a ‘normal life’ and can struggle to function, hold down a job and are seriously compromised in all daily activities.

 

  1. Craddock, N. and Jones, I. (1999): Genetics of Bipolar Disorder, J. Med Genetics, 36, pg 585
  2. Geddes, J.R. and Miklowitz, D.J. (2013): Treatment of Bipolar Disorder, The Lancet, 381, pg 9378

 

 

Genetic component

 

 

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