Let’s Talk About It:
Bipolar Disorder

By James Seymour, MD, Sierra Tucson

 

Bipolar disorder is a very serious mood disorder that is manifested generally by periods of alternating depression, mania, and normal moods. Along with schizophrenia it is considered one of the two major mental illnesses. It is associated with a high degree of complications including need for hospitalizations, substance use problems, disability, family break-ups, suicide attempts and completed suicides. There are two main types of bipolar disorder referred to as type I and type II. Type II is a somewhat milder but still a very serious form of the illness. I will touch on it briefly, but the majority of this article is about type I, which is sometimes referred to as the “classic” form of the illness. This article will describe definitions of the illness, it’s history, demographics, diagnosis, treatment approaches, complications, and recommendations for long term management.

 

Understanding Bipolar Disorder

The Diagnostic and Statistical Manual-5-TR is the handbook clinicians and psychiatrists use to diagnose psychiatric disorders describes bipolar disorders as a group of brain disorders that cause extreme fluctuations in mood, energy, and ability to function. The key thing to understand is that bipolar disorders are basically neurological disorders, not psychological ones. They are physical illnesses of the brain that manifest themselves in emotional, mental, and behavioral areas. Since they are physical disorders, they are some of the few psychiatric disorders that require medication treatment. Many disorders can be treated with medications but don’t require them. Bipolar disorders must have psychiatric medication as part of the treatment plan.

The hallmark of bipolar disorder is episodes of mania. Bipolar disorder is diagnosed in anyone with a manic episode that is not induced by drugs, alcohol, or a medical disorder, whether or not there are episodes of depression. More commonly though the person will suffer from both depressed episodes as well as mania.

 

What exactly is mania?

Mania is much more than an elevated mood, it affects appearance, mood, thought content, perceptions, anger or aggression, and judgment or insight. Usually, impairments in orientation and memory are not present.

• Thinking and talking are very fast, the person will often interrupt or talk over everyone else, have no sense of social boundaries and be behaviorally intrusive. Attire may be very disorganized, or very bright, colorful, or garish. Being with a manic person makes you want to find the “off button.”
• Mood tends to be inappropriate in terms of being elated, jubilant or euphoric, or a high degree of easy annoyance or irritability that seems totally out of proportion.
• Thought tends to be expansive and overly optimistic with inappropriate self-confidence or grandiosity, high distractibility, quickly shifting from one thought to another, and it can be very hard to follow the train of thought. Often there are thoughts of being special or having some sort of special knowledge with a need to excitedly tell others about this special knowledge.
• We often see overt delusions which reflect perceptions of power, prestige, self-worth or glory and will sometimes move to extreme paranoia or hallucinations.
• There can be suicidality, both in the manic and depressive phases of the illness.
• At times there is aggression and combativeness, demandingness, and acting out of the grandiose belief that others need to obey their commands or wishes.
• It is the severely impaired judgment that really differentiates mania from normal ‘highs.” Patients with mania generally have no insight, rarely see anything wrong with themselves, and resist efforts at treatment, not seeing any need for it. Serious mistakes in regard to finances, marriage and relationships and occupation, refusing to listen to anyone’s advice, often with devastating consequences.

 

 

Bipolar I

Bipolar I disorder occurs in about 1% of the population. Rates are equal between men and women, and equal across all nationalities, ethnicities, race, and economic status. It has been described in medical literature as far back as over 2,000 years ago. There is a strong genetic component and it tends to run in families. Onset is usually in late adolescence or early 20’s although it can start earlier or later. Many patients spend the majority of their time in the depressive phases of the illness. Prior to effective medication treatment over 15% of patients would die by suicide.

Alcoholism is a frequent complication with over 40% of men with bipolar disorder meeting the criteria for moderate to severe alcohol use disorder. Divorce rates are much higher than the general population, and there are high rates of long-term occupational disability. Despite the severity of the illness— bipolar disorder is highly treatable. Managed well one can have a very satisfying, meaningful, and productive life with few limitations. Managed poorly it can result in horrible and disastrous lives for both the patients and their family members.

 

“Bipolar I disorder occurs in about 1% of the population. Rates are equal between men and women, and equal across all nationalities, ethnicities, race, and economic status.”

 

The Pillars of Treatment

I describe what I call the three main “pillars of treatment”. I see these as like three legs of a three legged stool. With all three the stool is solid. Take one away and the stool collapses. The three pillars are: Maintenance of proper medication, avoidance of alcohol and drug problems, and continuously learning to manage stress, anxiety, self -care, and interpersonal communication and relationships.

 

Patience and Medication is Required

The effective medication treatment of bipolar disorder is very complex and differs widely between patients. There is no one medication approach. One reason is that there are four main tasks in medication treatment of bipolar disorder. These are treating depression, treating mania, preventing depression, and preventing mania. It is almost always the case that a patient will be on at least two different mood stabilizers. There are three different types of mood stabilizers and unlike antidepressants which are generally safe and easy to tolerate, the bipolar mood stabilizers tend to have frequent side effects as well as potential medical complications.

The three types are lithium, the anti-epileptic medications, and anti-psychotic medications. All three types of these medications require ongoing laboratory evaluation and monitoring as they can cause problems with the kidney, thyroid gland, and liver and some can result in significant weight gain, increased blood glucose and triglycerides, and can interfere with birth control contraception and menstrual periods and a number of them can create increased risk of birth defects. Despite these potential difficulties the benefits of the use of mood stabilizer medications far outweigh the problems. It often takes a long time to work out the best medication regimen for anyone. It requires patience and a structured disciplined approach by both the patient and psychiatrist to find the best combination of effective medication with the least amount of side effects or medical complications.

 

Bipolar II

Bipolar II disorder is manifested by chronic and recurrent depression with intermittent episodes of milder forms of mania which are also much shorter than those of bipolar I. Although often seen as a milder form of the illness it is very serious with many problems with severe long- term depression which is often difficult to effectively treat. It is experienced by about 3% of the population with rates higher in women than men. It is usually treated by a combination of a mood stabilizer and an antidepressant. It tends to occur in family members of those who have bipolar I disorder.

Overall, bipolar disorders are serious mental illnesses but they are highly treatable. Long term consistent proper treatment can result in lives that can be full, rich, and productive with few limitations.

For more information I recommend contacting the National Alliance on Mental Illness (NAMI). You can call 1-800-950-6264, text “helpline” to 62640, or e-mail mailto:helpline@nami.orgMonday through Friday 10 A.M. – 10 PM. Eastern Time. In a crisis call or text 988 (24/7).

 

James Seymour, MD, joined Sierra Tucson in 2010. Upon receiving his medical degree from the University of Tennessee and completing his psychiatric residency at the University of Virginia in 1987. 

Dr. Seymour’s areas of expertise include trauma recovery, addictions, cognitive behavioral therapy (CBT), and somatic mind-body therapies. Dr. Seymour believes strongly in the resilience of the human spirit and views the role of the psychiatrist as assisting the person in removing obstacles to the natural healing and recovery process.

To learn more about Sierra Tucson visit http://www.sierratucson.com and call 888-842-4487.