Bipolar disorder is a chronic mental disorder characterized by recurring episodes of mood swings, neuropsychological deficits, and behavioral changes (Harrison et al., 2016). In particular, patients with bipolar disorder have fluctuating experiences of emotional lows (depression) and highs (hypomania or mania) that trigger behavioral impairment and psychological distress. Bipolar disorder is classified into three types: bipolar I disorder, bipolar II disorder, and cyclothymic disorder (Harrison et al., 2016). Bipolar I disorder is identified when there is the presence of manic episodes that last within seven days. Bipolar II disorder includes at least one depressive episode alongside the presence of hypomania. The cyclothymic disorder involves recurring episodes of a hypomanic and depressive state that last for at least one year in children and two years in adults.

Signs and symptoms

Symptoms of bipolar disorder are classified into three categories: manic phase, depressive phase, and mixed-manic phase. The manic phase manifests when an individual is continuously irritable, happy, aggressive, high, and euphoric. If these moods are accompanied by racing thoughts, excessive energy, unusual talkativeness, easily distracted, poor judgment, and sleeplessness, then the person is in the manic stage of bipolar disorder. Mild experience of manic episodes is regarded as hypomania (Grande et al., 2016). A patient with hypomania experiences little disruption from bipolar disorder when carrying on with routine activities. However, hypomanic events may progress into manic episodes, causing severe disruption to individual behavior. The depressive phase is characterized by loss of pressure, weight gain or loss, guilt or worthlessness, difficulties concentrating, suicidal thoughts, and energy loss (Carvalho, Firth & Vieta, 2020). Typically, the depressive phase of bipolar disorder shares similarities with major depression that can last for a few weeks. Lastly, the mixed manic incorporates depressive and manic episodes that may occur simultaneously. For example, an individual may be weeping uncontrollably and still feel elated.

Pharmacological treatments

Patients with bipolar disorder are provided with mood stabilizers to alleviate symptoms of depression and mania/hypomania. Lithium is an FDA-approved medication administered to patients with bipolar disorder to stabilize moods (Malhi, Gessler, & Outhred, 2017). Lithium is given to children and teenagers with bipolar disorder. Also, it can be administered to adults. The use of lithium among adult patients with bipolar has been found to increase white matter integrity. The adverse effects of using lithium may include increased thirst, tremors, nausea, excessive urination, and muscle twitching (Malhi, Gessler, & Outhred, 2017). Antipsychotic drugs are also prescribed to patients suffering from bipolar II or bipolar I disorder. The adverse effects of the antipsychotic medication include blurred vision, fluid retention, weight gain, dizziness, and dry mouth.

Nonpharmacological treatments

Electroconvulsive therapy is an effective and well-tolerated intervention in treating elderly patients with bipolar depression. The procedure involves passing mild electrical impulses to trigger a brief seizure (Bahji et al., 2019). This intervention proves to have a significant improvement for mania and depression. However, long-term use of these interventions could lead to apathy, including loss of energy, drive, and creativity. Another nonpharmacological intervention is phototherapy, which involves using artificial or natural light to suppress depression among bipolar patients. Treatment may involve light-emitting diodes (LEDs), halogen bulbs, and fluorescent light bulbs. However, prolonged use of phototherapy can lead to nausea, folliculitis, itchy skin, and redness.

Community resources and referrals

Persons with bipolar symptoms should seek help from nearby health centers that deal with mental-related illness, including support. American Psychiatric Association (APA) is one of the leading organizations dedicated to educating people about a wide range of mental conditions and providing treatment. Another organization is the National Alliance on Mental illness (NAMI) which advocates for awareness of mental conditions. NAMI is a voluntary and non-profit organization that supports individuals affected by mental illnesses. Also, NAMI works with support groups, including loved ones. Nami’s contact information is 1-800-950-NAMI (6264).

References

Bahji, A., Hawken, E. R., Sepehry, A. A., Cabrera, C. A., & Vazquez, G. (2019). ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression. Acta Psychiatrica Scandinavica, 139(3), 214-226. https://doi.org/10.1111/acps.12994

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. DOI: 10.1056/NEJMra1906193

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572. https://doi.org/10.1016/S0140-6736(15)00241-X

Harrison, P. J., Cipriani, A., Harmer, C. J., Nobre, A. C., Saunders, K., Goodwin, G. M., & Geddes, J. R. (2016). Innovative approaches to bipolar disorder and its treatment. Annals of the New York Academy of Sciences, 1366(1), 76-89. https://doi.org/10.1111/nyas.13048

Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of affective disorders, 217, 266-280. https://doi.org/10.1016/j.jad.2017.03.052