Bipolar Disorder can be Debilitating, Difficult to Diagnose (article featured in The Tennessean)
The term “bipolar” has become a term that is often loosely used to describe a person who has frequent, sudden shifts in mood or opinions. Bipolar Disorder, however, is a much more entrenched disorder that can consist of many weeks of depression followed by episodes of mania, or vice versa. These episodes can be quite debilitating, and without treatment, can significantly increase the risk of suicide. The extreme moods experienced in this disorder originate from chemical changes in the brain, thus the depression and mania most often feel uncontrollable, and sometimes unmanageable, to the person experiencing them. Because of the severity of the disorder, it is important to recognize signs and symptoms so that an accurate diagnosis and treatment plan can be formulated.
Although depression is not always part of the clinical picture, the hallmark symptoms of Bipolar Disorder are prolonged sadness and elevated, irritable mood. These symptoms can be experienced at different times (several days/weeks of sadness followed by elevated mood, or vice versa), or they may be experienced within the same time period (symptoms of depression and mania experienced within the same day). These shifts in mood can include significantly increased or decreased activity and energy levels. They are not the normal “highs and lows” or “ups and downs” that most people experience, but rather episodes that include a number of symptoms that interfere with occupational and/or social functioning.
Depressive episodes are most often, but not always, present in Bipolar Disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) notes the following symptoms that may be included in a depressive episode. These symptoms are typically experienced daily for at least 2 weeks:
• Depressed mood most of the day (feeling sad, empty, hopeless, appearing tearful)
• Diminished interest in nearly all activities most of the day
• significant change in weight or appetite
• insomnia (trouble sleeping) or hypersomnia (sleeping too much)
• Psychomotor agitation or retardation (obviously moving more quickly or slowly)
• fatigue or decreased energy
• inappropriate guilt or feelings of worthlessness
• difficulty concentrating or making decisions
• recurrent thoughts of death, suicidal thoughts, plans, or attempts
Some people experience only the manic symptoms of the disorder. In addition to an elevated, or irritable mood, manic episodes seen in Bipolar Disorder include the following list of symptoms that are typically experienced for at least 4 consecutive days. It is important to note that not all symptoms must be present for a diagnosis to be assigned.
Decreased need for sleep (e.g., feeling rested after only 3 hours of sleep)
Increased talkativeness or pressure to keep talking
Flight of ideas or feeling as if thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity)
Increase in activities that have a high potential for painful consequences (e.g., excessive spending/buying sprees, sexual indiscretions, or foolish business investments).
Symptoms of other disorders can mimic symptoms of Bipolar Disorder. For example, the hyperactivity often seen in a person with Attention Deficit-Hyperactivity Disorder (ADHD) may present similarly to a manic episode. Also, because manic episodes can elevate to the point that a person experiences hallucinations and/or delusions, Schizophrenia and other Psychotic Disorders must be ruled out. Impulsivity and unstable behavior that is often seen in people with Borderline Personality Disorder can look like Bipolar Disorder as well. And, drug use can cause shifts in mood and produce symptoms of depression and/or mania. Because treatment for these other disorders is different from treatment targeting Bipolar Disorder, it is imperative that an accurate diagnosis be identified.
Treating Bipolar Disorder can be difficult due to the unpredictable and risky behavior that is often a part of the disorder. Because of the severity and chronicity of this disorder, it is imperative that a trained professional be involved in developing a treatment plan for the individual. Mood stabilizing medications are beneficial for preventing the extreme nature of the major depressive and/or manic episodes. Psychotherapy can be useful in coping with the consequences that Bipolar Disorder has on relationships, and family therapy is beneficial; especially when treating children and youth suffering from the disorder. Cognitive Behavioral Therapy proves useful in restructuring depressive and self-defeating thoughts that tend to exacerbate depressive episodes.
Primary care physicians can be good resources for providing referrals to a psychiatrist and a psychologist who specialize in treating Mood Disorders. If risky behavior or suicidality is too severe to wait for an appointment with a physician or mental health professional, immediate assistance should be sought by the nearest hospital’s Emergency Department. Once the mood is safely stabilized, a more long-term comprehensive outpatient treatment plan can be developed to target the symptoms and improve the quality of life of the person with the disorder.