Written by Daniel Bode [1]
National bipolar awareness day
National bipolar awareness day is observed annually on the 26th of May. This day provides an opportunity to reflect on this mental health condition. The goal of Bipolar Awareness Day is to raise awareness for bipolar disorders, attempt to eliminate the associated social stigma, and educate and improve sensitivity towards the illness.
What it is bipolar disorder?
Bipolar disorder is a mental health condition and is classified as a life-long mood disorder by the American Psychiatric Association (APA, 2019). It is characterised by unusual shifts in energy levels, distinct levels of emotional highs and lows, and the ability to carry out day to day tasks (Sadock et al., 2015; NIMH, 2020).
There are three types of bipolar disorder. All three diagnoses refer to different combinations in changes in energy, mood, and activity (NIMH, 2020; Begum, 2021; SADAG, 2022), namely,
Bipolar I
The primary identifier of bipolar I disorder is mania. Individuals experience at least one manic episode (lasting for at least 7 days) possibly preceded or proceeded by a hypomanic episode or a major depressive disorder (lasting for at least 2 weeks). Having just one manic episode will result in a bipolar I diagnosis.
Bipolar II
Primarily defined by a pattern of depressive episodes or hypomanic episodes, but never a full-blown manic episode. Individuals experience symptoms similar to bipolar one, but seldom as extreme.
Cyclothymic Disorder (Cyclothymia)
Is a diagnosis where individuals suffer from multiple hypomanic and depressive episodes over the span of 2 years (1 year in children and adolescents).
Signs and Symptoms
Signs and symptoms can be difficult to identify in children and adolescents (SADAG, 2022). Mood episodes are different from moods typical people experience (NIMH, 2020), with episodic symptoms occurring every day for majority of the day.
Manic episodes
Individuals…
| Feel elated, irritable (restless) or touchy (excessive happiness and excitement) |
| Feel “jumpy” or “wired” |
| Are lees concerned for/or have a decreased need for sleep |
| Have a loss of appetite or not eat entirely |
| Have rapid speech about multiple topics |
| Feel like their thoughts are racing |
| Think they can do a lot of things at once and without thinking (impulsivity) |
| Do risky things, with possible disastrous consequences, that show poor judgment |
| Feel like they are unusually important, talented, or powerful (a sense of grandiosity) |
Depressive episodes:
Individules…
| Feel very sad, empty, and worried |
| Lack energy and feel slowed down |
| Have trouble falling asleep , wake up too much (intimitant sleeping patterns) |
| Experience increased appetite and weight gain |
| Speak slowly, mumble, and forget a lot |
| Have trouble concentrating or making decisions, a sense of self-doubt |
| Feel unable to do even simple things |
| Have little interest in almost all activities |
| Feel hopeless or worthless, think about death or suicide |
Possible causes
There is no single cause of bipolar disorder. However, researchers have noted that there are multiple possibilities.
Genetics / Hereditary
Bipolar tends to run in the family as there are a number of genes associated with the illness (SADAG, 2022). There is a 70-90% chance for bipolar to be hereditary (Gordovez & McMahon, 2020), however, that chance is reduced even further when only one parent suffers from bipolar disorder.
Biochemistry
Chemical imbalances that occur within the brain can influence the onset of bipolar disorder (Berk et al., 2011), however, with the help of the appropriate medication can be corrected (SADAG, 2022).
Treatment and Therapy
Treatment can assist many individuals even in the most sevre cases. A combination of both psychotherapy and medication can be effective for many (SADAG, 2022; NIMH, 2020).
Psychotherapy
Cognitive Behaviourval Therapy (CBT): Helps correcting cognitive distortions and negative automatic thoughts by restructuring and replacing them with more positive alternatives (Burns & Roos, 2016). Through restructuring, individuals learn to manage stress and negative triggers, as well as help prevent relapse and medication adherence (Piet & Hougaard, 2011).
Interpersonal Social Rhythm Therapy (IPSRT): Is the idea that establishing daily and nightly routines or rhythms assist is stress and trigger management (Burns & Roos, 2016; NIMH, 2020).
Psychoeducation: Learning and teaching family, friends and the public about bipolar disorder allows individuals to provide suffers support during episodes or times or need.
Medication
Medication that is usually used to treat bipolar disorder includes mood stabilizers and antipsychotics (NIMH, 2020). There are many possible medicinal combinations, so it is imperative to consult with your healthcare provider before taking any medication.
Examples of possible medications (Ropper et al., 2020) can be:
- Mood stabilisers: carbamazepine (Tegretol), lamotrigine (Lamictal), lithium, or valproate (Depakote)
- Antipsychotics: cariprazine (Vraylar), lurasidone (Latuda), olanzapine (Zyprexa), and quetiapine (Seroquel).
- Antidepressants
Treatment of other forms
Electroconvulsive Therapy (ECT): is a brain stimulation procedure that allows individuals to receive relief from some of the sevre symptoms of bipolar disorder. ECT is delivered under general anesthesia and is safe. It generally regarded to be the most effective treatment for severe depressive and manic episodes (Norcross et al., 2016).
Transcranial magnetic stimulation (TMS): is a brain stimulation procedure that uses magnetic waves. It is delivered almost daily for approximately 1 month to a patient while fully conscious and aware (Harel et al., 2011).
HELPLINES
South African Depression and Anxiety Group (SADAG)
Tel: 0800 567 567 or 011 262 6396
Dr. Reddy’s
Tel: 0800 21 22 23 (8am to 8pm) / 0800 567 567 (24 hrs)
References
American Psychological Association (APA). (2019). Publication manual of the American Psychological Association (7th ed.). Washington, DC. : American Psychological Association.
Begum J. (2021). Bipolar Disorder. WebMD. https://www.webmd.com/bipolar-disorder/mental-health-bipolar-disorder
Berk, M., Kapczinski, F., & Andreazza, A. C. (2011). Pathways underlying neuroprogression in bipolar disorder: Focus on inflammation, oxidative stress and neurotrophic factors. Neuroscience & Biobehavioral Reviews, 35, 804-17.
Burns, J., & Roos, L. (2016). Textbook of Psychiatry for Southern Africa (2nd ed.). Cape Town, South Africa: Oxford University Press Southern Africa (Pty) Limited.
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular Psychiatry, 25, 544-59.
Harel, E. V., Zangen, A., Roth, Y., Reti, I., Braw, Y., Levkovitz, Y. (2011). H-coil repetitive transcranial magnetic stimulation for the treatment of bipolar depression: an add-on, safety and feasibility study. World Journal of Biological Psychiatry, 12(2), 119–126. https://doi.org/10.3109/15622975.2010.510893
National Institute of Mental Health. (2020). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
Norcross, J. C., VandenBos, G. R., Freedheim, D. K., & Pole, N. (2016). APA handbook of clinical psychology: Psychopathology and health. Washington: American Psychological Association.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review andmeta-analysis. Clinical Psychology Review, 31, 1032–1040. https://doi.org/10.1016/j.cpr.2011.05.002
Ropper, A. H., Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar Disorder. New England Journal of Medicine, 383(1), 58–66. https://doi.org/10.1056/NEJMra1906193
Sadock, J. B., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry. (11th ed). Virginia: Wolters Kluwer.
South African Depression and Anxiety Group (SADAG). (2022). Bipolar brochures. https://www.sadag.org/index.php?option=com_content&view=article&id=1879&Itemid=146
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