Management for bipolar disorder can be extremely complicated as it specifically depends on the whether the individual is exhibiting manic phases or depressive phases and the severity of these phases. If the individual is severely depressed and suicidal then inpatient management is best suited as opposed to a patient who is demonstrating racing thoughts and decreased sleep but who is able to function in daily activities in which that person will most likely benefit from outpatient treatment. Pharmacological therapy is indicated for manic episodes but the specific types of medication depend on the severity of the mania and the presence of psychosis. Mood stabilizing agents and antipsychotic agents are the first-line pharmacological treatment for manic episodes. Antidepressant agents are generally not used in combination with mood stabilizers and antipsychotics as this dangerous combination can worsen an individual’s symptoms. Antidepressants are generally indicated only when the individual is experiencing the depressed phase with no symptoms of mania. When left untreated it can create havoc in one’s life resulting in severe behavioral issues and can also lead to self-harm and suicide.
Depressive disorders are characterized under mood disorders and cause severe symptoms that affect how one thinks, feels, and interacts with others. Individuals with depression many not even report depressive signs and symptoms and instead present to their physician for somatic or physical symptoms such as headaches, abdominal pain, muscle pain, and fatigue. Individuals may also complain of irritability or problems concentrating.
This disorder may be difficult to initially diagnose, as many individuals may not show the clear-cut signs and symptoms of depression. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), at least five of the following symptoms must be present within a two-week period with at least one of the symptoms being depressed mood. Additionally these symptoms must cause apparent distress in social and occupational functioning.
Bipolar disorder affects men, women, children and adolescents from all different ethnic backgrounds and social classes. Like all other mental disorders, this disorder does not discriminate. The lifelong prevalence of this disorder is known to affect approximately one to two percent of the U.S. population. The age of onset for this disorder ranges from childhood to 50 years of age with the average age being 21. There is nearly an equal male-to-female ratio for this disorder.
Like the majority of mental health disorders, bipolar disorder is multifactorial meaning that many factors play a role in the development of this mood disorder. It is known to have a major genetic component involved in the etiology. First-degree relatives (parents, children, and siblings) of people with this disorder type I (BPPI) are seven times more likely to develop this disorder compared to the general population. Additionally a child of a parent with bipolar disorder is at a 50% increase of having a major psychiatric disorder diagnosed in life. Biochemical factors such as neurotransmitters, which are the hormones in the brain responsible for communication, are also known to contribute to this disorder as well as physical changes in brain regions and environmental stressors.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), manic episodes seen in BPI must last at least one week in duration whereas hypomanic episodes must last for four consecutive days in duration. Symptoms of mania are included below:
Depressive episodes must last for at least two weeks in duration and are characterized by the following symptoms:
A female with severe depression who spends excessive amounts of money or believes she can take over the world is experiencing clear-cut signs of bipolar disorder. A man with suicide ideations who speaks excessively fast and gambles away his life savings in a short period is also exhibiting characteristics of this disorder. Bipolar disorder type I (BPI) is characterized by alternative severe depression and mania which leads to hospitalization or a significant impairment in functioning. In comparison bipolar disorder type II (BPII) is characterized by episodes of severe depression that are punctuated by hypomanic episodes. Hypomania is a less severe form of mania that does not result in psychosis or cause impairments in social or occupational functioning. Cyclothymic disorder is diagnosed in individuals who portray periods at least two years in duration of both hypomanic and depressive symptoms without meeting the full criteria for hypomania, mania or major depression. In other words, cyclothymic disorder can be characterized as a less severe form of bipolar disorder compared to BPI and BPII while lasting for a longer duration.