Many of us have a friend or family member we wonder about because they seem to shift unpredictably from one mood to another. We are often worried or in awe of them because they can be on a high one day and despondent the next.
While it certainly isn’t always the case, people like this are sometimes suffering from a serious mood disorder called bipolar disorder or manic depression. This illness is characterized by cycling between mania and depression for no obvious reason.
Bipolar disorder affects between one and two per cent of the adult population and is increasingly being diagnosed in adolescents. It is a serious mental illness and is extremely disruptive to the individual’s life.
During episodes of depression, people with bipolar disorder exhibit the same symptoms found in major depression. They are persistently sad or anxious and lose energy and interest in enjoyable activities. Disrupted sleep and abnormal appetite are also common, as well as feelings of hopelessness and worthlessness. Suicidal thoughts or attempts can also sometimes affect those with bipolar disorder during depressive episodes.
On the other hand, when the cycle shifts to mania, sufferers either have an abnormally elevated mood or are extremely irritable. They may feel powerful, confident and important. Often, manic individuals talk excessively, have grand ideas and participate in behaviour that is impulsive, risky or dangerous to themselves or others. For example, manic people often go on impulsive spending sprees, participate in promiscuous sex or engage in high-risk activities when they normally wouldn’t.
Friends and family of a manic individual will usually notice that their loved one is behaving abnormally.
While bipolar mood swings can be extreme, they can also be more subtle. Some people experience only mild depression or mania or may experience one more severely than the other.
Simultaneous symptoms of both mania and depression are also possible. This is called a mixed state and requires special consideration in treatment.
Mood shifts in bipolar disorder can be triggered by life events, but often seem to occur for no observable reason. It is often the case that in the early stages of the disorder the mood changes are triggered by experiences. However, as the disease progresses, the individual’s brain may become sensitized so that no trigger is needed in order for a shift to occur.
It is uncertain exactly what causes bipolar disorder, but strong genetic links have been identified.
Bipolar disorder usually lasts for the individual’s entire adult life and requires continuous treatment in order to prevent recurring mood episodes. Once treated, many people with bipolar disorder can go back to normal routines without experiencing the disturbing symptoms.
It is important, however, to differentiate between bipolar disorder and depression. If a bipolar patient is treated with standard antidepressants there is a risk that the medication will trigger a shift into mania, a mixed state or rapid cycling between mania and depression. This is why a complete history is necessary for a doctor to correctly diagnose either depression or bipolar disorder.
While medication is usually necessary for individuals with bipolar disorder, simple lifestyle modifications can also help avoid triggering mood changes. Getting enough sleep every night, avoiding excessive caffeine or alcohol consumption and learning to deal with stress effectively are all important. Cannabis, cocaine, opiates and other drugs are not helpful and may make it impossible to get the mood under control.
If you think you or a loved one is experiencing symptoms of bipolar disorder, speak with your family doctor about it. Treatment is available.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.