Bipolar Disorder • Emotional ups and downs

Thinking of yourself as the happiest person in the world can be wonderful. But if you are bipolar (also manic-depressive), this feeling of elation feels much too intense – and then depression follows. What you should know about bipolar disorder.

Bipolar disorder is a two-faced condition.
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Everyone knows fluctuations in feelings. Sometimes the mood is good, then it tips and you feel weak and depressed. That is normal. However, people with bipolar disorder, often referred to as manic-depressive illness, live with extreme emotions and their fluctuations. Today the world is still at their feet, tomorrow the total crash into bottomless despair and listlessness can follow. A regular life between these poles is hardly possible.

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What is Bipolar Disorder?

Doctors also refer to bipolar disorder as bipolar affective disorder, because here two clinical pictures with strong emotions (affects) – depression and mania – alternate (bipolar). Those affected suffer from their strong mood swings, which affect their entire everyday life. While listlessness and dejection predominate in the depressive phase, mania is characterized by a real elation. It is not uncommon for symptoms of mania and depression to be present at the same time. In this case, doctors speak of "mixed states" of the disease.

Brain: Myths and Surprising Facts

Brain: Myths and Surprising Facts

The manifestations of bipolar disorder are divided as follows:

  • Bipolar I disorder: a manic episode lasting at least 14 days and at least one depressive episode.

  • Bipolar II disorder: at least one depressive episode lasting 14 days and at least one hypomanic episode (mild mania).

  • Cyclothymic disorder: Constantly slight manic and depressive mood swings for a period of at least two years. It is a persistent instability of mood in which the numerous, individual periods are not severe and persistent enough to meet all the criteria for diagnosing bipolar disorder. This instability usually develops in early adulthood and is common in relatives of patients with bipolar disorder. It takes a chronic course, although the mood can occasionally be normal and stable for months. It is possible that this could develop into bipolar disorder.

Course of bipolar disorder

There is no uniform course of bipolar disorder because it can show up very differently.

  • The Beginning Depressive episodes can begin slowly or suddenly, while manic episodes typically occur rapidly within hours or days.

  • The Duration individual manic and depressive episodes averages four to twelve months. The length of the cycles between excessive enthusiasm and abysmal despair varies from patient to patient.

  • Between each episode There can be periods of several months or years during which the patient is symptom-free and fully efficient.

  • The number the episodes of illness is postponed individually. While some patients only have one or two episodes, other patients have one episode of the disease every year.

Bipolar disorder: causes

There are several theories about how manic depression develops. Genetic factors are considered to be the main cause. Various genetic changes are to blame when bipolar disorder manifests itself. It is believed that stressful events in a person's life can lead to a manic-depressive illness being ruled out, especially if the genetic predisposition exists.

One of the most important risk factors for bipolar disorder is a familial burden in first-degree relatives: If one parent is sick, the chances of the child becoming sick are ten to 20 percent. If an identical twin has bipolar disorder, the corresponding probability for the other twin is 65 percent.

Changes in the brain metabolism are also seen as triggers of the disease.

Diagnosis is particularly important in bipolar disorder

According to the German Society for Bipolar Disorders, an estimated one and a half to three percent of the population suffer from the constant ups and downs of emotions. Although doctors and psychologists have been dealing with the manifestations of manic-depressive illness for years, it is often diagnosed and treated too late. Few of those affected know about their disease – only about five to ten percent receive treatment. Early diagnosis and targeted treatment can significantly improve the course of the disease.

Since there are no laboratory tests or other tests that can detect bipolar disorder, the diagnosis is based on discussions with the doctor – he tries to identify characteristic symptoms of the disease. Because many sufferers often only recognize their symptoms after years or shy away from seeing a doctor for a long time, it can take a long time from the first appearance of the signs to the diagnosis. According to the German Society for Bipolar Disorders, the correct diagnosis is often only made after several phases of the disease.

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Symptoms of bipolar disorder: recognizing mania

The three central characteristics of mania are feelings of elation, hyperactivity and lack of inhibition. This makes it exactly the opposite of depression.

The first symptoms of bipolar disorder usually appear between the ages of 20 and 30, and more rarely in adolescence. They differ depending on the phase in which the person concerned is currently.

The mania – cheering sky high: In the manic phase, intense feelings of elation, a strong thirst for action and exaggerated good mood occur for no apparent reason. Those affected feel excited and enterprising and believe they can think more clearly than usual. They are also often irritable, restless and disinhibited. Buying orgies, sexual lack of distance and increased consumption of alcohol are not uncommon and show a loss of relation to reality. In severe cases, people may have hallucinations, such as delusions.

Manic episodes can last up to three months if left untreated. The central characteristics of a mania – feelings of elation, hyperactivity, lack of inhibition – change with the degree of severity. The high mood is often accompanied by irritability and hostility, followed by a depressive episode. Depending on the intensity and duration, but above all the degree of social impairment, certain forms of mania are distinguished:

  • Hypomania: Less intensity of symptoms and impairment of lifestyle,
  • mania: Clearly abnormal extent of symptoms and severe lifestyle disruption,
  • Mania with psychotic symptoms: The self-confidence increases to megalomania.

Children and adolescents can also suffer from mania. In pre-puberty, however, irritability, emotional lability, increased activity and dangerous behaviors are more common than an elated mood. During puberty, the symptoms then match those of adults. Adolescents with mania, however, present psychotic symptoms more frequently and show severe impairments in social behavior.

If three to four of the following symptoms are severe, a Mania without psychotic symptoms present as bipolar disorder:

  • increased self-esteem or ideas about size
  • decreased need for sleep (for example only three hours)
  • unusually talkative to incessantly babbling
  • Flight of ideas or the subjective experience of mind hunting
  • Distractibility by all things around you
  • Increased purposeful activity or psychomotor restlessness
  • excessive preoccupation with enjoyable activities that are very likely to have unpleasant consequences.

If the abnormally changed mood is so severe that it significantly affects professional performance, this can be another indication of a manic episode.

If you have three of the following (or four if your mood is just irritable) and your lifestyle is severely disrupted, one may Mania with psychotic symptoms present:

  • increased activity or motor restlessness
  • increased talkativeness ("urge to talk")
  • Flight of ideas or subjective feeling of racing thoughts
  • Loss of normal social inhibitions resulting in behavior inappropriate for the circumstances
  • decreased need for sleep
  • excessive self-assessment or megalomania
  • Distractibility or constant change of activities or plans
  • foolhardy or reckless behavior, the risks of which the person concerned does not recognize, for example reckless driving, crazy business investments, far exaggerated spending on bulk purchases
  • increased libido or sexual practices that are unusual for this person.

Another indication of this form of mania is if the episode lasts at least a week and is severe enough to more or less completely disrupt professional and social functioning.

Hypomania – a weakened form of mania: At least three of the following symptoms must be present to diagnose hypomania and affect personal lifestyle:

  • increased activity or motor restlessness
  • increased talkativeness
  • Difficulty concentrating or being distracted
  • decreased need for sleep
  • increased libido
  • excessive shopping or other types of reckless or irresponsible behavior
  • increased sociability or excessive confidentiality.

Some of the features mentioned should be clearly and consistently present for at least two to four consecutive days. In addition, increased activity, restlessness and frequent weight loss as a bipolar disorder must be differentiated from similar symptoms of hyperthyroidism and anorexia.

The depressive phase – saddened to death: For example, a depressive episode manifests itself through feelings of worthlessness, fear, guilt, sadness, and pessimism. Those affected are often extremely unfocused, withdraw from social life and fall into lethargy. Even small household chores suddenly become an enormous burden. Very often there is a feeling of coldness or inner emptiness.

Physical symptoms such as exhaustion, sleep disorders, a reduced sex drive and weight loss are also part of the clinical picture in manic-depressive people in the depressed phase. The most serious sign of a depressive episode is thoughts of suicide. But even without such serious symptoms, the disease creates a great deal of suffering and should definitely be treated with acute and maintenance therapies.

Treatment: is bipolar disorder curable?

So far, doctors have administered drugs such as anti-epileptic drugs depending on the acute phase. Active ingredients such as lithium or valporonic acid increase the chance of a balanced life after manic depression. Talk therapy accompanies the treatment. So far there is no definitive cure for manic depression.

With suitable treatment, however, manic episodes can be controlled: In over 70 percent of patients, the number of episodes and their intensity can be significantly reduced or disappear.

Correct diagnosis and initiation of treatment is especially important to avoid suicide attempts, alcohol, drug and medication abuse, as well as relationship conflicts and incorrect treatment methods.

Treatment of bipolar disorder has three goals:

  • Acute treatment: get the person affected out of the episode of illness in acute treatment

  • Maintenance therapy: stabilize the patient's situation through medication and psychotherapy

  • Relapse prevention: prevent relapse through reduced drug therapy and psychotherapy

Medication for bipolar disorder

The most important drugs for treating bipolar disorder include mood stabilizers, neuroleptics, and antidepressants, depending on the prevailing condition.

The aim is to create a more stable state of health that makes it easier or even makes it possible to start long-term psychosocial therapy.

  • Mood stabilizer: Lithium salts are used in manic-depressive psychoses as so-called phase prophylaxis. So it's about stabilizing the mood and preventing both depressive phases and manic phases – hence the name as mood stabilizer. Lithium, for example, changes the dopamine, noradrenaline, and serotonin systems at various levels. Lithium takes effect after one to two weeks at the earliest. Possible side effects include weight gain, subtle tremors (tremors), lack of concentration and thyroid dysfunction. Lithium should always be taken exactly as directed by the doctor; medical supervision of the treatment is necessary. As an alternative, substances such as carbamazepine and valproic acid are prescribed.

  • Neuroleptics for severe manias: If it is a bipolar depression with symptoms of a psychosis, then neuroleptics are also used. They let delusions and hallucinations subside. However, few studies justify their use in depression. Neuroleptics work biochemically by blocking the receptors for the neurotransmitter dopamine. The therapeutic effect is based, among other things, on its dampening effect on psychomotor agitation, aggression, delusional thinking and hallucinations. Unwanted side effects include lack of drive and emotional flattening. For some years now, so-called atypical neuroleptics have been on the market, which, in addition to dopamine, also block the receptors for the messenger substance serotonin. The typical side effects occur only to a minor extent or not at all. This is accompanied by a significantly better general well-being, increased intellectual performance and greater success in the treatment of perceptual disorders.

  • Antidepressants in a depressed phase: In an acute depressive phase, the prescription of an antidepressant can be useful. However, due to the existing "switch danger" leading to a mania, careful selection is required. Together with the therapist, it is important to find the right treatment strategy.

Bipolar disorder: helping loved ones

The mood swings of the sick not only affect themselves – the environment has to deal with the various phases of the illness. This is a great challenge for relatives: on the one hand, manic-depressive people need someone they trust, on the other hand, the relatives should not exceed their own stress limits. All information and offers for relatives can be found at the German Society for Bipolar Disorders: www.dgbs.de. Do not hesitate to seek advice! Anyone who suspects that a loved one might suffer from bipolar disorder should seek advice.

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Bipolar disorder (also: manic depression) is a disease with several faces: two clinical pictures with strong emotions (affects) – depression and mania – alternate. In the various episodes of illness, those affected suffer from mood swings that affect their everyday lives: from cheering as high as the sky to saddened to death. Typical symptoms of mania are intense feelings of high spirits and a strong thirst for action, signs of a depressive phase are lethargy and pronounced feelings of sadness and worthlessness. Genetic factors are assumed to be the main cause. The course of a bipolar disorder is different for each patient. A diagnosis is usually only made after years because those affected do not recognize their symptoms or are afraid to see a doctor. In most cases, the disease can be well controlled with early treatment through medication and psychotherapy. There is no cure for bipolar disorder.