Researcher & Writer: Sanaa SETHI
Illustrator: Josetta SO
Bipolar Disorder (BD), formerly known as manic depression, is a chronic mental health condition that causes extreme mood swings. These mood swings can affect sleep, judgement, activity and ability to reason. According to studies and surveys from 2017, 46 million people suffer from BD around the world, including 1.4% of the Hong Kong population.
Let’s break down the phrase “Bipolar Disorder”. Just like the Earth, which has opposite poles (the north and south pole), a person with bipolar disorder experiences opposing moods, which are emotional highs (mania or hypomania) and emotional lows (depression). In a manic episode, it is common to experience large bursts of energy and creativity, feel euphoric, and become very talkative. One may feel that they can do twenty rounds of weightlifting, run ten kilometres and go grocery shopping, all on two hours of sleep. However, these are always followed by an emotional crash. Individuals will feel a loss of interest in previously rewarding and enjoyable activities, hopelessness, and sleep disturbances.
Bipolar Disorder at a neural level
In a recent study, researchers investigated if the genetic history of bipolar disorder affected the structure of the brain and the opportunity for the development of Bipolar Disorder. Researchers used a dMRI to scan the brains of participants with familial links to bipolar disorder, and those that don’t have any genetic history of bipolar disorder over a period of two years. They observed that in the group with a family history of BD, there was a relative reduction in neural networks related to regions in the brain involved with emotional regulation and decision-making. On the other hand, the group with no family history of BD had an increase in neural connections. This shows that individuals with a genetic risk factor are, indeed, at a much higher risk for developing BD.
The lack of connections to the medial temporal lobe (amygdala) and frontal lobe also explains the irrational decision-making and drastic shifts in mood of bipolar individuals. This shines a light on other effects of BD, such as a higher risk for the development of dementia.
This study is correlational, not causational, and there are other factors that can trigger Bipolar Disorder (shown below).
How are episodes caused/triggered?
As shown above, genetic factors significantly increase the likelihood of developing BD. Other factors are may contribute to BD development are
1. Use of Alcohol and Recreational Drugs
2. Physical Illnesses
3. Chemical Imbalances in the brain
Imbalance in neurotransmitters
4. Stressful Triggers
Loss of a relationship
Neglect
Physical, sexual, and emotional abuse
Financial issues
These are especially harmful during childhood, as the brain has more neuroplasticity.
Treatment
Although Bipolar Disorder is a chronic condition, its symptoms can be controlled and minimised by the following activities:
1. Taking appropriate medication
Doctors often prescribe separate medication to treat symptoms of mania and depression. These act upon the neurotransmitters, located at the synapses between neurons.
Certain mood stabilisers, such as lithium, anticonvulsant medicines and antipsychotic medicines, are used for maintaining a constant mood. They are found to strengthen neural connections in the frontal lobe and the medial temporal lobe (amygdala). This prevents irrational decision-making and drastic shifts in mood, which bipolar patients are vulnerable to.
Although lithium may be a miracle drug for 30% of the global population, it has its side effects, which is why 25% of psychiatrists don’t recommend this treatment option. The side effects are:
Irregular heartbeat
Confusion, difficult concentrating, poor memory
Hand tremors
Headaches
Nausea and vomiting
2. Psychotherapy
This involves talking with a mental health professional about your condition and will help you keep track of your moods, feelings, thoughts, and behaviours, and how to regulate them.
3. Staying active and eating well
Exercising is a great way to promote the release of endorphins and reduce feelings of depression. It also improves the quality of sleep and enhances brain function. Secondly, a healthy diet endorses a routine, which helps to reduce stressful events (which can induce episodes).
4. Avoiding recreational drugs and alcohol
Recreational Drugs prevent the brain from adapting to the prescribed medication and slow down recovery. It is important to steer clear of these, as this will help you gain stability from the manic and depressive episodes.
5. Having a supportive community
It is important to have the proper support system to oversee you during manic or depressive episodes and to talk to about your feelings. These can be family members, close friends, and even a BD Support Group.
Seeking medical assistance
Although Bipolar Disorder can occur at any age, it is typically diagnosed during the early 20s, according to the National Institute of Mental Health (NIMH). Symptoms are especially difficult to identify in children and teenagers, as their manic and depressive episodes differ from those of adults with Bipolar Disorder. It may be that mood changes are affected by stress, trauma, or other mental health conditions instead of bipolar disorder. Hence, it is important to reach out to medical professionals, if you notice any abnormal changes in behaviour aside from typical mood swings, to identify the correct source of the problem.
Seeking emergency help
Suicide thoughts and behaviour are common with bipolar disorder, and approximately 15-20% of attempts in BD patients have resulted in death. Without treatment, feelings of depression will only get stronger. If you or a loved one is at risk for suicide, please seek emergency help immediately.
Bibliography
Cleveland Clinic (Ed.) (2021). “Mania”. Retrieved December 16th, 2022, from https://my.clevelandclinic.org/health/diseases/21603-mania
NHS (Ed.) (2019) “Living with Bipolar Disorder”. Retrieved December 16th, 2022, from https://www.nhs.uk/mental-health/conditions/bipolar-disorder/living-with/
Mayo Clinic (Ed.) “Bipolar Disorder”. Retrieved December 16th, 2022, from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
Web MD. (Ed.) “Treatment and Prevention”. Retrieved December 16th, 2022, from https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-treatment-care
Science Daily (Ed.) (2022) "Evidence of brain changes in those at risk of bipolar disorder captured with MRI scans." Retrieved December 16th, 2022, from www.sciencedaily.com/releases/2022/03/220328092055.htm
Mind (Ed.) (2022) “Causes of Bipolar Disorder”. Retrieved December 16th, 2022, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/causes-of-bipolar/
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