What Is Bipolar Disorder? Part 2
Understanding Bipolar Disorder: Gender Differences and Coping Strategies
Mental Health Series
I wanted to add some more information regarding bipolar disorder that expands on the first blog post.
Bipolar disorder is a mental health condition characterized by extreme mood swings, encompassing episodes of mania and depression. Bipolar disorder (formerly called manic-depressive illness or manic depression) is also known to cause unusual shifts in a person’s energy and activity levels, as well as concentration. It affects individuals regardless of age and gender, but recent research suggests that the manifestation and impact of bipolar disorder can vary between men and women. In this blog post, we’ll explore bipolar disorder and provide practical tips for coping with this challenging condition.
According to the Nation Institute of Mental Health: There are three types of bipolar disorder. All three types involve obvious changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
Types-
- Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
- Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
- Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.
During the manic phase of bipolar disorder, one might feel-
- Elevated Mood: People may experience an abnormally high or euphoric (happy) mood.
- Increased Energy: Some people have surge in their energy levels.
- Rapid Speech: Speech may become fast and difficult to interrupt. Often times people are unaware of their speech patterns. Others might notice this before they do.
- Impulsive Behavior: Individuals may engage in risky behaviors such as excessive spending, reckless driving, or substance abuse.
- Decreased Need for Sleep: During manic episodes, individuals may feel rested with little sleep.
During the “low” phase of bipolar disorder, one might feel-
- Persistent Sadness: Feelings of sadness, hopelessness, and emptiness characterize these depressive episodes.
- Fatigue: Individuals may experience low energy levels and physical exhaustion.
- Sleep Disturbances: Many experience changes in sleep patterns, such as insomnia or excessive sleeping.
- Changes in Appetite: Significant changes in appetite and weight may be observed.
- Difficulty Concentrating: Concentration and decision-making abilities may be impaired.
- Loss of Interest: Loss of interest or pleasure in activities that were once enjoyable (this is a major sign of depression in general).
During Mixed Episodes-
- Some individuals may experience symptoms of both manic and depressive episodes simultaneously or in rapid succession.
- Mixed episodes can lead to heightened agitation, irritability, and a sense of being “wired but tired.”
During Cyclothymic Symptoms-
- Cyclothymic disorder involves milder mood swings, with periods of hypomania and mild depression that don’t meet the criteria for full manic or depressive episodes.
Psychotic Symptoms-
- In severe cases, individuals may experience psychosis during manic or depressive episodes. This can include hallucinations or delusions.
Those with bipolar disorder often experience neurological and physiological changes that contribute to the symptoms and characteristics of this condition. These changes can be seen in the structure and function of the brain, as well as alterations in neurotransmitter activity. Research has come a long way, but more research is always needed.
Changes in the size and activity of the amygdala and hippocampus, brain regions involved in emotion regulation and memory, have been noted in individuals with bipolar disorder. The prefrontal cortex, the area responsible for decision-making and impulse control, may show structural and functional abnormalities in individuals with bipolar disorder.
Dopamine: Dysregulation of dopamine levels is associated with manic episodes in bipolar disorder. Elevated dopamine activity is linked to increased energy and impulsivity.
Serotonin: Imbalances in serotonin, a neurotransmitter that regulates mood, may contribute to depressive episodes in bipolar disorder.
Glutamate: Changes in glutamate, an excitatory neurotransmitter, have also been implicated in bipolar disorder. Alterations in glutamate levels may affect mood and cognitive function.
Hypothalamic-Pituitary-Adrenal (HPA) Axis: Dysregulation of the HPA axis, which plays a role in the body’s stress response, has been observed in individuals with bipolar disorder. This dysregulation may contribute to mood fluctuations.
Melatonin: Disruptions in circadian rhythms, including alterations in melatonin production (within the pineal gland), may contribute to sleep disturbances often experienced by individuals with bipolar disorder.
Inflammation: Some studies suggest that individuals with bipolar disorder may have elevated levels of inflammatory markers. Chronic inflammation is associated with various psychiatric conditions, including mood disorders. Chronic inflammation has been linked to so much more than we ever knew…but that’s for another post.
It’s important to note that these neurological and physiological changes are complex and oftentimes interconnected. Additionally, personal variations exist, and not everyone with bipolar disorder will exhibit all same symptoms or patterns of brain activity or neurotransmitter imbalances. Advances in neuroimaging and molecular research continue to enhance our understanding of the neurological underpinnings of bipolar disorder, leading to more targeted treatments and interventions.
Gender Differences in Bipolar Disorder:
Onset and Diagnosis-
- Studies indicate that women often experience the onset of bipolar disorder later in life compared to men.
- Women are more likely to receive a misdiagnosis, such as depression or anxiety, before being correctly diagnosed with bipolar disorder.
Symptom Presentation-
- Women with bipolar disorder may experience more depressive episodes than men.
- Men may exhibit more externalizing behaviors during manic episodes, such as irritability and aggression, while women may display internalizing behaviors like sadness and fatigue.
Comorbidities-
- Women with bipolar disorder are at a higher risk of developing comorbid conditions such as eating disorders and migraines.
- Men may have a higher likelihood of substance abuse issues co-occurring with bipolar disorder.
Hormonal Influences:
- Hormonal changes, such as those related to the menstrual cycle, pregnancy, and menopause, can impact the severity and frequency of bipolar episodes in women.
While the majority of individuals with bipolar disorder experience a combination of manic, depressive, or mixed symptoms, there are “less common” symptoms that may occur in some cases. These symptoms can vary in prevalence, and not everyone with bipolar disorder will experience them.
Here are five “less common” symptoms:
Psychomotor Agitation or Retardation-
- Psychomotor agitation involves excessive restlessness, fidgeting, or pacing, often observed during manic episodes.
- Psychomotor retardation, on the other hand, is a slowing down of physical movements and cognitive processes, often associated with depressive episodes.
Catatonia-
- Catatonia is a state of unresponsiveness or abnormal motor activity. In bipolar disorder, catatonia may manifest as extreme physical immobility or excessive, purposeless movement. Catatonia is a separate symptom category from both dissociation and psychosis.
Hypersexuality-
- Some individuals during manic episodes may experience a significant increase in sexual drive and engagement in risky sexual behaviors. This hypersexuality can lead to impulsive decisions with potentially serious consequences.
Seasonal Pattern-
- While not exclusive to bipolar disorder, some individuals may experience a seasonal pattern in their mood changes, with a higher frequency of episodes during specific seasons, such as spring or fall. The lack of sunlight significantly impacts mental health overall.
Mood-Incongruent Psychotic Features-
- In bipolar disorder with psychotic features, individuals may experience hallucinations or delusions that are not consistent with the prevailing mood. For example, during a depressive episode, they may have manic-like delusions.
It’s important to emphasize that the manifestation of symptoms can vary widely among individuals, and not everyone will exhibit these less common symptoms. Additionally, these symptoms may overlap with those of other mental health conditions, highlighting the complexity of bipolar disorder diagnosis. Individuals experiencing any combination of symptoms should seek professional evaluation and guidance for accurate diagnosis and appropriate treatment.
Coping Strategies for Bipolar Disorder:
Medication Adherence-
- Strict adherence to prescribed medications is crucial for managing bipolar disorder. Consult with a healthcare professional to find the most suitable medication and dosage. Many times, I have patients that start to feel better overall and then stop taking their medications, which then leads to a psychiatric crisis. I’m not a big proponent of medications when they are not necessary, but with this one, it is non-negotiable to include medications if you want to feel better and/or until your feel more stable in life. PLEASE DO NOT STOP TAKING YOUR MEDICATIONS WITHOUT CONSULTING WITH YOUR PROVIDER.
Therapy and Counseling-
- Psychotherapy, including cognitive-behavioral therapy (CBT) and interpersonal therapy, can be effective in managing bipolar disorder. People need to be able to have some self-awareness and rationality to understand when they start to feel differences in their mood and be able to notice their own behavioral patterns for this to work.
- Couples or family therapy can provide valuable support for individuals with bipolar disorder and their loved ones. Many people do not realize how badly this disorder can impact their relationships, especially with their spouses and immediate family. For children, a parent may be more impulsive or overstimulating during manic episodes, while during depressive episodes, parents may have reduced engagement and energy with their kids. Consistent and stable parenting can be challenging for those with bipolar on top of everyday struggles of life. There are many more ways that children are impacted by bipolar parents, but it can be managed with support.
Lifestyle Modifications-
- Maintaining a regular sleep schedule is vital, as disruptions in sleep patterns can trigger bipolar episodes. For more tips on how I regulate my sleep, click here.
- Incorporate stress-reducing activities such as mindfulness, yoga, and relaxation techniques into your daily routine.
Social Support-
- Establish a strong support system with friends, family, and support groups. Open communication about your condition can help others understand and provide necessary support. Many people feel shame when they get a diagnosis of bipolar disorder. Please try not to judge or criticize people suffering from this disorder. If you cannot provide adequate support, please let them know that. For patients, if you do not have a good support system, please let your provider know so that they can help you with resources.
Monitoring Triggers-
- Identify and monitor personal triggers that may contribute to mood episodes. This could include stress, certain relationships, or lifestyle factors. Once you know your triggers, you can work to avoid, eliminate, or mitigate those triggers.
While a balanced diet (low in sugar and processed foods) and medications prescribed by healthcare professionals are the primary approaches to managing bipolar disorder, some individuals explore the use of supplements as complementary measures. It’s crucial to note that supplements should be discussed with a healthcare provider before adding them to your regimen, as they may interact with medications or have varying effects on individuals.
Here are some supplements that have been studied in relation to bipolar disorder:
Omega-3 Fatty Acids-
- Found in flaxseeds and fish oil, omega-3 fatty acids have anti-inflammatory properties and may play a role in overall brain health.
- Some studies suggest that omega-3 supplementation may help reduce mood swings in individuals with bipolar disorder, as well as many other mental health issues.
Vitamin D-
- Vitamin D is essential for overall health, and deficiencies have been linked to mood disorders.
- Limited exposure to sunlight, which contributes to vitamin D synthesis, may be more common in individuals with bipolar disorder. Supplementing with vitamin D may help address deficiencies.
- Light therapy devices many also help. Amazon has tons of these like this highly rated one here.
N-Acetylcysteine (NAC)-
- NAC is an antioxidant that has been studied for its potential benefits in various mental health conditions, including bipolar disorder.
- Research suggests that NAC may have mood-stabilizing effects and could be beneficial in reducing symptoms of bipolar disorder. This is one of my most recommended mental wellness supplements. NAC helps with so many things beyond mental health. Buy it here.
S-Adenosylmethionine (SAMe)-
- SAMe is a compound that naturally occurs in the body and plays a role in various biochemical processes, including the production of neurotransmitters.
- Some studies have explored the use of SAMe as an adjunctive treatment for bipolar disorder, suggesting potential mood-stabilizing effects. BE CAUTIOUS with this supplement as it could adversely impact some anti-depressants. Please consult your provider.
Magnesium-
- Magnesium is involved in numerous biochemical reactions in the body, including those related to mood regulation. Magnesium is a crucial electrolyte.
- Some research suggests that magnesium supplementation may have a positive impact on mood and could be considered as part of a comprehensive treatment plan. This is one of the most underrated supplements of all time in my opinion. There are many forms of magnesium to choose one, so be mindful to select what is right for you. Magnesium citrate and glycinate seem to be the best for those with bipolar disorder. I get my magnesium via Epsom salts topically in my bathwater, here is what I use. Epsom salt is even safe to add in children’s baths.
It’s important to approach supplements cautiously and with professional guidance. The effectiveness of supplements can vary among individuals, and their potential interactions with medications must be considered. Additionally, supplements should not be viewed as a substitute for prescribed medications or other evidence-based treatments. Always consult with a healthcare provider before introducing any supplements into your routine and keep your providers informed about all the substances you are taking.
Bipolar disorder is a complex condition that affects individuals in diverse ways. Recognizing and understanding the multifaceted aspects of bipolar disorder is essential for effective management and support. By implementing practical coping strategies and seeking professional help, individuals with bipolar disorder can lead fulfilling lives, breaking the stigma associated with mental health conditions. If you or someone you know is struggling with bipolar disorder, reach out to mental health professionals for guidance and support.
To read the entire article go to: What Is Bipolar Disorder? Part 2 — All For Myself
