Manic Depressive Disorder: Understanding the Diagnosis

We all experience our share of ups and downs but with manic depression one experiences these highs and lows quite intensely, affecting one’s job and school performance, personal relationships, and altogether disrupting one’s daily living.

Bipolar disorder was formerly known as manic depressive disorder. It is serious mood disorder marked by abnormal levels of mania and depression. Both these moods fall on two extremes on a spectrum, causing a serious effect on the individual’s mood, activity and energy levels. Mania is marked by elation, heightened energy levels and depression is marked by feelings of sadness, low and hopeless. Individuals may also experience hypomania, which are less severe manic episodes.

During a manic episode an individual may probably sleep for 3 hours and feel quite energetic, have an inflated sense of self, talk excessively, have poor attention, indulge in numerous activities, be impulsive wherein they would spend exorbitantly or engage in reckless activities, etc. Whereas in a major depressive episode an individual would experience low energy, low mood where they feel sad, hopelessness or emptiness, they would not find any activity interesting even the ones they previously enjoy, either sleep or eat too much or too little, low sense of self and feelings of guilt, decreased ability to think and have thoughts on death or suicide..

There are types within the bipolar disorders they include:

• Bipolar I disorder – It is characterized by manic episodes that last for at least 7 days followed by hypomanic episodes or major depressive episodes which should last about 2 weeks. Individual could also experience both symptoms of depression and manic at the same time.
• Bipolar II disorder- It is characterized by one or more than one major depressive episodes and at least one episode of hypomania. Individuals with bipolar II disorder experience more depressive episodes than episodes of hypomania.
• Cyclothymic disorder- It is characterized by an innumerable periods of hypomanic symptoms and depressive symptoms that last about 2 years in adults and 1 year in children and adolescents. Here individuals do not meet the diagnostic criteria for a hypomanic episode and a depressive episode, which are severe than the symptoms.

Causes of Bipolar Disorder

The causes of bipolar disorder aren’t entirely known. But, over the years, doctors have gained a better understanding of the bipolar spectrum – the highs of mania to the lows of major depression, including the various mood states between the extremes.

Generally, bipolar disorder is seen to run in families. Besides, evidence has also pointed out that an individual’s environment and lifestyle also make an impact on the severity of the disorder. Manic depression can be very difficult to treat if the individual is a victim of alcohol or drug abuse or dealing with extremely stressful life events.

Many experts are also of the opinion that bipolar disorder or bipolar behaviour stems from an underlying problem with the functioning of brain chemicals and specific circuits.

Who to Go to If You Have Bipolar Disorder? 

Since you may need medications for bipolar disorder, it’s best to see a psychotherapist since they know when and which drugs to administer to treat you. Although primary care doctors such as general practitioners can help with an initial diagnosis like depression, diagnosing a complex disorder like bipolar disorder can only be done by a trained psychotherapist. 

Psychologists and mental health counsellors can offer psychotherapy as a part of treating bipolar disorder. They can also perform psychological and neuropsychological testing as part of the diagnosis process. 

When Is Bipolar Disorder Diagnosed?

Usually, bipolar disorder in individuals can appear between the ages of 15 and 24 and persist for an entire lifetime. Although rare, bipolar disorder or manic depressive disorder has been seen in young children and adults over 65 years of age as well.

People with bipolar disorder tend to have symptoms with varying levels of severity. While the symptoms in some may be quite less, in others, it may affect their ability to carry on with the day to day activities and lead a normal life. Bipolar disorder is marked by relapses and remissions, and in case of severe mania, patients have to be hospitalized to keep them from engaging in risky behaviours.

Individuals with severe depression also need hospitalization to prevent them from acting on suicidal thoughts and psychotic symptoms, such as delusions, disorganized thinking, and hallucinations.

How Is Bipolar Disorder Diagnosed?

There is no laboratory test or brain imaging method to diagnose bipolar disorder, but a doctor or therapist can evaluate the signs and symptoms after a physical exam. Usually, they will ask a question about personal medical history and family history. A lab test will be done to check for any medical illnesses that may be affecting the mood.

Once that is ruled out, they may talk to the family members to identify any events when the person was overly elated or energized. Although the feeling elation may feel good or normal during periods of depression, in bipolar disorder, it is hard to judge whether the mood was too high. Individuals in a manic phase may make unwise business or financial decisions and display social behaviour that can cause serious problems and embarrassment.

How to Know if you Have Bipolar Disorder? 

People with bipolar disorder generally tend to have frequent mood and energy shifts. There are several different symptoms that each individual faces, based on the type of bipolar disorder, that can be classified under manic or depressive episode. 

Some of the symptoms of manic episode are:

• Feeling euphoric
• Higher energy or activity levels 
• Restlessness
• Speaking very fast
• Irritability
• Insomnia
• Reckless behaviour

Some of the symptoms of depressive episode are:

• Feeling sad and hopeless
• Lower energy and activity levels
• Difficulty in concentration
• Lack of sleep
• Tiredness
• Suicidal thoughts

Many people with bipolar disorder are not aware when their moods are affecting their daily functioning. Most bipolar disorder patients don’t get the right treatment for their symptoms. Since most of them get medical help during their depressive phases, they are prone to be diagnosed with depression. 

In some cases, they may need urgent medical attention too. Some of the emergency situations in which you should get help are: 

• Getting suicidal thoughts
• Prone to causing self-harm
• Prone to causing danger to yourself or others

How Is Bipolar Disorder Treated?

Bipolar disorder or mania disease is a condition that stays lifelong. The primary treatment method for depression is a combination of medications and psychotherapy. Depending on the individual’s condition, treatment may include the following.

• Medications: Mood stabilizers like lithium can help in controlling mania or depression symptoms. Anticonvulsants, benzodiazepines, and antipsychotics such as olanzapine (Zyprexa) and ziprasidone (Geodon) can be helpful in stabilizing the mood. Antidepressants, antidepressant-antipsychotics such as Symbyax, and anti-anxiety medicines such as benzodiazepines may also be given to boost the mood.
• Maintenance treatment: As bipolar disorder is a lifelong condition, maintenance treatment is necessary even during times when the individual is feeling better. Skipping this can lead to a high risk of relapse or turn minor mood changes to full-blown mania.
• Day treatment programs: Such programs provide the support and counselling needed when symptoms are under control.
• Psychotherapy – This is an important part of bipolar disorder treatment and can be done in individual, group, or family settings. There are various types of psychotherapy such as interpersonal and social rhythm therapy (IPSRT), cognitive behavioural therapy (CBT), psychoeducation, and family-focused therapy. 
• Hospitalization: Hospitalization is necessary when the patient has suicidal tendencies and is detached from reality. 
• Treatments for bipolar disorder will also include the participation of the patient in education and support groups.

In some cases, other treatments can also be used depending on your need. If none of the above options work, you may move on to electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). 

 

Bipolar disorder is a treatable and manageable illness. A combination of medications such as antipsychotic, mood stabilizers and antidepressants along with psychotherapy like cognitive behavioural therapy (CBT), interpersonal therapy, family-focused therapy and social rhythm therapy would aid in treating and keeping a check with the illness. An effective treatment is an essential part of an individual’s recovery along with support from family, friends and community members. For treatment of bipolar disorder, call us now on +919611194949.