Bipolar Disorder

Biology 202
2006 Third Web Paper
On Serendip

Bipolar Disorder

Faiza Mahmood

Bipolar disorder is a disorder that causes unusual shifts in a person's mood, energy, and ability to function. We all know that everyone has their good days, and their bad days. We all have our ups and downs—this is all part of life. However, this is quite different from the symptoms that characterize bipolar disorder. Bipolar disorder, often referred to as manic depression, is a serious and chronic mental illness that is characterized by dramatic and disruptive mood swings ranging from high (manic) to low (depressive) states. It is one of the most common, severe, and persistent mental illnesses that exist today. (1). It is estimated that more than 2.5 million Americans have bipolar disorder. However, this figure may be largely inaccurate because bipolar disorder is difficult to detect and is often misdiagnosed As many as 80 percent of individuals go undiagnosed or misdiagnosed for up to 10 years. (6)

Bipolar disorder is an illness that causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. (2). It might be helpful to think of the various mood states of this illness as a spectrum or continuous range. At one end is severe depression, which includes moderate depression; then comes mild and brief mood disturbances, then normal mood, then hypomania (a mild form of mania), and then mania. (5).

Symptoms of the manic state include increased energy, restlessness, increased libido, racing thoughts and talking, a decreased need for sleep, excessive euphoria, reckless behavior without regard for consequences, unrealistic beliefs in one's ability and powers and severe thought disturbances, which may or may not include psychosis. Symptoms of the depressive state include loss of interest or pleasure in activities once enjoyed; a distinctly low or irritable mood; change in appetite and sleep patterns; fatigue, and thoughts of death or suicide, or suicide attempts. (7) Between these highs and lows, patients usually experience periods of higher functionality and can lead a productive life. Sometimes, sufferers may experience mixed episodes, when they feel both manic and depressive symptoms simultaneously (2)

The symptoms described above are primarily characteristic of BPI. However, varying degrees of bipolar disorder exist. BPII is a milder disorder consisting of depression alternating with periods of hypomania. Hypomania is essentially a less severe form of mania that does not include psychotic symptoms or lead to major impairment of social or occupational function, which BPI does. There are also different subtypes of bipolar disorder, depending on the frequency of the episodes. A person suffers from rapid cycling when they experience four or more episodes per year. Ultra rapid cycling is similar to rapid cycling except the episodes occur more often, experiencing four or more episodes per week. (5) Thus, the type, severity and duration of mood episodes experienced can vary. Some individuals might have a predominance of either mania or depression, whereas some sufferers may experience equal numbers of both. However, in general the depressed mood tends to last longer than the manic mood. If left untreated, these episodes can last from several days to several months. (6)

No racial predilection exists for this illness and the disorder seems to be equally prevalent among genders, although rapid cycling is more common in women. (1) However, the timing of when Bipolar disorder typically develops can vary. It usually tends to occur in late adolescence or early adulthood. Nevertheless, some people can have their first symptoms during childhood, and some develop them late in life. In its early stages bipolar disorder may be often seen as more of a problem rather than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen and the person experiences episodes of full-fledged mania and clinical depression. (1)

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. (1) Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnosis of BPI usually requires the presence of a manic episode of at least 1 week's duration that leads to hospitalization or other significant impairment in occupational or social functioning. This episode of mania cannot be caused by another medical illness or by substance abuse. This also may or may not include the occurrence of a depressive episode. (7)

The causation: of bipolar disorder is still unclear. The disorder symptoms appear to be caused by biochemical imbalances of hormones or certain neurotransmitters in the brain (especially dopamine, serotonin, norepinephrine, and acetylcholine). However, the cause of this imbalance is unclear. (6) Often times bipolar disorder tends to run in families, which leads to the proposal that there are genetic factors involved in producing this imbalance. The gene for bipolarity has mainly been traced to chromosome 18 as well as some others. However this is uncertain because it has been found in some cases that chromosome 18 is unaffected in bipolar patients. It also, likely that bipolar disorder is linked to several genes acting together. However, this may not be the only cause of bipolar disorder, as evidenced by studies of identical twins, who share all the same genes. These studies indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. (6) Therefore, what are other possible causes?

The psychodynamic theory holds that the dynamics of manic-depressive are linked through one common pathway. Practitioners of this theory feel that depression is a manifestation of the losses (the loss of self-esteem and the sense of worthlessness.) Therefore, mania serves as a defense against the feelings of depression. However, biochemical causes seem to implicate the opposite of this proposal and hold that multiple biochemical pathways are most likely contributing to bipolar disorder. For example the blood pressure drug reserpine, which depletes catecholamines from nerve terminals, was noted to cause depression. This led to the catecholamine hypothesis, which holds that an increase in epinephrine and norepinephrine causes mania and a decrease in epinephrine and norepinephrine causes depression. Other things that may exacerbate mania include hormonal imbalances and disruptions of the hypothalamic-pituitary-adrenal axis involved in homeostasis and the stress response, causing symptoms of bipolar disorder. Lastly, environmental factors may play a role in the onset of bipolar disorder. It seems that in some cases the cycle the illness may be directly linked to external stresses or the external pressures, which may be serving to exacerbate some underlying genetic or biochemical predisposition. (7) It seems that there is no single cause for bipolar disorder but rather many factors act together to produce the illness. It may be that although the initial triggers of bipolar disorder may begin differently and take different pathways, they all ultimately lead to a common pathway that induces the illness in those who experience it. It also still seems unclear to me whether the biochemical imbalances are a cause of mood disorders, a result of the symptoms, or a little of both.

Although the cause of bipolar disorder may be unclear, one thing that is clear is that bipolar disorder is a serious lifelong struggle and challenge (7) If left untreated it can result in damaged relationships, poor job or school performance, and even suicide. However, with treatment people with this illness can lead full and productive lives. (2) Theoritically there is no cure for bipolar disorder; however treatment to cope with the illness is available. Two forms of treatment exist, physiological, and psychotherapeutic. Different categories of drugs are used to help cope with the illness including, mood stabilizers, anti-depressants as well as anticonvulsants. The two most commonly used medications are lithium and valaproate. Lithium, a mood stabilizer, can control episodes and decrease the likelihood of reoccurrence, but it is still unknown exactly how it works and why it works for some and not others Valaproate, an anticonvulsant or antiepileptic drug (AED), that can also be used as a mood stabilizer and is usually used in cases where the patient cannot stand the side effects of or does not respond to lithium. (7) Psychotherapeutic treatment may include behavioral therapy, family therapy and general education about the disease. Because bipolar disorder is a recurrent illness, long-term preventive treatment is encouraged. A strategy that combines medication and psychosocial treatment is usually optimal for managing the disorder over time. (6).

Bipolar disorder, is an illness that raises questions and challenges the concept of brain=behavior. It is diseases like this one which makes us reexamine the whole concept of brain=behavior. During both manic and depressive episodes, the person loses control on a behavioral level. However is this behavior equivalent to what is occurring in the brain, or is it due to something that, that seems to override the so called force of the brain?

Whatever the force may be that is responsible for the symptoms associated with bipolar disorder, it is nevertheless, a very real illness that can have a devastating impact on many people. Close personal experience with bipolar disorder has sparked my interest in this topic. My father was very recently diagnosed with bipolar disorder, and I have first handedly witnessed many of the symptoms and behaviors previously discussed. Bipolar disorder is undiagnosed all too often and the consequences of this can be very hard for not only the person with the illness but those that surround them as well. Like other serious illnesses it can be hard on spouses, other family members and employees. Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees and out of control behavior) and the lasting consequences of these behaviors. (6)

Initially upon begging my research, I was aware of the basics of bipolar disorder; however my understanding included only that extreme shifts of moods occured, ranging from depression, to mania, or even psychosis. However; I was largely unaware of the actual symptoms and behavioral characteristics of the disorder. Upon starting my investigation, I had a lot of unanswered questions. Was bipolar disorder something that could just appear? When does it usually emerge? Can it really be undiagnosed for that long a time period? Many of these questions were answered by my research. Initially, the diagnosis didn't make much sense, as there is no family history of bipolar disorder in our family. However, it seems that multiple factors may have cause the onset of the illness, and perhaps there was a rare genetic mutation that occurred causing the onset of the illness that may or may not have included environmental triggers targeting the genetic or biochemical predisposition of the illness.

I feel as though through research and personal experience that there are alarmingly high rates of misdiagnosis and under-diagnosis of bipolar disorder. This is something that must be addressed. Bipolar disorder is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. (6) Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life. (6) For this reason awareness of recognizing the illness and urging those experiencing its symptoms to seek help must be made. An NMHA survey recently revealed that while more than 60 percent of people can identify bipolar disorder as a mental illness; however more than two-thirds of those surveyed said they had limited or no knowledge of it. (3) This points to gaps in public awareness of the illness. It just seems that there are too many Americans living with bipolar disorder that are unaware of the illness and the toll it may be taking on their lives, work and relationships. Bipolar disorder can have serious, life-altering consequences if left untreated. In fact, bipolar disorder has one of the highest mortality rates among all mental illnesses. Approximately 25-50% of those with bipolar disorder attempt suicide and 11% actually commit it. (7)

There is also certain stereotypes and stigma surrounding bipolar disorder that still persists today, thereby discouraging people who may have the illness from seeking a diagnosis and treatment. Many people think that people with bipolar disorder are just crazy; they do not consider it an illness. This is not the case, in fact many people with bipolar disorder have been some the worlds most talented and famous people today and during history. Beethoven, Winston Churchhill, Mark Twain, Marilyn Monroe, Larry King, Billy Joel, Elton John to name a few noteworthy individuals. (4). Nevertheless, there still seems to exist a stigma surrounding bipolar disorder, which may be in large part due to the fact that the media's role in coverage of bipolar disorder seems to be more negative then positive. Whatever, the case the stigma surrounding bipolar disorder must be eliminated.

People must educate themselves and others about bipolar disorder and other mental illnesses. I know that I for one would have liked to have had more knowledge about the disorder so that the undiagnosis in my own family wouldn't have gone undiagnosed for so long. However, for those who have the illness or know someone who does it is important to realize that this illness can be a very treatable one. It is possible to restore one to their "normal" selves, that is to say their nonmaniac or depressive selves. I have begun to recently witness the power of treatment myself. There does seem to much hope for those with bipolar disorder, for those who are lucky enough to be properly diagnosed, at least.