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Get in the Know: Basics about Bipolar Disorder

Bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. Jenni Nierstheimer-Jaroscak, MD, NorthShore Clinical Psychologist, tackles some of the common questions:

What is bipolar disorder?
Bipolar disorders are mood disorders markedly by changes in mood and energy. An individual may at times feel excessively elated, impulsive, irritable, or irrational (called mania) or hypomania (a milder form of mania). Other times they may feel excessive sadness (called bipolar depression).

Can you talk about some of the common symptoms of bipolar disorder?
Bipolar Disorder is categorized in two ways; Bipolar I and Bipolar II. Common symptoms of Bipolar disorder I include a manic episode preceded and/or followed by a hypomanic or major depressive episode. Symptoms of a manic episode include a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy for at least 1 week or more.

During a manic episode, additional symptoms may include:

  • Inflated self-esteem
  • Rapid speech
  • Jumping from topic to topic
  • Decreased need for sleep
  • Distractibility
  • Frenzied presentation to complete tasks or multiple tasks at one time
  • Involvement in activities that have a high potential for danger

The elevated mood can impact areas of functioning (relationships, work, etc.) and/or require hospitalization. Additionally, research has shown more than 60% of individuals with bipolar disorder abuse alcohol and or drugs. The main difference with Bipolar II is the manic episode is milder and may not last as long.

What are the noticeable similarities and differences between major depression and bipolar depression?
Similarities between these two include feelings of sadness, having trouble doing ordinary things like getting dressed, cooking and attending to responsibilities at work or school. The individual may have little or no interest in activities once enjoyed. Additional similarities include appetite changes, troubles with sleep, loss of energy, feeling worthless and/or guilty, difficulty concentrating and or making decisions and possibly thoughts of death or suicide.

Bipolar depression is likely to be more melancholic in quality than depression experienced alone. What this means is the individual has a near-complete absent capacity for pleasure. The interest in activities is not merely diminished, but absent entirely. The individual can not experience joy even temporarily when good events occur. The individual may also display visible slowing of physical and emotional reactions, including speech and facial expressions. While sleep troubles and appetite changes are observed in both, an individual with bipolar depression may experience these symptoms more commonly and more intensely.

How bipolar depression currently is treated? (meds, therapy, etc)
Treatment recommendations include a combination of medication management and psychotherapy. One treatment difference between bipolar depression and unipolar depression is antidepressant medication management is typically not recommended in bipolar depression. Once the worst symptoms of mania or depression are under control, treatment focuses on preventing a recurrence.

People who have suffered a manic episode are often advised to continue taking medicine(s) to control bipolar disorder. This usually includes a single mood-stabilizing medicine. Other medicines may also be recommended if, for example, a single drug is not helpful or you cannot tolerate the side effects.

Usually, after the acute episode has passed and/or is being treated with medications, psychotherapy is an important role in treatment. Therapy options include:

  • Cognitive Behavioral Therapy (CBT)
  • Family-focused therapy
  • Education
  • Dialectival Behavioral Therapy (DBT)
  • Support groups
  • Interpersonal and social rhythm therapy (IPSRT)

IPSRT focuses on managing sleep patterns, daily routines, and mealtimes. A consistent routine allows for better mood management and individuals with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise

What are some misconceptions that people/media seem to have about bipolar disorders?
Common among many mental illnesses, mood disorders are often misunderstood and stigmatized. Some misconceptions include mood disorders are a state of mind and can be treated by “thinking positively.”

Other misconceptions include individuals with a mood disorder are dangerous, unable to hold jobs, should not have children and/or a partner and are incapable of independent living. Individuals are often unaware there are different types of bipolar and each type of bipolar disorder has its own criteria and symptom presentation.