Mania and Depression must both be present for bipolar diagnosis

For our next series, we are going to look at bipolar disorder, beginning with a summary of the condition today, before later moving onto exploring what the condition means for those who are suffering from it, the range of treatment options available, and a look at the common medications prescribed to help patients deal with their condition.

Defining Bipolar Disorder

Bipolar disorder is defined at[1] as the following;

“An affective disorder characterized by periods of mania alternating with periods of depression, usually interspersed with relatively long intervals of normal mood.”

There are currently no concrete figures available in terms of numbers of people who suffer from bipolar disorder.  There are several reasons for this.  First, much is still being understood about various mental illnesses, meaning that several people are likely to be mistakenly diagnosed with bipolar disorder, while at the same time some individuals may go undiagnosed altogether.

Alongside this, we have to consider the stigma that is attached to mental illness, even today, which means that people will inevitably be suffering from bipolar disorder and likely be aware of it, yet through a misplaced sense of shame or embarrassment are not prepared to visit a doctor or psychiatrist, for example, to discuss their condition.

One common misconception that is held around bipolar disorder is that people ‘are depressed’ all of the time, and the issue of euphoric episodes as a sign of bipolar disorder are often ignored, or not even known, by the layperson.

Signs of Bipolar Disorder

In fact, exhibiting manic behaviors is what is used in many cases to define a patient as suffering from bipolar disorder rather than a more general form of depression.  Mania is defined as a prolonged period of either elevated or excitable mood, and can last for a period of up to a week.  At times, this leads to patients being admitted to hospital to manage their euphoric state, while patients who have been previously diagnosed may have learned skills to help them deal with this period.

Mania is different in how it affects each individual, and is similar to the effect of drinking alcohol in that regard.  Some become happy and may burst into spontaneous laughter, while others can quickly become irritable, angry, and aggressive.  Unsettled sleep is one of the main ways that manic episodes can be foreshadowed; however increased anxiety and changes in appetite are known to occur up to three weeks before mania takes hold.

Hypomanic episodes are not as severe as manic ones, and in many cases those having an episode exhibit many of the behaviors seen in ‘happy’ occurrences of mania.  Often, hypomania can go untreated, especially if it is not followed by a depressive stage, as individuals and those around them regularly fail to recognize what is happening.  At the same time, hypomania is not always believed to be problematic, although those who do suffer mood swings require urgent treatment.

The depressive stage of bipolar disorder mirrors the signs of ‘normal’ depression, with feelings of sadness, anxiety, guilt, and many more taking over a person’s mentality.  It is important to remember that bipolar disorder cannot, or should not, be diagnosed without evidence of manic or hypomanic episodes in addition to depression.  It is also possible for those suffering from bipolar disorder to experience ‘mixed episodes,’ where depressive and manic feelings are experienced in quick succession, or even at the same time.  These can be the most dangerous episodes of all in terms of bipolar disorder, and risk factors relating to a person’s behavior can increase dramatically at this time.

What Causes Bipolar Disorder?

There is currently little scientific evidence to suggest definitively that one or a combination of factors is responsible for causing bipolar disorder.  There is no strict ‘risk analysis’ available that states whether one person is more likely to develop bipolar disorder than another, and the similar numbers of men and women who suffer from the condition clouds this issue further.

However, there have been a number of theories but forward in an attempt to unlock the mystery behind this condition.

  • Children whose parents are older are believed to be at a marginally higher risk of suffering from bipolar disorder throughout their lives.  This theory is linked to genetic mutations that occur as we age, and are subsequently passed to our children during the reproduction process.
  • Abnormalities within the brain have also been linked with bipolar disorder, although not to the extent that they have been to depression as a stand-alone condition.  Given the variation in condition from mania to depression, it has been difficult for scientists to find any consistency in looking for the cause of bipolar disorder.
  • Traumatic events play a part in the development of several mental illnesses that develop in later life, and bipolar disorder is no different in that respect.  However, suffering traumatic and abusive experiences as a child has never been, nor is it likely to be, given as a sole cause of bipolar disorder.  There is also nothing to suggest that a person is more at risk of developing bipolar disorder than other illnesses, such as post-traumatic stress disorder, having experienced trauma at a young age.

Away from these studies and theories, there has been debate among the scientific community for a number of years concerning a potential link between cannabis use and bipolar disorder.  While the link between cannabis use and paranoia is well documented, there is as yet no scientific studies to support the claim, although consensus does seem to be growing.  There is doubt, however, as to whether bipolar disorder is an outcome of using cannabis, or whether it is the other way round, given that increased risk of substance abuse is a known risk factor for those with the condition.

There is still much to be understood about bipolar disorder, and it could be argued that progress is slowed by misconceptions and a willingness by many to base arguments on opinion, rather than the evidence placed before them, which is currently lacking in any real weight.

In our next installment, we will go on to look at the potential consequences of bipolar disorder.



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