What is BPD, and What does BPD mean to you?
Bipolar Disorder is a mood disorder which ranges from the very highs to the very lows. This goes beyond the normal ups and downs that an individual may experience from time to time, and usually a patient of BPD experiences these mood changes as a crisis, or it is very noticeable, especially by others around them. The hallmark of BPD is the manic and depressive episodes. BPD is episodic, and each diagnosis of BPD relates to a certain combination of episodes. For instance, BPD I is characterized by at least one full blown manic episode in a lifetime. That is all that is necessary for that diagnosis.
BPD can be a very manageable disease when a patient is properly medicated with mood stabilizers or antipsychotic medications. These medications are designed to keep a patient balanced. They keep the 'manic' episodes from flaring up which makes a person irritable, excited and extremely energetic. Also, these medications can keep the depressive episodes at bay, which are periods of time when a patient is overly tired, sleepy, and feels a loss of enjoyment from normal activities, as well as acting a little retarded.
The causes of BPD are not to be determined to be exact. Rather, experts believe that BPD is a combination of causes that actually attributes to the diagnosis. The general, and most researched causes are Genetic, Brain Structure, and Traumatic Trigger Events.
Recent studies by the National Institute of Mental Health show that BPD is largely a genetic disease, with the certain chromosomes being factors for the eventual diagnosis of BPD. Such studies have pinpointed the actual sets of chromosomes that bring on BPD. Other mental illnesses such as Autism, Depression and Schizophrenia share a certain percentage of the genes that can lead to BPD.
It has long been understood that the family line of an individual pertains to whether or not a certain individual will or can get BPD. If a grandparent, parent, uncle, aunt, sister, or brother has BPD, there are certain percentages that explain how a certain individual may contract the disease. Even twins have an unusually large percentage chance of both getting the disease, in the case of identical twins, which have the exact same genetic makeup. It is also noted that when both parents of a child have BPD, the chance of the child getting the disorder is increased dramatically.
However, on the note of the twin studies, not all twins get BPD in the same way. In a certain percentage, sometimes only one of the twins get BPD, which goes to show that there are other factors in the development of the disease. Scientists say that BPD has to do with the developmental brain structure and traumatic life events of that individual.
Brain Structure, Development and Traumatic Trigger Events
The brain structure has a lot to do with the development of BPD. In children, the prefrontal cortex develops at a different rate, and quality such that the lack of development causes mental illnesses of children, including ADHD and Bipolar Disorder. And as such, this developmental abnormality is what causes BPD in adults as well. Studies have shown that adults with BPD have a less developed prefrontal cortex which has to do with executive functions and decision making. This was determined by analyzing MRI or magnetic resonance imaging tests.
The causes of brain structure development and Bipolar Disorder has a lot to do with genetics, however, as it was described with twin studies, there are certain variables to the development of BPD, because a person containing the genes and chromosomes of bipolar propensity does not necessarily denote that an individual will get the disease. These variables or the wild cards in this situation are the development, and thus the activities and experiences that an individual has that allow or disallow certain formations within the brain and prefrontal cortex. Such variables or qualities or activities an individual can experience are things such as drug abuse, divorce, mental, emotional or sexual abuse, losing a partner in a important relationship, car accidents, head trauma, whether or not an individual studies a great deal, or plays games which build the brain, diet, nutrition, or exercise or other unknown environmental variables.
Traumatic events almost always precede and account for criteria for having Bipolar Disorder. For instance, if an individual spends all their money, engages in promiscuous sex, or makes a bad investment, these activities actually not only are traumatic, but count towards the explanation for having the disorder. As a result, it should be explained to children not to engage in these activities or to take extreme care, because the consequences can be a double whammy. No wonder our parents taught us not to engage in these types of behaviors, or to be careful of these behaviors or outcomes.
Bipolar Disorder Signs and Symptoms
Bipolar Disorder is made up of episodes. Because Bipolar Disorder is episodic, we should all look for these signs, like psychiatrists, to determine if someone is potentially Bipolar. A Manic episodes is the episodic behavior when the individual is feeling a persistently elevated mood. This includes speaking incessantly, or having a pressure to keep on talking. It also includes risky sexual escapades, or poor or risky investments, as well as spending sprees. Depressive episodes typically last one to two weeks. They include marked increased need for sleep, loss of pleasure of activities that were normally pleasurable, marked slurred speech or retardation, suicidal thoughts or tendencies, and others. Most episodes, except hypomanic episodes need to last for one to two weeks to qualify.
Hypomanic episodes are like manic episodes, except they are not psychotic, and only need to last for three days. These episodes do include the marked elevated mood and temperament, and goal directed behavior, and can be quite productive and elated periods of time. Psychotic tendencies of Bipolar Disorder include hallucinations, or thinking that one is God, the President of a Country, or a famous person, or that one has relations with famous families or personages.
Substance Abuse may also be a symptom, as the substance of choice may be used excessively to self medicate the problems of mania or depression away. Although the individual will think that they are helping the situation, they may find that they cause themselves to turn psychotic, and may take a hypomanic episode to a full blown manic episode. The only medication that should be taken during these episodes should be antipsychotic medications, or mood stabilizers.
Lastly, an individual may experience a mixed state, which would be a mixture of both manic and depressive symptoms. This includes a persistently elevated mood with retardation, and low self worth, extreme sleepiness, but extreme energy while awake, and marked weight gain or loss.
Who is at Risk?
Most of the people who are diagnosed are determined to have Bipolar Disorder before the age of 30. Some patients are even diagnosed at first in their childhood. This trend is increasing at an alarming rate. Overall, Bipolar Disorder strikes at an earlier age.
Bipolar Disorder Diagnosis
Diagnosing Bipolar Disorder can be a complex task. It is done by a psychiatrist. The DSM is used as a guideline to determine what mental disorder the patient is exhibiting. The DSM stands for the Diagnostic and Statistical Manual for Mental Disorders. It is a large volume dedicated to the classification, codification, and description of mental disorders, including Bipolar Disorder. If you think that you are a candidate for Bipolar Disorder, your psychiatrist will be looking at your most recent mood episode, (manic, hypomanic, depressed) and your past, and current symptoms to make a diagnosis.
Bipolar I Disorder is a type of Bipolar Disorder that an individual can qualify for if they have had at least one manic epsisode in their lifetime. Remember, that a manic episode usually contains a form of psychosis or contains delusions. The individuals diagnosed with Bipolar I may also have depressive episodes or hypomanic episodes, however, they will have had at least one manic episode in their lifetime. Bipolar Disorder II usually contains hypomanic episodes and depressive episodes, and by nature does not contain any psychosis associated with mania. Some arguments have been made that Bipolar II may be the more damaging form of Bipolar Disorder because patients may experience more hypomanic episodes, and may not seek treatment for them, and further, that Bipolar II Disorder is not to be considered the lesser form of Bipolar Disorder just because these patients are not experiencing psychosis.
Rapid Cycling is determined when someone has four or more mood episodes in a calendar year. This type of Bipolar Disorder diagnosis usually is prevalent in the younger age groups of children and adolescents. Bipolar Disorder Not Otherwise Specified is a terminology used when the patient displays bipolar symptoms, but does not meet the criteria of Bipolar I or Bipolar II. And finally, Cyclothymia is used as a specifier when patients display hypomanic symptoms and mild depression but do not meet the criteria of Bipolar II.
A psychiatrist will discuss with you your family history, as it is necessary to delve into your lineage to determine if the Bipolar family of Disorders runs in your family. Also, a psychiatrist will discuss any of your other medical conditions to try to rule out your symptoms, and whether they might be due to another condition such as stroke, heart attack, a brain tumor, or some other serious medical condition that causes Bipolar symptoms.
Remember that diagnosis and treatment of Bipolar Disorder is very important, because left unchecked, Bipolar Disorder can lead to trouble in relationships, employment, and even the criminal justice system. If someone is forced to be treated by the government, that individual will likely be involved with the courts to mandate that they pursue treatment, or even get committed to the nearby psychiatric hospital.
Substance Abuse will also be ruled out by a psychiatrist, because the symptoms of Substance Abuse Disorder can mask, cover, distort or exhibit symptoms of Bipolar Disorder, and there is a clause within the DSM that a Bipolar Disorder diagnosis may not be appropriate for someone who was taking mind altering drugs.
Bipolar Disorder Treatments
The treatment of Bipolar Disorder is usually done with a two pronged approach, which includes medications and psychotherapy. Certain studies have found that patients who continue with not only medication treatment, but prolonged psychotherapy tend to perform better on mood assessments, and display stable mood periods of time longer than patients who do not continue therapy. Longer periods of time when a patient is in therapy tends to prolong the amount of time before a relapse. This may be due to learning and understanding logical precepts surrounding the benefits of medications despite the side effects. One of the leading causes of relapse is when a patient decides to terminate medication therapy. Psychotherapy institutes an understanding that thwarts any relapse for these reasons.
Bipolar Disorder Medications
There are three types or classes of medications that are commonly used to treat Bipolar Disorder. These are atypical antipsychotics, mood stabilizers, and antidepressants. Atypical antipsychotics are used as mood stabilizers, but are most notably used to bring a manic patient out of psychosis. Zyprexa, Risperdal, Abilify, Seroquel and Geodon are some of the older atypical antipsychotics that are used to treat mania, and combat its return to an individual. Mood Stabilizers such as Depakote and Lithium are also used for the same reasons, however the way they work are slightly different. Lithium is one of the oldest Bipolar Disorder mood regulator there is, and it is not only used to keep mania and depression at bay, but it can also help bring a patient out of mania. The only drawback is the excessive thirst it causes, as well as needing to do blood work on a regular basis, because too much lithium in the blood can cause serious side effects and health problems. Anticonvulsants such as depakote are designed to prevent seizures, but can also be used to treat Bipolar Disorder and treat mania and depression as well as prevent it. Antidepressants such as Zoloft and Prozac treat the symptoms of Depression. Although studies have found that treating with antidepressants are no more influential to keep depressive episodes at bay than antipsychotics, some doctors treat off-label, and do so because they feel that such a prescription is actually helpful. Antidepressants are also used as a sleep aid for Bipolar Disorder patients, such as Trazadone.
Medications need to be taken consistently, because they do not cure Bipolar Disorder. Rather, they treat the symptoms by maintaining a blood level of the active therapeutic ingredient. If the blood level drops, detrimental symptoms may develop again, and the patient most likely will go into a mood episode, such as mania, hypomania, or depression. It is very important to continue your medication regime and treatment without hindrance, to prevent adverse effects.
Mood Stabilizers such as Lithium Carbonate, and Valproic Acid, or Depakote are critical medications to maintaining a balanced mood for many patients. These drugs are usually the first choice for treatment of Bipolar Disorder. Lithium was approved by the FDA in the 1970's, and since then remains the only drug completely approved to treat children with Bipolar Disorder mood episodes. Depakote is an anticonvulsant, or originally designed to treat seizures, but was approved to treat mania in the mid 1990's. There are side effects to the mood stabilizers, with Lithium causing extreme thirst, because it is a salt, and also having to take regular blood work to see if the amount of Lithium one takes is becoming toxic to the body.
Depakote may have side effects, such as acne or cold symptoms, dizziness, upset stomach, or headache, but is overall very effective and tolerable. If you begin to take mood stabilizers, and you can not stand the side effects, you will want to speak with your doctor promptly to make an adjustment to make life more bearable on another drug. Note also that Depakote is known to the FDA to cause complications during pregnancy, and should be avoided while pregnant, as it may cause injury to the unborn fetus.
Atypical antipsychotics are drugs that influence the serotonin and dopamine uptake avenues in the brain. They prevent re-uptake, thereby increasing the amount of the neurotransmitters in the brain. They include Zyprexa, Risperdal, Abilify, Zyprexa and Geodon, among others. It is recommended that a Bipolar Disorder patient choose the long-lasting injectable form of the medication because it ensures medication compliance, and takes away the strain of having to remember to take the pill form of the medication every day. Currently, the injectable form of the medication is available in two week, and month long variations for Zyprexa, Risperdal, and Abilify.
The most widely used atypical antipsychotics are Abilify, Zyprexa, Risperdal, Seroquel and Geodon. One atypical antipsychotic may work for a patient, while others will not; and likewise, a completely different atypical antipsychotic may work for another patient. There are certain side effects of using atypical antipsychotics, with most of the complaints being weight gain, and drowsiness. This is due to certain metabolic changes that take place with use of the medication. Also, cardiovascular issues including hypertension, and cholesterol issues may take place as a side effect. Diabetes is also another issue that individuals experience taking atypical antipsychotics.
There is a certain neurological disorder related to the use of atypical antipsychotics, which is a side effect, called tardive dyskensia. This disorder causes uncontrollable shaking and tremors. The onset of Tardive Dyskensia usually takes place after prolonged usage of these drugs. Even after stopping treatment, tardive dyskensia may continue, although it usually completely or partially subsides.
Antidepressants are usually prescribed for Bipolar Disorder with the use of mood stabilizers. These pharmaceuticals help with the symptoms of depression, or help prevent another depressive episode. Antidepressants can also be used as a sleep aid for Bipolar Disorder patients that have issues sleeping regularly. There are certain side effects of antidepressants, and they are most commonly reported as sexual issues, agitation, nausea and headache. If you have issues with a certain antidepressant, it is important to speak with your psychiatrist to change the drug altogether, or to have a change in dosage. Also, it is important to note that taking an antidepressant alone is not sufficient enough to keep an even mood, as they don't prevent manic episodes from flaring up. In fact, if you only take an antidepressant, you will most likely find yourself involved in another manic episode.
Women who are pregnant
There is a warning issued by the FDA for women who are pregnant or nursing while taking mood stabilizers or antipsychotic medications. The drug Depakote, if used while in pregnancy, can cause harm to the fetus. The drug of choice while pregnant is Lithium. Although, Lithium may cause some heart trouble for the unborn fetus. Also, the drugs are passed into the child while breast-feeding, which may be harmful. Speak with your doctor immediately should you become pregnant. You may also read an additonal article on Bipolar Disorder and Pregnancy under the patients tab.
Psychotherapy is another aspect of treatment for Bipolar Disorder. Typically, a patient will be involved in group or individual therapy. In therapy there is a certain level of education and awareness built up about Bipolar Disorder as an illness, and about being diagnosed with the disorder. It is recommended that if you are in a relationship with a significant other, that you attend couples therapy to mitigate the adverse behavioral effects of the disorder, and to allow for open communication to repair what has been done or said. Studies show that people who take or involve themselves in psychotherapy longer have longer periods of time between mood episodes. This is thought to be due to increased medication compliance, as patients are educated and coached to understand the beneficial effects of the medication. It is recommended to take what your therapist has to say seriously, and give thought to the points that he or she makes. The more active a person is in therapy, the apt they are to benefit from the positive effects.
Bipolar Disorder Electro Convulsive Shock Therapy
This form of therapy is not a first line defense against or for mood episodes. Rather, it is a last resort to try to change the mood of individuals who do not respond, or can not take medications. Typically, a sedative will be administered, and electrical shocks will be given for 30 to 90 seconds. Because the patient is under anesthesia, they don't experience pain. After some time, patients re-orient themselves, and can go home the same day. This therapy for Bipolar Disorder mood episodes can be given to pregnant women, because of the adverse effect that medications have on the unborn fetus. Also, patients who are behaving badly, and absolutely can not defeat the symptoms of BD are given electro convulsive shock therapy. This form of therapy is typically effective to treat symptoms of Bipolar Disorder mood episodes, which is why it remains a viable treatment option.
Patients of BD are known to have sleep problems or issues. A Doctor may prescribe a stronger dose of an antipsychotic medication, to assist with sleep. If problems still persist, a second more mild sleep agent may be given such as Trazadone or Benadryl. If these treatments don't work, other more stronger medications will be prescribed. Sleep is very important, and your doctor knows this. If you have problems sleeping be sure to bring it up with your psychiatrist.
Bipolar Disorder Naturopathic Treatments
Naturopathic Doctors are a type of doctor that prefers, if at all possible, to allow the body to heal itself, rather than use invasive health practices such as surgery. In regards to Bipolar Disorder, there are a few things that a Naturopathic Doctor can do. One type of treatment has to do with neurotransmitter analysis. A test will be given to track the amount of certain neurotransmitters in the brain. Each neurotransmitter, such as serotonin and dopamine and noepineprine, and others will be given a value allowing the doctor to see where a patient is deficient. Then, certain supplements and naturopathic medicines will be given that will help boost the body's natural production of these neurotransmitters. In this way, the patient can begin to feel better.
Also, a keylation can be given to remove toxic heavy metals from the body. A keylation will be given, and a urinalysis will determine the amount of toxic heavy metals in the blood stream. Then further treatments will be given that will eventually drain all the toxic, heavy metals out of a individuals body. Heavy metals such as mercury, nickel, and cadmium are tested and removed. It is known that these heavy metals cause neurological disorders, and naturopathic doctors believe that by removing all the toxic, heavy metals from the bloodstream, and also the brain, as well as the whole body, a patient will become more healthy.
Also, certain supplements such as B vitamin complexes, and Fish oil will be given, as these provide some of the building blocks for neurological functioning. It is also proven that populations or countries that have fish-heavy diets, have lower levels of overall depression. As such, fish oil prevents depression.
Naturopathic doctors will explain that a patient should take the BD medications, such as mood stabilizers, atypical antipsychotics and or antidepressants in conjunction with the naturopathic treatments. And remember, that natural remedies are not a substitute for medications that you would receive from your psychiatrist such as antipsychotics and mood stabilizers.
Friends with BD
Relationships and BD
BD and Substance Abuse
Living with BD
If someone close to you, or someone you live with has Bipolar Disorder, the disease affects you too. It is important to attend therapy for your own needs, and educate yourself on the subject matter of Bipolar Disorder. Be sure to be a positive influence and encourage your loved one to continue their treatment, because with time, they will get better. Also take them out for walks, and good activities that will help alleviate stress, and have fun. Because we know all too well that BD can be stressful. Also go to some doctor's appointments with your loved one and show support for him or her. You should also learn to listen very carefully, so that you too, can understand what it is like to experience bipolar symptoms and side effects.
As a caregiver, it is important to take care of yourself, and enjoy your free time, and time spent at work without worry. Although caregivers usually help with medical care, it is important for a caregiver to take care of him or herself because if the caregiver does not, it is more likely that the patient of Bipolar Disorder will not follow a treatment plan, and relapse into another mood episode. Be sure to get away from it all, sometime, and engage in therapy.
Where can I go for help and how can I help myself?
For starters, if you have BD, and for the sake of those around you and yourself, get treatment. Being compliant with medication is a huge step towards getting your life back together again. Do seek psychotherapy, and even attend group therapy sessions such as DDR, for instance if you have substance abuse issues. You can get help from your psychiatrist, a case worker, help and support telephone lines, and free clinics. You can even get a subscription to BD magazine, as well as take part in discussion groups online, such as the ones on this website. If you need help, all you pretty much need to do is ask, and follow up on the answers that you are given.
What if I am in crisis?
If you are in crisis, go to an emergency room immediately. If you feel like you might hurt yourself or other people, call 911 immediately. There are also suicide prevention hotlines that you can call. The 1-800-273-TALK hotline is standing by if you feel like you could hurt yourself.