Bipolar Disorder Unveiled: Shedding Light on World Bipolar Day 

Every year on March 30, World Bipolar Day is observed to raise awareness about Bipolar Disorder and to eliminate stigma surrounding this complex mental health condition. It's a day to educate, support, and advocate for those living with Bipolar Disorder, as well as their loved ones. This blog post delves into a general overview of what Bipolar Disorder is, how to differentiate between its subtypes, signs to watch for, common misconceptions, treatment options, and resources for support and management. 

UNDERSTANDING BIPOLAR DISORDER 

Bipolar Disorder is a complex mental health condition in which a person experiences ‘mood swings’ (ie, alternates between episodes of mood symptoms that fall into two extreme forms). These episodes are generally referred to as emotional ‘highs’ (mania or hypomania) and ‘lows’ (depression). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three subtypes of Bipolar Disorder: 

1. Bipolar I Disorder: This subtype involves a manic episode that lasts at least seven days, or is severe enough to require immediate medical attention. Episodes of depression may also occur, typically lasting at least two weeks. 

2. Bipolar II Disorder: In this subtype, individuals have experienced at least one hypomanic episode and at least one episode of major depression, but they have never experienced a full-blown manic episode as seen in Bipolar I Disorder. 

3. Cyclothymic Disorder: Cyclothymia involves chronic fluctuations in mood, but the symptoms are mild compared to those seen in Bipolar II Disorder. Individuals experience periods of hypomanic symptoms (mildly elevated mood, increased energy) and periods of depressive symptoms (mildly depressed mood, decreased energy), but the symptoms are not severe enough to meet the criteria for a hypomanic episode or a major depressive episode. For diagnosis, these fluctuations must occur for at least two years in adults, and only one year in children and adolescents.  

THE DIFFERENCE BETWEEN BIPOLAR I AND BIPOLAR II 

The main difference between Bipolar I (with manic episodes) and Bipolar II (with hypomanic episodes) lies in their severity and impact on daily functioning. A manic episode involves more intense symptoms, often leading to significant impairment in social or occupational functioning.  

During a manic episode, a person may experience grandiose thoughts or beliefs, such as believing they possess special powers or abilities, having unrealistic confidence in their talents, or feeling invincible. They may also have racing thoughts, jump from one idea to another rapidly, and engage in impulsive behaviours such as excessive spending, risky sexual behaviour, reckless driving, and impulsive decision-making (eg, quitting a job without forethought). 

On the other hand, during a hypomanic episode, individuals may have similar grandiose thoughts or beliefs but to a lesser extent. They may feel unusually energetic, productive, or creative, and may engage in goal-directed activities with increased enthusiasm. However, they are typically able to maintain a semblance of normal functioning and may not experience the extreme impulsivity or impairment in judgement seen in a full-blown manic episode. 

** A person experiencing a manic episode is more likely to need hospitalisation to help bring their thoughts and beliefs back in touch with reality. Also, for a diagnosis of Bipolar Disorder I, an individual needs only to have experienced a manic episode, but does not need to have experienced a depressive episode. In contrast, for a diagnosis of Bipolar Disorder II, an individual must have experienced at least one major depressive episode and at least one hypomanic episode.  

SIGNS TO WATCH FOR 

Recognising the signs and symptoms of Bipolar Disorder is important for prompt intervention and effective management. Some common signs to watch for include: 

1. Manic Episodes (in Bipolar I Disorder): 

• Feeling overly euphoric or elated 
• Increased energy and activity levels 
• Decreased need for sleep (the person does not feel tired after receiving little or no sleep) 
• Racing thoughts or rapid speech 
• Impulsive or reckless behaviour 
• Unusual beliefs or thoughts that are not plausible or realistic 

2. Hypomanic Episodes (in Bipolar II Disorder): 

• Elevated mood (this generally does not reach the level of euphoria seen in Bipolar I but can entail a noticeably more positive outlook on life) 
• Increased energy and activity levels 
• Decreased need for sleep (the person does not feel tired after receiving little or no sleep) 
• Irritability 
• Racing thoughts or rapid speech 

3. Depressive Episodes: 

• Persistent sadness or feelings of hopelessness 
• Loss of interest in activities once enjoyed 
• Fatigue or loss of energy 
• Changes in appetite or weight 
• Feelings of worthlessness or guilt 
• Difficulty concentrating or making decisions 
• Early morning wakening (waking earlier than desired and unable to fall back asleep) 

• Thoughts of death or suicide 

** The types of symptoms within each episode, as well as the severity and frequency of these episodes can vary between individuals. Two people with Bipolar I or Bipolar II Disorder can exhibit very different profiles of symptoms. 

MISCONCEPTIONS AROUND BIPOLAR DISORDER 

Bipolar Disorder is often misunderstood. Addressing the misconceptions helps to increase awareness and understanding of this condition, and reduce stigma surrounding mental ill-health in general. Here are the most common myths: 

Myth 1: People with Bipolar Disorder are ‘moody’ 

The term ‘mood swings’ according to the DSM-5 is a hallmark feature of Bipolar Disorder, however, this medical term is sometimes used in an unfavourable manner (aka ‘moody’ or similar connotations). Incorrect or casual terminology around ‘mood swings’ may imply that the symptoms of Bipolar Disorder are simply fleeting changes in emotions akin to everyday fluctuations, downplaying its severity and complexity. It’s important to note that an episode of mania/hypomania or depression is generally constant for at least several days in a row, not a few seconds or minutes which might erroneously suggest frequent mood shifts in a single day. And within either a manic or depressive episode, there are symptoms that are not traditionally linked to a mood state. For example, decreased need for sleep, talking quickly, or an increase in energy and activity levels are all part of the ‘mood swing’ framework, highlighting the fact that there is more to Bipolar Disorder than the loose term of being ‘moody’. People living with Bipolar Disorder often face significant challenges in managing their symptoms, which can have a profound impact on daily functioning and overall wellbeing. 

Myth 2: People with Bipolar Disorder are always either manic or depressed 

While episodes of mania/hypomania and depression are characteristic of Bipolar Disorder, individuals often experience lengthy periods where symptoms of mania/hypomania or depression are either less severe or fully absent. For example, a person with Bipolar I Disorder may experience a full-blown manic episode only once every few years and nothing else in between. The periods of being symptom-free are referred to as ‘euthymia’ in clinical practice, and are essential for recovery and maintaining overall functioning.  

Myth 3: People with Bipolar Disorder are unpredictable and unstable 

There is nothing unpredictable or unstable about Bipolar Disorder. For most people with Bipolar Disorder, there are no sudden or dramatic changes in the person’s behaviour that arise out of the blue. Episodes of mania/hypomania and depression are often preceded by early warning signs which a person (and their loved ones) can learn to recognise. For example, the person may start to experience an increase in energy levels, have some unusual thoughts, or show a reduced need for sleep which can signal the possibility that they may be heading into a manic or hypomanic episode. Subsequently, if a person does proceed into a full-blown manic episode, this can be managed quickly with medical treatment.  

Myth 4: People with Bipolar Disorder cannot lead successful lives 

With proper treatment and support, many people with Bipolar Disorder can lead fulfilling and productive lives. While managing the condition can be challenging at times, it is possible to achieve a full range of professional and personal goals. In fact, people with Bipolar Disorder successfully work in every profession that exists and enjoy healthy interpersonal relationships with families, partners, children, and friends. 

Myth 5: Bipolar Disorder is a temporary condition that will go away 

Bipolar Disorder is not a temporary condition. It is a complex mental health issue that involves biological, genetic, and environmental factors, requiring proper diagnosis and treatment, and long-term management. While the type, severity and frequency of symptoms may change over time, the underlying condition does not disappear on its own. Early intervention and ongoing treatment are essential for managing symptoms and preventing relapses. 

TREATMENT OPTIONS 

While Bipolar Disorder is a chronic condition, it can be effectively treated with a combination of psychiatric management, psychological therapy, and lifestyle adjustments.  

i. Psychiatric Management 

This generally involves the use of medications which fall into the following categories: 

• Mood stabilisers such as lithium, valproate, lamotrigine, carbamazepine, or oxcarbazepine can help regulate manic episodes and prevent depressive episodes.  
• Antipsychotics such as olanzapine, quetiapine, aripiprazole, risperidone, and ziprasidone can help control manic and depressive symptoms, and particularly the acute manic symptoms.  
• Antidepressants are sometimes used cautiously in combination with other medications to manage depressive symptoms. Certain antidepressants can trigger a manic episode in some individuals, so this is carefully considered by the psychiatrist. 

ii. Psychological Therapy   

• Cognitive Behaviour Therapy (CBT) helps individuals and their loved ones to recognise the early warning signs of a manic or hypomanic episode, become mindful of potential triggers of a manic or hypomanic episode, manage negative thought patterns and behaviours associated with depression, and promote healthy lifestyle choices.  
• Interpersonal and Social Rhythm Therapy (IPSRT) focuses on stabilising daily routines and interpersonal relationships to help prevent mood episodes. 
• Family-Focused Therapy (FFT) involves working with family members to improve communication, reduce conflict, and provide support for the individual with Bipolar Disorder.  
• Mindfulness-Based Therapies incorporate mindfulness meditation practices to help individuals cultivate awareness, acceptance, and self-compassion. These practices can be helpful for managing stress, reducing rumination, and enhancing emotional regulation in Bipolar Disorder. 

** Most forms of psychological therapy require good cognitive functioning, and therefore individuals with Bipolar Disorder are best to engage with the therapy when they are non-symptomatic, as episodes of mania and hypomania can interfere with the capacity to sustain adequate attention and concentration. This will help maximise the benefits of the therapy in the longer-term management of their condition.  

iii. Lifestyle Choices 

Healthy lifestyle choices are encouraged to help prevent relapse into an episode and include: 

• Maintaining a regular sleep schedule: Getting enough sleep is vital for mood stability. 
• Minimising use of alcohol and drugs: Substance use can worsen the symptoms. 
• Engaging in regular exercise: Physical activity can help improve mood and overall well-being. 

** Whilst there are various treatment options across psychiatric and psychological domains as described above, what works for one person with Bipolar Disorder may not work for another. It is important for individual treatment plans to be tailored for each person.    

OTHER RESOURCES FOR SUPPORT AND MANAGEMENT 

Connecting with others who have Bipolar Disorder can provide valuable support, understanding, and encouragement. Here are some useful links to find suitable support groups and resources for understanding and managing Bipolar Disorder: 

• Bipolar Australia Organisation 
• Online Bipolar Support Group (Across Australia) 

• Bipolar Support Groups (Victoria) 
• Bipolar Disorder: Health Directive 
• Bipolar Help: Living with Bipolar Disorder 
• MoodSwings Australia 

World Bipolar Day serves as a reminder of the importance of understanding and supporting individuals living with Bipolar Disorder. It's important to recognise the signs of an episode, use accurate and respectful language when referring to Bipolar Disorder, acknowledge the serious and complex nature of the condition, and understand the need for empathy, support, and appropriate treatment for those affected. By raising awareness, addressing misconceptions, eliminating stigma, and promoting access to effective treatment, we can help improve the lives of those affected by this condition. 

Dr. Carissa Coulston-Parkinson is a Clinical Psychologist with specialist knowledge in the areas of depression, bipolar disorder, anxiety, schizophrenia, intellectual disability, personality disorders, traumatic brain injury and neurological conditions.