The Hope Project (THP): Understanding Bipolar Disorder

Personalities differ from person to person. In fact, the individuality of each person's mental process, conduct, and temperament is comparable to that of a snowflake (Federman, 2012). In 2021, in the era of gaining knowledge about mental health through social media, it has often been observed that people reduce having mood swings as a reaction to everyday troubles to bipolar disorder. So how can one tell the difference?


Bipolar mood swings are much more extreme and continue much longer than regular mood swings. All emotions, whether positive or negative, are amplified. One may notice drastic changes in energy, activity, and sleep patterns that are out of the ordinary. A low mood normally passes in a few days, but for someone with bipolar disorder, it might endure weeks or even months (Mcfeeters, 2017). Let us look at the diagnosis of bipolar disorder to understand these differences from a closer lens.


A Story; Katey's Diagnosis


Katey, a thirty-year-old woman in outpatient therapy, says she has always struggled with moodiness and substance addiction. Her "mood swings" began in youth following her first split with a partner, she claims and persisted throughout her undergraduate and early professional years. She typically uses alcohol and hard labour to compensate for mood swings (Kearney & Trull, 2011)


Katey claims that she could work for two or three days without sleeping, and that this hard activity helps her feel better. Her mood swings, on the other hand, continue to torment her. She doesn't sleep much and prefers to "meet new and fascinating individuals." She frequents dance clubs and pubs and travels through dangerous alleyways with recklessness to meet new people. She also claims she has to speak quickly because "so many thoughts fly through my head". Katey also elucidates that she has considered harming herself at times. These thoughts normally arise when she is sad, but they have recently become more intense as her strange behaviour has become more distressing (Kearney & Trull, 2011).


Katey’s life experiences constitute a definitive illustration of “mixed episodes”, wherein the symptoms of both, a manic (the far end of the happiness/euphoria continuum) and a depressive (the far end of the sadness continuum) episode, are observed (Kearney & Trull, 2011). Although the symptoms of each episode do not normally appear at the same time, the person does cycle quickly from depression to mania and back (Kearney & Trull). These symptoms form the basis of bipolar disorder, which is characterised by fluctuating episodes of high and low mood.


As of 2017, it was estimated that 0.6% of the world’s population, i.e 46 million people were diagnosed with bipolar disorder (Richie & Roser, 2018). Bipolar disorder is a category that comprises three main conditions (Truschel, 2020):


Bipolar I disorder: is a manic-depressive disorder that can be present either with or without psychotic episodes


Bipolar II disorder: is characterised by alternating depressive and manic episodes that are typically less severe and do not interfere with daily activities.


Cyclothymic disorder: is a cyclic disorder that causes hypomanic (comprises the same symptoms as a manic episode but may not cause extreme impairment in daily functioning) and depressive episodes for a short period of time.


Diagnosis of Bipolar Disorder


The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines bipolar illnesses as a collection of brain disorders that produce severe fluctuations in a person's behaviour, activity, and ability to operate (Truschel, 2020). Between depressive disorders and schizophrenia spectrum disorders, bipolar and associated disorders are given their own chapter in the DSM-5 (Truschel, 2020).


Symptoms vary from person to person, according to the International Bipolar Association. An episode might last months or even years for some people (Neuman, 2021). Others may experience "highs" and "lows" at the same moment or within a short period of time (Neuman, 2021).


Mania/Hypomania

A person must have had at least one episode of mania or hypomania to be diagnosed with bipolar disorder (Truschel, 2020). The elevated, expansive, or irritated mood must remain at least one week and be present for most of the day, practically every day, to be called mania (Truschel, 2020). Hypomania requires a mood that lasts at least four days and is present for the majority of the day, practically every day (Truschel, 2020).


Three or more of the following symptoms must be present and indicate a massive change in behaviour during this time (Truschel, 2020):


  • Grandiosity or inflated sense of self

  • Sleep requirements are reduced.

  • Increased chattiness

  • Thoughts that race

  • Easily swayed

  • Increased goal-directed activity or agitation of the psychomotor system

  • Engaging in behaviours that have the potential to cause pain, such as walking alone in dangerous alleyways as seen in Katey's story.


Depression

A major depressive episode, which results in a gloomy mood or a loss of pleasure in life, characterises the depressive side of bipolar disorder. To be diagnosed with a severe depressive episode, a person must have five or more of the following symptoms for two weeks, according to the DSM-5 (Truschel, 2020).

  • Depressed mood for most of the day

  • Loss of enjoyment or interest in all, or nearly all, activities

  • Significant weight reduction, as well as a decrease or rise in appetite are all possible outcomes.

  • Pacing the room, for example, is an example of unintentional movement.

  • Fatigue or a lack of energy is a common occurrence.

  • Feelings of inadequacy or guilt

  • Inability to focus or concentrate, as well as indecisiveness

  • Suicide attempt, persistent death thoughts, or recurrent suicidal ideation without a definite plan


DSM Criteria for Bipolar I Disorder

To be diagnosed with bipolar I disorder, one needs to have experienced at least one manic episode and may have been preceded or followed by a hypomanic or major depressive episode. Additionally, the eventuality of the manic episode should not be better explained by schizoaffective disorder, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders (Substance Abuse and Mental Health Services Administration, 2016).


DSM Criteria for Bipolar II Disorder

To be diagnosed with bipolar II disorder, one needs to have experienced at least one hypomanic episode and at least one major depressive episode, without an occurrence of a manic episode, and at the same time, the presence of hypomanic episodes and major depressive episodes is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizophrenia spectrum and psychotic diseases (Substance Abuse and Mental Health Services Administration, 2016).



What causes Bipolar Disorder?


Genetics

According to Legg (2020), when compared to someone who does not have a parent or sibling with bipolar disorder, people who have a family history of bipolar disorder have a 4 to 6 times higher risk of having it. Bipolar disorder has a heritable component, according to a 2016 assessment of twin research. An identical twin has a 70% risk of being diagnosed with bipolar disorder if their twin has it, according to the American Academy of Child and Adolescent Psychiatry.


Brain Structure & Functioning

According to the National Institute of Mental Health Information Resource Centre, people with bipolar disorder have brains that are different from people who do not have a bipolar illness or any other mental disorder. Mood problems can be exacerbated by the loss or destruction of brain cells in the hippocampus (the memory-related portion of the brain) and also has an indirect impact on mood and impulses (Legg, 2020). Bipolar disorder may be connected to neurotransmitter imbalances (Legg, 2020).


Environmental Factors

Manic or depressed episodes can be triggered by a variety of circumstances. These variables raise stress levels in the body, which is a trigger (Legg, 2020):


  • The birth of a child, a work promotion, relocating to a new house, or the termination of a relationship are all examples of stressful life events that can be perceived to be negative.

  • a change in routine, such as sleep, eating, exercising, or social activities; a disruption in regular sleep patterns, such as decreased or increased sleep or bed rest; a change in routine, such as sleep, eating, exercising, or social activities.

  • Overuse of alcohol or other substances can lead to bipolar symptoms, relapses, and hospitalizations.


Age, Gender, and Hormones

Bipolar disorder usually appears between the ages of 15 and 25, or around the age of 25, at least half of all instances are discovered before the patient reaches the age of 25, and some people, on the other hand, do not have symptoms until they are in their 30s or 40s (Legg, 2020).


Women are more likely than men to suffer from bipolar II disorder. Bipolar I disorder, on the other hand, affects both men and women equally (Legg, 2020). Thyroid hormones, according to experts, have a significant impact on adult brain function and thyroid dysfunction has been linked to depression and bipolar disorder (Legg, 2020). Hypothyroidism, or an underactive thyroid, is common in people with bipolar disorder (Legg, 2020).


Treatments for Bipolar Disorder


The available options of treatment of bipolar disorder aim at reducing the severity and occurrence of manic and depressive episodes. Some of the management techniques are mentioned below:


Medication

People with bipolar disorder are often prescribed mood stabilizers which can avert depressive and manic episodes. According to the NHS UK (2019), the most common medicines used for bipolar disorder are lithium, anticonvulsant medicines (valproate, carbamazepine, lamotrigine), and antipsychotic medicines (aripiprazole, olanzapine, quetiapine, risperidone). These medications must be prescribed by qualified healthcare or mental health professional and must not be procured through unregulated means in order to avoid extreme reactions and effects.


Learning to recognise triggers and avoiding isolation

With the support of mental health specialists, people with bipolar disorder can learn to detect the warning symptoms of an impending bout of mania or despair (Legg, 2020). This will not stop the episode from happening, but it will allow you to seek help sooner (NHS UK, 2019). Psychoeducation, i.e., learning more about the disorder can also help with identifying triggers and adapting to the condition in a better manner (Legg, 2020).


One may enjoy particular activities, such as reading or baking, when not depressed, and while being depressed, however, one could find it difficult to motivate themselves to do anything (Legg, 2020). Regardless of the lack of energy, it's critical to continue participating in things that one normally likes (Legg, 2020).


Psychological Treatment


When used in conjunction with medication, some patients find psychological counseling to be beneficial in between episodes of mania or depression (NHS UK, 2019).


This could involve the following:


CBT (cognitive behavioural therapy) is particularly effective in the treatment of depression.

Family therapy focuses on family ties and encourages everyone in the family or relationship to work together to enhance mental health.


Psychiatrists or psychologists may suggest other forms of therapy based on each individual’s unique experiences of the disorder in order to provide them with the most useful tools.


Conclusion


Mood disorders like bipolar disorder often develop during the adolescent ages of an individual (Kearney & Trull, 2011). There are many areas of development that could be targeted in order to prevent the occurrence of bipolar disorder which not only causes lifelong distress but also increases the risk of extreme symptoms like self-harm and suicide. People without any symptoms of mood disorders, people at risk for developing mood disorders, such as children of parents with mood disorders, and people with mood disorders who want to avoid recurrence are all targeted by mood disorder prevention programmes (Kearney & Trull, 2011). These kinds of programmes should be supported in every community to help persons with bipolar disorder cope with the daily ups and downs of feeling, hopelessness, troublesome thoughts, and self-destructive conduct that they encounter.

 

Unwired India is a neurotech-startup that aims at integrating state-of-the-art research and developments in STEM, for catalyzing the transition of Neuroscience to Neurotechnology. We develop avant-garde non-invasive neurostimulation products used to solve some of the world’s most critical global issues and challenges. Our mission is to take cutting-edge brain research directly into the lives and homes of people, thereby fostering a unique culture of sustainable neuroscience and scientific literacy in India.

  • Founded in 2020, we are the pioneers of Nootropics and non-invasive Neurotechnology devices in the country, and offer so much more than high-quality, delicious Brain Nutrition products for daily cognitive support; a full-service health and fitness startup that has become an important part of the local community, here in New Delhi, India.

  • We develop non-GMO, all-natural nootropic (smart-drug) formulations, Himalayan herb blends, and specialized amino-nutraceutical interventions and supplements for enhanced brain function, cognition, neuroinflammation, and neurodegeneration.

 

The Hope Project (THP) is a neuro-disorder awareness initiative within the organizational framework of Unwired India. The initiative aims at creating and scaling awareness against the stigma, fear, and apprehensions associated with Neurological disorders.


Aims: To promote and develop awareness across global masses and to emphasize the importance o