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Bipolar Disorder is a condition in which someone undergoes massive shifts in their energy, their perception, and their mood. It is very important to know that these shifts are all maladaptive and can often cause major damage to the person suffering from Bipolar as well as for the people in their lives.
Bipolar is a very severe condition. These people are at 20x or 30x greater risk of suicide than the general population. It impacts about 1% of people. The typical age of onset is 20-25 years old, although it can be much earlier. The earlier the onset, the higher likelihood that the disorder will be a stable feature of that person's psychology.
Not everyone who has Bipolar Disorder experiences massive highs and lows. There are two kinds of Bipolar Disorder.
Bipolar 1 is characterized by a fairly extended period of mania. Mania is a period of very elevated mood, energy, distractibility, impulsivity, and more. This manic episode is EXTREME. A key feature is that it is not always noticeable to the person suffering from it. One of the key diagnostic criteria is that a person suffering from these manic episodes much display it for 7 days or more.
A psychiatrist or therapist will look out for the following symptoms:
1. Distractibility - but very extreme.
2. High Impulsivity in relation to actions (fidgeting with something and then suddenly going on a high spending spree).
3. Grandiosity: Actual beliefs (not lies) the person comes to have about their position in the world. They may think they will run for president.
4. Flight of Ideas: people talking extensively about one thing and then switching to something else. A random selection of different topics that exist in a categories and topics in a random way.
5. Agitation - shaking, difficulty sitting down and being still
6. NO SLEEP or very minimal sleep: people can often go 7 days or more with zero sleep and they are not troubled by it.
7. Rapid pressured speech (not offering opportunity for a back and forth conversation
A person needs to present at least three of these symptoms for at least 7 days.
It is usually characterized by both episodes of mania & depressive episodes OR hypomania. Hypomania is a somewhat suppressed level of mania which would be due to duration and not the intensity of mania. Manic episodes would last for four days or less.
It is often expressed by dropping into a depression and then going back to normal and then manic again. The way bipolar can present can vary very differently from person to person. It can take a lot of different forms. One person may go from very high highs to very low lows. Others can rapid cycle (3 days manic 3 days normal 3 days depression).
Percentage of time is an important distinguish of BP1 or BP2. BP1 on average spend approximately 53% of the time symptom free. About 32% depressed (MAJOR depression), or sleeping far too much, suppressed appetite and libido. 15% of the type in a manic state (7 days or more).
BP2 people spend half their time in a depressed state. They tend to be in a depressed state more often (MAJOR depression). People's outlook on life becomes very diminished. They really feel as if there is no opportunity for anything to improve. 45% of the time on average, people with BP2 are in a normal state. Only 4 - 5% of the time are they in a state of hypomania. This is what makes it difficult to distinguish between BP2 and major depressive disorder.
Heritability vs. Genetic Contribution ( not the same).
What is the risk of someone having Bipolar in the general population? (1%)
Major Depressive Disorder (10 - 17%)
Genes vs. Environment
If an identical twin has Bipolar Disorder, the likelihood for the other identical twin to have it is 40-70% likely. Clearly we have a genetic component that is VERY high. If someone has Bipolar Disorder, the heritability is 85% higher for someone else who has Bipolar in their genetic lineage. It is very likely they inherited a susceptibility within their genes to environmental influences that can trigger the onset.
What environmental factors contribute? Science is not super clear.
Important to distinguish from Borderline Personality Disorder.
Key Distinctions: In BPD, there can be episodes that resolve mania or hypomania, and yet more often than not, there is an environmental trigger. With BP Disorder, there is no need for a trigger. With BPD, almost always there is going to exhibit flights of mania or mood shifts in response to things that are coming through external relationships. Splitting is a concept in BPD where they feel they absolutely adore you and think the world of you and can genuinely feel that way and then for whatever reason, they can suddenly shift or split their emotions into what's called moving from a can do no wrong object to a wrong object.
Reaching out to a board certified psychiatrist is the very first step that must be taken. This not only includes the person suffering, but also the family members or those closest to that individual. Then, you would want to support your loved one who is suffering from Bipolar by finding a therapist or psychologist.
You must consult with a psychiatrist to discuss which treatment is the safest and most appropriate for you to start trying.
Most psychiatrists will tell you that therapy on it's own is RARELY effective for BP1 or BP2. Combining therapy with psychiatry is the best combination with psychiatry being a MUST.
Lithium & Ketamine, anti-epileptic meds are initial lines of treatment often explored.
Cognitive Behavioral Therapy is the most effective form of therapy and that is where I come into play. Shame is a really deep emotion many who come out of their manic episodes can struggle immensely with. Family-focused therapy is also highly recommended. Family members can be excellent windows into whether someone is doing well or needs further support. Interpersonal & Social Rhythm Therapy is another form of therapy that is also recommended.
A more last resort form of treatment that is showing a ton of success is electric shock therapy in a controlled setting in a hospital. It is a very effective treatment for major depression. This would be more appropriate for those who are less responsive or treatment resistant to drug therapies. ECT is quite invasive and has a fairly high cost and may have some associated memory loss.
Cannabis has not been proven or shown to be effective for either manic or depression phases. The only potential positive would be in support of sleep.
Psilocybin has not been PROVEN to be effective however many have self reportedly shared that it dramatically reduced anxiety.
Alcohol = can induce psychosis - staying away is the best idea for those with Bipolar
Two nutrition supplement based recommendations that are shown to have some effectiveness in adjusting some of the symptoms. This alone or combined with talk therapy is not enough.
1. Inositol (reducing anxiety & improving sleep)
2. Omega 3 fatty acids
The following can indirectly support the nervous system of someone with Bipolar Disorder:
1. Better Sleep
2. More Exercise
3. More morning sunlight
4. Less bright light at night
5. Proper Nutrition
6. Quality social interactions