Bipolar Disorder Treatment in Delhi, India

Bipolar disorder, formerly known as manic-depressive illness, is a mental health condition characterised by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood swings can be intense and may occur infrequently or several times throughout the year, with some individuals experiencing intermittent emotional symptoms between episodes, while others may not experience any. In addition to mood swings, individuals with bipolar disorder may also experience changes in energy levels, sleep patterns, activity levels, and behaviour. These shifts in mood and behaviour can have significant impacts on relationships, work or school performance, and overall quality of life.

There are several types of bipolar disorder, including:

• Bipolar I Disorder: This involves manic episodes that last at least 7 days or are severe enough to require immediate hospital care. Depressive episodes typically also occur, lasting at least 2 weeks.
• Bipolar II Disorder: This involves a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown manic episodes.
• Cyclothymic Disorder (Cyclothymia): This involves numerous periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
• Other Types - In addition to the aforementioned types of bipolar disorder, there are other variations. These include bipolar and related disorders induced by certain substances like drugs or alcohol, or resulting from medical conditions such as Cushing's disease, multiple sclerosis, or stroke.

The exact cause of bipolar disorder is unknown, but it's likely a combination of genetics and environmental factors.

Genetics

Bipolar disorder is more common in people who have a family history of the illness. Studies have shown that identical twins, who share all of their genes, are more likely to both have bipolar disorder than fraternal twins, who share only half of their genes.

Biological Differences

Imbalances in neurotransmitters (chemical messengers in the brain), such as dopamine, serotonin, and norepinephrine, may contribute to bipolar disorder. Structural and functional changes in the brain may also play a role.

Environmental factors

Several environmental factors may increase the risk of developing bipolar disorder, including:

• Stressful life events: Experiencing a traumatic event, such as the death of a loved one, a serious illness, or a financial setback, can trigger a manic or depressive episode in someone who is already predisposed to bipolar disorder.
• Drug or alcohol abuse: Substance abuse can worsen bipolar symptoms and make it more difficult to treat the disorder.
• Certain medical conditions: Some medical conditions, such as thyroid problems, can trigger mood episodes in people with bipolar disorder.
• Changes in sleep patterns: Disrupted sleep can trigger a mood episode in people with bipolar disorder.

Other risk factors

• Certain personality types: People with certain personality types, such as those who are highly impulsive or extroverted, may be at an increased risk of developing bipolar disorder.
• Gender: Women are more likely to be diagnosed with bipolar II disorder, while men are more likely to be diagnosed with bipolar I disorder.

It's important to note that having one or more of these risk factors does not mean that one will develop bipolar disorder. However, if anyone is concerned about their risk, it is important to talk to a mental health professional.

The symptoms of bipolar disorder can vary widely depending on the type and severity of the condition, as well as individual differences. Here are some common symptoms associated with bipolar disorder:

Manic Episode Symptoms

• Feeling euphoric or unusually happy
• Extreme irritability
• Increased energy, activity, or restlessness
• Racing thoughts or flight of ideas
• Reduced need for sleep
• Impulsive behaviour, such as excessive spending or risky sexual encounters
• Grandiose beliefs or inflated self-esteem
• Difficulty concentrating or staying focused
• Agitation or aggression

Hypomanic Episode Symptoms

• Similar to manic episode symptoms but less severe
• Increased energy and activity
• Elevated mood
• Increased confidence or productivity
• Racing thoughts

Depressive Episode Symptoms

• Persistent sadness or hopelessness
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite or weight
• Difficulty sleeping or oversleeping
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating or making decisions
• Thoughts of death or suicide

Mixed Episode Symptoms

• Simultaneous occurrence of manic and depressive symptoms
• Feeling agitated or restless
• Irritability
• Rapid mood swings
• Trouble sleeping
• Suicidal thoughts or behaviors

Other Symptoms

• Anxiety
• Psychosis (hallucinations or delusions)
• Behavioural problems
• Substance abuse or addiction
• Physical health problems related to neglect of self-care during mood episodes

It's important to note that not everyone with bipolar disorder will experience all of these symptoms, and the severity of symptoms can vary over time. Additionally, symptoms can be influenced by factors such as stress, sleep patterns, medication adherence, and life events. If you or someone you know is experiencing symptoms of bipolar disorder, it's crucial to seek professional help for an accurate diagnosis and appropriate treatment.

Diagnosing bipolar disorder typically involves a comprehensive evaluation by a healthcare provider, such as a psychiatrist or psychologist, and may include the following steps:

• Initial Assessment: The healthcare provider will conduct a thorough assessment, which may involve a review of the individual's medical history, family history, and current symptoms. They may also inquire about any previous mental health diagnoses or treatments.
• Physical Examination: A physical examination may be performed to rule out any underlying medical conditions or medication side effects that could be contributing to the symptoms.
• Diagnostic Criteria: The healthcare provider will assess whether the individual meets the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include experiencing periods of both manic/hypomanic episodes and depressive episodes.
• Symptom Evaluation: The healthcare provider will inquire about specific symptoms experienced during manic, hypomanic, and depressive episodes, including changes in mood, energy levels, sleep patterns, activity levels, and behaviour.
• Mood Tracking: Keeping a mood diary or using mood tracking tools can help individuals and healthcare providers monitor mood fluctuations over time and identify patterns or triggers for mood episodes.
• Psychological Assessment: Psychological assessments, such as interviews and standardised questionnaires, may be used to assess the severity of symptoms, functional impairment, and the impact of the condition on daily life.

Bipolar disorder shares symptoms with other mental health conditions, such as major depressive disorder, schizophrenia, and substance use disorders. The healthcare provider may conduct additional assessments or tests to rule out these conditions.

Treatment for bipolar disorder typically involves a combination of medication, psychotherapy, and lifestyle modifications to manage symptoms, stabilise mood, and improve overall functioning. Here are some common treatment approaches:

Medication

• Mood Stabilizers: Medications such as lithium, valproate, and lamotrigine are commonly used to stabilise mood and prevent manic and depressive episodes.
• Antipsychotics: Atypical antipsychotic medications like olanzapine, quetiapine, and risperidone may be prescribed to control symptoms during manic or mixed episodes.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or other antidepressants may be used cautiously in combination with mood stabilisers to manage depressive symptoms, but they are often avoided during manic or mixed episodes to prevent mood destabilisation.
• Other Medications: Some individuals may benefit from adjunctive medications such as benzodiazepines for anxiety or sleep disturbances, or thyroid hormone supplements for thyroid-related mood symptoms.

Psychotherapy

• Cognitive-Behavioral Therapy (CBT): CBT focuses on identifying and changing negative thought patterns and behaviours associated with bipolar disorder. It can help individuals develop coping strategies, manage stress, and prevent relapse.
• Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT helps individuals stabilise their daily routines and manage interpersonal relationships, which can help regulate mood and prevent mood episodes.
• Family Therapy: Involving family members in therapy can help improve communication, reduce conflict, and provide support for the individual with bipolar disorder.

Lifestyle Modifications

• Regular Sleep Patterns: Maintaining a consistent sleep schedule, including adequate sleep duration and quality, is essential for mood stability.
• Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall well-being and may help stabilise mood.
• Regular Exercise: Engaging in regular physical activity, such as walking, jogging, or yoga, can help reduce stress, improve mood, and promote overall health.
• Avoiding Substance Abuse: Limiting or avoiding alcohol and recreational drugs is crucial, as substance abuse can trigger or worsen mood episodes.

Hospitalisation

In severe cases or during acute mood episodes, hospitalisation may be necessary to ensure safety, stabilise symptoms, and initiate appropriate treatment.

Support Groups

Participating in support groups or peer-led programs can provide individuals with bipolar disorder and their families with emotional support, education, and practical coping strategies.

Regular Monitoring and Follow-Up

Regular appointments with healthcare providers are essential to monitor symptoms, adjust medications as needed, and prevent relapse.

Treatment for bipolar disorder should be individualised based on the specific needs and preferences of each person, and it may require ongoing adjustments over time. It's crucial for individuals with bipolar disorder to work closely with a qualified healthcare team to develop a comprehensive treatment plan and achieve long-term stability and well-being.

While there isn't a guaranteed way to prevent bipolar disorder because the exact cause is unknown, there are steps you can take to manage your risk and potentially delay or lessen the severity of episodes:

• Early intervention: If you have a family history of bipolar disorder or notice warning signs of a mood episode in yourself, seeking professional help early can be crucial. A doctor or therapist can develop a treatment plan to help you manage your symptoms and prevent future episodes.
• Manage stress: Stress can be a trigger for mood episodes in people with bipolar disorder. Learning healthy ways to manage stress, such as relaxation techniques, exercise, and getting enough sleep, can be very helpful.
• Maintain a healthy lifestyle: Getting regular exercise, eating a healthy diet, and getting enough sleep are all important for maintaining good mental health and can help regulate moods.
• Avoid alcohol and drugs: Substance abuse can worsen bipolar symptoms and make it more difficult to treat the disorder.
• Develop a support system: Having a strong support system of friends and family can be very helpful for people with bipolar disorder. Talking to people you trust about your condition can help you feel less alone and can provide you with encouragement and support.
• Stick to your treatment plan: If you are diagnosed with bipolar disorder, it is important to stick to your treatment plan as prescribed by your bipolar disorder doctor. This may include medication, therapy, or a combination of both.

Remember, even though bipolar disorder can't be prevented completely, these steps can help you manage your risk and improve your overall well-being.

Why is bipolar disorder no longer called manic-depressive illness?

Bipolar disorder is no longer called manic-depressive illness because the term "bipolar" reflects the two main mood states involved: mania and depression.

What’s the difference between borderline personality disorder and bipolar disorder?

Borderline personality disorder is characterised by unstable relationships, self-image, and emotions, while bipolar disorder involves distinct episodes of mania and depression.

Who does bipolar disorder affect?

Bipolar disorder can affect anyone, regardless of age, gender, or background, but it often develops in late adolescence or early adulthood.

What lifestyle changes can help with bipolar disorder?

Lifestyle changes such as maintaining a regular sleep schedule, eating a balanced diet, exercising regularly, and avoiding substance abuse can help manage bipolar disorder symptoms.

Can I live a normal life with bipolar disorder?

With proper treatment and support, many individuals with bipolar disorder can lead fulfilling lives and achieve stability in their mood and functioning.

Is bipolar a serious mental illness?

Yes, bipolar disorder is a serious mental illness that can significantly impact a person's quality of life, relationships, and ability to function in daily activities.

How long do bipolar patients live?

On average, individuals with bipolar disorder may have a slightly shorter life expectancy compared to the general population, primarily due to factors such as suicide risk and medical comorbidities.

Will bipolar get worse with age?

Bipolar disorder can vary in severity and may not necessarily worsen with age, but proper management and treatment are essential for maintaining stability.

When should I see my healthcare provider about bipolar disorder?

You should see your healthcare provider if you experience significant mood swings, changes in energy or behaviour, or if your symptoms interfere with daily functioning or quality of life.

Is bipolar a genetic disease?

Bipolar disorder has a genetic component, meaning it can run in families, but environmental factors also play a role in its development.

When should I go to the emergency room (ER) for bipolar disorder?

You should go to the emergency room (ER) if you experience severe mood episodes, thoughts of harming yourself or others, or if you are unable to cope with your symptoms safely.

Can a neurologist treat bipolar?

While neurologists primarily treat disorders of the nervous system, they may work with psychiatrists to manage bipolar disorder, especially if neurological conditions are involved.

Is there a permanent cure for bipolar disorder?

There is no permanent cure for bipolar disorder, but with ongoing treatment and support, many individuals can effectively manage their symptoms and lead productive lives.

What is the outlook (prognosis) of bipolar disorder?

The outlook (prognosis) of bipolar disorder varies depending on factors such as the severity of symptoms, adherence to treatment, and the presence of comorbid conditions.

What are the side effects of bipolar disorder medications?

Common side effects of bipolar disorder medications may include weight gain, drowsiness, tremors, gastrointestinal issues, and sexual dysfunction.

Are there any mood stabilisers for bipolar disorder?

Mood stabilisers such as lithium, valproate, lamotrigine, and antipsychotic medications are commonly used to manage symptoms and stabilise mood in bipolar disorder.

Reviewed by Dr. Sandeep Govil, Senior Consultant - Psychiatry, Mental Health And Behavioural Sciences on 9-May-2024.