“Am I bipolar?”

Written by Jamie Ang

“Am I bipolar?” Although many may have asked themselves this question, it is relatively rare. Bipolar disorder affects approximately 1.2% of the population in Singapore and the age of onset is between the ages of 15 to 25 (SingHealth, 2021). It is more likely to run in families whose parent, sibling or relative have bipolar disorder or depression. Irregularities in brain structures and environmental factors such as traumatic experiences and stress may increase risk in developing this condition (Holland et al., 2023).  

Bipolar disorder (BD) is a mental illness that causes unusual shifts in an individual’s mood, energy, concentration, and the ability to function. Persons with BD experience intense emotional states ranging from days to weeks, known as mood episodes, involving distinct changes in the activity levels, energy and mood (National Institute of Mental Health, 2023). These mood episodes are characterized as manic (extremely high, elated or irritable) or depressive (dejected, indifferent or hopeless). Less severe manic episodes are categorized as hypomanic and do not cause irregularities in daily functioning unlike manic periods. They can keep with day-to-day life and are able to get things done. It lasts only for days but without proper treatment, individuals with hypomania may develop severe depression or mania. Those without BD experience mood fluctuations and it only lasts for a few hours (National Institute of Mental Health, 2023). These changes do not encompass difficulties with social interaction and daily routines, nor the extreme behavior change exhibited by people with BD during mood fluctuations (Howland & Sehamy, 2021). Mood episodes are distinct from a person’s everyday behaviors and emotions. Its symptoms last throughout the day and potentially extend over several days or weeks.

Key symptoms of a manic episode include at least 3 changes in behavior:

·  Feeling extremely high-spirited and irritable

·  Racing thoughts

·  Decreased need for sleep (energetic despite significant less sleep)

·  Faster and increased speech

·  Increased risky behavior (reckless activities)

·  Increased activity (multi-tasking)

Key symptoms of a depressive episode include at least 5 changes in behavior:

·  Intense despair or anxiety

·  Loss of interest in activities

·  Restless

·  Increased/decreased sleep

·  Increased/decreased appetite

·  Feeling guilt or worthless

·  Frequent thoughts about suicide or death

·  Difficulty concentrating

The main features of BD are mania, depression, and hypomania. Different combinations of such features make up different types of BD (Holland et al., 2023). There are 3 types of BD – Bipolar I disorder, Bipolar II disorder and Cyclothymic disorder.

Bipolar I disorder (BDI) is characterized by having manic and depressive episodes together or individually that last for at least 7 days that require immediate medical care (National Institute of Mental Health, 2023). Persons with BDI may feel hopeless and extremely energized at the same time. Their behaviors are out of character and cause dysfunction in work, family and social activities. For instance, someone who is usually patient may tend to disagree with their partner more easily during a manic episode or engage in sudden binge drinking or spending sprees (Holland et al., 2023). Many with BDI are also diagnosed with other conditions such as attention-deficit/hyperactivity disorder, eating disorders, substance use disorders, and anxiety disorder. Those who have severe manic or depressive episodes may sometimes experience symptoms of psychosis – delusions or hallucinations (Howland & Sehamy, 2021). For example, someone having psychotic symptoms during a manic episode may falsely believe that they have special powers. Howland et al. (2021) has also found that people with BDI have higher risks of suicide as compared to the general population.

Bipolar II disorder (BDII) is defined by a pattern of hypomanic and depressive episodes (National Institute of Mental Health, 2023). People with BDII are able to return to their day-to-day functioning between episodes. They are likely to seek treatment after their first depressive episode as hypomanic episodes are often pleasurable and can increase school or work performances (Howland & Sehamy, 20221). Similar to BDI, these individuals are frequently associated with substance use or anxiety disorder that can exacerbate symptoms of hypomania or depression.

Cyclothymic disorder is a milder form of BD with recurrent depressive and hypomanic symptoms that are less severe than BDI or BDII (Holland et al., 2023). Persons with cyclothymic disorder experience multiple mood swings, fluctuating between mild depression and hypomania. This pattern is irregular and unpredictable, meaning individuals might have normal moods for more than a month or may cycle continuously from hypomania to depression, with no normal period in between. These symptoms do not last long nor meet the criteria for a depressive or hypomanic episode.

Although the specific causes of BD are unclear, BD symptoms improve with a combination of medication and psychotherapy, known as talk therapy, to help patients learn more about their condition and prevent future mood episodes. Techniques such as keeping a mood journal can be effective in observing mood fluctuations and identifying trigger patterns. Mood stabilizers such as valproate and lithium can reduce the severity and frequency of mood episodes. Consuming lithium also decreases the risk of suicide (National Institute of Mental Health, 2023). If those do not work, people with BD can opt for electroconvulsive therapy. It helps to relieve severe symptoms of BD by supplying several sounds of brief electrical current to the scalp, leading to a short, controlled seizure, to remodel brain signaling pathways (Howland & Sehamy, 2021). Since BD is a chronic illness where mood episodes tend to recur, it is essential that people with BD explore different combinations of treatment to find out what works best for them. Following an effective treatment plan enables individuals to manage their symptoms and have a better quality of life.

References 

Holland, K., Raypole, C., & Sharon, A. (2023, January 25). Everything you need to know about Bipolar Disorder. Healthline. https://www.healthline.com/health/bipolar-disorder

Howland, M., & Sehamy, A. E. (2021, January). What are Bipolar Disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

National Institute of Mental Health. (2023, February). Bipolar Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder#:~:text=People%20with%20bipolar%20disorder%20experience,periods%20are%20called%20mood%20episodes

SingHealth. (2021). Bipolar. SingHealth. https://www.singhealth.com.sg/patient-care/conditions-treatments/Bipolar#