# Bipolar Disorder Types I & II

In a report from the National Alliance on Mental Illness (NAMI), over 9 million people are diagnosed with Bipolar Disorder every year, with 83% of those cases being ranked as severe.

## Understanding Bipolar Disorders

[1] Bipolar Disorder is a chronic mental condition which causes those suffering from it to experience dramatic mood shifts, ranging from extreme mania to intense depression, with varying degrees in between. The average age of onset is 25, and it is diagnosed in men as often as it is in women. (NAMI, 2016)

Those experiencing this condition find themselves in frequent states of agitation or euphoria, shifting to extreme depressive states of intense unhappiness. Sometimes, and depending on what kind of bipolar disorder that is present, there can be longer periods of excited or mania states versus depression and vice versa. This can lead to profound feelings of exhaustion, melancholy, anger, and despondency, as well as unhealthy pleasure-seeking or risk-taking behaviors, and even suicidal thoughts.

It is important to note that every case of bipolar disorder is different depending on the person and In most cases, if these symptoms are left untreated, they only get worse. Over time they end up taking a heavy toll on the people living with them and those closest to them. Bipolar disorder can affect every aspect of your life including work and interpersonal relationships.

With a structured self-management system, including a functional treatment plan and healthy lifestyle, living with this condition is entirely manageable. As with any mental illness, the key to successfully managing the condition is believing in your own ability to overcome the symptoms and then doing whatever is necessary, for your specific situation, to make certain you do.

### Symptoms:

Bipolar disorder can cause a wide range of symptoms and for this reason is often confused with other disorders all together. Noting the timing of bipolar episodes and breaking them down into categories of highs and lows can make it easier to determine whether or not you actually have bipolar.

During the manic or mania phase of bipolar disorder, you may notice a slight increase in self-confidence, or it could be a greatly exaggerated optimism that increases the impulse to participate in risky or out of the norm behaviors. Here are a number of things that you should keep and note, then make sure you report your findings to your doctor or therapist.

#### Mania: Also known as the “Highs”

— Intense Feelings Of Elation
— Extreme Agitation
— Sleeplessness
— Exaggerated State Of Self-confidence
— Scattered Thoughts And Excessive Talkativeness
— Careless Tendencies (Pleasure-seeking Behaviors)
— Dangerous Tendencies (Risk-taking Behaviors)
— In The Most Severe Cases, Delusions And Hallucinations

During the depression phase of bipolar disorder, you may find yourself falling into bouts of listlessness and feelings of intense anxiety. This leads to many various issues including sleeping excessive amounts, panic attacks, feelings of inadequacy, and in some cases even suicide. Here are several symptoms to be aware of and to share with you doctor or therapist should you find yourself experiencing any of them.

#### Depression: Also known as the “Lows”

— Extended Periods Of Intense Melancholy
— Loss/increase In Appetite And Sleep
— Irreconcilable States Of Anger And Agitation
— Hopelessness
— Lack Of Energy And Lasting Despondency
— Exaggerated Feelings Of Guilt Or Shame
— Difficulty Focusing And Indecisiveness
— Loss Of Interest In Hobbies And Social Activities
— Random Feelings Of Physical Discomfort
— Suicidal Thoughts

## Classifications:

### Bipolar I Disorder

Bipolar I disorder is defined by experiencing one or more occurrences of mania or depression, or any combination of both, everyday for a week. This type of bipolar disorder is the most serious due to the periods of intense mania and dramatic mood shifts. In this type, the phases of mania are often severely pronounced with the sufferer being more amped up than normal to a drastic degree.

People that suffer from this kind of bipolar disorder are likely to experience intense feelings of grandiose behavior, experience a need to act out in extraordinary ways including risky behavior (drugs or sex) and gambling.

### Bipolar II Disorder

Bipolar II disorder is defined by having one or more occurrences of extreme depression, in addition to at least one instance of hypomania, allowing for mellowed periods in between occurrences.

Considered a “milder” form of bipolar, this does not make the disorder less serious than bipolar II. Those with bipolar II experience what is called “hypomania” which is a manic stage that essentially functions as a less intense version of the mania state experienced in bipolar I disorder.

#### Hypomania

This form of the bipolar illness is frequently misdiagnosed as different types of basic depression, causing it to be overlooked in many cases. So if you believe you are experiencing recurrent episodes of depression, refer to this list. If you have been experiencing any of these symptoms in combination with your depression, contact your doctor or therapist to seek appropriate treatment.

Symptoms:

— Four Or More Days Of Unexplainable Energy Or Agitation
— Exaggerated Sense Of Self-importance Or Confidence
— Sleeplessness Without Fatigue
— Unnaturally Wound Up Or Talkative
— Unrelenting Frustration Or Snapping At People
— Trouble Focusing Or Mind Racing
— Increasingly Goal Oriented In Uncharacteristic Areas Of Your Life
— Increased Sense Of Need To Partake In Pleasurable Activities
— Do You Feel Like, Or Have People Mentioned You, Acting Out Of Character

The first step to successful treatment of any mental illness is getting the correct diagnoses. So if you believe you may be experiencing episodes of hypomania, talk to your physician and get yourself on track to getting your condition under control. Don’t let yourself be one of the millions that go undiagnosed. Get yourself the treatment you need and put yourself on the path to a happy healthy life style.

### Other Aspects of Bipolar I and II

#### Not Otherwise Specified (NOS)

This form of bipolar disorder is classified as Not Otherwise Specified (NOS), because those with this condition can’t be diagnosed by the classic emergent patterns in their behavior or moods, such as frequent hypomanic occurrences minus depressive episodes or swinging quickly between mania and depressive symptoms.

#### Cyclothymia

Cyclothymia is classified as a less intense form of bipolar disorder, because it’s has multiple hypomanic episodes with lessened depressive behaviors which interchange for 2 years or more. Though this form of bipolar disorder is less extreme, without treatment it can grow more severe over time.

#### Rapid Cycling

Rapid cycling is considered a lesser form of the disorder due to its shorter length overall, however can be more severe due to the intensity of its shifting episodes. It is classified by having episodes in excess of four, over the length of a year, involving severe hypomania, mania, or depressive symptoms. Rapid cycling is a possible occurrence across all forms of the bipolar disorder, however it may only be temporary for those experiencing it.

### Diagnosis:

The study of depression traces all the way back to ancient greek culture, with Aretaeus of Cappadocia, a famous greek physician and philosopher, though his ideas on the subject weren’t taken seriously until modern times. Both working independently, Jules Baillarger and Jean-Pierre Falret presented their findings to the Académie de Médicine, the same year in Paris 1854. The terms we use today have a much more recent history with “manic-depressive illness” dating back to the 1950’s, and the term “bipolar disorder” only dating back to the 1980’s.

Despite this long history of study into the subject, it is important to note that this condition is not curable, but only treatable. However living with the bipolar condition is entirely possible with the right treatment plan.

The rules for diagnosis used by doctors today are taken from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Far too many people go undiagnosed currently because relevant details aren’t shared with their doctor or therapist when they see them, or due to incomplete medical histories, their doctors misdiagnose their condition as major depression.

Make sure to note your symptoms as they occur, so you can share them when you see your doctor, whether they are happening at that moment or not. This condition typically begins in late adolescence, and affects men and women equally. According to the Depression and Bipolar Support Alliance (DBSA), almost 6 million adults are afflicted with some form of the bipolar disorder in America today.

A proper examination should include a personal interview, a physical checkup, and lab tests. If you are suffering from bipolar disorder, the lab tests and physical examination frequently do more to rule out what your condition isn’t, but can also identify other issues leading to your change in behavior or mood, like brain tumors, thyroid conditions, or a stroke. The personal interview helps distinguish the factors your doctor can’t track by physical means, such as the patterns of emergent behavior, and the length and frequency of the mood changes you are experiencing.

Once it is established that your condition isn’t caused by other illnesses, your doctor may refer you to a psychiatrist to continue with a mental evaluation and possible treatments. Make sure the psychiatrist you choose has experience in identifying the specific factors involved in bipolar disorder, so that you can avoid being misdiagnosed with other disorders sharing similar symptoms.

A person suffering from unipolar depression does not experience mania nor hypomania, so it is crucially important that you find experienced help identifying the specific factors involved in the various forms of bipolar disorder. Your mental health professional will need to know about any history of mental illness in your family, and they will need to get a complete history of your particular symptoms in order properly diagnose you.

While there is no single cause for this disorder, most scientists agree that it comes down to a combination of genetics and or altered brain structure and functioning. The genetic causes are why providing a detailed family medical history to your doctor, is so important, just as the lab tests, such as brain scans, are important for identifying altered brain structure or function. it is also important to recognize the difference between this disorder and regular mood swings.

The distinguishing factors are:

— Severity
— Timeframe
— How much they interfere with your everyday life.

With bipolar disorder your mood shifts are much more intense, they last more than a few days, and they become a very real impediment to your work, school, home, and social life. Here is some important things to know when making your decision on the best treatment for you

### Treatment:

There are several different ways to treat bipolar disorder, and the correct combination for your specific situation can only be found through trial and error. A person suffering from bipolar disorder can choose between finding a psychiatrist who will treat their condition mainly through medication, a primary health provider (PCP) who will treat any diseases or physical ailments contributing to their condition, and a psychologist who will treat the condition through conversational therapy. In the case of reaching a worsening and untenable state to your condition, outright hospitalization can also be an option. It is also important to know your DSM diagnostic code to assist with classification for insurance coverage. The main DSM diagnostic code for bipolar disorder is 296, with the number counting up by fractions for the various stages and forms of the condition.

#### Mood Stabilizers

Lithium (Eskalith or Lithobid)

An effective mood stabilizer used since 1970, for treating both manic and depressive episodes

Side Effects of Lithium:

— Sleeplessness
— Cotton Mouth
— Bloating Or Indigestion
— Breaking Out In Pimples
— Sensitivity To Cold Conditions
— Random Pain Or Discomfort
— Frail Hair And Nails

General Side Effects of Mood Stabilizers:

— Feeling Excessively Lethargic
— Feeling Faint
— Diarrhea Or Constipation
— Indigestion
— Swinging Emotional States
— Symptoms Similar To The Common Cold

Anticonvulsants

Originally created to treat seizures, anticonvulsants have also been used as mood stabilizers

— Depakote (Divalproex sodium or valproic acid)- This is frequently used instead of lithium. Though young women should consult their doctor before using.

— Lamictal (Lamotrigine)- This is commonly used in maintenance treatment of depressive symptoms

— Neurontin (Gabapentin)- This has been found to be helpful addressing the combined treatment of refractory and co-morbid conditions

— Topamax (Topiramate)- This is used for controlling rapid cycling and a combination of bipolar conditions

— Trileptal (Oxcarbazepine)- This is used for long term treatment of bipolar disorder

It is important to note that the use of many kinds of anticonvulsant are experimental, and have FDA warnings that they may cause suicidal thoughts and behaviors. So the possible side effects and the mixing of your medications should always be discussed with your doctor beforehand.

Atypical Antidepressants

These medications are most commonly used in combination with your other forms of treatment.

— Zyprexa (Olanzapine)- Given in combination with an antidepressant, this assists in reducing the symptoms of severe manic or psychotic episodes. In some cases it is also used as a maintenance medication, whether or not your symptoms are presently occurring.

— Abilify (Aripiprazole)- This is used for treating mania and combined episodes. It can also be used as a maintenance medication.

— Seroquel (Quetiapine)- This is used to treat the depressive lows, manic highs, and their various combinations, as a short term medication, but when used in combination with lithium or divalproex it has been shown to be useful as a long-term maintenance medication for the treatment of bipolar I disorder.

— Risperdal (Risperidone)- This medication is used alone as well as in combination with other medications, for short-term monotherapies of various manic and depressive states experienced with bipolar I disorder

— Geodon (Ziprasidone)- Geodon is used to treat manic depressive states in adults and children above the age of ten.

Side Effects of Antipsychotics:

— Sleepiness
— Faintness
— Fuzzy Vision
— Increased Pulse Rate
— Negative Reaction To Sunlight
— Epidermal Rashes
— Menstrual Issues In Women

Antidepressants

These are occasionally used to treat bipolar disorder, however it is important to be aware that use of this kind of medication can sometimes lead to developing issues previously not present, such as mania, hypomania, or rapid cycling disorder. To avoid this your physician may insist you take medications to stabilize your mood, in conjunction with the antidepressants. Several popular examples of these kinds of medication are Prozac (Fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Wellbutrin (bupropion). Specifically Selective Serotonin Reuptake Inhibitor (SSRI) medications function through increasing serotonin levels to decrease the effects of clinical depression and anxiety.

Side Effects of Antidepressants:

— Feeling Nauseous
— Feeling Wound Up
— Decreased Sexual Drive
— Issues Performing And Enjoying Sex

Psychotherapy

This treatment is generally given in combination with your current medications to address various types of bipolar disorder, and can also provide an educational source for learning to live with your condition.

— Cognitive behavioral therapy (CBT): This is used to learn healthy methods for altering destructive behaviors and hurtful thought patterns.

— Family-focused therapy: This treatment uses family to develop healthy coping skills, as well as improving interfamilial relations.

— Interpersonal and social rhythm therapy- This teaches how to strengthen relationships and methods for reliably accomplishing your regular routine.

— Psychoeducation: This educates people in the details of bipolar disorder and its different forms of treatment. In addition to teaching how to identify when episodes are about to happen, so you can treat them before they become more severe.

— Electroconvulsive Therapy (ECT) : In cases where all other forms of treatment unsuccessful electroconvulsive therapy has been shown to be useful. With this therapy you are given a muscle relaxant and put under anesthesia for a short period of time, so you will not feel the electricity being administered. The pulses typically last 30-90 seconds, and you will recover completely within 5-15 minutes.

— Sleep Medications: Those with this disorder frequently experience sleeping issues and turn to medications to improve their resting periods. If over the counter medication doesn’t improve your sleeping patterns however, you may wish to consult your physician for stronger sedatives or sleep medicine.

— Herbal Supplements: Not much is known about the effectiveness of herbal or natural supplements for bipolar disorder. St. John's wort (Hypericum perforatum), advertised as a natural antidepressant, might affect a change to mania in those who suffer from bipolar disorder. However it can also lessen the effectiveness of other medications, including a few antidepressant and anticonvulsant forms of medication.

Common herbal remedies used for at home treatment of bipolar disorder include:

St. John’s Wort
Fish oil
— Brahmi
Ashwagandha
— Valerian Root
Passion Flower
— Magnesium

It is important to note that most supplement treatments are not approved by the FDA. They are not considered medicine, but have properties that can help.

#### A Note on Treatment

This guide is not to be used as a diagnostic tool or to treat any variation of bipolar disorder. Before you approach any kind of diagnosis or treatment, please talk to your primary care physician or therapist. The writing in this article is meant to be informational only.

— Cited sources:

https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Overview

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145402

http://www.dbsalliance.org/site/PageServer?pagename=education_bipolar

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