Bipolar Disorder
What is Bipolar Disorder?
Bipolar disorder, historically referred to as manic-depressive disorder, is a mental health condition in which an individual will have poor regulation or uncontrolled shifts in mood, energy, and activity levels. There are 3 different types of bipolar disorder (1). All three types demonstrate clear changes in mood, energy and activity levels. These moods will be on a spectrum from extreme highs to extreme lows. “Highs” include elation, irritable or energized behavior and it may include a small or significant period with a lack of sleep. “Lows” include sadness, being indifferent, hopelessness or depression.
How Common is Bipolar Disorder?
Bipolar disorder is a fairly common disorder, affecting about 2.8% of the United States population. This disorder is known to affect males and females equally, and 83% of the diagnosed cases are considered to be severe (2). It can occur at any age, although it usually develops during late teens to early twenties and is diagnosed most frequently during this time frame. Pregnancy and childbirth may also be times of onset of the disorder in women.
What Causes Bipolar Disorder?
Currently, there is no known definitive cause of bipolar disorder. The two causes with the most evidentiary support are currently physical structural differences in the brain and genetics. Studies have demonstrated structural differences in the white matter of the prefrontal cortex of those living with bipolar disorder. It is theorized this is a contributing factor to the behavioral differences in those struggling with the condition. People who have a first-degree relative with the condition are also more likely to suffer from the disorder [3].
What are Symptoms of Bipolar Disorder?
Symptoms of this disorder are characterized as unusually intense emotions, changes in activity level, and changes in sleep patterns. These also partner with unusual actions and uncharacteristic behaviors. These behaviors are often harmful to the individual, however they are unable to recognize these behaviors as problematic at the time. There are periods of time where there may be high energy, a sensation of feeling elated, jumpy or “wired.” They may have a decreased need for sleep or food and their decision-making follows illogical thought patterns. These periods are considered “manic” episodes. There are also periods of “depressive” episodes which include feeling down, slow, hopeless, or restless. They have difficulty concentrating, talk more slowly, have little interest in almost all activities, have a decreased or absent sex drive, increased sleep and appetite, among other depressive symptoms. These periods of time are considered mood episodes and can last for days to weeks. Depending on the type of disorder they have, they may fluctuate through depressive and manic episodes in the same day. Symptoms may also vary over time.
The three different types of Bipolar Disorder are as follows (1):
Bipolar I Disorder - manic episodes lasting at least 7 days or manic symptoms that are of the severity that they require hospitalization. Depressive episodes often last at least 2 weeks. Depressive and manic symptoms may also coexist.
Bipolar II Disorder - a pattern of depressive and hypomanic (less severe) episodes, but not the severity of symptoms seen in Bipolar I Disorder.
Cyclothymic Disorder (aka Cyclothymia) - defined by periods of hypomania and depressive symptoms that last for at least 2 years in adults, or 1 year in children. The symptoms are not severe enough to meet requirements of the previous 2 disorders.
What Happens to the Brain in Bipolar Disorder?
Bipolar disorder deals with fluctuating symptoms as a result of unstable neurotransmission in the brain. Neurotransmitters are signals sent from one brain cell (neuron) to another. Depending on the neurotransmitter, some are responsible for excitation of the next neuron and some for inhibition. During a manic state, specific regions of the brain are hyper-activated (activated too much) while other regions of the brain that are normally responsible for inhibition of this activity are not functioning properly. Manic patients demonstrate hyperactivity of a few neurotransmitter projections, such as ventromedial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DLPFC) and nucleus accumbens. Each of these areas result in the different types of manic symptoms (5). Poor impulse control or increased risk taking is due to hyper activation of the VMPFC again, as well as the DLPFC. DLPFC hyperactivity is also associated with distractibility and poor concentration. Other subcortical areas, such as the thalamus, hypothalamus and basal forebrain are over excited when there is a decreased need for sleep. Other systems, such as the OFC, should be able to inhibit some of these circuits, however there is too much activity for it to function properly. Therefore, BD is a result of excessive excitatory neurotransmitter production, excessive receptor site response, dysfunction of the inhibitory systems and glutamate excitotoxicity.
TMS Treatment
Medications are targeted toward treating either the main symptoms of mania or the main symptoms of depression when they occur. Transcranial Magnetic Stimulation (TMS) is a newer therapy being utilized to treat bipolar disorder (4). Its greatest efficacy has been demonstrated for treatment of bipolar depression, both during acute symptoms and as a maintenance therapy.
Best Next Step
Living with bipolar disorder is extraordinarily challenging, but there is hope for relief and improvement. To see if TMS is right for you, contact our front desk and schedule a free consultation with Shauna Hahn, PMHNP.
And remember, it’s never too late to start feeling better.
References:
1. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
2. https://www.nhs.uk/conditions/bipolar-disorder/
3. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder