Bipolar disorder

Bipolar disorder (BD), or manic-depressive illness is a complex psychiatric illness characterized by relapsing of fluctuating mood, elevated anxiety, euphoria, delusion, unusual shift in energy/ activity levels and unpredictable manic-depressive episodes.1 These symptoms combined with its nonadherence to treatment could potentially result in fragmented social relationships (friendships or marriages), inability to excel at work or school and at worst, suicide.2 There are two known types of bipolar disorder: bipolar I disorder and bipolar II disorder. Patients with bipolar I disorder present with mania whereas patients who are diagnosed with bipolar II disorder often majorly depressed and hypomanic. Although quite similar, mania is a significantly intensified episode of elevated energy levels in comparison to hypomania. Maniac episodes often require medical intervention whereas in the case of a less severe version called hypomania, patients do not require hospitalization as there are lack of symptoms which indicate the need for it. 1 However, both types of bipolar disorder cause the patients to spend most of their lives with a depressed state of mind. Some of these patients have also been found to have substance abuse disorders and other psychiatric illnesses which lead to shorter life expectancy and an overall reduced quality of life.3

There are multiple scientific explanations for the rise of bipolar disease. However, approximately 50% of patients diagnosed with bipolar disorder have a family history of the illness hence suggesting that the disease is genetic. Statistical analysis suggests that the disease is passed down through polygenic inheritance.4 The genes which are inherited in turn control brain development which is why the typical onset for bipolar disorder is adolescence or early adulthood. Advances in neurobiology has shown that there is little impact of environment factors on the development of bipolar disorder. This is proven by the fact that children who develop bipolar disorder later in life do not show obvious symptoms until they reach adolescent stage 5 and the fact that it affects everyone from all racial backgrounds living in various environments and from all walks of life. Hormonal imbalance has also been said to be the cause of bipolar disorder. For instance, the rise of a steroid hormone called cortisol is found in patients who suffer from manic episodes as well as those with severe depression. However, its correlation and extent of effects remain vague. Others have also linked mania to sleep-wake cycle which is controlled by a hormone known as melatonin. They suggest that sleep disturbances/deprivation due to low levels of melatonin contribute to the symptoms of bipolar disorder, as well as trigger mood fluctuations.6

Due to its episodic nature and unpredictability, bipolar disorder is sometimes misdiagnosed and as a result, ineffectively treated. Although mania and severe depression is easily diagnosed, it is relatively difficult to distinguish between mania and hypomania. Since the symptoms of bipolar disorder is sometimes very similar to borderline personality disorder and other psychological diseases, a wrong diagnosis is not uncommon.7 In most cases, a confirmation by a mental health specialist is necessary to confirm the diagnosis of bipolar disorder. Due to the lack of pathophysiological base of bipolar disorder, doctors depend on phenomenological analysis to make the diagnosis. They also depend on the definitions for each disorder to clearly define thresholds and make the most accurate diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) systems serve as a guideline for doctors to distinguish between similar mental illnesses. 8

Although many medications and treatments for bipolar disease are still under ongoing extensive research, some people suffering from bipolar disorder can keep their symptoms under control with therapy and pharmacological drugs. However, medications and therapies for patient suffering from bipolar disorder is customized individually and are often feature a combination of treatments. The current plausible treatment is lithium monotherapy, used to treat acute bipolar depression. Lithium is a type of mood stabilizer which is said to have the potential to reduce suicidal and self-harm tendencies in BD patients. Doctors combine lithium with other antidepressants to intensify its effects which could help in more severe cases. Scientific data supports the effectiveness of lithium and dopamine supplements in long-term treatments, but since chances of relapse remain high, BD patients are advised to continue consumption even when they show no symptoms. Although lithium is proven to be effective in BD treatment, its side effects require regular monitoring.9 Antidepressants has also been proven to help with episodes of depression suffered by BD patients. However, doctors worry that these antidepressants could potentially induce a change in depressed state to manic state. Although there are other alternatives such as neuroleptics (Dopamine receptor-blocking drugs), antiepileptics and even placebo drugs, there are limited studies on the extent of its effectiveness.

Despite the remarkable research that has been persistently done on bipolar disorder, its complexity and unpredictability remain puzzling for doctors. The combination of similar symptoms in comparison to other mental disorders and lack of pathological presentation makes it difficult to fully comprehend. This brings the dire need for more research on symptoms, diagnosis as well as treatments for BD in the years to come.