What is Bipolar Disorder?

Bipolar Disorder, also known as Manic Depressive Disorder is characterized by dramatic mood fluctuations , “highs” and  “lows”. The” highs” are the hypomanic or manic episodes . The difference between those is manifested throughout the intensity and the duration of symptoms: the energy is high, people are more talkative and more social that usual,  spending money that they can not afford, on things that they do not need. The impulse control is poor. The need for sleep is poor and the person will be able to go on with just 2-3 hours of sleep. Mind racing, cleaning at night, starting multiple projects, having grandiose  thoughts are some example as of presentation of these episodes.

The “downs” are depressive episodes expressed as depressed mood. One can experience inability to enjoy activities , low interest and motivation, isolation, self  blame, guilt , shame, low energy, or agitation and irritability, sense of hopelessness and helplessness.

Bipolar disorder is classified in different subtypes according to intensity of  symptoms, length, and type of episodes. Sometimes the swings can happen several times a year.  In extreme cases even weeks or days like in Bipolar Disorder Rapid Cycling .Sometimes the manic symptoms of mania  and depression can coexist like in Mixed Bipolar Disorder

It is enough to experience one hypomanic or manic episode to diagnose Bipolar Disorder. These mood fluctuations are very exhausting for patients, and significant  others. Untreated, the disorder can lead to disruptions of  relations, losing jobs, dropping out of school ,and  eventually suicide. Lack of education about the disease and stigma are contributing in delaying or not reaching   professional help.

Causes of Bipolar Disorder

Genetic Causes of Bipolar Disorder

Bipolar Disorder has a strong genetic component as shown in family, twins and adoption studies. In a household with a parent suffering for Bipolar Disorder, every child has about 18% percent risk to develop the disease; and twins have risk of about 50%.

Environmental Causes of Bipolar Disorder

Environmental factors are very diverse and can trigger also Bipolar Disorder: parents divorce, neglect, trauma, loss, daily stress etc Drugs can trigger the condition when the person is vulnerable. Drugs are sometimes use to “handle” the condition: “uppers” and “downers” inducing a vicious circle of symptoms that interfere with efficacy of treatments.

Symptoms of Bipolar Disorder

Both type of episodes affect all areas of functioning and interfere with the quality of life of the person affected and of the significant others.

Treatment of Bipolar Disorder

Medication in the treatment of Bipolar Disorder

The agents that are prescribed in Bipolar Disorder, are called mood stabilizers. Their role is to diminish the fluctuations in mood, and to reach stability. There are three categories of these medications: Lithium Carbonate, Anti-epileptic, and Antipsychotic. Each of these categories is administered by themselves or in combination. Antidepressants are avoided in Bipolar Depressive Episodes due to risk of inducing mania. Unfortunately, sometimes these agents are partially effective and associated with a lot of unwanted side effects.
The side effects spectrum varies:

• kidney failure
• thyroid dysfunction
• decrease in cell blood count
• liver dysfunction,
• weight gain
• Hyperlipidemia
• Diabetes
• Parkinson’s like symptoms

 
Blood work needs to be drawn periodically for some medications, to evaluated systemic functions and levels of medication.

Psychotherapy

Different forms of psychotherapy are important addition to a medication regimen. The role of this intervention is educating the patient in recognizing the symptoms, importance of compliance, coping in daily stressful situation, impulse control, structure ,enhancing the support system, readjusting and so much more.

Lifestyle changes and Neuroplasticity

Implementing lifestyle changes is an essential ingredient in healing process. This starts with very basic steps like:

• sleep hygiene
• healthy eating habits
• listening to one’s body need for rest
• relaxation training
• physical activity

New studies show that small and consistent adjustments in life style induce changes in brain architecture. This process is called neuroplasticity, This will result in improvement in mood, sleep, satisfaction and quality of life in general.

TMS Treatment of Bipolar Disorder

TMS offers a strategy of treatment that is noninvasive and free from the systemic side effects of medication. Electromagnetic pulses, applied with certain frequency and intensity, at certain intervals, stimulate areas of the brain that are responsible for mood regulation.

Four to six weeks of treatments, 5 times a week are typically required to treat the acute symptoms. In order to consolidate the results, we will continue with a tapering regimen for an additional period of time. There is a rare risk of seizure that is enhanced by alcohol.

Patients are requested not to drink any alcoholic beverages during the period of treatments and any changes in medical conditions or medications to be reported to the technician. Headaches are reported during or after the first few sessions. Those are transitory and treated with Tylenol or NSAID’s. Twitching of the face during the stimulation The treatment differs from Electroconvulsive Therapy. It does not require anesthesia. Patient can drive, can continue to go to work, or to be involved in the activity of daily living. TMS is not FDA approved for treatment of Bipolar Disorder.