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Let’s learn what causes bipolar disorder in brain.
The word bipolar means two extremes. For the people experiencing this condition, life is split between two different realities, elation and depression.
Type 1 has extreme highs known as manic episodes followed by extreme lows. These periods of extreme highs exceed ordinary feelings of joy, making a person feel euphoric. Symptoms include racing thoughts, sleeplessness, rapid speech, impulsive actions, and intense behaviours.
The depressed phase manifests in many ways like mood swings, dwindling interest in hobbies, changes in appetite, feeling worthless or guilty, too much or too little sleep with persistent thoughts of suicide.
Type 2 involves briefer periods of elation interspersed with long periods of depression.
Type 3 involves constantly see-sawing between two emotional states, making it impossible to find a healthy life balance.
Bipolar Disorder in the brain is mainly caused due to chemical imbalances in the brain. Neurotransmitters in the brain like serotonin, noradrenaline, and dopamine are responsible for maintaining these chemical balances.
When there is an imbalance in any one of these neurotransmitters, symptoms of bipolar disorder are observed. Bipolar disorder is also known as manic depression.
What are manic episodes?
Mania is an abnormally elevated mental state characteristic of bipolar disorder and typified by extreme exhilaration, energy, and euphoria. However, mania can spiral out of control resulting in anger, irritability, extreme mood swings, and aggression. This change is unnoticeable to your usual self but noticeable to others.
People in a manic state may indulge in reckless decision-making like going on a gambling spree, quitting jobs, and reckless driving. These intense emotional states may also include inappropriate sexual behaviour and substance abuse.
Some people tend to have a milder form of mania known as hypomania. It doesn’t last long as the manic episodes and don’t interfere with daily activities.
What are the different types of bipolar disorder :
Bipolar I disorder: People with bipolar disorder have experienced both the episodes of mania and depression. During these episodes, they may feel at the top of the world. Most people with bipolar I disorder have a neutral mood, while some may experience hypomanic and depressive symptoms.
Usually, these depressive symptoms last at least two weeks. People with bipolar I disorder also have other mental disorders like anxiety disorders and substance use disorders
Symptoms or criteria to meet bipolar I disorder include:
- abnormally persistent elevated moods
- persistent goal-directed activity with energy lasting for more than one week and nearly present every day
- Major manic symptoms like inflated self-esteem or grandiosity, an urge to keep talking constantly, decreased need for sleep
Sometimes manic episodes are triggered if the mental illness is misdiagnosed with depression. Intake of antidepressant pills during their condition can increase your risk of going through a manic episode.
During mania, patients reportedly feel good and productive about themselves, but this does not last long, making them regret their decisions during these episodes.
People with bipolar disorder can also feel mixed emotions like mania and depression, at the same time creating irritation for themselves.
Unlike bipolar ii disorder, patients diagnosed with bipolar I disorder do not experience major depressive episodes.
Bipolar ii disorder: People with bipolar ii experience a major depressive episode and a hypomanic episode. Unlike bipolar I, they don’t experience acute mania. Hypomania is less impairing than a full mania but more debilitating than bipolar I due to episodes of chronic depression.
Symptoms must include:
- depressed mood, loss of interest or pleasure in things
- a significant change in weight gain/loss
- feeling fatigued, restless, and worthless almost every day
- diminished ability to think or concentrate.
Cyclothymic disorder: People with cyclothymic disorder have a chronically unstable mood. They experience mood swings all the time. They also experience hypomania and depressive episodes, but none of them qualify for the state of major depression or mania.
Pediatric bipolar disorder: Children can also get affected by this brain disorder due to environmental or genetic factors. Symptoms in children include frequent mood shifts, anger outbursts, and crying all day.
Children with pediatric bipolar disorder also tend to show less clear episodes like adults but show mixed behaviours of mania and depression followed by irritability.
The difference between bipolar I disorder and bipolar II disorder
The difference between these two disorders lies in a manic episode. People with bipolar I disorder do not experience major depression or major depressive episodes, while people with bipolar ii disorder experience hypomania.
The difference between hypomania and mania lies in the degree or the severity of the episode.
Which part of the brain is affected by bipolar disorder?
Reduced gray matter: Bipolar disorder affects the thinner inner cortical gray matter of the frontal-temporal and parietal regions of the brain.
The gray matter in our brain plays an important role in carrying sensory signals across the central nervous system, which helps us perform simple tasks.
Due to the thinning of the gray matter layer, patients often struggle with simple motor skills such as speaking, balancing, and writing.
The major symptoms of a reduced gray matter include decreased control over senses, reflexes, and reaction time.
Shrinking of Hippocampus: The hippocampus located in the temporal lobe of the brain is responsible for memory, emotions, and verbal and visual memory.
Shrinking of the hippocampus leads to depressive symptoms, Irritation, mood shifts, and memory problems, leading to paranoia. These symptoms explain why manic episodes are often impulsive and reckless.
What causes or triggers the bipolar disorder
A stressful event or life event mainly triggers the bipolar disorder. Examples include a loss of a relationship, stressful life events like the death of a loved one, sexual or emotional abuse, etc.
Social Rhythm disruption affects more bipolar patients with mania. It also affects memory and a person’s mood. Other problems include biological problems like loss of brain cells in the hippocampus can lead to mood disorders.
Along with affecting a person’s mental health, bipolar disorder also affects the neurotransmitters responsible for memory.
Evidence suggests that the platelets tend to uptake less serotonin during a hypomanic episode. However, high serotonin levels can trigger a manic episode.
As we know that the mitochondria are the powerhouse of the cell, problems in mitochondrial matrix compositions may lead to such mental disorders where there is a change in energy production and use.
Researchers have also seen abnormal cellular activity in certain brain parts while performing MRIs on patients.
Bipolar disorder can be triggered by environmental factors like major life changes or stressors. This may include quitting a job, getting a divorce, starting a new job, or going to college.
Family or twin adoption studies say that bipolar disorder can run in families and possess a genetic link. It is usually seen in people who have first-degree relatives suffering from similar mood disorders.
Age/gender risk and other factors :
Bipolar disorder usually affects those between the age group of 25 to 45, and sometimes also, people in their 40s are affected.
Children below 6 years of age also have bipolar disorder, but this may be due to previous trauma. Generally, women suffer from bipolar ii disorder more than men, although bipolar i is common in both sexes.
People with bipolar disorder often have an underactive thyroid or hypothyroidism.
The thyroid gland is present on both sides of the neck and releases hormones called thyroxine which help in regulating growth and development.
Treatments for bipolar disorder
Your evaluation for bipolar disorder includes a series of steps:
Physical exam: Physical exam includes testing for symptoms of other medical health conditions that can trigger bipolar disorder.
Psychiatric assessment: Your doctor may ask you if you have undergone previous therapy sessions for any mental health condition. Then you are asked to fill out a psychiatric assessment in the form of a questionnaire.
You are asked to talk about your thoughts and episodes of depression or mania to understand your behavioural patterns better.
Charting out your mood: You may be asked to record your mood and sleep patterns daily to understand better if you have a mental disorder.
Some patients may need medications, whereas some patients are treated with the help of psychotherapy. This depends upon the severity of symptoms and diagnosis inference determined by your health care provider’s
These are needed to control the mood swings during a hypomanic episode or major depressive episode.
Some medications that help stabilize your mood include lithium, valproic acid (Depakene), divalproex sodium Depakote, carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal).
Antipsychotics and antidepressants
If the signs and symptoms of intense sadness and bipolar illness continue despite the medication, adding antipsychotic drugs like risperidone, quetiapine, and ziprasidone may help.
Along with mood stabilizers, your doctor may prescribe antidepressant drugs like Symbax. Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine to treat depression-related symptoms.
Benzodiazepines also help improve sleep in hypomania patients, but that is only temporary.
Taking bipolar disorder medication during pregnancy can be associated with possible congenital disabilities and can pass through the breast milk to affect your baby.
Birth control medicines tend to lose effect if taken along with bipolar medicines; hence one should consult with their health care provider.
Provides patients with an understanding of their bipolar symptoms and illness. It covers topics such as the nature and course of bipolar disorder, potential benefits and adverse effects of various treatments, and the most effective ways to prevent a relapse.
Identification of early warning signs of a relapse and behavioural changes that reduce the likelihood of relapse.
Interpersonal and social rhythm therapy: In this therapy, people first learn to recognize their sleep and wake cycles. Their daily routines and mental health symptoms are all connected.
Treatment then focuses on creating a daily routine regarding sleep, diet, and exercise. This treatment also addresses potential problems that may disrupt this routine and develops strategies to improve these problems.
Family-based treatment: This is a way for families to work together for recovery. Here families attend educational sessions where they will learn basic facts about mental illness, coping skills, communication skills problem-solving skills to help in recovery.
People who participate in family services and take medication have less relapse, better medication adherence, and increased positive communication between family members.
Cognitive or behavioural therapy (CBT): Behavioural therapy focuses on a person’s actions and aims to change the unhealthy behavioural pattern. CBT involves psychoeducation along with problem-solving techniques. Patients learn to identify what triggers this manic episode.
This can help them manage the types of stress that lead to hospitalization. CBT helps people challenge their thoughts and replace them with healthy thoughts logically.
CBT encourages people to schedule pleasurable activities to help reduce depressive symptoms. It may be done one on one or in a group setting.
Social skill training (SST): Many people with bipolar disorder struggle with effective communication and social skills. Social skills training aims at helping people express their emotions and communicate more effectively.
These skills are taught with the help of modelling, role-playing, and positive reinforcement.
Electroconvulsive therapy(ECT): Electroconvulsive therapy is done on patients to rewire their brains or reverse mental illness conditions. This is performed when the patient is in general anesthesia in which small electric currents are passed through the brain, intentionally triggering a small seizure.
A muscle relaxant keeps spam from spreading to the rest of the body. This causes a huge number of neurons to fire in unison.
The only symptom of electrical pulses being imparted to the brain includes a twitching foot. Most patients can resume their normal activities after an hour or so.
Ect seems to change the brain chemicals to reverse the bipolar symptoms quickly. Although modern ect is far more effective than what it used to be, patients can experience some side effects like aching, nausea, and feeling fatigued.
Some people might forget about the incidents that happened right before the session. Ect works better when paired with medication.
Disorders similar to bipolar disorder:
Borderline Personality Disorder
This disorder is similar to bipolar disorder, where a person experiences constant mood swings and has difficulty forming stable relationships.
People with BPD often fear abandonment, have an unclear self-image, and resort to self-harm or self-sabotaging behaviours in extreme cases.
BPD is a personality disorder, and bipolar disorder is a mood disorder. The mood swings in BPD do not last as long as a few days or weeks as in Bipolar disorder. The treatment of BPD involves psychotherapy, whereas other mental illnesses are generally treated with medication.
The treatment for BPD is dialectic behaviour therapy, whereas, for bipolar disorder, it is cognitive-behavioural therapy.
ADHD (attention-deficit/ hyperactivity disorder)
Bipolar disorder is mainly a mood disorder and usually is episodic, and ADHD is an ongoing disorder with periods of normal mood interspersed with depression.
Symptoms include Impulsiveness, trouble multitasking, poor time management skills, and mood disorders.
Substance use disorder
People with bipolar disorder often tend to self-medicate using drugs and alcohol, which temporarily helps them get out of a manic episode.
This also includes dug addiction to partially create a sedative effect and lower the feeling of being depressed or utterly euphoric.
Soon this becomes a habit and leads to worsening of the mental condition. This explains why most patients with bipolar disorder are addicts.
Some patients addicted to cocaine show similar symptoms to bipolar disorder. It is advised to visit an experienced psychiatrist who can differentiate between them.
Major depressive disorder /MDD
People with related disorders like Major depressive disorder show decreased levels of certain monoamine neurotransmitters and including serotonin, norepinephrine, and noradrenaline.
So it’s been hypothesized that increased levels of these neurotransmitters may lead to mania which is bipolar disorder. Those affected may also occasionally have delusions or hallucinations.
How to cope with bipolar disorder
Once you are aware of your symptoms and are clinically diagnosed with bipolar disorder, you need to follow steps to keep track of your medicines and mental health.
Preparing for the sessions: You should prepare for your therapy sessions beforehand by self-reflecting on your emotions and thoughts.
Keeping track of previous therapies in a journal helps you revisit the things taught by your therapist and things to keep in mind whenever you are in the middle of an episode. You should feel relaxed upon arriving at your therapy clinic and not rush things.
Do your homework if the therapist assigns you any recreational activity or fill up any mental health questionnaire.
Do not refrain from asking questions and taking notes during your sessions. Take time after the sessions to review your emotions. Remember, your therapist needs to know your behavioural patterns to better your mental condition and not judge you.
Spend some time alone reflecting on those intense emotions and keep repeating this process to attain sound mental health in the near future.
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