Power of empathy: How to recognize, understand and treat bipolar disorder

Interesting Engineering (IE) spoke to two experts based in India to gain a deeper insight into bipolar disorder, Dr. Neelam Raina, a consultant psychiatrist, and Roshni Mathur, a consulting psychologist.

Symptoms and types of bipolar disorder

The most common symptoms of bipolar disorder include episodes of mood swings, according to Raina.

"These episodes can range from mania, characterized by loud and fast speech, increased energy, and reckless behavior, to periods of depression, characterized by feelings of sadness or hopelessness, low energy, and loss of interest in activities," said Raina.

"Other common symptoms may include insomnia, difficulty concentrating, irritability, and changes in appetite or weight. It's important to note that these symptoms can vary in severity and frequency, and diagnosis requires a thorough assessment by a qualified mental health professional."

"In some people, the mania can present itself as psychomotor agitation, inflated self-esteem, or grandiosity, and low attention span, and the depression presents itself as recurrent suicidal ideation and increased irritability," added Mathur.

There are three broad subtypes of bipolar disorders commonly termed bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

Bipolar I is characterized by at least one episode of mania that lasts for at least one week and can be accompanied by symptoms of major depression, although not everyone with bipolar I has depressive episodes. "In some cases, mania might trigger a break from reality or psychosis," added Mathur. 

Bipolar II is characterized by at least one episode of hypomania that has lasted for at least four days, and at least one episode of major depression.

"Hypomania is a less severe form of mania lasting at least four consecutive days," explained Raina. While those suffering from bipolar I disorder can have difficulty functioning 'normally,' people with bipolar II disorder often still function relatively normally in their daily life.

Cyclothymic disorder is characterized by chronic fluctuations in mood, with episodes of hypomanic and depressive symptoms over a period of at least two years, where symptoms are not severe enough to meet the full criteria for bipolar I or II disorder.

"While the three subtypes differ in the severity and duration of their manic and depressive episodes, they share core symptoms of bipolar disorder, including alternating periods of elevated or irritable mood and major depression," noted Raina. 

How is bipolar disorder diagnosed?

The process of diagnosing bipolar disorder involves a thorough examination of the patient's symptoms, behavior, and medical history, as well as a physical exam and laboratory tests to rule out any underlying medical conditions that may be causing the symptoms.

"Other medical conditions, such as thyroid disorders or substance abuse, can mimic symptoms of bipolar disorder, and thus, these factors should always be ruled out before a diagnosis is made," Raina stated. 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have experienced at least one episode of mania or hypomania to be diagnosed with bipolar disorder. The diagnosis is carried out by either a psychiatrist or a clinical psychologist using standardized assessment tools. 

The mental health professional will conduct a comprehensive psychiatric evaluation that includes a detailed assessment of the patient's symptoms and behavior, as well as their personal and family history of mental illness.

Raina noted that sometimes the mental health professional may also consult friends and family members to understand how the symptoms are affecting the patient's daily life.

"Some standardized self-report measures like the YMRS (Young Mania Rating Scale) or BDI (Beck Depression Inventory) might be used to assist with the diagnosis and inventorying of the symptoms. However, these self-report measures alone aren't enough for a diagnosis, but only help in diagnostic formulation," explained Mathur.

At the end of the day, only a mental health professional can diagnose someone with bipolar disorder. A diagnosis will help the mental health professional to formulate a treatment plan to manage and treat the condition.

What are the treatment options for bipolar disorder?

Treatment for bipolar disorders most commonly involves a combination of medication and psychotherapy. Mood stabilizers, antipsychotics, and antidepressants are some medications that can help manage the symptoms.

Psychotherapy in the form of cognitive behavioral therapy (CBT) has proven to be effective in the treatment of bipolar disorder and can help lower the frequency of episodes as well as mania severity and also improve depressive symptoms.

"It can also help people with bipolar disorder develop coping skills and improve their ability to manage stress and regulate their moods," said Raina. 

Several lifestyle changes can also help to manage the symptoms, such as regular exercise, maintaining a consistent sleep pattern, and avoiding drugs and alcohol.

"The effectiveness of these treatments can vary depending on the person, the subtype of bipolar disorder, and the severity of symptoms," she said.

"The bottom line here is that though there is no cure for bipolar disorder, with the right treatment and support, it is a highly manageable condition," expressed Mathur.

Living with bipolar disorder

Living with bipolar disorder can be challenging and often requires significant adjustments to daily life.

"People with bipolar disorder may struggle to maintain healthy relationships due to mood swings. During manic episodes, they may become impulsive, irritable, and aggressive, which can harm relationships with their loved ones. During depressive episodes, they may withdraw from social interactions, which may cause them to feel isolated and withdraw from social interactions," explained Raina.

People with bipolar disorders also struggle to perform at work.

"In a low state, a person has no energy to carry out day-to-day tasks. Normal functioning gets impaired, which might result in responsibilities getting neglected at the workplace," said Mathur.

It is not just the person with bipolar disorder that is affected; it is also their loved ones. So what can loved ones do to support someone with bipolar disorder?

Both Raina and Mathur suggest patience and understanding from family members. Additionally, they also encourage family members to educate themselves about symptoms and treatment, offer emotional support, and encourage treatments to the person with bipolar disorder.

It may also be helpful for family members and loved ones to receive counseling themselves, to better manage the stresses of living with someone affected by bipolar disorder.

Stability and routine are essential for people with bipolar disorder, and loved ones can help with establishing these. "You can encourage healthy habits that will help with symptom management. This includes engaging in healthy lifestyle habits such as regular exercise, a nutritious diet, and sleep hygiene," added Raina.

At the end of the day, bipolar disorder is a difficult diagnosis. People with bipolar disorder may do or say things that they don't really mean. Loved ones need to be understanding and supportive in order to support them through their journey.

Misconceptions about bipolar disorder

As mentioned earlier, bipolar disorder is often misunderstood and misrepresented in popular media. Most commonly, it is depicted as extreme mood swings. While this is a hallmark symptom of bipolar disorder, the condition is much more complex than that.

The manic state of euphoria is not what most people assume it to be. "There is a common misconception that hypomania and mania are always pleasant experiences. However, these states can often be highly stressful and impulsive and may have severe consequences in a person's life, such as financial ruin, risky behaviors, and personal struggles," described Raina.

Mathur is also of the same view. "Imagine being in a state of euphoria, with no fear of consequences over any of your actions. Even if this sounds amazing, excessive amounts of it can make you have unrealistic expectations and poor judgment," she said.

There are also many stigmas surrounding medication that can help manage bipolar disorder. "Some patients believe that once they start medication, they will need to take it for life and that there is no possibility of getting off medication eventually. This is not always accurate, as the duration of medication use will depend on individual circumstances. Decisions regarding medication use should always be made in consultation with a mental health provider," clarified Raina.

Educating oneself about bipolar disorder is, therefore, very important. It can help eradicate stigma, self-blame, and shame that come with mental health conditions like bipolar disorder.

Conclusion

In recent years, there have been significant advancements in the understanding and treatment of bipolar disorder. "One area that is gaining attention is the study of the gut-brain connection and how diet and microbiome may impact bipolar disorder. Researchers are also exploring new medications and therapies, including transcranial magnetic stimulation (TMS), that may provide effective treatment options for individuals with bipolar disorder who do not respond to traditional therapies. Additionally, there is a growing focus on personalized medicine and individualized treatment plans to better meet the unique needs of each individual with bipolar disorder," says Raina.

With new treatments being researched every day, this is an encouraging time for those living with bipolar disorder. Additionally, seeking therapy and a support system and showing empathy can provide a sense of community and understanding. It's important to remember that every person's experience with bipolar disorder is unique, and finding a personalized treatment plan with the help of a healthcare professional is crucial. With dedication and patience, it is possible to manage symptoms and lead a happy and fulfilling life.