Bipolar diagnosis and treatment via telehealth at Epsychiatry

Bipolar affective disorder refers to a group of conditions that are characterised by mood swings. Ranging from depressive lows to manic highs. Periods of low mood are called depressive episodes. Whilst periods of slightly elevated or elevated mood are called hypomanic and manic episodes, respectively. Mood episodes can last days to months at a time, depending on the person.

Everyone experiences periods of high and low mood. However, people with bipolar disorder have extreme mood changes that can be highly distressing for themselves. In addition for around them. These changes in mood can lead to a range of symptoms that interfere significantly with a person’s functioning at work. Secondly, at home and in their personal lives. Between episodes, however, people may have periods of normal mood and functioning. 

What’s Manic Depression?

Previously known as ‘manic depression. Bipolar disorder is considered to be a lifelong or chronic condition, which affects just over 1% of Australians. Symptoms of bipolar disorder usually start in early adulthood and vary considerably between individuals. Manic symptoms may include things like increased energy, decreased need for sleep and risky or impulsive behaviour; whilst depressive episodes may include things like low energy, lack of interest or pleasure in daily activities and suicidal thoughts. 

There are two types of bipolar disorder. Bipolar I and II. People with bipolar I disorder experience manic episodes, whereas people with bipolar II disorder experience only hypomanic episodes. Depressive episodes can occur in both types of bipolar disorders, but they are not necessary for a diagnosis. We don’t know exactly what causes bipolar. However, a combination of genetic, environmental and neurological factors are thought to play a role. 

There is no test for bipolar, rather your psychiatrist or psychologist will ask a series of questions as part of the diagnostic and assessment process.

 

What is the difference between manic vs hypomanic episodes?

Whilst the features of mania and hypomania are quite similar, hypomania is a much milder form of elevated mood. In hypomania, symptoms similar to those in mania may be present. However, they are much less extreme and interfere less with your daily life. For example, if you are hypomanic, you may have more energy. In addition, be more talkative and feel more positive or euphoric than normal. This can cause mild problems in your life, but not to the extent that mania can. Hypomania may be noticeable by others who know you well, but it will not necessitate admission to the hospital.  

In addition to being more severe than hypomanic episodes, manic episodes generally last longer. According to diagnostic criteria, symptoms must last a minimum of seven days to meet the criteria for a manic episode. Whereas symptoms must last a minimum of four or more days for a hypomanic episode. Manic episodes cause a significant disruption in work, social and other important aspects of life. People in the midst of a manic episode may also experience psychosis (disconnection from reality). They may require hospitalisation to contain their symptoms. 

 

What are some of the signs and symptoms of mania?

While they vary in intensity, symptoms of mania and hypomania are mostly similar. Some of the key signs and symptoms are listed below:

  • Feeling abnormally happy, upbeat or euphoric (includes greater self-confidence and grandiosity)
  • Having higher than normal energy levels, which may result in increased activity and goal-directed behaviour
  • Feeling agitated, ‘wired’ or restless
  • Reduced need for sleep
  • Racing thoughts and having a lot of new ideas
  • Making new plans and starting things you won’t be able to finish
  • Uncharacteristic talkativeness and being more social than usual
  • Decreased inhibition and greater risky or impulsive behaviour (e.g. gambling, unsafe sex, substance use)
  • In more severe cases, delusional thoughts, hallucinations and paranoid thoughts may also be present.

In addition to periods of elevated mood, almost everyone with bipolar will experience periods of depression. These episodes are characterised by overwhelming sadness, withdrawal and feeling hopelessness. With bipolar depression, people can lose their appetite, feel agitated or think about death. 

 

What causes bipolar disorder?

There are a number of risk factors for developing bipolar disorder. It is likely that there are different triggers or factors working together to cause bipolar disorder. These factors include things like genetics, environmental factors, physical illnesses and the impact of substances.

Genetic factors

Bipolar disorder often runs in families. Research has shown there to be a strong genetic link (up to 80%) for this condition. If one or both parents have bipolar, the risk of their child developing the condition is 10% and 40%, respectively. This is much greater than the risk in the general population. Whilst having someone with bipolar in your family may predispose you or place you at greater risk. It does not mean that you will develop bipolar yourself.

Environmental factors

Our environment often interacts with our genetics to influence health outcomes. For example, a family history of abuse, difficult childhood experiences and other stressful life events (e.g. the death of a loved one, problems with money or significant changes in sleep/routine). Each of these can increase one’s risk of developing bipolar disorder.

Physical injury, biological factors and substance use

Certain drugs and some types of brain injury are associated with bipolar disorder. For example, antidepressant medication has the potential to trigger a hypomanic or manic episode in at-risk individuals. Certain substances can also mimic the symptoms of mania, including corticosteroids and stimulants like cocaine, ecstasy and amphetamines. Research suggests that some chemical/neurological abnormalities in the brain may also play a role in the development of the bipolar disorder.

The take-home message is that no one thing causes bipolar disorder. Rather it is often a complex interaction of many factors. Some of these factors are within our control (e.g. substance use), whereas others are not (e.g. genetics).

 

Is there a test for bipolar disorder?

There is no blood test or brain scan that can be performed to confirm a diagnosis of bipolar disorder. Your psychiatrist or psychologist will ask you a series of questions to establish a diagnosis. They may also want to speak with your friends or family (if you feel comfortable with this). After that, they might ask you to fill out some questionnaires to assist with their assessment. Ensure your physical health is not impacting your mood. Your doctor may also carry out blood tests and other physical examinations.

 

Treatments for bipolar disorder

The primary goal of treatment for bipolar disorder is to restabilise the person’s mood and manage their symptoms. Secondly, to prevent them from relapse down the track. Treatment for bipolar may include medications, psychotherapy, and other physical/lifestyle interventions. Symptoms of bipolar vary widely from person to person. So finding the right therapy for you may be a process of trial and error.

Depending on the severity of symptoms, you may be treated as an inpatient in a hospital. Hospital treatment may be needed if someone has become psychotic, highly aggressive or suicidal. Someone involved in clearly destructive and irrational behaviour. The majority of people with bipolar never have a hospital admission. Rather, they are managed at home by their GPs and mental health clinicians.

Medication

Medication forms just one aspect of the treatment for bipolar disorder. However, it is often the cornerstone of treatment for manic or hypomanic episodes. There are several medications that can help manage bipolar symptoms. These often fall under the drug classes of 1) mood stabilisers (e.g. lithium), 2) antidepressants, 3) antipsychotics, and 4) sedating medications to help with sleep or anxiety. Psychotropic or psychiatric medications, like all tablets, can cause unpleasant side effects. We would encourage you to discuss this with your psychiatrist. 

Psychotherapy

Psychotherapy can help a person learn about their bipolar disorder and equip them with skills to better manage their condition. Key aims of therapy for bipolar may include things like learning to understand your triggers and cope better with stress, recognise and manage your early warning signs, and learn strategies for mood management so that future episodes can be prevented. Psychotherapy may also help people build their social network and enlist the support of others, such as family, friends and colleagues, who may also be able to keep an eye out for early warning signs of relapse that you may miss.

Other physical/lifestyle approaches

Leading a healthy lifestyle is incredibly important for mood management and the prevention of bipolar relapse. Lifestyle choices such as maintaining a regular routine, eating a healthy diet, getting enough exercise and ensuring you keep a regular sleep/wake pattern. These can all help maintain a stable mood and keep symptoms at bay. Reducing your use of substances, like cannabis and alcohol, is also recommended. This could form part of your work with your psychologist or psychiatrist.

In the short term or ‘acute’ phase, the focus of treatment for bipolar is to stabilise your mood and reduce the risk of harm to yourself and others (e.g. from suicide, self-harm and risky choices). In the long term, the aim of treatment is to maintain the improvements made in the acute phase, improve quality of life and prevent relapse. Ideally, you will be able to return to home, work and social life as normal, and remain healthy well into the future.

 

Recovery from Bipolar

With the right treatment and support, recovery from bipolar disorder is absolutely possible! Bipolar is a lifelong condition. Whilst there is no ‘cure’ per se, it can be managed well so that symptoms are not present. The person can certainly reach their full potential. Over time, people with bipolar can learn about their symptoms and how to best manage them. There are many people with bipolar disorder who have successful careers, meaningful relationships and fulfilling lives.