Category: Bipolar Disorder

B is for beehives and buzzing and bipolar and bloodlines and Bryant, my mother’s maiden name. My great-grandfather, the beekeeper, died from taking too much from the hands that feed him, from the bees. My great-grandfather, the beekeeper, spent a lifetime bee-keeping to quiet the buzzing in his mind. And although he has since passed, he also passed down this buzzing that infects my mind. It all comes down to structure, intricate structure much like the structure of a beehive or the spiral of a single strand of DNA. I like to find all of these similarities like a pattern that plays on repeat in my mind, like the Fibonacci sequence that can be consistently found in the number of petals on a flower where the bees take their nectar. This would be the same sequence that can be found in the structure of naturally occurring beehives, as well as in the mating and reproduction patterns found within the species of honey bees. There’s a consistency that we find in nature that can be found in genetics as well, like the passing of DNA from one generation to the next. However, there are inconsistencies too. Unlike the bees where all the work flows in an upward direction, to please the queen.. genetics flow in a downward direction or spiral, if you will, allowing one to inherit traits, both physical and mental.

They say that smoke makes the bees tranquil; it doesn’t hurt them, it just puts them into a sort of daze. The antipsychotics and mood stabilizers do something similar. Sleepy like bees in the smoke. The smoke makes the buzzing of the bees go quiet and the medication essentially does the same.

I started supplementing sugar with honey, my mother told me it’s more natural, more us. By us she means Bryant, meaning family in Birmingham, like my great-grandfather, the beekeeper. Birmingham is where the beehives were, where he was getting the honey from to ease the buzzing in his mind. Honey is sweet but it never fully covers the taste of the medication.

Bees buzzing actually brings about productive results in the process of pollination. The buzzing is used to create these vibrations that shake pollen off of flowers and allows it to stick to a bees body where it will then be transferred to another flower. It brings about more life. That is where another inconsistency comes about. The buzzing that my great-grandfather passed along for me to inherit, is one that roots in pain.

I have all of these thoughts that buzz around in my head. Much like a colony of bees or the static of an old television set from my childhood. I keep trying to find the right station; a soothing melody that surpasses these frightening patterns I find in my thoughts without needing more smoke. The words keep rearranging themselves into these puzzles that I try to sort out through a kaleidoscope lens, but every time I look I get dizzier and dizzier. More buzzing. More distraction. More fog.

I keep wanting to look at something more softened, more modified. I want to be past this exceedingly intractable version of myself and I keep trying to heal this hollowing numbness inside of me, I keep trying to feel the sadness, all of the anger. I keep trying to grieve, but every time I reach into the beehive to get a taste, I find myself drenched in honey and it sends the bees into this crazed frenzy. All or none. I can never just have a taste. I catapult myself into a state of mania again. I go from the soft hum of a busy mind, a colony of bees, to a raging swarm ready to sting the first person who startles me. I never mean to hurt anyone, I just want to feel. I just wanted a taste.. something warm inside me other than the numbness. I keep trying to articulate what it’s like to live with Bipolar Disorder to the people around me but it keeps coming out in the form of apologies that buzz in the air around them. I wanted something sweeter, more aligned with the consistency of honey. Something that flowed in an upward direction that yields more life and not pain.

My great-grandfather, the beekeeper, who passed down this disease, spent a lifetime tending to bees until one day he was stung and died from a bee allergy.

“It’s a disorder NOT a decision.” Bipolar Illness is a health issue that creates imbalanced mood changes with a certain amount of time and strength of each emotion. Some may call the mood changes mood switches or even an episode. This mental disorder can influence the person who may have been diagnosed and whomever cares for that person. It usually starts in children or young adults and can have effects on their mental and physical health, educational/occupational functioning, and interpersonal relationships for the rest of their lives.

Those who are diagnosed with BD usually have mood changes that are portrayed as manic, hypomania and depressive. A manic episode usually goes like this, feeling bad about oneself, little to no sleep, overthinking, and risk-taking activities. A hypomania occurrence may look like enhanced energy, irritability, mood irritation, and some of the same symptoms as mania. A depressive episode may look like lost interests, weight loss/gain, fatigue, worthlessness, lack of focus, and suicidal tendencies. There’re two types of BD one that is called Bipolar Disorder 1 and the other that is Bipolar disorder 2. BD 1 is where there is at least one mania and depressive disorder as BD 2 there is at least one Hypomania and depressive episode. There are certain times that doctors must consider a patient a red flag due to rapid cycling. Rapid cycling is more than four mood changes in less than a year; if a patient is going through rapid cycling then they usually are hospitalized.

To be correctly diagnosed it is smart to go to a primary doctor, psychiatrist, or psychologist. When diagnosed, accurately the doctor may prescribe medications such as a mood stabilizer. A mood stabilizer is a psychiatric medication usually used to help mood shifts found in Bipolar disorder as well as Schizophrenia. On top of the medication one should do physical examinations and lab tests, the reason for this is to make sure one’s immune system is able to handle all the medication. Psychiatric medication can sometimes hurt the immune system. To make sure everything is going well it is a smart idea to ask family members or friends who are around that person how their symptoms are and if anything is good or bad.

The best way to treat BD is by Pharmacological treatment which is a therapy of medications. In addition, to the pharmacological treatment, one will also need maintenance treatment, which is the goal to stop large amounts of mood changes. Some of the medications one may need to take is Lithium, this medication helps reduce suicidal thoughts and is used to not only help bipolar disorder but major depressive disorder. Lithium does require a lot of blood work because it can cause progressive renal insufficiency and thyroid toxicity. Known side effects to Lithium is tremors as well as gastrointestinal problems such as nausea, vomiting, and diarrhea. A more commonly used medication is sodium valproate which is a mood stabilizer. Not only does one need a mood stabilizer but also an antidepressant which treats major depressive disorder and anxiety disorders. In which they both are included with Bipolar Disorder.

Bipolar disorder impacts the persons’ day heavily it can ruin family relationships, intimate relationships, work life, and education. The best thing for someone who suffers BD is peer support. Support groups is a good way to talk and express what that person may be feeling and hear what others may say on how to get help or work on what is going on in their life. If you are a family member who has someone in your life that suffers from BD do not judge them just be there to try and help because the person who goes through the battle also doesn’t understand why they have mood changes and frequently as they do.

There are a ton of challenges a person with BD goes through and one of the main reasons why is because they do not understand why they have what they have. When one goes through a manic episode and does a risk-taking action the next day, they will not understand why they had done that or what really made them do it. If the person is in a depressive episode and they just start crying out of nowhere it may embarrass them because they are not quite sure on why it is happening and what exactly made them cry. When that happens just be sure to be there for that person make sure they know that they do not need to be embarrassed about what happened instead they can be comfortable and understand that no one is judging them for being themselves.

There are many people in this world who suffer from BD but, they keep themselves quiet because when mental health is brought up people decide to run away. Why does mental health make others uncomfortable? Well I believe it is because they may suffer from it and they are surprised when others are so comfortable with sharing what goes on instead of trying to hide it because they don’t want people to see their true selves. If you are someone who has a mental disorder, please speak up and do not ever be afraid of telling people about who you really are instead stand strong and be confident with it !!!

All together bipolar disorder is not a decision it is something one just cannot handle. It is a medical issue that brings several mood changes to a person and can cause a lot of havoc in that persons’ life. As a person who has Bipolar disorder, I want to bring the awareness towards this medical illness and give everyone the information they deserve to understand what BD really is, and BD is not a bad thing instead it can be the most beautiful thing if you let it.

Works Citied

1. Esposito, Joseph. Philip G. Janicak. “An update on the diagnosis and treatment of Bipolar Disorder, Part 1: Mania” Psychiatric Treatment. vol.1, no.1 2015, pp 29- 34 https://libcat.sanjac.edu.
2. McCormick, Ursula .” Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses” Clinical nurse specialist. vol. 1, no. 1,2015 pp 530-542. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034840/.

In this essay I will be focusing on the notion that King Saul suffered from Bipolar Affective Disorder (BAD). According to the NHS, “bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another” (NHS 2014). BAD also includes periods of mania and depression. I will be concentrating on the idea that Western interpreters, who in my opinion heavily conform to the medical model of disability, are very quick to diagnose biblical characters, such as Saul with this type of condition. The medical model of disability is defined as focusing “on curing or managing illness or disability” (Wikipedia 2018). I will be exploring the effects that such a diagnosis might have. I will argue that although a modern diagnosis of an ancient character with a mental illness might aid us in our understanding of the text, at the same time, it is hugely stigmatising. Within my argument I shall investigate the notion of Western interpreters perhaps conforming to a different model of disability such as the social or cultural model. I will be looking at the text of 1 Samuel and how Saul’s modern diagnosis of BAD by Western interpreters may subsequently be brought to bear on the text. I will also look at potential alternative explanations which suggest that the view of King Saul which has been widely held by modern commentators may not necessarily be the correct one.

To begin my account, I will first refer to Martijin Huisman’s notion that Saul suffered from work-related stress. In 1 Samuel 13:5, we see that the Philistine army is far larger than Saul’s as they had “troops like the sand on the seashore in multitude” (1 Sam 13.5 NRSV) and that Saul has to wait seven days for the arrival of Samuel so that he can be given his orders. Huisman argues that “Clearly, the demands are extremely high: fighting a war against all odds, keeping his frightened soldiers under control and facing what appears to be almost certain defeat.” (2007). Huisman’s account of Saul suffering from work-related stress is an intriguing one. According to Bupa, “nearly half a million people in the UK have work-related stress at a level that’s making them ill” with the feeling of depression being one of the emotional effects (Mayfield-Blake 2017). It is here that we can see Huisman as a prime example of how a Western interpreter has inflicted a very modern concept on an ancient Biblical character. This is a line of thought that would not have been present when Saul was leading and therefore is an interesting concept. However, it is a notion that closely relates to the medical model of disability, it is a diagnosis and an exposé of Saul’s shortcomings. Huisman is, in my opinion, excusing Saul’s actions by saying they are as a result of a specific illness and argues that as a result of feeling stressed, and under pressure, Saul makes questionable decisions. For example, because Saul cannot control his people and Samuel is nowhere to be seen, he offers God burnt offerings, an act which is strictly forbidden from a King in the eyes of God. Saul is subsequently labelled “a man after his own heart” (1 Sam 13.14 NRSV) by Samuel. According to my line of thinking, Huisman is guilty of projecting, as Lawrence wrote, damaging sanist stereotypes in order to ‘classify’ those who are morally ambivalent or are negatively perceived characters within biblical literature (2018, 27).

I believe that what might be perceived as Saul’s mental distress begins to appear in 1 Samuel 16:14. The ancient proverb goes, “whom the gods wish to destroy they first make mad”. This is certainly clear in this verse. Gordon, in his commentary of 1 Samuel says: “Saul, bereft of the spirit of Yahweh, falls victim to bouts of Kierkegaardian melancholia here attributed to an evil spirit from Yahweh’ (1999, 152). Here we see the first signs of Saul falling into a state of jealousy-ridden despair: “an evil spirit from the Lord tormented him” (1 Sam 16.14 NRSV). However, can we really deduce from this that Saul subsequently fell into a state of depression? Lawrence notes that “Diagnosing the long gone dead, leave alone those who are known to us only as characters in ancient literary texts, is, of course, a precarious (historical) enterprise, magnified further by the projection of alien (and disputed) frameworks onto such traditions.”. (2018, 37) I agree strongly with Lawrence here as projecting a modern illness on biblical characters can be perceived as risky because such illnesses would not have existed at the time. The likes of George Stein are very focused on diagnosing Saul with a mental health condition. In his work he writes how Saul displays moments of frenzy both in 1 Samuel 10.10-13 and 19.23-24 and concludes by saying that it is because of this “then perhaps Saul qualifies for a DSM–IV diagnosis of bipolar affective disorder.” (2011, 212). I believe that by trying to diagnose Saul with BAD using two sections of a rather large book as evidence is rather unjustified. I would argue this because although Stein makes sound conclusions he is, in my opinion, falling victim to the common line of thinking of many western interpreters. In trying to diagnose Saul with a mental illness, Stein is thereby conforming to a medical model of disability, one that is focused on a diagnosis and a cure rather than anything else.

By diagnosing the likes of Saul with BAD, western interpreters are opening the gates to the stigma surrounding BAD. The sanist perception of BAD, particularly today, is one that is deeply stigmatising and can make the lives of those living with BAD challenging. Stephen Propst wrote that “a person with a mood disorder still encounters a challenging environment where he is often seen as a second-class citizen.” (2018). Although, thanks to modern medicine, there are now ways in which one can live with BAD and there are treatments, the stigma of suffering with such a disorder is yet to go away, particularly by those who conform to the medical model of disability. It is interesting to think that there is still huge amounts of stigma surrounding BAD, and that is in a society where mental health is now widely spoken about. How BAD might be perceived by ancient biblical characters is thought-provoking.

Throughout my research I discovered that Saul is perceived as the villain in 1 Samuel and his jealousy-ridden frenzy is why he is thought to become manic and depressed. For example, R. D. Stuart refers to him as “a selfish man who would not share the limelight with anyone” (2008, 155). In addition, Philip R. Davies said that “where Saul is remembered alongside David, it is as a failed or wicked counterpart to the successful and righteous King.” (2013, 131). The fact that Saul is frequently referred to as a villain, selfish and wicked, hundreds of thousands of years later, shows the effects that stigma has had for the likes of Saul. It is also interesting to consider that mental illness is seen by some to be related to sin. Rodger K. Bufford wrote that “mental disorders, like any other human malady, came with the Fall and the entrance of sin in the world” (1988, 117). Admittedly, Bufford wrote this in 1988, before mental health was spoken about as openly as it is today. However, that does not take away from the fact that what he is saying is extremely sanist and stigmatising and in doing so may have influenced accounts of mental health within the Bible that followed. As mentioned previously, it was interesting in my research that from children’s to adult’s bible studies, Saul is labelled as one of the Bible’s ‘bad guys’ and how this was often related to the biomedical model of mental illness. Lawrence says “Interesting, too, is the fact that if one runs database searches on ‘madness and the Bible’, time and again the same ‘morally ambivalent’ biblical characters are thrown into view − Saul, Nebuchadnezzar, Ezekiel, Herod, and so on” (2018, 35). Although I am not specifically discussing madness, it is noteworthy that I too came to the same conclusion as Lawrence in my investigation of Saul. The sanist western interpreters are, according to my way of thinking, responsible for Saul’s reputation as a villain.

I also found the notion of demonic possession within the Bible particularly intriguing and how this too is attributed to those in the Bible who are thought to be morally ambivalent. It is often deduced that a biblical character who is ‘demon possessed’ is therefore mentally ill. Bufford wrote “an analysis of the demon-possession accounts suggests that most of those symptomatic manifestations are also considered to be symptomatic of one or more mental disorders.” (1988, 131) In addition, Dr. Jospeh Layock writes that the idea of possession “in a lot of cultures, [it] can be a good thing or it’s a neutral thing. And it’s kind of unique in Christianity that we have this idea possession is always bad, is always demonic.” [need reference here]. Henceforth, it might be understood that it is the responsibility of Christian western interpreters consistently conforming to the medical model of mental disability, that we find ourselves attributing possession, specifically demonic possession, to biblical characters who are thought to have had poor mental health. Chris Cook argued that “there is a danger that we look for demonization amongst those who are psychiatrically ill” and that “if science does not have convincing answers, then we look elsewhere.” (Cook 1997). I agree with Cook here; it is my understanding that western interpreters want go as far as using demonic possession to excuse why a biblical character may have suffered from a mental illness. It is for this reason that I want to challenge this line of thought as I believe that in the same way that God might curse an ancient character with an ‘evil spirit’, he can also retract it. For example, in the book of Matthew we see the cursed boy is cured of his demons, “And Jesus rebuked the demon, and it came out of him, and the boy was cured instantly.” (Matthew 17.18 NRSV). The boy in question has been cursed with a demon and has had this curse taken away by Jesus. The cursed boy’s mental health may have worsened when he was possessed by the demon but is it realistic that his mental health would suddenly be what it once was as a result of being ‘cured’? Such an experience might linger with the boy and as a result his mental health might not be what it once was.

In my research I came across a piece written by Rev. Michael Tanner titled “King Saul & the Stigma of Madness”. Within this piece he explores ‘recasting stigmatizing texts’ which he does in three ways. The first is by listening to countervailing texts by looking at other parts of the scripture. In this case, Tanner is referring to Matthew 22.39 “You shall love your neighbour as yourself” (Matthew 22.39 NRSV). He says that in doing so “no room remains for exclusion or neglect of people with mental illness or other impairments, Saul and his evil spirit notwithstanding.” (Tanner 2010, 22). I agree with Tanner here as, so often western interpreters focus too much on one specific part of the Bible, not looking elsewhere in doing so. By loving your neighbour there is no place for the sanist’s projection on a text. I believe that what Tanner has deciphered here is refreshing, he is not conforming to a restricting medical model but rather embracing Saul’s quirks in a different way. I agree with Tanner in relating more to the cultural model of disability where he is embracing Saul as different rather than a man needing a cure. Tanner’s second recast of the text is by listening to the rest of the narrative, in particular how Saul is treated. He looks at how David stands by Saul as his lyre player, he does not exclude or neglect Saul, “to exclude and neglect people based on 1 Samuel’s attribution of Saul’s madness to an evil spirit from God is to ignore the whole of the story.” (2010, 23). I am not sure I agree with Tanner here. Although I understand his point of view, I do not believe Saul is treated in the best manner. I agree with Tanner’s stance on the matter namely, that David is not the wrongdoer in this scenario. I would however argue that he is the man at the root of Saul’s jealous rage, so perhaps even though David has good intentions, his very presence and its effect on Saul suggests that a different lyre player may have been more suitable.

Thirdly and finally Tanner discusses the paradox of madness. This is what I consider to be Tanner’s most thought-provoking idea. He recalls how Saul falls into a state of “prophetic frenzy” in both chapter 10 and chapter 19 of 1 Samuel, two very different points in Saul’s reign. According to Samuel, Saul’s prophetic frenzy is a sign that God is with him in his reign. Tanner notes “in each case we have the same man, the same ecstatic behaviour, the same attribution to God’s spirit, and contradictory connotations.” (2010, 23). I found this particularly interesting as what Tanner has picked up on here is so subtle. He goes on to quote Simon Horne who discusses how stigma can hinder us from seeing the real meaning, “In the ancient world, impairment and inability are frequently understood as paradox – within inability is striking capability.” (Horne 1998). We see through Horne that Saul’s jealousy and wariness of David cohabit with his love and admiration of him. Tanner also goes on to say that people with disabilities force us to face our own vulnerabilities. He quotes Thomas Reynolds who says that “Disability confronts non-disabled persons with their own fragility and contingency. For all humans are only partially and temporarily able-bodied…” (Reynolds 2008). Tanner goes on to say that “We may get an inkling of the paradox when we consider our own suffering and ask ourselves whether we would erase it from our lives. We may be surprised to discover that our suffering is as much a part of our identity as our joy” (2010, 25). What Tanner has touched on here is both refreshing and different. He is not following the common western interpreter’s notion that we should be finding a cure for Saul but rather following the cultural model of disability by redefining what it is to have a mental disability. The notion of vulnerability and discomfort around disability is particularly interesting and an issue that is still rife today. For example, “In a survey of 2,000 British adults to coincide with the advertising campaign, Scope found that two out of three people feel uncomfortable talking to disabled people.” (McGuinness 2014). It is my view that vulnerability is a huge cause of this discomfort; we are, as Reynolds says, confronted by our “own fragility”. It is perhaps as a result of this that, in my opinion, the western world so often wants to find a cure rather than embracing a difference as per the cultural model of disability.

Another fragment of 1 Samuel that is worthy of mention is Saul’s death. The event that led to his death is described in 1 Samuel 28.5-6: “5When Saul saw the army of the Philistines, he was afraid, and his heart trembled greatly. 6When Saul inquired of the Lord, the Lord did not answer him, not by dreams, or by Urim, or by prophets.”. We see here that Saul has been abandoned by God and is filled with great fear at the prospect of another battle. He is subsequently badly wounded in battle and so says to his armour bearer “Draw your sword and thrust me through with it, so that these uncircumcised may not come and thrust me through, and make sport of me.” (1 Samuel 31.4 NRSV). When his armour bearer refuses, Saul draws his own sword and falls upon it. Claude Marriotinni talks of how this is now understood as suicide, though there is no word for suicide in the Hebrew Bible. He says how Saul took his own life to “to avoid the humiliation that his enemies would cause him” and “in taking his own life, Saul was revealing the troubled aspect of his life and his isolation from God.” (Mariotonni 2018). It could be argued that Saul’s death was almost heroic. He suffered both at the hands of God and his people for many years and so to avoid humiliation he takes his own life rather than dying in a way that he might perceive to be in vain. It is also conceivable that his inner mental turmoil could have bought him to this point. This further illustrates the point that interpretation of this final act depends on whether Saul’s “disability” was the reason for his death. If it were, in my opinion, it was a natural act; if it wasn’t, it was an act of heroism.

It is clear that western interpreters more commonly conform to the medical model of disability than the cultural model. This means that the diagnosis of Saul’s ill health is almost inevitably one of bipolarity. This was the conclusion reached by a number whom I have mentioned such as Huisman and Stein. Throughout the book of 1 Samuel, Saul, from his original anointing by Samuel, acts in an increasingly unpredictable manner. The bearing that this has on the text is that it has been interpreted by many people as a progressively degenerative bipolarity disorder. The consequence of this is that Saul has been perceived as a villain in the Old Testament. However, my own feeling is that whilst it is possible that BAD was a condition that controlled Saul, rather than casting him as a villain, it could be better to attempt an understanding of his behaviour. That is therefore why I am more persuaded by Tanner’s approach to the subject of King Saul’s ill health. By studying Saul through a lens focused more on culture than the medical model, we see the possibility of a different way of thinking and one which embraces disability as opposed to seeking a cure for it.

Is it possible for an emotionally traumatized person to develop some physical pain? The answer is yes, moreover, most of the physical pain such as stress is highly related to brain function, which contains our thoughts, emotions, and behaviors. Furthermore, our emotions and mood changes within the normal range, but it is possible to be dysfunctional and create some moods disorders. Mood disorders, additionally recognized as mood affective disorder, can defined as bothering emotions that can affect one’s mind, which will lead to disturbing one’s ability to function well and feel discomfort, or can be both. Mood disorder can classified into two categories: manic which can be defined as an emotional state of having elevated mood, euphoric, or restlessness that resulting in hyperactivity. In addition, depression, which is also, an emotional state but ones is going to have intense sadness, and feelings of worthlessness, and withdrawal from society. This essay will discuss the Mood Disorders such as major depressive disorder and bipolar disorder, symptoms, diagnostic criteria, and how it can develop [1,2].

Major depressive disorder (MDD) is one of the most common mental illnesses that affect humans referring to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, the prevalence of major depressive disorder among the United States is 5% of the populations. Furthermore, major depressive disorder is defined as a chronic feeling of sadness, emptiness, hopeless, and a sense of despair. Due to its complications, MMD is a serious mental illness. For example, a chronic feeling of emptiness and sadness for one’s life view will lead him or her to self-harm or even committing suicide [1,2].

There are two major symptoms that are obviously seen for someone who is suffering from major depressive disorder. The first symptoms of MMD is chronic sadness. Moreover, persistent feeling of sadness leads to despair feeling and hopelessness. Although sadness is a temporary feeling and can be changed with some cheering up actions, chronic sadness cannot be help with the same methods as the usual sadness [1,2].

Another symptom of major depressive disorder is suicidal thoughts. Suicidal thought is defined as annoying thoughts and ideas that aim to end someone’s life by making him or her believes that being dead is the reliever of this pain. Furthermore, this suicidal thought symptom is considered one of the most serious symptoms a depressed patient can develop [5].

Like every disorder, the major depressive disorder has a specific diagnostic criterion. One of the diagnostic criteria is the existence of five or more of the following symptoms which are depressed mood nearly every day, emptiness, hopelessness, insomnia or hypersomnia, significant weight loss, loss of energy, and recurrent thoughts of death. Moreover, these symptoms must be appearing in a period of two weeks continuously or more [1,2].

MDD has many risk factors that develop from, which are temperamental, environmental, and genetic and physiological. Each one of these risk factors has a characteristic and specific method to develop depressive episodes. First, the temperamental factor is considered as a risk factor due to its response to stressful life events. The second risk factor is the environmental factor, which affected by childhood experiences and traumas in one’s life. Lastly, major depressive disorder has some genetic features that it can appears from. For example, a parent who is suffering from MDD, his children have a higher risk to diagnose with major depressive disorder [3].

Major depression contains a couple of subtypes such as melancholia, seasonal pattern, and peripartum onset. Furthermore, every subtype has its own characteristics. First, melancholia, which is a subtype of depression, describes a particularly severe type of depression. Second, seasonal pattern which is defined as an onset of depressive episodes that a cause from seasonal changes. The last subtype is peripartum onset, this subtype occurs during pregnancy in women or within four weeks after birth delivery [3].

Another major mood disorder is bipolar disorder. Bipolar disorder previously was called manic depressive disorder due to its characteristics which are being in an extreme happiness mood with impulsive behaviors that called mania and extreme depressive episodes with suicidal thoughts that called depression. Moreover, there are two types of bipolar disorder, which are bipolar 1 that contain mania and depression, and bipolar 2 which has hypomania and depression [3,4].

In the beginning, bipolar disorder has multiple characteristics that affect someone’s life and behaviors and may expand to effects the patients’ surroundings such as his family or friends. The first important characteristic of bipolar disorder is manic or hypomanic episodes. In addition to that, manic episodes is a mental illness marked by periods of great excitement or euphoria, delusions, and overactivity. Another characteristic is depressive episodes, which explained previously as chronic sadness, severe despair, and loss of hope [4].

To identify these characteristics for patients they must go with specific diagnostic criteria. For mania, there must be a presence for three or more of the following symptoms at least for a week or more (decreased need for sleep, inflated self-esteem, distractibility, highly energetic, irritability of mood). On the other hand, depression diagnostic criteria are must contain five or more of the following symptoms for two weeks continuously (depressed mood, sadness, despair, loss of interest, significant weight loss, and feeling tired) [4].

Bipolar disorder has a couple risk factors. One of the risk factors is environments; in high-income countries has a higher chance of having bipolar disorders in the community than lower-income countries. Moreover, separated or divorced individuals have higher rates of developing bipolar disorder. Another risk factor is genes and physiology. A family history of bipolar disorder 1 or bipolar disorder 2 is associated with a higher risk chance for individuals than those who have a nonfamily history for bipolar disorders. Lastly, the chance of gender associations with bipolar disorder makes female has a higher risk than males to develop one of the two types of bipolar disorders [3,4].

One of the major complications for bipolar disorders is suicidal risk and dysfunctional life tasks. Suicide risk may develop in bipolar patients in their depressive episodes, but dangerous attitudes in their mania episodes may lead to death or severe health conditions. In addition to that, many life tasks may be dysfunctional due to the impulsivity in patent’s manic episodes or loss of interest in patents’ depressive episodes [3,4].

In brief, for these illnesses, we have two types of treatments, either psychotherapy or pharmacotherapy. Psychotherapy can be classified to many things that psychiatric patient can treat with, but the most common and effective one is Cognitive Behavioral Therapy, which aims to reduce the emotional disturbance by changing and treating the cognitive and behavioral aspects for the psychiatric patient, another one is transcranial magnetic stimulation, deep brain stimulation, psychodynamic therapy, and vagal nerve stimulation. Another method is pharmacotherapy, which falls under the scope of antidepressant medications, such as Selective Serotonin reuptake inhibitor, Serotonin non-epinephrine reuptake inhibitor, and tricyclic antidepressants. For those psychiatric patients who diagnosed with major depressive disorder, we need to start with psychotherapy then pharmacotherapy, on the other hand, for those psychiatric patients with the bipolar disorder we need to start with pharmacotherapy at first [4].

In conclusion, mood disorder has a variety of illnesses. Major depressive disorder, bipolar 1, bipolar 2 which are the most significant and common mental disorders. In addition to that, both of them can fall under the scope of mania (euphoria) for bipolar disorders, or depression (dysphoria) for major depressive disorder. Both of these illnesses have a higher mortality rate for those patients who not treated. Therefore, everyone needs to be aware of when he or she is dealing with those psychiatric patients. In brief, the treatment is essential for those patients to get good prognosis and good outcomes.

What happens inside the head of one who has Bipolar Disorder? Is it easily controlled or does your body take over? Within the scope of this bipolar disorder essay, I explored the intricate dynamics that unfold as individuals navigate through ever-changing perspectives. Over the course of time, people view the world differently and their moods could change within a split second. Staying inside, secluding yourself from what life has to offer. Sometimes, it is not easy to see from the outside but only from your brains point of view is where it comes to life. Hearing others stories and what direction it lead them and outcomes is a major way to pick apart what the disorder really is and how it could impact anybody’s life, even in the early stages.

Before going further in, Bipolar Disorder is a serious medical condition that has major effects on your brain, mental health, relationships, self care, and possibly even physically. These types of people have mood swings that go from mania, a high point, to depression, a low point. The disorder usually happens in late teens and adulthood, this illness usually lasts your whole life. You may experience a lack of sleep, mixed emotions, anxiety, depression, mood swings, and a change in everyday activities. These episodes may cause hospitalization, treatments like medication, or therapy to get back on track and to a stable condition. Bipolar disorder may not always be something the world can see, but maybe something that is an internal struggle.

Symptoms differ between adults and children in some ways but the difference is very slight. There are many types of Bipolar Disorder that one may be diagnosed with. Starting off, Bipolar I Disorder is when someone has one manic episode followed by another depressive episode. Bipolar II Disorder is when someone has one major depressive episode but never any manic episodes. Cyclothymic Disorder is when someone has at least two years of depressive symptoms. Some other types may be induced by alcohol, drugs, or a certain type of medical condition. Anxiety, melancholy, psychosis, and pregnancy may also cause a type of Bipolar Disorder that may become worse if not taken care of. Moods will shift during episodes and people may even have periods of time without mood swings between episodes. These are known more of severe mood swings, a lot different than someones normal mood swings (Mayo Clinic).

Bipolar Disorder may impact an individual on a day to day basis and may include the symptoms of isolation, abuse of drugs and alcohol, damaging relationships, and poor performance at work and school. A time where severe help should be seeked is when one has depression or starts to have suicidal thoughts or actions. Long hours during the week may mess with how someone performs at their job and poor work ethic (Pacific Grove Hospital).

An individual does not always have to go through this with medical attention to help with the symptoms. There are many ways and steps that someone could take to manage the stress. Take regular breaks, take a walk, try deep breathing, or even listen to relaxing music. Letting go of stress is a good way on the journey of where to go from then on. Calling a friend and talking about what is going on in your head or talking about something unrelated may take your mind off a certain topic and let your mind roam less. Do not ignore the symptoms and take your medication as prescribed, do not mess with the cycle. WebMD states, ““It’s not uncommon for people with bipolar disorder to need extra sleep — 8 to 10 or even up to 12 — hours a day. Your doctor may be able to change your dosing time or amount to help reduce drowsiness or other side effects at work.” They also say an important way to stay on track and keep a positive mentality through the process is, “If you’ve taken time off from work, pace yourself as you return. This is a time when working part-time may be the best option” (Goldberg).

Taking your medication is a major part of getting through Bipolar Disorder and getting to a better state of mind. Lithium is the first type of medication and work to stabilize moods. This may take weeks or months to work and side effects may include nausea, shaking, dry mouth, frequent urination, and weight gain. Anticonvulsant medications treat seizures within bipolar disorder and mania. Medications within this type are Depakote, Lamictal, and Topamax. Side effects include nausea, weight gain, dizziness, drowsiness, and blurred vision. Some also take antidepressant and anti-anxiety medications (Burgess). All of these medications and treatments help to stabilize your body and brain, this is not an alternative to staying on track of your mental health in other ways.

Not everything that people read must come from medical websites that tell them information about the disorder. Real life stories are also posted all the time to show people that this is a real thing that happens all the time. For example, a male at age 23 started showing signs of bipolar disorder, he had never felt symptoms like this before. The male explained, “I remember feeling a rush of adrenaline and like my arms were on fire. I remember my hands shaking a lot, and a lot of anxiety for the first time in my life. I struggled through the final because I physically didn’t feel right.” He later was placed into the psych ward and began having paranoid delusions. The male later on started taking medications for these delusions but started to lean off of them. After a while, he started losing sleep over them and explained one severe incident, “The second episode of mine was more severe. I had fantastical paranoid delusions, thinking I was the antichrist, the messiah or both. I believed the news channels were broadcasting me live on TV as the messiah/antichrist was in the local hospital for all the world to see… I had many auditory hallucinations, from anyone from my classmates and professors to God.” This forced him to drop out of graduate school and focus on himself, but not too much later he was in a severe accident when he got lost during an episode. After many hospital trips, he was finally diagnosed with severe Bipolar I Disorder with psychotic effects and put back on medication. Now currently the male says he has not had an episode in four years (NAMI).

There are two types of severe episodes that may occur with someone that is diagnosed with Bipolar Disorder. The first type of episode is called a manic episode. During this episode people could experience any of the following; energy bursts, trouble sleeping, irritability, doing risky activities, talking fast, or feeling like everything is running fast around them. Another type of episode is called a depressive episode. This type could experience any of the following; trouble sleeping, decreased energy, feeling sad or down, forgetfulness, eat too much or too little, suicidal thoughts, or feeling depressed (NIMH).

If anyone around you or close to you are having these symptoms or are diagnosed with Bipolar Disorder there are many things that can be done. First off, learn about the condition and ask the individual what may trigger some of their symptoms or actions. Second, offer help and support to them, maybe help create a support plan, “A support plan reassures both partners that they will know how to respond to a very high or low period. This can reduce anxiety around the idea of the person with bipolar becoming unwell.” Someone may also communicate feeling more to help others open up and share their story. There is so much a partner could do to help the other get through this difficult period in their lives and offering and being the support is one of the biggest (Burgess).

So, what really goes on inside someone’s body when these episodes take over? The brain takes over the body and sometimes nothing can be done. Many people in the United States struggle with this disorder and many receive help and treatment to improve. Keeping up with lifestyle and with an individual’s mental health is one of the best ways to improve the disorder. The brain is a tricky organ and can do a lot more than one thinks it can. This disorder may be discovered through many ways, being brought to life through actions and symptoms. Bipolar Disorder is a serious condition and should be taken seriously and should consult a doctor during early symptoms and stages to get the correct medical help.

References

1. NIMH. (n.d.). Bipolar Disorder. Retrieved November 30, 2019, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
2. Mayo Clinic. (2018, January 31). Bipolar Disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.
3. Burgess, L. (2019, February 6). Bipolar disorder and relationships: Everything you need to know. Retrieved November 30, 2019, from https://www.medicalnewstoday.com/articles/324380.php.
4. Goldberg, J. (2018, September 23). Healthy Lifestyle Tips for Managing Bipolar Disorder. Retrieved from https://www.webmd.com/bipolar-disorder/guide/living-healthy-life-with-bipolar#1.
5. NAMI. (n.d.). Retrieved from https://www.nami.org/Personal-Stories/My-Story-with-Bipolar-Disorder#.
6. Pacific Grove Hospital. (n.d.). Signs, Symptoms & Effects of Bipolar Disorder: Pacific Grove Hospital. Retrieved from https://www.pacificgrovehospital.com/bipolar/symptoms-signs-effects/.

Bipolar disorder, today, can be defined as a brain disorder that causes changes in a person’s mood and energy that cause significant impairment in daily functioning. It can be categorized into three different conditions: bipolar I, bipolar II, and cyclothymic disorder. Symptoms-wise, patients with bipolar disorder experience mood episodes in which they experience extreme and intense emotional states. These mood episodes can further be categorized as manic, hypomanic, or depressive. Patients with bipolar disorders also generally have periods of normal mood in between the manic, hypomanic, or depressive states. Today, as a result of many significant contributions from various influential people, bipolar disorder can be treated, and patients can generally lead full and productive lives. Treatment is individualized to meet each individual patient’s needs, and it most commonly includes mood stabilizers and antidepressants, depending on the specific symptoms. If depression symptoms are severe and the patient does not respond to medication, ECT can also be considered. [1] However, this current understanding of bipolar disorder symptomatology and treatment has a remarkable and elaborate background.

Bipolar disorder is perhaps one of the oldest known mental illnesses. The origins of bipolar disorder can be traced back to humoral medicine. Starting with the classical Greek physician, Hippocrates (430-377 BC), and disseminating even wider by Roman Galen (129-216 AD), the basic idea of balance behind humorism was developed. It was the understanding that balance was needed between the four humors found in the human body: black bile, yellow bile, blood, and phlegm. Each of these humors represented different qualities. For example, back bile was cold and dry, yellow bile was hot and dry, blood was hot and wet, and phlegm was cold and wet. With these combinations of different qualities, the four humors also matched the four seasons, the four elements, and four different emotional characteristics. Specifically, they represented different temperaments: black bile was melancholic, yellow bile was choleric, blood was sanguine and phlegm was phlegmatic. Melancholic people were described as despondent and gloomy. Choleric people were described as bad-tempered. Sanguine people were courageous, hopeful, and amorous. And phlegmatic people were calm, cool, and unemotional. [2]

The classical practice of medicine at that time focused on balancing these humors by changing everyday life things, such as diet, lifestyle, occupation, and climate, or by administering medication. The focus on balance was also believed to be key to maintaining emotional well-being, as melancholic people were believed to have excess black bile, and manic people were believed to have excess blood or yellow bile causing the problem. [2] Although nowadays we still consider balancing an integral part of treatment, with the continual discovery of pharmacology, the treatment of bipolar disorder has made leaps and strides moving from balancing humor to treat mania to considering the implication of genetics on this disorder and the use of psychopharmacology with the discovery of lithium and later more modern options such as lamotrigine.

The journey of shifting from “mania” to “bipolar disorder” continued throughout the 19th century when the terms mania with delirious and non-delirious states were established by Philippe Pinel. He also hypothesized that mania was closely linked to psychosis. Then, halfway through the 19th century, with the rise of a new mentality, the anatomoclinic mentality, semanticist movements began to emerge in the field of psychiatry. Following with these new movements, Jacques-Joseph Moreau de Tours and Wilhelm Griesinger suggested a structural alteration of the brain as an etiological basis of “madness.” Finally, during this same anatomoclinical period, Emil Kraepelin, at the end of the 19th century devised the concept of manic-depressive psychosis and separated this disorder from the “dementia praecox” or schizophrenia. Later, in the 1950s, Karl Leonhard was the first to introduce the concept of polarity in the understanding of affective disorders and this concept was later included in the DSM diagnostic criteria. [3]

Despite this elaborate history, bipolar disorder did not always receive the properly deserved scientific and social recognition it enjoys today. This can potentially be attributed to “scientific negligence” at the time when compared to other psychiatric disorders such as major depression or schizophrenia, the lack of knowledge about its etiology or pathogenesis, the underestimation of its prevalence, and the general underdevelopment of treatments that had not been amended until about 2 decades ago. As a matter of fact, until the mid-1990s, before valproic acid’s anti-manic effects were demonstrated, the only medication available for treating bipolar patients was lithium. In parallel to valproic acid, carbamazepine (another anti-epileptic medication), was also developed for the treatment of patients with bipolar disorder. Finally, since 2000, different atypical antipsychotics have been approved by the FDA to use for antigenic or antidepressant indications. Lamotrigine, a modern anti-epileptic medication was authorized in 2003 for the prevention of depressive episodes in bipolar disorder. [3]

However, obtaining the approval to use lamotrigine for bipolar disorder was not an easy task. The development of lamotrigine for bipolar disorder provides an interesting story of chance, clinical observation, and a willingness to take on major financial risks despite the limited but convincing clinical experiences. Like many things in medicine, chance is often the driving force in new discoveries. Many of the medications used to treat psychiatric conditions such as iproniazide and imipramine were first developed to treat other conditions. And similarly, Cade’s discovery of lithium’s mood-stabilizing properties was originally driven by observations of its CNS effects on animals. Even the anticonvulsant properties of valproic acid were accidentally discovered when it was being used as a solvent for other agents being tested in animals. Overall, the lack of well-established animal models for mood bipolarity has not permitted the more systematic pattern of medication development that has been seen in other disorders such as major depression. As a result, treatment discovery for bipolar disorder has almost exclusively been driven by clinical observations of potential mood-stabilizing properties that existing medication can offer. These discoveries are often made by physicians who are looking for treatment alternatives for their patients. This was the case in the development and licensing of lamotrigine as a treatment option for bipolar disorder.

Lamotrigine was first synthesized in the early 1980s after no medication for the treatment of epilepsy had been developed for over thirty years. Lamotrigine first entered human phase I studies in the early 1980s, where it was demonstrated to be rapidly absorbed, have high bioavailability with oral dosing, linear pharmacokinetics, no active metabolites, and a half-life of approximately 1 day. An extensive series of clinical trials followed these phase I studies which led to the approval of lamotrigine for use in epilepsy in 1990 in Ireland, followed by worldwide regulatory approvals for epilepsy over the next several years. In 1994, in the United States, the FDA approved it for adjunctive use in epilepsy.

The first recorded use of lamotrigine in the treatment of bipolar disorder was presented at the 1994 annual meeting of the American Psychiatric Association. Dr. Weisler can be credited for first identifying lamotrigine’s usefulness in bipolar disorder treatment back in 1993. He was the first to present his successful treatment using lamotrigine with two of his severely treatment-resistant patients. Dr. Weisler’s clinical observations and theory about lamotrigine’s positive impact on depressive symptoms and mood cycling helped propel further research that led to lamotrigine being approved in 2003 by the FDA as the first new medication for the maintenance treatment of bipolar in 30 years. [5] More in-depth, this story provides an interesting example of serendipity and clinical observation in medication development.

Dr. Weisler had first heard of lamotrigine in the late 1980s while he was conducting clinical trials with bupropion. At that time, he was then treating two of his long-term private patients with bipolar disorder who had failed to respond to any of several licensed and experimental treatments available at that time in the United States. Based on previous work of Ballenger, Post, and others, Dr. Weisler then speculated that lamotrigine’s potent anti-epileptic effects, its sodium channel blockade effects, and anti-glutamatergic activity might be helpful for the treatment of bipolar disorder. Unfortunately, lamotrigine was not currently approved for the treatment of bipolar disorder in the United States, and it would not be available in the U.S. for at least an additional year.

Nonetheless, Dr. Weisler shared the information about the anticipated date of FDA approval with one of his most treatment-resistant patients. This patient was a 43-year-old white male with Bipolar II disorder who had experienced many years of depression followed by several years of rapid cycling (about 8 cycles/year) between hypomanic and depressive episodes. He had tried several prior treatments including lithium, carbamazepine, ECT, clonazepam, valproate, 11 different antidepressants, buspirone, levothyroxine, verapamil, and phototherapy. Although he did show some response to several of these treatments, he continued to cycle and tolerated most medications poorly. When the patient heard about lamotrigine, he gave informed consent to undergo experimental treatment and was able to import it from Europe under an FDA compassionate use exemption. This new medication was added to his treatment regimen of lithium, bupropion, and levothyroxine. The dosing of lamotrigine was started at 25 mg every morning and 50 mg at night. The patient noted that the addition of lamotrigine produced immediate improvement in his mood and energy. Given his positive response to the treatment, over the next 4 months, the dose of lamotrigine was titrated to 400 mg every day and bupropion was discontinued. He tolerated lamotrigine well and exhibited no evidence of cycling while on it. Seven months after he initiated treatment with lamotrigine, unfortunately, the patient experienced a depressive relapse when he ran out of the medication, but about one week after resuming lamotrigine at his old dose, the patient reported an improvement in his symptoms and returned to his normal energy level. He continued to notice significant benefits from lamotrigine over a period of more than ten years. This remarkable clinical story not only highlighted the value of lamotrigine in the treatment of bipolar disorder but also shed light on potentially helping other treatment-resistance patients in the future.

Following this encouraging result, Dr. Weisler discussed the possible use of lamotrigine with another of his treatment-resistant patients. This second patient was a 77-year-old female with a 50-year history of Bipolar I mood disorder, with predominant major depressive episodes, several serious suicide attempts and psychiatry hospitalizations, and a few manic episodes dating beginning in the 1960s. She had also tried several previous treatments including ECT, lithium, carbamazepine, valproic acid, and a variety of antidepressants. She had shown some improvement with carbamazepine but experienced sedation as a side effect. Since treatment options available at the time had been exhausted, Dr. Weisler obtained informed consent to use lamotrigine, and again it was imported from Europe under an FDA compassionate use exemption. Treatment was initiated at 50 mg twice a day and then one week later it was increased to 100 mg twice a day. Lamotrigine was an adjunct to her current medication regimen which included only a stable dose of levothyroxine. Over the next several weeks after the initiation of the treatment the patient demonstrated steady clinical improvement. She was able to maintain a high level of functioning and was able to participate in and enjoy normal activities. At the time of the 1994 APA presentation where lamotrigine was presented as a potential treatment for bipolar disorder, she had evidenced no further manic or psychotic symptoms and was experiencing her longest period of stability in the past 4–5 years.

Considering that clinical data was only available from these two patients at the time, the decision to commit substantial resources to a clinical trial was risky but ultimately successful. During the time that an open-label study was being organized and conducted, other investigators also began conducting a series of open-label trials with lamotrigine in various phases of bipolar disorder. These began to appear in the scientific literature in 1996, beginning with the description (Calabrese et al., 1996) of the response of a treatment-refractory rapid cycling patient, and followed by other descriptions (e.g., Walden et al., 1996, Sporn and Sachs, 1997, Kusumakar and Yatham, 1997a) of responses to lamotrigine treatment in a variety of refractory patients, usually characterized by prominent depressive symptoms and/or rapid cycling. Lamotrigine was also shown to be successful as a monotherapy in a series of newly diagnosed rapid cycling bipolar patients by Kusumakar and Yatham (1997b). However, as with its anti-epileptic use, the development of a skin rash with lamotrigine was a concern. Therefore, slow titration at treatment initiation was done and in a few cases, the treatment was discontinued when patients experienced a rash. The favorable results from these open case reports provided a supportive ground and help build positive expectations for conducting subsequent clinical studies, some of which did not produce positive results.

From January of 1995 through mid-1996, the sponsor (originally Burroughs Wellcome, and then GlaxoWellcome) conducted a large (n = 75), 12-month open-label study of lamotrigine used as both an add-on or monotherapy at 5 international study sites (Calabrese et al., 1999a). The results, although uncontrolled, suggested a potential efficacy against both mania/hypomania (81% marked response rate, 74% decrease in Mania Rating Scale scores) and depression (48% marked response rate, 42% decrease in Hamilton depression scores). Secondary analyses further suggested benefits in rapid cycling as well as non-rapid cycling patients and a more prominent benefit was noted in the depressive aspects of bipolar disorder (Bowden et al., 1999). Lamotrigine was generally well-tolerated with the most common side effect being dizziness, tremor, somnolence, headache, nausea, and sometimes a rash. Based on these promising results, the sponsor embarked on a full development program for lamotrigine in bipolar disorder, with the hope that the medication would prove to help both the mania and depressive symptoms.

Between 1996 and 2001 the sponsor (eventually GlaxoSmithKline) initiated and completed one of the largest Phase III development programs ever undertaken in bipolar disorder. The program originally consisted of 10 double-blind, controlled trials, including 2 studies of the acute treatment of bipolar depression (later expanded to 5), 2 studies of the acute treatment of mania, and 4 prophylaxis studies (1 each in recently stabilized manic and depressed patients, and 2 in rapid cycling patients) that enrolled a total of more than 2400 patients across 4 continents. Because previous bipolar disorder drug development programs (e.g., for lithium, valproic acid) were conducted entirely in North America, the lamotrigine program became the first major bipolar development to be conducted internationally. However, neither of the mania studies demonstrated efficacy, and the depression studies provided mixed results.

The first study to complete (Calabrese et al., 1999b) did not reach statistical significance (p = 0.08) on the primary endpoint (Hamilton 17-item depression scale) but did separate significantly on a number of other key measures including MADRS, Hamilton depressed mood item (item 1) and CGI severity and improvement. Despite these encouraging results, the 4 studies that followed, which included both separate and mixed populations of bipolar I and II patients, failed to provide clear efficacy signals in the acute treatment of depression, although a recent meta-analysis of all the studies suggests a small but significant treatment effect (Geddes et al., 2007). Because of the need to titrate lamotrigine slowly (i.e. over a 6-week period to avoid rash) than originally used by Dr. Weisler, it is possible that lamotrigine’s failure in most of these studies (which were a maximum of 10 weeks in duration) was due to delay in reaching therapeutic levels. These secondary analyses also indicate that lamotrigine had no or minimal benefits on insomnia and reduced appetite. More recently, lamotrigine has demonstrated efficacy as an add-on therapy to lithium in the acute treatment of bipolar depression (van der Loos and Nolen, 2007).

The prophylaxis studies produced clearer results, especially in non-rapid cycling patients. The latter consisted of paired studies (Bowden et al., 2003, Calabrese et al., 2003, respectively enrolling manic and depressed patients) that allowed open stabilization on any combination of drugs including lamotrigine, followed by randomization to parallel groups receiving monotherapy with either lamotrigine, lithium or placebo. Patients were then followed for up to 18 months, with the primary endpoint being time for the next mood episode. The studies showed that both lithium and lamotrigine delayed time to intervention for any mood episode in both recently depressed and manic patients, with differing and potentially complementary spectra of action (lithium more efficacious for mania prophylaxis, lamotrigine more efficacious for depression prophylaxis). These studies remain two of the largest and longest bipolar maintenance studies ever conducted (over 1300 patients were initially enrolled), and provide some of the most compelling evidence of maintenance efficacy for lithium uncontaminated by potential treatment discontinuation artifacts. Largely based on these 2 studies, lamotrigine has been granted a license for the maintenance treatment of bipolar disorder in over 50 countries worldwide. These remain the only large-scale studies to date to account for the polarity of the acute presenting episode (i.e., depressed or manic) on the spectrum of performance of treatment for bipolar disorder in the maintenance phase. [4]

Overall, this journey that resulted in the use of lamotrigine for the maintenance treatment of bipolar disorder can serve as an example to show how the concept of balance still remains central in the treatment of psychiatric disorders. This serves as an example of how balancing the risks and benefits of trying a new medication can lead to a new discovery that will help patients’ symptoms be better controlled and live a more balanced life.

Diseases often manifest physiologically, when a person is diagnosed with an illness oftentimes you are able to see it with your own two eyes. If it’s the flu; you may see that they are flushed with fever, lethargic, and congested. Mental disorders, on the other hand, are not always easily identifiable and cannot be seen at first glance. The brain is an organ that is still very undiscovered, and mental health is not widely acknowledged around the world and is often stigmatized, even in highly developed countries. An example of a mental illness that often goes unnoticed in the public’s eye is bipolar disorder. Formerly called manic-depressive illness, bipolar disorder is characterized by shifts in mood, energy levels, and activity levels. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a strict definition for all mental health disorders, in the DSM-5 bipolar disorder is divided into different categories based on the symptoms; Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.

To be diagnosed with any form of bipolar disorder the individual must experience at least one episode of mania and one depressive episode. Bipolar I Disorder, the most common form of bipolar disorder among those diagnosed, has a specific set of criteria in the DSM-5; a manic-depressive disorder that can exist either with or without episodes of psychosis. Bipolar II Disorder has a seperate set of criteria, it is defined as alternating depressive and manic episodes that are less severe and does not hinder one’s ability to function. This form of the disorder is a lot easier to manage but unfortunately because of that it can go undetected and undiagnosed. Cyclothymic Disorder is defined as a cyclic disorder causing brief episodes of hypomania and depression. This form of bipolar disorder is not as easy to endure in the way that the episodes cycle makes it very difficult to live with, but the hypomanic episodes in Cyclothymic disorder are more manageable than manic episodes experienced in Bipolar Disorder I and II.

Mental illnesses are generally very stigmatized, even in the West where access to mental health resources are more readily available. The stigmatization of bipolar disorder may not come from a place of disrespect but rather from a lack of knowledge on mental healthcare, because people do not freely talk about psychological issues they are often seen as rare and odd but the truth is that one in five people experience a mental illness at some point in their life. Individuals with bipolar disorder are often mislabeled as “crazy,” and many inaccurately use the name of the disorder to describe how they are feeling. The truth is that bipolar disorder is a serious mental disorder that must be diagnosed by a psychiatrist or mental healthcare provider and often requires medication and intensive counseling to be managed.

The cause for bipolar disorder is not entirely understood, but neuroscientists are aware that neurochemistry has a lot to do with the disorder. Genetic factors account for sixty to eighty percent of the cause of bipolar disorder, the rest is determined by environmental factors such as trauma, stressful life factors, major life changes, and even seasonal factors. Other triggers of bipolar disorder include heavy drug and alcohol use, during pregnancy, and the postpartum period. Bipolar disorder is not transmittable in the traditional sense. Normally, we would think of the common cold as transmittable through the air or respiratory droplets when a compromised individual sneezes or coughs. Mental illnesses are not contagious, but it is believed that there are genetic components of the disorder that can make it hereditary. This means that there is a higher probability of developing bipolar disorder at some point in one’s life if they have a family history of bipolar disorder or any mental illness. The probability of being diagnosed with bipolar disorder increases significantly with trauma and other environmental factors. A person with a family history of mental illness can live free of mental health issues, but trauma may trigger the disorder because the effects of traumatic events often outweigh genetic predispositions.

For a more detailed view of the disorder it is beneficial to take a look at a case study. Client A is a 29 year old woman recently diagnosed with bipolar disorder. This client has a family history of mental illness on both sides of her family; her father was diagnosed with bipolar disorder and her mother experienced postpartum depression after her pregnancy, along with a few aunts and uncles with varying mental illnesses including generalized anxiety disorder and major depressive disorder. Up until her recent diagnosis, this client has not experienced mental illness despite her significant genetic predisposition until the recent death of her significant other, loss of her job, and an increase in substance and alcohol use. The impact of the events caused significant trauma for the client and ultimately led to the trigger of bipolar disorder. Client A now experiences several weeks in a major depressive episode during which she has a lack of appetite, sleeps excessively, has a major loss of energy, cries uncontrollably, and is easily irritated. After weeks of a depressive episode, Client A suddenly gets a burst of energy lasting anywhere from one to two weeks, during this manic episode she experiences a quick shift from irritability and sadness to extreme joy and excessive happiness. Throughout this period the client feels overly confident and takes on major projects with unattainable goals, she does not sleep regularly, and often makes irrational decisions with unfortunate repercussions. This cycle is very familiar to Client A, she later attends a yearly physical with her primary care physician who is cautiously aware of her symptoms and refers her to a private psychiatrist. Her psychiatrist is then able to diagnose her with Bipolar Disorder I, she experiences severe episodes of mania and depression with psychosis.

The symptoms of bipolar disorder can be categorized into two classifications, mental health professionals often separate the manic symptoms from the depressive symptoms. Mania is a state of high excitement, euphoria, and overactivity. Symptoms that may occur during mania include; extreme confidence, impulsivity that leads to reckless decision making, increased energy, less need for sleep, unusually high sex drive, excessive hapiness, hopefulness, excitement, and delusions and hallucinations can also be experienced during manic episodes. Individuals with bipolar disorder often experience a form of a manic episode, these episodes make them feel uncharacteristically confident and may often lead to irrational decisions. A manic episode may be experienced for as short as a week to as long as a couple months before a depressive episode begins, manic episodes are generally very emotionally and physically draining for the individual and generally do not last as long as depressive episodes for this reason. Hypomania can occur only in cyclothymic bipolar disorder and is defined as a mild form of mania, all of the symptoms are the same; they are just not as extreme. Symptoms of a depressive episode include; sadness, loss of energy, trouble concentrating, loss of appetite, insomnia or oversleeping, and feelings of hopelessness or suicidal ideation. These episodes can be very debilitating, especially with Bipolar Disorder I, they may make daily tasks such as going to work, school, or socializing very hard to complete. The right medication and psychotherapy can make the symptoms of both manic and depressive episodes easier to manage, and healthy coping mechanisms can be given to help manage the disorder.

Brain chemistry has a lot to do with various mental disorders, bipolar disorder included. What happens inside of our brains on a microscopic level, greatly affects our mental health. The cells in our brains, nerve cells also known as neurons, interact with each other and send messages to other parts of our brain and our bodies. These messages are sent through chemicals called neurotransmitters, the axon terminal of the neuron sends the chemical to the next neuron where it passes through the synapse and to the receiving end of the neuron called the dendrite. The neurotransmitters of the brain are in charge of sending messages that determine how we feel, if we can talk, move, and even breathe. Individuals may be genetically disposed to experience either a lack of a certain type of neurotransmitter, an overload of specific neurotransmitters, or an issue with the transmission of neurotransmitters. The neurotransmitters involved in bipolar disorder include dopamine, norepinephrine, serotonin, gamma-aminobutyrate, glutamate, and acetylcholine. The imbalance of these chemicals affects individuals with bipolar disorder greatly by causing the dramatic shifts in mood. For instance, norepinephrine is a neurotransmitter that plays one of the most significant roles in mood disorders, specifically manic depressive disorders such as bipolar. When norepinephrine levels are high the neurotransmitter has the ability to give feelings of euphoria, induce elevated blood pressure, and cause hyperactivity. Lower levels of norepinephrine can cause a lack of energy, inability to concentrate, and even depression. Another example is dopamine, which causes feelings of euphoria and happiness in the reward center of one’s brain, when dopamine is low it can contribute to a depressive episode and when the levels are too abundant it can trigger a manic episode. Gamma-aminobutyrate does not directly affect mood levels, rather it affects the ability for the communication of cells in the brain, thereby affecting whether a neuron is able to receive a signal. The hypothalamus controls many of these neurotransmitters and is able to either send more or limit the distribution of these chemicals. Neurotransmitters are significant when looking at the various factors that affect bipolar disorder, and medication is often able to stabilize these imbalances in brain chemistry, but medication alone does not suffice as a method to treat bipolar disorder cognitive therapy and a support system is key in treatment.

Bipolar disorder does not have a concrete treatment that can outright cure the disorder, management would be a better term to describe treatment for bipolar disorder because the mental illness will likely always be a factor in the individual’s life. Treatments for bipolar disorder can be separated into two categories; psychotherapy which includes various therapy methods to help the individual find healthy coping mechanisms and an outlet for the symptoms of their disorder and psychiatric medication, where brain chemistry is altered by medication to assist with the symptoms of bipolar disorder. Psychotherapy is generally administered by psychologists, psychiatrists, or other mental health providers such as counselors and certified clinicians. The most common type of therapy used for bipolar disorder is cognitive behavioral therapy oftentimes along with family therapy and support group therapy; which is especially beneficial for children and adolescents with bipolar disorder as support therapy allows the youth to have a strong support system that could help with triggers or safety planning. There are a few other forms of therapy and procedures that are no longer commonly used to treat bipolar disorder but have been known to improve symptoms. These procedures include electroconvulsive therapy, which uses small electrical impulses through the brain to reverse symptoms and transcranial magnetic stimulation which uses magnets to stimulate cells in the brain to relieve the symptoms of depression. Medications are also often used alongside therapy, to aid with the imbalance of neurotransmitters in the brain. The medications often prescribed for individuals with bipolar disorder include; selective serotonin reuptake inhibitors, a type of antidepressant that works by increasing serotonin levels in the brain, lithium is most well known and widely used for bipolar disorder it helps with the severity and frequency of manic episodes, and antipsychotics such as Haloperidol which can be used to manage psychotic breaks during manic episodes. While medication is very useful and effective for side effects, it is important to remember that bipolar is not curable and medication alone cannot rid the individual of the disorder. Intensive therapy, counseling, and support from family and friends is essential alongside medication for individuals to manage the disorder.

Bipolar disorder affects individuals in all parts of the world and while mental illness is prevalent everywhere, information on it is not. For this reason, we see a lot of cases of bipolar disorder, amid other mental disorders, go untreated and unaccounted for. Of the statistics available on the disorder, the highest known rates of bipolar disorder are found in Australia, Brazil, New Zealand, and Finland. The exact reasons for the higher rates in these nations are unknown, but it is inferred that the statistics for the disorder are found to be prevalent in these countries because the individuals are seeking treatment and the disorder is reported. This means that in less developed regions bipolar disorder is not reported and there are not statistics on it. As we know, bipolar disorder is caused by various factors including genetics and environmental stressors, so it is likely that people around the world experience it.

Over the years, bipolar disorder has grown more and more prevalent among youth and adolescents. The percentage of adolescents between the ages of seventeen and eighteen with bipolar disorder is 4.3%, and for those fifteen to sixteen years old the percentage is 3.1%. Bipolar disorder has increased in the younger population at a significant rate, psychologists and researchers are doing their best to interpret these numbers and find a reason for the spike in adolescent bipolar disorder. One speculated reason for these numbers would be the effects that social media, school, bullying, and the many other pressures that teenagers face. Trauma is one of the main triggers for bipolar disorder, which means that teens and young adults are facing trauma very early on in life. It’s important for adults and the leaders in children’s lives to take a look at these issues in their communities, and try to better understand where this trauma may be stemming from to find a solution to this problem.

Bipolar Disorder cannot be eradicated, but a few significant actions can prevent some individuals from going undiagnosed, untreated and undiscovered. It all starts by ending the stigma behind mental illness, being open to talking about feelings and emotions, and creating a safe environment for those struggling with mental illness. By allowing individuals to express emotions and encouraging they seek professional help, the rate of suicide and untreated Bipolar disorder will very likely decrease. Knowing how to handle mental illness and crisis in teenagers is important for those who spend a significant amount of time around children and teens; teachers, youth leaders, and parents should have a significant amount of knowledge surrounding the topic and should know what to do in certain situations. Knowing when it is time to see a professional, identifying a mental health crisis, and understanding what language is appropriate to use with youth suffering from mental illness is also very important. Taking these precautions and steps can help decrease the amount of undiagnosed individuals and individuals without a support system.

Bipolar disorder is a mental disorder that affects individuals all over the world, it is important to understand the signs and symptoms of an individual with this type of disorder to know when it is time to get professional help. Bipolar disorder is characterized as a mood disorder creating a cycle of depression followed by a manic episode, the severity of the changes in mood and the longevity of the episodes is based off of what type of bipolar disorder the individual has; bipolar disorder I is the most severe form of the disorder causing drastic mood changes, longer manic and depressive episodes, and in some cases psychotic episodes. This disorder is not contagious, it is brought on by various factors, the most significant ones being genetics and environmental stressors especially trauma. The disorder is a lifelong disorder but can be managed with a combination of cognitive therapy and medication. Knowing the facts surrounding the disorder can not only help destigmatize mental illness, but it can also help reduce the amount of people who go undiagnosed and untreated.

The biological model of psychology focuses on treating the underlying physical issues that might be causing psychological disorders. For example, let us say there are two different individuals who are suffering from psychological disorders. The first one is Eric. Everyone knows that Eric is strange. He talks back to voices that only he can hear. He thinks that he’s being watched and that his opponents are trying to control him with a device they planted in his arm. He also feels very little emotion and doesn’t take care of his basic needs, like personal hygiene.

Jessie, meanwhile, seems normal. She doesn’t talk to imaginary people and doesn’t have delusions about being persecuted. She showers and seems to act normally. But, Jessie feels very sad all the time. She sometimes has trouble getting out of bed in the morning and doesn’t really care about things that she used to really enjoy doing.

Even though Eric and Jessie seem very different, they are both suffering from psychological issues. There are a wide variety of mental disorders and a wide variety of ways to treat them. For example, one psychologist might look at Jessie’s depression and say that it is caused by a problem from her childhood. As such, that psychologist would try to get Jessie to talk about her childhood in order to treat her.

Another psychologist might say that Jessie’s problem is her thought process. If she can change the way she thinks, they argue, then she will not be depressed anymore. The biological model of psychology says that psychological disorders are caused by biological problems. Biological psychologists or neuropsychologists treat the underlying problems in the brain and nervous system in order to help alleviate the symptoms of the disorder.

For example, a psychologist who believes in the biological model might say that Jessie’s depression is caused by a chemical imbalance in her brain and prescribe antidepressant medications to help bring her brain back into a healthy balance. Let’s look closer at some common treatments in biological psychology which could be medication, electrical therapy, and psychosurgery. On the other hand, The word psychosocial might make people ponder. Psychological interventions can be defined as ‘psycho’ refers to psychology the study of human nature or the mind, its functions, and behavior, and ‘social’ refers to society. A group of people living together with shared laws and organizations. If we put these two ideas together, we can see that psychosocial means how humans interact with and relate to others around them. It focuses on relationships and how humans work in society.

When a person is not interacting with society well, psychosocial intervention may be used to help guide the person back into a healthy state of being. That is the use of non-medicinal means to alter a person’s behaviors and relationships with society in order to reduce the impact of the person’s disorder or condition. The key to psychosocial intervention is that it does not use pharmaceutical assistance in the endeavor to change a person’s behaviors toward a more healthy interaction with society.

Psychosocial intervention can be used in cases of some psychological disorders, the termination of negative behaviors especially harmful addictions, and in well-being programs. While there are many different therapies with different focuses, educating the person suffering and their family or support system about the condition and treatment approach is key to the success of any psychosocial intervention. There are many types of intervention styles associated with a psychosocial intervention that fall under two main umbrellas of therapy which are cognitive therapy and behavioral therapy.

In a nutshell, biological interventions view mental illness as having physical causes. To overcome that physical treatment is used to treat brain dysfunction and the chemical imbalance in the brain. On the contrary, psychosocial interventions are viewed as having a mental illness as the cause, and treatment is used to assist the patients in developing adaptive thought and coping up with an emotional imbalance. The root cause will be looked into while dealing with the issues.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior known as manic episodes to very sad, “down,” or hopeless periods known as depressive episodes. Less severe manic periods are known as hypomanic episodes.

Bipolar I Disorder is defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features like having depression and manic symptoms at the same time are also possible.

Secondly, Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.

Lastly, it is Cyclothymic Disorder (also called cyclothymia) is defined by numerous periods of hypomanic symptoms as well as numerous periods of depressive symptoms lasting for at least 2 years and 1 year in children and adolescents.

If a person is not treated, episodes of bipolar-related mania can last for between 3 and 6 months whereby episodes of depression tend to last longer, often 6 to 12 months. But with effective treatment, episodes usually improve within about 3 months. Most people with bipolar disorder can be treated using a combination of different treatments. These can include 1 or more of the following such as the usage of medicine to prevent episodes of mania and depression and these are known as mood stabilizers and can be taken every day on a long-term basis. Next is medicine to treat the main symptoms of depression and mania when they happen. Lastly, to learn to recognize the triggers and signs of an episode of depression or mania.

My proposal for bipolar disorder would be through the usage of medications from a biological intervention perspective. Different types of medications can help control symptoms of bipolar disorder. An individual may need to try several different medications before finding the ones that work best for him or her. Several medicines are available to help stabilize mood swings. Medications generally used to treat bipolar disorder include mood stabilizers, lithium, atypical antipsychotics, antidepressants, and antimanic or anticonvulsant medicines (Divalproex). Depakote (divalproex sodium) is a medication known as an anticonvulsant that is used to treat the manic symptoms of bipolar disorder. In the UK, lithium is the main medicine used to treat bipolar disorder.

Lithium is a long-term treatment for episodes of mania and depression. It’s usually prescribed for at least 6 months. If one has been prescribed lithium, they have to stick to the prescribed dose and not stop taking it suddenly unless told to by the doctor.

For lithium to be effective, the dosage must be correct. If it’s incorrect, one may get side effects such as diarrhea and get sick. A regular blood test at least every 3 months while taking lithium. This is to make sure lithium levels are not too high or too low. Plus kidney and thyroid function will also need to be checked every 2 to 3 months if the dose of lithium is being adjusted, and every 12 months in all other cases.

Anticonvulsants (Depakote) are sometimes prescribed when patients experience rapid cycling of mood episodes and work by calming the hyperactivity of the brain during mania. Depakote was introduced when its therapeutic value was noted through improved mood stability.

As with most drugs used to treat bipolar disorder, anticonvulsants do have significant side effects which vary from person to person. For example, most can cause dizziness and drowsiness, headaches, dry mouth, etc. In many cases, though, side effects can lessen over time as the body becomes more accustomed to the medication. Despite all the problems associated with anticonvulsants, in some cases, they are more effective and less problematic than classic treatments.

Most people find that treating the symptoms of bipolar disorder requires a combination of medication, psychotherapy, and psychoeducation. Sometimes substance use treatment, intensive outpatient programs, and hospitalization are necessary as well. However, medication is an important part of treating bipolar disorder and stabilizing moods. As has been proposed above, Lithium (Eskalith, Lithobid) is one of the most widely used and studied medications for treating bipolar disorder. This is also been mentioned in an article from WebMD Medical Reference under bipolar disorder treatment. Lithium helps reduce the severity and frequency of mania. It may also help relieve or prevent bipolar depression.

Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic and depressive episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy. Lithium acts on a person’s central nervous system (brain and spinal cord). it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking, and behavior.

Another statement from the article VerywellMind stated that Lithium is a naturally occurring element that was found, in the late 1800s, to have mood-stabilizing properties. The first paper on using lithium to treat what was then called manic depression was published in 1949. The FDA approved lithium in 1970

Psychotherapy. While medications are usually the cornerstone of treatment for bipolar disorder, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family, or group settings. Routine psychotherapy helps patients stay on their medications. Several types of therapy may be helpful. These include:

• Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking, and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet, and exercise.
• Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and cope with upsetting situations.
• Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what’s going on can help you get the best support, identify issues, make a plan to prevent relapse, and stick with treatment.
• Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Cognitive-behavioral therapy (CBT), which involves trying to change your patterns of thinking, is effective for bipolar disorder, according to the American Psychological Association. Strategies that are used in CBT include role-playing to get ready for interactions that could be problematic, facing fears directly rather than practicing avoidance, and learning techniques to calm and relax the mind and body.

Research suggests that adding cognitive-behavioral therapy to a treatment plan can improve the outcome of bipolar disorder, according to the American Psychological Association. 1

A good treatment outcome is one in which the mood episodes are stabilized and the patient is equipped with the cognitive and behavioral skills necessary to become more aware of triggers and how to manage them more effectively, Dr. Rego says. “In the case of Bipolar 1 Disorder, we may also measure a good outcome by a decrease in hospitalizations as well as a re-engagement in work, better interpersonal relationships, and an overall improvement in the quality of life,” he explains.

“I believe that CBT is helpful,” says Scott Krakower, DO, assistant unit chief, psychiatry, Zucker Hillside Hospital in Glen Oaks, New York, “It’s effective with both adolescents and adults. There is a mindfulness component to this form of therapy that is also useful to patients.”

CBT can help a person with bipolar to recognize the warning signs of a mood change and can help them learn to change unhealthy patterns of behavior, Dr. Krakower explains. If someone you live with has bipolar disorder, maintain a calm environment, particularly when that person is in a manic phase. Keep to regular routines for daily activities — sleeping, eating, and exercising. Adequate sleep is very important in preventing the onset of episodes. Avoid excessive stimulation. Parties, animated conversations, and long periods of watching television or videos can exacerbate manic symptoms. Alcohol or illicit drug use can cause or worsen mood symptoms and make prescription medicines work less effectively.

Bipolar disorder is a common chronic illness. The characteristics of bipolar disorder are change in moods, shift in moods, behaviours, normal day to day activity and their energy stages. Bipolar disorder, also known as manic-depressive illness, bipolar disorder was not differentiated from major depressive sickness. it’s a brain disorder. It is a lifelong condition. Bipolar disorder is preserved with medications and psychological counselling. According to new researchers their say “Bipolar disorder is now recognized as a potentially treatable psychiatric illness that has substantial mortality and high social and economic impact.” (Alan C. Swann, M.D. 2006). Bipolar disorder is treated with medications and psychological counselling.

Bipolar disorder is one of the understood psychiatric condition. The bipolar disorder can damage your day to day life style, educational life or your relationships. By giving treatments can manage shift in moods and symptoms. some further studies show, the most common age for the diagnosis is between 20 – 30 years. This indeed can extraordinarily influence an individual, youth, including youngsters since it is at this age, they develop their own associations and path for successful preparing and diverse pieces of life.

A proportionate extent of the two genders experience the evil impacts of bipolar disorder. Makers uncovered make back the initial researchers with rate of ailment in individuals reflect no basic sexual introduction capabilities. Researchers review the composition on sex differentiates in bipolar disorder sickness. An expansive part of the examinations, square with sexual introduction extent in the inescapability of bipolar issue. In any case, some of studies did report an extended danger in women of bipolar issue II/hypomania. An equal sex event in bipolar disturbance implies that there no basic differentiations among individuals. There are a couple of sex differentiates in showing the signs. Most symptoms are entirely practically identical between the two sexual introductions, for instance, apprehension, while two or three differentiations are noticeable.

The state of BD is passionate and social outcome. Alcohol and prescription abuse, suicide tries and the stunning effects of careless, with down direct on marriage, family life and work. The reactions travel all over whimsically. Now and again turning to sum things up period among hyper and distress.

Lithium is a standout amongst the most raised quality measurement demeanour stabilizer medications for bipolar patients. Lithium, anticonvulsants, or antipsychotic medicines can adequately dump down points of view. patients don’t continue with the meds; they keep up a key separation from prescriptions and meds in light of the way that those meds have responses. They may be put off by progressiveness, weight enlargement, or loss of the pleasurable hyper high. Influenced by craze, they may reason that they never again need unfaltering treatment. At whatever point discouraged, they may wrap up induced that everything, including drug treatment, is inconsequential and hopeless.

“Lithium, anticonvulsants, or antipsychotic drugs can effectively damp down mood cycles” (see Mental Health Letter, April and May 200)

The most major gauges are to set up a strong obliging organization an admission to the frameworks and conclusions of treatment and to drug action is indispensable regardless deficient. fortunately, there are diverse specific deal with oversee help bipolar patient adapt to their reactions and manage their lives. psychosocial treatment of bipolar issue combines family at whatever point possible. there is various psychosocial treatment of bipolar issue are consolidating psychoeducation total treatment personal development get-togethers psychodynamic treatment abstract social treatment and family medications. those are dynamically valuable for bipolar patients to control their day of work in perspectives and control them self.

Psychoeducation-gives general data about bipolar conflict and give data identified with the patient’s specific condition. insightful lead and right their twisted considering. get-together treatment fills in as a typical truly solid framework. psychodyanamic treatment can enable patients to build up a supposition of their character in the midst of the perplexity of points of view. social and social treatment is a modification of social treatment for patients with bipolar perplexity and their families. envisioning and keeping a grieving need over explicit individuals with bipolar disorder.

Bipolar disorder is a condition that has several diagnoses. These are, Bipolar Ⅰ, Bipolar Ⅱ, Cyclothymic disorder, substance/medication induced bipolar, bipolar and related disorder due to another medical condition.

According to the DSM Ⅴ, in Bipolar Ⅰ, there has to be at least one manic episode while in Bipolar Ⅱ, there has to be at least one hypomanic episode and at least one major depressive episode.

Manic and hypomanic episodes are defined by an expansive, euphoric or irritable mood marked increase in energy, there is decreased need for sleep, rapid speech, inflated self esteem, even impulse pleasure seeking.

Mania is usually diagnosed when there is significant impairment in interpersonal, social or work function (for example, harming oneself or others) , however, hypomania is diagnosed when these same symptoms represent significant change on an individual’s behavior but do not produce functional impairment. (Strakowski, 2014)

Individuals who have Bipolar Disorder are at a high risk of experiencing events that cause trauma because of their behavior during manic period or increased exposure to trauma in their childhood. (Quarantini, et al, 2010)

This study was conducted in Brazil and it involved 355 participants (248 women and 127 men). It stated that women with Bipolar Disorder (either Ⅰ or Ⅱ), are twice more likely to have Post Traumatic Stress Disorder than men who have Bipolar (20.9% vs 10.6%). It also reported that a history of trauma may be related to both causation and illness course of Bipolar Disorder. (Otto, et al, 2004)

The participants were divided into three groups. The first group comprised of Bipolar Disorder patients with Post Traumatic Stress Disorder, Bipolar Disorder patients that had been exposed to trauma but did not have Post Traumatic Stress Disorder and the third group was participants who had Bipolar Disorder but with no trauma and no Post Traumatic Stress Disorder.(Quarantini, et al, 2010).

The results revealed that the Bipolar Disorder patients with Post Traumatic Stress Disorder have rapid cycling 2.2 times more than the patients who had Bipolar Disorder with Trauma. Also Bipolar Disorder patients with Post Traumatic Stress Disorder were reported to be significantly more likely to attempt suicide than the two other groups of patients. They also screened higher scores pf manic symptoms in comparison to the two other groups.

The quality of life for Bipolar Disorder with Post Traumatic Stress Disorder was much worse than the other groups. They recorded worse for pschological, social relationships and environment domain. (Otto, et al, 2004)

This study reported that comorbidity of Post Traumatic Stress Disorder with Bipolar Disorder is strongly associated with negative clinical outcomes, for example, mood instability, impaired quality of life, higher risk of suicidal behavior and elevated likelihood of rapid cycling. (Quarantini, et al, 2010)

PTSD and Bipolar Disorder (BD) are highly co-occuring and together they create important challenges for the patient and clinician as well. Research has found that individuals with a diagnosis of BD are more likely to develop Post Traumatic Stress Disorder than individuals with a diagnosis of Major Depressive Disorder. This is due to difficulties adjusting to post trauma. (Dilsaver, et al, 2007 as cited in Carter, et al, 2017). Just like in the previous study, patients who have Bipolar Disorder with Post Traumatic Stress Disorder have increased suicide risk, increased number of hospitalization, more rapid cycling, lower quality of life and poorer treatment outcome.

The focus of this study is suicide risk among patients with Bipolar Disorder and PTSD. The fact that co-occuring PTSD is also associated with lower quality of life also increases risk for suicide. The research found that PTSD may sometimes go undiagnosed in patients with Bipolar Disorder Ⅰ because the symptoms of PTSD and Bipolar overlap, misdiagnosis is common. (Carter, et al, 2017)

According to this study, the difference in suicide attempts in patients with bipolar Ⅰ and bipolar Ⅱ were not very significant. The study suggests that there is more significance to clinicians to do thorough diagnostic differentials in order to tailor make treatments appropriately as accurate diagnosis of both Bipolar 1 and Post Traumatic Stress Disorder. The study also found that lower quality of life in the participants contributed to increased suicidal risk.

Participants who had bipolar Ⅰ Disorder with co-occuring Post Traumatic Stress Disorder expressed significantly high scores for suicidal ideation. This communicated that effects of PTSD on suicidal ideation is dependent on the type of Bipolar Disorder.

Symptoms that overlap in Bipolar and PTSD such as impulsivity and delusions of grandeur (which are recorded more in bipolar Ⅰ Disorder) increase the risk of suicidal ideation.

This study was conducted using 148 publications, 12 independent meta-analyses were conducted for each of the clinical outcome of Bipolar disorder. This meta-analysis showed that a history of maltreatment in childhood in patients with bipolar is associated is increased severity of manic, depressive and psychotic symptoms and also risk of comorbid PTSD. Also, a history of childhood maltreatment can be an early indicator of bipolar disorder progression. (Blais and Danese, 2016)

Bipolar disorder and Post Traumatic Stress Disorder comorbidity is significantly high. Comorbid PTSD is also an important indicator of worse clinical outcomes in Bipolar Disorder. There is need for proper clinical assessment because there also seems to be an overlap in the diagnosis of these disorders and patients. Proper care of patients with this comorbidity is also vital in order to get proper diagnosis and assess risks thoroughly. With this in mind, there is need for more research on PTSD comorbidity in individuals with Bipolar because it has been noted to be an increased predictor of suicide risk. (Carter, et al, 2017)