Bipolar Disorder: An Essay

    Bipolar disorder, also known as manic depression, is a common, recurrent, and debilitating mood disorder which causes extreme shifts in energy and mood. The word bipolar indicates the two main polar extremes which a person with the disorder experiences. According to NIMH, a  branch of the National Institutes of Health (NIH) that oversees neurological and psychological  research, this disorder affects about 2.3 million adults in the United States and about 1.2 percent of the population worldwide. The first signs of this disorder usually appear in adolescence and  early adulthood, with cases seldom occuring in childhood. No findings have been made to indicate a difference in frequency among those of differing race or ethnicity. Bipolar disorder can sometimes be co-morbid with several other disorders, including panic disorder, social phobia, generalized anxiety disorder, and substance dependence. This essay will discuss the underlying causes of bipolar disorder, study its symptoms and the different forms that it takes, look into its treatments and possible cures, and finally, examine its supposed link with artistic creativity.

    There are three different types of bipolar disorder, most of which are characterized by the  presence and/or frequency of certain episodes, of which there are several kinds. Manic episodes normally last for at least one week and are characterized by persistently irritable and elevated  mood, euphoria, impulsiveness, and expansiveness. People suffering from a manic episode will  usually have racing thoughts and will speak using quick, run-on sentences. They will be noticeably more active than usual, get far less sleep, engage in several activities at once, and be very unorganized in said activities. One of the most dangerous symptoms is the excessive involvement in risk-taking activities, known as hypersexuality. If an episode worsens, people may even begin to experience  symptoms similar to those of schizophrenia, including hallucinations, delusions, and severely disorganized thinking and reasoning. This often leads to the misdiagnosis of people with  bipolar disorder as schizophrenics. Sometimes the episode can even lead to unprovoked violence towards an object or another person. During these manic episodes, people will usually not even perceive exactly what they are doing and will have little, if any, control over their thoughts and  actions.

      A hypomanic episode is similar to a manic episode only less severe. The symptoms of a  hypomanic episode include most of those in a manic episode, with a decreased need for sleep, racing thoughts, occasional anger, and elevated mood. However, hypomanic episodes are usually not perceptible to others and do not impair a person's social, work, or family life in any significantly obvious way. People who are going through a hypomanic episode are usually cheerful and pleasant, need little sleep, and seem to always have an abundance of energy. They may even feel a sense of heightened creativity. While hypomania sounds in many ways like a desirable condition, there are significantly negative downsides. Even though hypomania is less severe than mania, it can still impair a person's judgment with overconfidence, leading to  dangerous actions with consequences that the person may not have considered. Even more  alarming is the fact that hypomania is very difficult to diagnose because those with the affliction are often mistaken for simply having a naturally energetic temperment. It is very important to diagnose hypomania, because as a stage of bipolar disorder, it will eventually cycle into depression, which carries with it the potential risk of suicide.     

    A major depressive episode will usually last for at least a two week period. During this time,  people with bipolar will become deeply depressed and fatigued, experience either insomnia or hypersomnia, become indecisive and easily agitated, and lose or gain a significant amount of weight. They will experience feelings of worthlessness and guilt, along with the decreased ability to concentrate and a diminished interest in daily activities that they would normally enjoy. The two week period during a major depressive episode is arguably the most dangerous time for people who suffer from bipolar disorder because it is the time when the vast majority of them contemplate death. This can range from the idea of suicide without any specific plan to an actual suicide attempt. These episodes are usually not diagnosed when the same symptoms could be connected with the recent loss of a loved one or some other traumatic experience. Usually speaking, people with  bipolar will usually be depressed far more often than they are manic.     

    A mixed episode, also known as a dysphoric manic episode, is a combination of depressive and manic symptoms, such as agitation, change in appetite, difficulty sleeping, and suicidal  thinking. Severe depression or agitation in this state can also be accompanied by symptoms of psychosis. These symptoms include delusions and hallucinations. Bipolar individuals often describe these episodes as ‘sad mania.' This episode is the one most commonly seen in children.  Though not uncommon, mixed episodes are not widely recognized. Studies show that only 40 percent of people who have both manic symptoms and a sufficient number of depressive symptoms are diagnosed as being in a mixed depressive and manic state. Studies have also shown that suicidal thoughts are greatly increased in people while in a mixed state. Its treatment has not been well-studied, but recent progress indicates that newer medications, like Zyprexa, may be  more beneficial than older methods of treatment such as lithium.       

    The three main types of bipolar disorder are known as bipolar I, bipolar II, and bipolar III. Bipolar I is characterized by the occurrence of one or more manic or mixed episodes followed by  one or more major depressive episodes. Although it is not the most common type of bipolar disorder, it is arguably the most widely known. Bipolar I seems to affect both men and  women equally, according to the DSM (Diagnostic and Statistical Manual of Mental Disorders.)  Bipolar II consists of one or more major depressive episodes accompanied by at least one  hypomanic episode. Between these episodes, there tend to be periods of normal functioning. The DSM indicates that women are more likely than men to suffer from bipolar II.
   
    Bipolar III, a fairly recently discovered form, comes  about as the result of the medication prescribed to people with depression. Often an individual who suffers from depression will be given drugs such as the steroid cortisone or antidepressants which can actually reverse the depression into mania. The resulting cycle of depression and drug-induced mania manifests into a sort of artificial bipolar disorder. Needless to say, this is often due to negligence on part of the doctor, mistakenly prescribing a dosage which exceeds that which is needed. Thankfully these manic symptoms are usually reported eventually and the perscription is consequently corrected. Another disorder, called cyclothymia, is similar to bipolar I, though less severe. Because of this, it is sometimes mistaken  as a personality trait. It is characterized by periods of mild depression followed by periods of  normal or slightly elevated mood. Some cyclothymics go on to develop full-blown bipolar  disorder (usually bipolar II ) at some stage in their lives, others suffer from forms of depression  or other more severe mood disorders, and some simply do not change at all.   

    Searching for the causes of bipolar disorder has been a decidedly difficult task. This is mainly due to the the fact that it is a mood disorder, and inherently does not physically manifest itself in any outwardly identifiable way. However, scientists and medical researchers have been making progress, and the majority of  them agree that bipolar disorder is not the result of one factor, but several combined, such as environment and heredity.
 
    Bipolar  disorder tends to run in families, and because of that, researchers have paid special attention to  identifying  and studying the specific genes which they believe might play an important role. While at present, no one gene has been isolated which is believed to individually cause the disorder, findings have indicated that specific mutations in certain genes may lead to the development of bipolar disorder much more frequently than others. One of the more recent discoveries was made in 2003 by a group of  American and Canadian researchers, who discovered that a mutation in the gene GRK3 is a  possible cause of up to ten percent of the cases of bipolar disorder worldwide. This gene is  directly associated with a kinase enzyme involved in dopamine metabolism, meaning that a  possible target has been found for new drugs that could help to treat bipolar disorder more  effectively.
   
    While tangible progress may be slow,  scientists are confident that the advanced research tools now in use will lead to more effective treatments for  bipolar disorder in the future. Researchers have also been making use of MRIs in order to examine the brain structure and function of people with bipolar disorder. The majority of this  research has been focused on characterizing the networks of interconnected nerve cells in the  brain and the interactions among them which form the foundation for normal and abnormal neural behavior. Researchers have begun to speculate that certain abnormalities in these networks could  be a factor in the development of bipolar and other mood disorders. Another possible cause that  has received a great deal of attention is the imbalance of chemicals in the brain which transmit  messages from one nerve cell to another, known as neurotransmitters. The neurotransmitters which are most commonly associated with mood disorders include the monoamines ( serotonin,  norepinephrine, and dopamine), GABA (Gamma amino butyric acid), and glutamate. Several things can go wrong with the transmitting process, including  an overabundance or lack of certain  neurotransmitters or a premature shutdown of the release of neurotransmitter molecules. Many  researchers believe that a low production level of a specific neurotransmitter such as dopamine or  serotonin followed by a high production level may be the main cause of bipolar disorder. Others  believe that changes in the sensitivity of  the receptors on the nerve cells are the cause. While  further research is needed to determine its exact role in bipolar disorder, the majority of scientists and researchers agree that it is certainly a plausible factor.

    While there is no available cure for bipolar disorder as of yet, prescriptions focusing on the management of symptoms are readily available. There are a variety of different drugs on the market, as many people with bipolar disorder require several different types of medication, sometimes up to  five. Some people with bipolar choose to augment their traditional medication with cognitive  therapy and herbal or holistic treatment. However, even with optimal treatment, many of those  with bipolar often still have residual symptoms.

    There are several basic medications available to  those with bipolar disorder. Mood stabilizers are used to prevent or control depressive or manic episodes. Because they are decidedly more effective at treating mania than depression, periods of depression are often treated by taking antidepressants. However, these antidepressants carry an increased risk of mania, especially if not taken with a mood stabilizer. Some of the more severe  cases of bipolar where psychosis is present require the use antipsychotic drugs. However, these  antipsychotics sometimes carry side-effects which are just as detrimental as the symptoms they treat. Several people have reported that these antipsychotics cause panic attacks, mania, and  psychosis. Unfortunately, compliance with medications can present a major problem as well, as an individual is quite likely to lose the awareness that they need to be medicated during a manic episode.
   
    One of the oldest and most widely used medications used in treating bipolar is lithium. In ancient times, people with mental illnesses were sent to drink from ‘alkali springs' as treatment. These ancient  doctors were actually prescribing lithium, which was present in high concentration in the springs. Approved by the FDA for acute mania in 1970, lithium has been an effective treatment for those  with bipolar disorder for many years, mainly because of its mood-stabilizing properties. Side  effects of ingesting lithium include high blood pressure, water retention, and constipation. Regular  blood testing is also required while taking lithium, because the correct therapeutic dose is so close  to the toxic dose.
   
    One of the newest additional treatments for bipolar is the use of omega-3 fatty acids.  Researchers have found that the therapeutic ingredient seems to be eicosapentaenoic acid (EPA). One of the major upsides of taking omega-3 fatty acids is that there do not appear to be any negative side-effects. There have also been recent claims that medical marijuana could help to  control the mood swings associated with bipolar disorder. In theory, the euphoriant effect of THC could elevate depressive phases, while its tranquilizing effects could also help to control  manic phases. However, due to the current controversy and legal issues surrounding its use, this treatment is most likely to be more difficult for those interested in it to obtain.

    One of the most interesting aspects of bipolar disorder is its supposed link with artistic  creativity. Throughout history, there are examples of intensely creative and artistic men and  women who have suffered from bipolar disorder. Kurt Cobain, who expressed his anger and  depression through his music, was one of the greatest musicians of the 90's, and arguably one of  the best rock musicians of all time. He used his depression and mania as musical tools, moving  back and forth in many of his songs between high-energy distorted guitars with screaming vocals  and softer, melancholy vocals with clean guitar. This technique is especially apparent in songs like ‘Lithium' and ‘Heart Shaped Box'. Many believe that Cobain's suicide in 1994 was a result of  a deep depressive stage of bipolar disorder.

    Another artist who is now thought to have had  bipolar disorder was the legendary musician Jimi Hendrix, who many people argue was the most talented and creative  guitar player who ever lived. This is probably due mostly to one of his most famous songs  named ‘Manic Depression' in which Hendrix abstractly explains what it is like dealing with the disorder. One of history's greatest painters, Vincent Van Gogh, is now commonly believed to have suffered from bipolar disorder.  During one unusually long manic episode, Van Gogh painted an astounding total of one-hundred  and eighty-nine paintings. One of his most famous paintings, Starry Night, was painted while he  was in the hospital for mentally disturbed people in St. Remy de Provence, France.

    Despite continued research, bipolar disorder remains a mystery in many ways. What is its true  cause? Is there any way to permanently cure it? And is there any truth to its supposed link with  creativity? These questions and many more still remain unanswered by the scientific and medical community. Perhaps one day we will find the means to uncover the answers, yet for the time being, they remain undisclosed.

Furthur Suggested Reading:

NIMH Bipolar Disorder - Complete Publication
http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publicatio...

NAMI - What is Bipolar Disorder?
http://www.nami.org/Template.cfmSection=By_Illness&Template=/TaggedPage/TaggedPa...

WebMD - Bipolar Disorder Health Center
http://www.webmd.com/bipolar-disorder/

The Bipolar Brain and the Creative Mind
http://serendip.brynmawr.edu/bb/neuro/neuro02/web1/seberhardt.html

Stability Versus Creativity
http://bipolar.about.com/cs/myths/a/aa030911.html