Bipolar disorder is a complex mental illness that affects about 2% of the population. The most telltale sign of bipolar is the shifting in mood between periods of sickening lows (sadness, hopelessness) to periods of exhilarating highs (elation, high energy), with normal mood in between.
Who gets bipolar disorder?
Bipolar disorder isn’t fussy. It can afflict anybody and like so many mental illnesses, we really don’t know why some people are struck by it and some people aren’t. What we do know is that bipolar has absolutely nothing to do with intelligence, character or personality. It has a physiological basis, but it expresses itself through emotion, behaviour and mood.
Researchers have identified small variations in a number of genes that are closely connected to an increased risk of developing bipolar disorder. A family history of bipolar seems to be the greatest risk factor, but it’s important to remember that most people who have the family history will never go on to develop the illness.
What does it feel like?
For people with bipolar, the extreme shifts between depression and exhilaration and back to depression are cruel and unpredictable. Bipolar disorder takes people to the greatest highs and plunges them to the most devastating lows.
In a manic state, the elation and high energy can feel euphoric. Confidence escalates. Limits disappear. Thoughts and ideas race, with a new one beginning before the last one is finished. Speech, behaviours, and actions speed up to keep pace with a mind that is catapulting forward. Energy feels boundless and sleep can feel irrelevant.
Sometimes, people in a manic state can become agitated and irritable, particularly when it feels as though other people can’t keep up, don’t understand them or are trying to dampen their energy. They might love hard and hate just as hard.
People in a less extreme manic episode might function well and be highly productive, working through the night to get things done. The first sign that bipolar disorder might be behind the high productivity are the shifts in mood and activity levels. Often, the person might feel as though nothing is wrong, so it’s not unusual for people close to the person to be the first ones to notice that something isn’t right.
The manic phase of bipolar can feel unbelievably exhilarating. Inhibitions are stripped right back, and it can feel as though anything is possible. Because of this, people in a manic state might do risky things. They might have reckless sex, overspend, or make impulsive, catastrophic decisions. They might make wild plans that involve huge amounts of money, grand intentions or famous people who will surely understand and applaud their vision. Again, this has nothing to do with intelligence or character. It happens because they are being driven by a mind that is hurtling them forward, convincing them they can do anything, be anything and achieve anything. Their body backs this up by giving them more energy than someone without bipolar might ever get to experience at a single point in a lifetime.
Then comes the crashing depression. The crash would feel thunderous for anyone, but when the fall is from such an extravagant, lofty height, it’s devastating. The exhilaration and extreme feelings of freedom and possibility are replaced with intense sadness, emptiness, and hopelessness. The high energy crashes. The mind is burnt out and the body is exhausted, and the reality of decisions made during manic phase hit home. The things that usually bring immense joy now bring a dead nothingness. In a depressive state, people can have difficulty concentrating, and they might be forgetful. Extreme hopelessness and sadness can drive suicidal thoughts, and the shame and guilt from the things done during a manic episode might feed the darkness even more. In the darkest times, suicide might feel like the only way out of the pain.
The presence of bipolar disorder might not always be obvious. Sometimes, the depression and mania can exist together. When this happens, people might have a lot of energy, but at the same time feel intense sadness and hopelessness.
More recently, bipolar disorder has started to be classified as early-stage bipolar or late-stage. The classification isn’t so much about the length of time the person has had the symptoms, but more about the number of episodes and the severity of the symptoms. People with early-stage bipolar disorder have had fewer manic or depressive episodes, whereas those with late-stage bipolar have had more episodes with more severe symptoms.
Some new insights …
One day, those who attach a stigma to mental illness will be seen to have the same level of naivety as those who believed the earth was flat. As we uncover more about the causes and characteristics of certain mental illness, it becomes increasingly clear that mental illnesses have a physiological cause. They are physical illnesses that come with physical symptoms, as well as behavioural, emotional or cognitive ones. Here are some of the things we are learning about bipolar disorder:
The architecture of the brain of people with bipolar disorder is different.
The brains of people with bipolar disorder show typical features that are different to the brains of people without bipolar. First, the brains of people with bipolar have a reduced volume and show evidence of a process in which the brain re-writes the connections between its neurons (brain cells). This is something that normally happens with learning and memory and recovery from brain damage, but in people with bipolar, the process is associated with a loss of neurons and a deterioration in cognitive function.
The blood of people with bipolar disorder is different.
Research has shown that the blood of people with bipolar disorder has some interesting features that are associated with the severity and frequency of mood episodes. Their blood has several markers related to inflammation and oxidative, and lower levels of the protein (BDNF) that supports the growth and survival of neurons, and helps to establish connections between neurons.
The bipolar brain has less of a protein that helps it to adapt to stress.
The brains of people with bipolar disorder have lower levels of a protein (EGR3) that helps the brain to cope with stress and changes in the environment.
Lower levels of omega 3 in the blood of people with bipolar disorder.
Faty acids have a vital role in brain health, the immune system, and the inflammatory system. Research has found that people with bipolar disorder have lower levels an omega-3 fatty acid called EPA in the blood, which is the type that crosses the blood-brain barrier to enter the brain. (Previous research exploring the connection between fatty acids and bipolar has focussed on the levels of fatty acids in cell membranes.)
Cells in a brain with bipolar disorder are more sensitive to stimuli.
Research recently published in the journal Nature, found that the neurons from people with bipolar are much more sensitive than neurons from people without bipolar disorder. Normally, neurons are stimulated and then they respond. In people with bipolar, the neurons are very quick to respond – they don’t need a lot of stimulation. The energy-producing powerhouses in the cells – the mitochondria – are also more active.
‘After a few months, it’s possible that this hyperexcitability becomes too much for the cell to handle and it crashes into a less excitable state … That could signal the shift between the depression and mania that patients experience.’ Rusty Gage, senior researcher and professor, Salk Institute Laboratory of Genetics.
The blood of people with bipolar disorder is toxic to the brain.
Recent research published in the International Journal of Neuropsychopharmacology has found that the differences in the blood of people with bipolar are also associated with changes in the brain of people with bipolar disorder. As part of the research, neurons were exposed to blood from individuals with bipolar or without bipolar. The neurons that were exposed to the bipolar blood showed evidence of a loss of neuron connections when compared to the non-bipolar blood. The difference was only noticed in those with late stage bipolar. The blood from early stage bipolar was similar to the people without bipolar.
‘Our results indicate that the blood of BD [bipolar disorder] patients is toxic to brain cells and affects the connectivity ability of neurons. Considering our previous knowledge on the association between mood episodes and blood toxicity, we believe that the more episodes a patient has, the more cellular components are produced that impair the brain’s ability to deal with environmental changes, inflammation and stress.’ Fabio Klamt, lead researcher, Federal University of Rio Grande do Sul.
And finally …
Incredible advances in technology are opening up our capacity to observe and learn about the brain. With this increased knowledge comes great opportunities for new treatments that are more effective and have fewer side effects. Researchers are continually edging closer to finding a way to manage bipolar disorder so that its effects are less intrusive for those who have the disorder, and the ones who love them.
Thank you for this beautifully succinct, wonderfully explained and solidly scientific research based article. I was recently diagnosed and have done my own research on the physiology of the disorder which has helped me to realise how concrete the affliction is and to get treatment. I feel so much less stigma now that I truly believe this is a real physical condition. It would be wonderful if we could raise this awareness more and I thank you for writing this article to help our cause.
I am in complete despair with this illness i need a bit of a miracle separation from my children is making me suicidal.
Iain there will be way through this. Keep fighting for you. It might take a bit of experimenting to find the support that works best for you, but please don’t give up hope. Here is a list of places that will be able to offer you some direction and support. I understand how lonely this can feel, but know that you don’t have to fight your way through on your own. I wish you love and strength.
Hang in there Ian…..
You CAN get through this….
Change psychiatrists if you must…
We are all guinea pigs trying to stabilise on the correct meds….
We are all different so this is a difficult task…for sure!!
Find a psychologist or a caring friend or even start your own Support grp as I have…
We meet once a month and share our stories and a comforting meal …
And are there for each other during the exhilarating highs and excruciating lows…
Remember …we are Not Alone…
Be Strong…. there Is Light out of the Dark recesses of your Mind…
Read An Unquiet Mind by Kay Jamieson .
It sheds Much Light on us Polar Bears 🙂 🙂
I contracted GBS three years ago. I am trying to see if there is a connection between my BD and recovering from Guillian Barre Syndrome.
My pain has not subsided since my initial recovery period and seems to increase greatly when I am experiencing a cycle of depression.
Thank you so much for this insight. I just witnessed for the first time my dad experiencing mania and I was so terribly frightened because I could not make sense of what I was seeing and he got so agitated and angry at me for trying to do so. I walked away rather than escalated the situation and wanted to understand so that I can approach him with love and understanding.
Katrina I’m so pleased this article was able to help you. Watching someone you love in a manic episode can be really scary. I imagine this is a frightening experience for him also – is he seeing a doctor? The symptoms of bipolar can be managed with the right medication, but sometimes finding the right medication and the right dose (to be effective but with the least side effects) can take a little bit of experimenting. You sound beautifully supportive and open to what your dad is going through. He is lucky to have you.
any thoughts about hospital like Silver Hill for help,
understanding and aid? is it all about medication, once realization of BD is understood? or are there methods to help prevent future episodes of “regret” for actions past?
thank you, rick
I’m in Australia, so I’m not sure. A local doctor or counsellor would be the person to ask. If you call Silver Hill directly, they would have someone there who would be able to talk to you about the type of support they offer. It’s an important question to ask and you’re wise to be thinking of support that includes therapy as well as medication.
I was diagnosed with BP I about twelve years ago (I am 36) after a hospitalization for severe mania. I have ‘lived the cycle’ most of my teenage and adult life and never knew why, I thought it was normal. I would wake up every day not knowing how I would feel that day, so it made it hard to make and commit to plans. It affected my relationships, jobs…everything. Thankfully my family was a solid support system, and after my hospitalization and subsequent diagnosis, I began a medication regimen that included at least six different medications. Again, thankfully, I finally found a doctor with whom I could experiment a little, as the side effects were pretty burdensome, eventually titrating down from 6 medications to 1 over the course of a a few years under close supervision. That one medication has proved to work well for me, and I have not had any major episodes in over five years.
Since my diagnosis and treatment, I have gone on to get married, became a father to two young children, hold a steady professional job, and am happy, healthy, and stable. Recovery is possible, though I am cognizant that my brain is ‘wired’ differently than others and I have to take care of it. To go from suicidally depressed and out of control manic to a holistic model of mental health is nothing short of a kind of miracle, in my opinion. A lot of things came together to make it happen.
If I may ask, are there any scientific studies you can point to/reference where you drew the numbered list of ‘new insights’ from? I’m curious to follow up on my own. I do struggle with memory and what I’ve always suspected was a loss of some kind of cognitive function, and wondered the cause (thought I suspect it has to do with BP).
Thanks for writing succinctly on the topic.
Rob you’re very welcome and thank you so much for sharing your story. Your words and your experience are powerful and I’m sure they will bring hope to many who read it.
I can definitely point you to the studies. The links to the studies are all hyperlinked in the article. Look for the words that are in dark blue and if you click on them, you’ll go straight to the study.
Good article. it’s informative. This needs to be shared.
This has been a Very Interesting article to read…. especially about our BD blood…wouldn’t it be great if we could just go and get a complete blood transfusion from a reliable source that would solve all our extreme moods!! 🙂
My condition has a lot to do with genetics and of course conditions in the home from childhood…
I have done countless healing therapies…have a number of diplomas of all sorts behind my name…and yet my bouts are becoming more frequent and intense for longer periods….
I have been on medication for many years now….more recently on Valdoxane and forever on Epitec …
This lack of a particular protein…..surely there is some form of it that we could be given???? What about some new brain neurons?? Surely there is some super intelligent brain surgeon out there that has figured this out?? Maybe he is also a BD sufferer and can totally relate to this condition. …
I have had breast cancer and a mastectomy with double chemotherapy and radiation and I can truly say I would choose that physical illness anyday over this mental one….
Only those that have travelled this road will understand. …
Thank you for your information. .and yes..to the other sufferers out there….You are not Alone….Don’t be afraid to get help…it’s not your fault….
Thanks Sharon. Hopefully, now that we understand more about the physical sides of bipolar, we are closer to finding a cure. I love your final words – bipolar is not anyone’s fault and it’s so important to remember that there are many people struggling with this, and many who understand.
There is schophina in my family along with depression. I’ve had bouts of depression off and since my 20’s. Five years ago I had a head injury due to a car crash. Since then I have no control over how high or low my emotions go, how raging mad I can become or historically crying I can become. I have suicidal thoughts with the lows and the highs are never the extreme high as talked about.
Is this BD? Or do I have this massive mess of emotions because of the crash. (I have had memory loss of the crash day and subsequent short term memory loss ever since. My medical Dr. said I have adult ADD but given a task I can’t remember oral instructions, written instructions I fallow but confuse the steps or can’t remember what step I have completed. If I do not do a new “learned” task for even a day I don’t remember.
When the lows are really low I have a conversation in my head constantly trying to stop the negative thought process and the way my brain wants to view situation to the reality that it is. Times I can’t remember what I was saying or what I had just said in a conversation. I can’t pick up the conversation even when promted by others.)
Looking for answers to the jumbled up mess inside my head.
Crystal it’s really important that you get a thorough assessment. If what your doctor has told you doesn’t feel right, or if the treatment you have been given isn’t working, it may be very worthwhile getting another opinion. There are so many possible reasons for your symptoms, and a correct diagnosis is important for knowing how to best manage those symptoms.
It is only in the last several years that I have been officially diagnosed with BD. Looking back on my life, I realize that it has been a part of me since my teens. The highs, the manic times when I felt I could accomplish anything, and the lows that sometimes led to suicidal thinking.
This article is encouraging since it validates that the condition exists (something that has spawned many an argument with those who thing I exaggerate). It has piqued my interest especially regarding the role of certain proteins and also Omega 3s. Hopefully more research will lead to better ways to make life easier for us with a “roller coaster” existence.
There is more discussion lately on the effects of BD on the brain, but I would also like to see more written about how it simply wrecks the body. Being in a wired state makes my body run at 90 mph, and then the crash which brings with it pure exhaustion, which can last for a week or more. Over time, I really feel wrung out and can barely get out of bed after days of being on a “high”. It’s not just the mental part that effects the quality of one’s life. I think many don’t appreciate that side of the equation.
It’s so frustrating isnt’ it that even with everything we know about mental illness, there are still people who think that it doesn’t exist, or that the symptoms are exagerated. I’m pleased that the article helps you to feel validated. The concrete evidence about the physiology of bipolar will hopefully add to the destigmatisation. There is a lot of research happening in the area and yes, I can imagine that there is a lot for us to find out about the effects of bipolar on the body. We are certainly getting closer to understanding more.
Thank you. Even your reply has helped me feel better about myself. Another aspect in those of us who suffer from this condition is that modern technology is helping greatly. It’s hard to deny the images of the brains of, say, bi-polar people to those who don’t suffer from this. Actual, physical proof. There is hope yet!