Wednesday, 28 March 2018

Hormones and Bipolar Disorder

Medical professionals do not completely understand bipolar disorder. The symptomology is clear, yet patients experience different levels of mood fluctuation at different rates. Some individuals experience primarily one symptom or another, and these symptoms can closely resemble those of other conditions, such as simple depression or schizophrenia. There is no clinical test for bipolar disorder; rather, a diagnosis is made on the basis of reported behavior and tests that eliminate other possibilities. For all these reasons and more, professionals often misunderstand and misdiagnose bipolar disorder.

Suspected Causes of Bipolar Disorder

Hormones may encourage bipolar disorder to develop, but they do not make the list of suspected causes. Mental health specialists believe bipolar disorder results from a combination of internal and external factors, just as with other conditions like cancer or diabetes coming from environmental factors that trigger a latent genetic predisposition.

How Fluctuating Hormone Levels may Impact Bipolar Disorder

Although medical professionals have not indicated hormones as a possible cause of bipolar disorder, it is likely that fluctuating hormone levels contribute to the condition. Bipolar disorder is considered a mood spectrum disorder, a condition that shifts moods from one extreme to the other. Hormone levels may also cause rapid or extreme mood changes. Additionally, the hormones of someone with bipolar disorder may combine with stress to trigger an episode. It may be in some cases that all other factors were in place to experience an episode, and fluctuating hormone levels were the spark that lit the fuse.
Women suffer the effects of changing hormone levels more profoundly than do men. Some women experience fluctuating hormones to such a degree that they commonly experience depression or extreme mood swings. The result may be so severe that their moods resemble the shifts in bipolar disorder. This can present problems for diagnosis, because a doctor may think bipolar disorder is present when a patient in fact suffers from hormonal issues. Of course, a woman with bipolar disorder who experiences mood swings due to fluctuating hormones is likely to suffer more frequent and more severe episodes.

Treatment for Bipolar Disorder

If you need help finding treatment, or if you have questions about bipolar disorder and treatment, call our toll-free, 24 hour helpline right now for instant support.
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What should you know about bipolar disorder

Last updated
By Christian Nordqvist
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Previously known as manic depression, it is a serious mental illness that, if left untreated, can destroy relationships, undermine career prospects, and seriously affect academic performance. In some cases, it can lead to suicide.
An estimated 2.9 percent of Americans have a diagnosis of bipolar disorder, and 83 percent of cases are classed as severe.
Diagnosis most commonly occurs between the ages of 15 and 25 years, but it can happen at any age. It affects males and females equally.
Fast facts on bipolar disorder
Here are some key points about bipolar disorder. More detail is in the main article.
  • Bipolar disorder is a serious condition that involves severe abnormalities in mood.
  • The person experiences alternating bouts of mania or hypomania and depression, which may involve psychosis.
  • Episodes may last several weeks or months, with periods of stability in between.
  • It can be managed with medication, but it may take some time to find the right dose and combination.
  • What is bipolar disorder?
Bipolar disorder involves many mixed emotions.
Bipolar disorder involves many mixed emotions.
The main symptoms of bipolar disorder are alternating episodes of extreme euphoria, or mania, and major depression.
The fluctuations can be severe, but moods may be normal between the peaks and troughs.
The mood swings involved in bipolar disorder are far more severe, debilitating, and incapacitating than those experienced by most people.
Hallucinations and other symptoms may occur in some people.
With treatment, many people with the condition can work, study, and live a full and productive life. However, some people stop taking their medication or choose not to take it.
Some studies have shown that people with bipolar disorder may have enhanced creativity. However, mood swings can make it hard to sustain attention to projects or follow through with plans, resulting in the person having a lot of projects started, but nothing finished.

Symptoms vary between people, and according to mood. Some people have clear mood swings, with symptoms of mania and then of depression each lasting for several months, or with months of stability between them. Some spend months or years in a "high" or "low" mood.
A "mixed state" is when a manic and a depressive episode happen at the same time. The person may feel negative, as with depression, but they may also feel "wired" and restless.

Mania or hypomania

Hypomania and mania refer to a "high" mood. Mania is the more severe form.
Symptoms can include:
During a manic episode, a person may engage in risky behavior, such as spending excessive amounts of money.
During a manic episode, a person may engage in risky behavior, such as spending excessive amounts of money.
  • impaired judgment
  • feeing "wired"
  • a sense of distraction or boredom
  • missing work or school, or underperforming
  • thinking they can "do anything"
  • belief that nothing is wrong
  • being extremely forthcoming, sometimes aggressively so
  • likelihood of engaging in risky behavior
  • a sense of being on top of the world, exhilarated, or euphoric
  • excessive self-confidence, an inflated sense of self-esteem and self-importance
  • excessive and rapid talking, pressurized speech that may jump from one topic to another
  • "racing" thoughts that come and go quickly, and bizarre ideas that the person may act upon
This may include squandering money, abusing illegal drugs or alcohol, and taking part in dangerous activities. A higher libido may lead to promiscuity.

Depressive symptoms

During a depressive episode, the person may experience:
  • a feeling of gloom, blackness, despair, and hopelessness
  • extreme sadness
  • insomnia and sleeping problems
  • anxiety about trivial things
  • pain or physical problems that do not respond to treatment
  • guilt, and a feeling that everything that goes wrong or appears to be wrong is their fault
  • changes in eating patterns, whether eating more or eating less
  • weight loss or weight gain
  • extreme tiredness, fatigue, and listlessness
  • an inability to enjoy activities or interests that usually give pleasure
  • low attention span and difficulty remembering
  • irritation, possibly triggered by noises, smells, tight clothing, and other things that would usually be tolerated or ignored
  • an inability to face going to work or school, possibly leading to underperformance
In severe cases, the individual may think about ending their life, and they may act on those thoughts.
Psychosis can occur in both manic and depressive episodes. The person may be unable to differentiate between fantasy and reality.
They may believe during a "high" that they are famous, or have high-ranking social connections, or that they have special powers. During a depressive episode, they may believe they have committed a crime or that they are ruined and penniless.
Symptoms of psychosis may include delusions, which are false but strongly felt beliefs, and hallucinations, involving hearing or seeing things that are not there.
Children and teenagers with bipolar disorder are more likely to have temper tantrums, rapid mood changes, outbursts of aggression, explosive anger, and reckless behavior.
These features must be episodic rather than chronic to receive a diagnosis of bipolar disorder.
It is possible to manage all these symptoms with appropriate treatment.

Diagnosis

A psychiatrist or psychologist bases the diagnosis on criteria set out in the Diagnostic and Statistical Manual, fifth edition (DSM-5).
The person must meet certain criteria for mania and depression, including an elevated or irritable mood and "persistently increased activity or energy levels." These must have lasted at least 7 days, or less if symptoms were severe enough to need hospitalization.
The individual and their family members, colleagues, teachers, and friends can help by relating experiences of the patient's behavior.
Other healthcare professionals may have detected secondary signs of the condition.
The doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests.
This can help to eliminate other possible causes of symptoms, such as substance abuse.
Other conditions that may occur with bipolar disorder are:
However, these may also mask a diagnosis.
A person is more likely to seek help during a time of depression than during a "high." The National Institute of Mental Health (NIMH) urge health care providers to look for signs of mania in the person's history, to prevent misdiagnosis.
The person may receive a diagnosis of one of three broad types of bipolar disorder.

Bipolar I disorder

For a diagnosis of bipolar I:
  • There must have been at least one manic episode
  • The person must also have had a previous major depressive episode
  • The doctor must rule out disorders that are not associated with bipolar disorder, such as schizophrenia, delusional disorder, and other psychotic disorders.

Bipolar II Disorder

For a diagnosis of bipolar II, the patient must have experienced one or more episodes of depression and at least one hypomanic episode.
Some people experience a mixed state, in which they may feel depressed but also restless.
Some people experience a mixed state, in which they feel depressed but also restless.
A hypomanic state is less severe than a manic one.
Features of a hypomanic episode include sleeping less than normal and being competitive, outgoing, and full of energy.
However, the person is fully functioning, which may not be the case with manic episodes.
Bipolar II can also involve mixed episodes, and there may be symptoms of mood-congruent or mood-incongruent psychotic features.
A mood-congruent psychosis would involve features that match the mood. For example, if a person is experiencing depression, mood-congruent psychosis could have a theme of sadness.

Cyclothymia

Cyclothymia involves episodes of low-level depression that alternate with periods of hypomania.
The DSM-V classifies it separately from bipolar disorder, because the mood changes are less dramatic.
A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enter a period of stability, but they will always have the diagnosis.

Treatment

Treatment aims to minimize the frequency of manic and depressive episodes, and to reduce the severity of symptoms to enable a relatively normal and productive life.
Left untreated, a bout of depression or mania can persist for up to 1 year. With treatment, improvements are possible within 3 to 4 months.
Treatment involves a combination of therapies, which may include medications and physical and psychological interventions.
The person may continue to experience mood changes, but working closely with a doctor can reduce the severity and make the symptoms more manageable.

Drug treatment

Lithium carbonate is the most commonly prescribed long-term drug to treat long-term episodes of depression and mania or hypomania. Patients usually take lithium for at least 6 months.
It is essential for the patient to follow the doctor's instructions about when and how to take their medication in order for the drugs to work.
Other treatments include:
  • Anticonvulsants: These are sometimes prescribed to treat mania episodes.
  • Antipsychotics: Aripiprazole, olanzapine, risperidone are some of the options if behavior is very disturbed and symptoms are severe.
Medication may need to be adjusted as moods shift, and some drugs have side effects.
Some antidepressants given to patients before they have a diagnosis of bipolar disorder may trigger an initial manic episode. A physician who is treating a patient with depression should monitor for this.

Psychotherapy, CBT, and hospitalization

Psychotherapy aims to alleviate and help the patient manage symptoms.
If the patient can identify and recognize the key triggers, they may be able to minimize the secondary effects of the condition.
The person can learn to recognize the first symptoms that indicate the onset of an episode and work on the factors that help maintain the "normal" periods for as long as possible.
This can help maintain positive relationships at home and at work.
Cognitive behavioral therapy (CBT), as individual or family-focused therapy, can help prevent relapses.
Interpersonal and social rhythm therapy, combined with CBT, can also help with depressive symptoms.
Hospitalization is less common now than in the past. However, temporary hospitalization may be advisable if there is a risk of the patient harming themselves or others.
Electroconvulsive therapy (ECT) may help if other treatments are not effective.
Keeping up a regular routine with a healthy diet, enough sleep, and regular exercise can help the person maintain stability.
Any supplements should first be discussed with a doctor, as some alternative remedies can interactwith the drugs used for bipolar disorder or exacerbate symptoms.

Bipolar disorder does not appear to have a single cause but is more likely to result from a range of factors that interact.

Genetic factors

Some studies have suggested that there may be a genetic component to bipolar disorder. It is more likely to emerge in a person who has a family member with the condition.

Biological traits

Patients with bipolar disorder often show physical changes in their brains, but the link remains unclear.
Brain-chemical imbalances: Neurotransmitter imbalances appear to play a key role in many mood disorders, including bipolar disorder.
Hormonal problems: Hormonal imbalances might trigger or cause bipolar disorder.
Environmental factors: Abuse, mental stress, a "significant loss," or some other traumatic event may contribute to or trigger bipolar disorder.
One possibility is that some people with a genetic predisposition for bipolar disorder may not have noticeable symptoms until an environmental factor triggers a severe mood swing.


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Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.
  • Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
  • Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.
  • Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
  • Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.
Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.
Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.
Both a manic and a hypomanic episode include three or more of these symptoms:
  • Abnormally upbeat, jumpy or wired
  • Increased activity, energy or agitation
  • Exaggerated sense of well-being and self-confidence (euphoria)
  • Decreased need for sleep
  • Unusual talkativeness
  • Racing thoughts
  • Distractibility
  • Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:
  • Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
  • Marked loss of interest or feeling no pleasure in all — or almost all — activities
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
  • Either insomnia or sleeping too much
  • Either restlessness or slowed behavior
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Decreased ability to think or concentrate, or indecisiveness
  • Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.
Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.
The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.
And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
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