What is bipolar disorder?

Bipolar disorder or manic-depressive illness

Bipolar disorder is a psychiatric disease that progresses with depressive (depression), manic (extremity) and hypomanic episodes, does not show any symptoms between periods, causes serious loss of function, and can sometimes be life-threatening.

Normally, everyone can have periods when they feel good or feel bad. These periods can be consecutive. These are not considered bipolar disorders. Periods of feeling good or feeling bad in bipolar disease seriously affect the daily functions, family relationships, social life, school and work life of the person. There are serious fluctuations in the energy, emotions and thoughts of the person. The patient, who feels extravagant, overactive, sleeps little but feels very energetic during the manic period, does not want to get out of bed during the depressive period, is hopeless, and feels exhausted.

The disease, which is seen in 2-3% of the society on average, is an important public health problem that can cause important problems in family, friend relations, social life, business life and economy.

Since it is a spectrum of diseases that includes different and contrasting periods rather than a classical disease period, its initial form, course, and response to treatment are complex. The risk of recurrence is high.

The disease has been defined in various ways since the 5th century BC, and different causes have been suggested. However, the definition of modern medicine was made at the beginning of the 19th century and it was evaluated as a biphasic mental illness.

The disease occurs at approximately the same rate in both sexes. However, there may be differences between the sexes in terms of disease periods and course. For example, additional diseases, drug use, mixed episodes, manic episodes that can be triggered by antidepressant drugs, and psychotic features are slightly more common in women. The incidence of only manic episodes without depressive episodes is higher in men.

The age of onset of the disease is around 17-25 years. In most patients, symptoms begin to appear before the age of 20. It rarely starts after the age of 40. Many studies focus on familial transmission. There are publications indicating that manic episodes are more common in spring-summer, and depressive episodes are seen in autumn-winter.

It is reported that nearly half of the patients have attempted suicide and approximately 15% have died due to suicide attempts.

Types of bipolar disorder: 

Bipolar disorder is evaluated in 4 different types:

• Bipolar disorder I (manic or mixed episode): The classic manic-depressive form of the illness is accompanied by at least one manic episode or mixed episode. It usually, but not always, includes at least one depressive episode.
• Bipolar disorder II (hypomania or depressive episode) : The person does not have full-blown manic episodes. Instead, the disturbance includes episodes of hypomania and severe depression.
• Cyclothymia (hypomania and mild depressive episode): It is a mild form of bipolar disorder. It includes manic and decessive episodes. But the symptoms are milder than full-blown mania or depression.
• Other: Bipolar disorders caused by certain drugs or alcohol, etc., or due to a medical condition such as Cushing’s disease, multiple sclerosis, or stroke.

Bipolar disorder causes: 

The causes of the disease are not fully known. Different reasons have been suggested. However, the reasons may differ from person to person, or they can be complex and interrelated.

Commonly cited causes for the disease include:

• Genetic factors: Theses have been put forward for a very long time on familial transmission of the disease. Recent studies show that familial transmission may be a factor in 60-80% of the disease. The incidence of the disease is 5-10 times higher in people with a first-degree relative with the disease. If both parents have the disease, the risk of disease in children can reach up to 75%. However, it has not been clarified yet which gene or gene region is effective on disease transmission.
• Biochemical changes: Studies have shown that there is an imbalance in the mechanisms of serotonin, noradrenaline and dopamine among the disease factors. There are data showing that manic episodes develop when they increase, and depressive episodes develop when they decrease. Apart from these, acetylcholine, GABA and glutamate are also thought to contribute to the development of the disease.
• Diseases: It is thought that some diseases that may have effects on hormones such as thyroid disorders, Cushing’s disease, Multiple sclerosis, brain tumors, dementia, stroke, HIV/AIDS, head trauma may play a role in the emergence of the disease, albeit to a lesser extent.
• Environmental factors: It is claimed that traumas such as loss of family members or a loved one, separation of parents, separation from loved ones, physical or sexual abuse, which can be an important cause of stress in a person’s life, may trigger the disease. In addition, the lifestyle habits of the person, alcohol use, drug addiction, and some drugs used for other diseases may also play a role in the emergence of the disease. In women, the event of childbirth can have an effect on the disease. In addition, there are studies that excessive exposure to sunlight in the summer months may also be a trigger.