Bipolar disorders

Events in our lives cause us to experience moments or periods where our mood can change and fluctuate up or down. A new relationship or a breakup, a new job or a job loss, a special activity or an ordeal can leave us feeling happier and more confident or more depressed and worried. Usually, our mood slowly returns to normal, but, for some people, the amplitude of these mood changes can be extreme, without these changes having any relation to real life situations. For a certain time, the mood can be exalted and swing much lower afterwards. When these changes become very noticeable or seem to follow repetitive cycles, or when it is difficult to control mood swings, we may be facing a bipolar disorder.

Even with a diagnosis of bipolar disorder, we can still find balance, normal functioning, and a good quality of life. We have a better chance of succeeding if we allow ourselves the time to find the right treatment and adopt adequate strategies to manage our daily life. To learn more, please refer to the tab on the right side of the page or contact us.

For additional information, please click on the sections below

Whatever the scale of the disorder, not only can the disorder be managed using a variety of methods, it is also possible to regain normal functioning and good mental health. To learn more, please refer to the tabs on the right side of the page or contact us.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is bipolar disorder?

When we think about different kinds of mood swings, it's very important to distinguish between the normal fluctuations that everyone experiences and more serious mood swings that may signal bipolar disorder – also known as manic-depression.

Everyone has highs and lows – these are usually due to the social, psychological, and biological factors affecting us. For example, it's normal for someone who has just fallen in love to be "up", and for that same person to feel down for a while after losing the person they love. These are predictable reactions, though everyone responds differently to the different factors that affect mood.

Extremely rapid or severe mood swings, however, may be due to bipolar disorder.

Like everyone else, people with bipolar disorder have calm periods, when they function in an apparently normal way.

The different bipolar cycles

In people with bipolar disorder, periods of depression and mania can last anywhere from a few days to several months.

  • Long cycles: the depressive and manic phases last several months.
  • Short (rapid) cycles: at least four cycles of depression or mania per year, each lasting several weeks.
  • Mixed phases: both depressive and manic symptoms occur in a single day.

Some data on bipolar disorder

  • It affects 4% of the population;
  • It occurs in all segments of society and in every country in the world;
  • It is commonly seen in high socioeconomic settings, because people with bipolar disorder have higher than normal energy levels, get totally involved in work and thus achieve greater professional success;
  • The family history usually reveals other cases of bipolar disorder, reflecting the following genetic risk factors:
    - 20-25% with one bipolar parent;
    - 50-75% with two bipolar parents;
    - 80% with a bipolar identical twin;
    - 20% with a bipolar fraternal twin.

Predictors

The biological and psychological factors below can help trigger manic and depressive episodes, though this will vary in degree from person to person.

Biological factors

  • Genetics : researchers have identified chromosomal regions where genes for susceptibility to affective disorders are found.
  • Hormones: : we see changes in glucocorticoids, as well as reduced immune function.
  • Neurotransmitters :
    • In the depressive phase: : decreased serotonin, which leads to feelings of depression, anxiety, and obsessive thoughts, as well as sleep and appetite loss; decreased norepinephrine, which causes a loss of energy and motivation, and negative thoughts; and decreased dopamine, which leads to reduced feelings of pleasure and concentration problems.
    • In the manic phase: elevated norepinephrine levels cause a considerable increase in energy, pleasure at any cost, and elation.

Psychological factors

In the manic phase, people with bipolar disorder may show certain psychological signs, including:

  • developing an antidepressive response to counter their depression; and
  • various kinds of distorted thinking.

In the depressive phase, people with bipolar
disorder may:

  • feel rejection and loss with respect to loved ones, even if they are still close by;
  • be very self-critical, subject themselves rigid moral judgments, and want to punish themselves for their past misdeeds;
  • have negative thoughts, believe they are bad, that everything around them is bad, and that everything will always be bad;
  • feel that life is worthless, hopeless, and that there is no help possible.
Bipolar disorder Characteristics Common reaction by
the affected person
Common reaction
by the family
Type 1 Alternating phases of major (deep) depression and mania During the manic phase: does not feel at all worried During the depressive phase: feels worried
During the manic phase: feels very worried During the depressive phase: feels reassured
Type 2 Presence of major (deep) depression and hypomania (less severe manic phases) During the hypomanic phase: pleasant feeling During the depressive phase: painful feeling
During the hypomanic phase: pleasant feeling During the depressive phase: painful feeling
Type 3 Cyclothymia (small, less intense up- and-down cycles) Long-term fluctuations Long-term fluctuations

In general, the natural history of the disease shows that people spend about 10% of their time in the manic or hypomanic phase, about 40% in the depressive or mixed phase, and are stable about half the time.

Symptoms

In the depressive phase

  • depressed mood nearly all day, every day, for at least two weeks;
  • sleep problems (insomnia or hypersomnia);
  • appetite problems with weight loss or gain;
  • lack of energy and fatigue;
  • loss of interest and loss of pleasure;
  • psychomotor agitation or slowing;
  • decreased ability to concentrate, think, or make a decision;
  • guilt feelings;
  • recurring thoughts of death (60% of cases) and recurring suicidal thoughts (15% of cases).

Associated symptoms

  • anxiety;
  • social withdrawal.

In the manic phase

  • inflated self-esteem or grandiosity;
  • less need for sleep;
  • more talkative or talking non-stop;
  • racing thoughts or the feeling of having too many ideas;
  • easily distracted – unable to focus;
  • sudden increase in social, professional or school activities;
  • psychomotor agitation;
  • excessive increase in pleasure-seeking and high-risk behaviours, for example, spending, sex, financial investments.

Treatment

The goal of psychological, medical, and community-based treatment for bipolar disorder is to improve the person's general condition, given the various biopsychosocial factors involved.

1. Psychotherapy

Early in treatment, psychotherapists can help people with bipolar disorder by:

  • offering them support and education;
  • meeting with their families to provide information;
  • getting them involved in their recovery.

During a crisis, someone suffering a major depressive episode can get specific individual help through:

  • cognitive-behavioural therapy;
  • interpersonal therapy.

Once the crisis has passed, the therapist can begin:

  • more in-depth therapy with the person;
  • therapy involving the family.

Throughout this process, it can be very helpful to refer people with bipolar disorder and their families to community organizations like Revivre.

2. Medical treatment

Initially, bipolar disorder is usually treated with mood stabilizers:

  • lithium;
  • anticonvulsants;
  • atypical antipsychotics.

To enhance the effects of the mood stabilizers, or if they cause side effects, the doctor may also prescribe other drugs, including:

  • anxiolytics;
  • antidepressants.

Where to go for help

If you think that you or someone you love might have bipolar disorder, contact Revivre or consult your family doctor. He or she can probably treat the illness or make a referral to a mental health professional.

Patricia Garel, M.D., Psychiatrist, and François Maranda, M.D., Psychiatrist, CHU Sainte-Justine

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What is bipolar disorder?

Bipolar disorder is mood disorder that is characterized by alternating up (mania) and down (depression) phases. Professionals talk about bipolar mood disorder when referring to this illness, which affects 1% to 3% of teens. The disorder can begin with either manic or depressive symptoms. The ups alternate with the downs. People can even feel both extremes at almost the same time. However, depressive episodes are much more frequent, which can make it hard to differentiate this disorder from major depression.

Bipolar disorder is considered to be a disease, but it is not really like other diseases, because it alters a person’s judgment. However, like other diseases, it must be explained, demystified, and treated quickly. The teenager and his family must understand the issues involved in both the illness and the treatment. There is no reason for needless suffering or isolation. Bipolar disorder in teens can be treated.

Warning signs

Factors that can contribute to an increased likelihood of a teenager developing bipolar disorder:

  • Having a family member who suffers from bipolar disorder;
  • Having a family member who has committed suicide.

The diagnosis of bipolar disorder is not based on a single symptom, but on a variable set of symptoms that change over time within a given context. A teenager who suffers from bipolar disorder can present with some of the symptoms associated with this illness.

Symptoms

During the manic phase, a teen who suffers from bipolar disorder will exhibit some of the following symptoms:

  • Severe mood changes, as compared to people in his own age group and environment. The teen may be particularly happy, annoying, or very irritable;
  • Unrealistically high self-esteem (grandiosity). For example, he may believe that he has a special relationship with God;
  • Increased energy and the ability to function for several days with little or no sleep without feeling tired;
  • Increased speaking rate: talking too much and too fast, changing subjects very frequently, and unwilling to be interrupted;
  • Extreme distractibility: attention constantly switches from one thing to another;
  • Risk-taking with no fear of consequences: such as jumping off a roof, believing that he can’t be hurt.

During the depressive phase, a teen who suffers from bipolar disorder will exhibit some of the following symptoms:

  • Sustained difficulty in relationships with family and friends;
  • Abnormal irritability and apathy toward everyday things;
  • Poor personal hygiene and not keeping his room tidy;
  • Delinquent behaviour: such as skipping school, violent behaviour (verbal and physical), and alcohol and drug abuse;
  • Appetite changes;
  • Attention and concentration problems;
  • Sleep problems: insomnia or hypersomnia (sleeping all the time);
  • Sadness disguised as irritability and aggressiveness;
  • Suicidal behaviour or pervasive suicidal thoughts – wanting to die in order to end the suffering.

Some of these signs are also found in other problems that affect teens, such as drug abuse, delinquency, attention deficit hyperactivity disorder, and even schizophrenia. A thorough evaluation by a child psychiatrist is often required in order to clarify the situation, reach a diagnosis, and begin appropriate treatment.

Treatment

Effective treatment for bipolar disorder usually includes educating the teenager and his family with respect to the illness, along with medication and some type of psychotherapy.

1. Pharmacological treatment

The doctor will prescribe one or more medications that act on neurotransmitters (mood stabilizers, antidepressants, antipsychotics, or other medication). Neurotransmitters are the chemicals that are used by neurons to communicate and carry out brain functions. This communication is altered during the depressive phase. The purpose of the medications is to properly restore this communication. You should know that these medications don’t start to work right away. Sometimes you have to wait a few weeks for them to reach their full effect. When they are effective, they help the teen to gradually get his life back in balance in the following areas:

  • Sleep;
  • Appetite;
  • Normal energy level;
  • Normal concentration level (this sometimes takes longer);
  • Enjoying activities again;
  • Realistic plans;
  • Interest in pursuing studies, etc.

2. Psychological treatment

Psychotherapy helps the teenager to accept his illness, adapt to stress better, rebuild his self-esteem, and carry on better relationships with others.

Cognitive therapies aimed at correcting the misconceptions and false perceptions surrounding depression are effective, and they complement the pharmacological treatment. Other types of therapy (group therapy, analytically- oriented therapy, etc.) may also be indicated in certain cases.

It is important to consider a healthier lifestyle for any teenager who suffers from depression, particularly in terms of schedule, diet, sleep, exercise, and not taking drugs (especially marijuana).

Where to go for help

Roles of the various people involved in helping a teenager who suffers from bipolar disorder

Parents are often the first ones to notice a problem with their child’s functioning. Although the parent-child bond can sometimes influence their perceptions, they are still in the best position to observe what is happening. Therefore, it is important for them to express their fears or doubts to a qualified person. Parents are always essential in the process of evaluation and care.

The family doctor is often the first person to be consulted for the various physical symptoms that go along with depression (fatigue, pain, etc.). He will carry out a medical workup in order to rule out any physical ailment that may explain the symptoms (thyroid problem, infection, anaemia, etc.), and will pursue the evaluation with the teenager and his parents. He can then request a consultation with a psychiatrist, or begin treatment after a reasonable amount of time.

A psychiatrist is a doctor who specializes in mental disorders, and is the best person to coordinate all aspects of treatment.

School practitioners (nurse, psychologist, social worker) are often the first to be consulted by the youngster. They play a crucial role in welcoming, supporting, and caring for the teenager in distress. They will steer him to the appropriate specialists.

The teenager can also meet with and confide in a trusted teacher, who can advise and support him in getting help from a doctor or an organization.

The CSSS youth mental health teams are specialists in the problems that teens face. Don't hesitate to contact them.

Organizations Revivre, Kids Help Phone and Tel-Jeunes provide information and support for clients and their families. They are available anytime for information concerning resources, referrals, help, and support at various levels.

Siblings and friends can help!
A teenager who is not feeling well will often confide in a friend, sister, brother, etc. who can help him through the bad time, and who will not allow him to be alone or isolated. They can put him in touch with an adult who can take the necessary steps.

If you recognize some of the signs and symptoms of bipolar disorder in your teenager, consult a general practitioner or a child psychologist. Recognizing the illness and having it treated quickly by qualified professionals is the best thing you can do.

Bipolar disorder self-assessment

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Self-Management Support Program for anxiety, depression and bipolar disorder - J'avance! Program (French only)

The psycho-educational workshops of Revivre’s J’avance! program provide support for health self-management.This strategy the efficiency of which has been proven is increasingly recognized as an indispensable component in the treatment of those suffering from anxiety or mood disorders.

J’avance! Website (French only)

Support groups (French only)

Participants are given the opportunity to share their experiences and offer mutual support in a welcoming and respectful environment.

Schedule

  • Monday and Wednesday afternoons: 1:30 p.m. to 3:00 p.m.
  • Monday evening: 7:00 p.m. to 8:30 p.m.
  • Friday morning: 9:30 a.m. to 11:00 a.m.

Where : At Revivre