The month of March holds a special place in my heart. This month is all about raising awareness and educating people about Bipolar disorder, a complex mental health diagnosis impacting approximately 2.3 million Americans. March 30th is World Bipolar Day and, coincidentally, this is also the birthday of one my favorite artists, Vincent Van Gogh, who was suspected of struggling with bipolar disorder. 

Trees and Undergrowth by Vincent Van Gogh (1853-1890), Paris, July 1887, oil on canvas. Credits: Van Gogh Museum, Amsterdam (Vincent van Gogh Foundation)

A Few Facts about Bipolar Disorder

Fact 1: Bipolar disorder is a complex mental health diagnosis that impacts 2.3 million Americans according to research reported by NAMI (the National Alliance Mental Illness). It is often confused or made more complicated to diagnose because other psychiatric illnesses such as ADHD, Borderline Personality Disorder, Schizoaffective Disorder, and Cyclothymia have overlapping symptoms.

Fact 2: Bipolar disorder is also called “manic depression” and involves a cycle of moods that are both elevated (“high,” “hypomanic,” or “manic”) and depressed. In essence, there is an instability of mood that can be mild, moderate, or severe.

Fact 3: In order to be diagnosed with bipolar disorder a person must have a persistent, markedly unstable mood that includes at least 1 episode of hypomania or mania that lasts at least 4 consecutive days or more.

Fact 4: Although a complex and difficult mental health diagnosis, individuals with Bipolar disorder can lead healthy and productive lives with access to appropriate treatment and support from family and friends.

Causes 

The causes of Bipolar disorder aren’t so easily defined. There is ongoing research to support a combination of factors that contribute to the development of this illness. These factors include having a close family member (i.e., parent or sibling) diagnosed with Bipolar disorder, a precipitating and significant stressful or traumatic event (or events), and substance abuse. Also worth noting is the current research being conducted which is looking at the role of inflammation as well as gut microbiome diversity in individuals with Bipolar disorder (and other severe mental illnesses). We cannot assume causation, per se, but there is some research that suggests there is a correlation between these two things and having a mental health diagnosis.

About Treatment

Treatment for Bipolar disorder often includes a multimodal approach: medications, therapy, and lifestyle modifications including stress management, nutrition, exercise, and sleep hygiene. 

Medication: There are several different medications that have been found to be helpful in managing symptoms, most of them are mood stabilizers and antipsychotics. In some cases, individuals with Bipolar disorder have found it helpful to have a combination of medications that include a mood stabilizer, an anxiolytic, and an antidepressant (depending upon safety and other comorbid issues). 

In November 2021 the Brain & Behavior Research Foundation reported on a double-blind study spanning 6 nations that was conducted on the efficacy of Lumateperone in reducing depressive symptoms in individuals diagnosed with Bipolar 1 and Bipolar 2. Preliminary reports indicate there are lower incidences of the most common side effects of antipsychotics, including metabolic, endocrine, and cardiovascular changes as well as uncontrolled body movements. Of course, more long-term studies will need to be conducted and with larger groups of individuals to determine just how effective this medication can be. Nonetheless, these findings are promising. 

Psychotherapy: Talk therapy is an important piece of helping individuals with Bipolar disorder lead healthy, productive lives. What research suggests is including family in therapy can be beneficial along with cognitive-behavioral and active skills training. Educating families and teaching individuals to self-monitor, understand their unique stressors and warning signs, as well as providing them with active coping skills to reduce emotional pain and suffering can improve their quality of life. 

Additionally, lifestyle modifications can (and should) be addressed in therapy as well. Eliminating mood altering substances such as alcohol, marijuana, or other illegal substances will have a positive impact in mood management. Similarly, understanding the importance of sleep hygiene and the sleep – mood cycle interaction is also helpful in maintaining mood stability. Additionally, the role of good nutrition and a balanced lifestyle that includes exercise, healthy relationships with others, healthy stress management techniques, and spirituality are also helpful in managing symptoms and creating life experienced as one that’s worth living.

Wrapping Up

While Bipolar disorder is a serious and complex mental illness, there is hope! If you are struggling with your mood or are concerned about a loved one, seek help from a trained professional. If you are unsure of where to start, reach out to your primary care physician and ask for a referral to see a psychiatrist, psychologist, or therapist for an evaluation. 

Recommended Additional Reading

If you are interested in learning more about Bipolar disorder here are my top 5 recommendations:

1. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz, PhD.
2. Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner by Julie A. Fast and John D. Preston, PsyD.
3. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
4. Nutrition Essentials for Mental Health: A Complete Guide to the Food-Mood Connection by Leslie Korn
5. Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness by Matthew S. Stanford

Please Note: There is so much to write on this topic, narrowing it down to bite-sized pieces is difficult, because it can come across as reductionist.This article is not intended to stigmatize or to provide information for anyone to self-diagnose or diagnose others. It is, instead, intended to inform, educate, and facilitate awareness and understanding. 

Resources:

1. https://www.nami.org/Blogs/NAMI-Blog/May-2021/Myths-and-Facts-of-Bipolar-Disorder
2. https://www.nature.com/articles/s41380-022-01456-3
3. https://www.bbrfoundation.org/content/lumateperone-antipsychotic-tested-phase-3-trial-major-depressive-episodes-bipolar-i-and-ii
4. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2771207
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922774/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536930/?_escaped_fragment_=po=12.7193#R81
7. https://www.researchgate.net/profile/Sheri-Van-Dijk/publication/230614857_A_randomized_controlled_pilot_study_of_dialectical_behavior_therapy_skills_in_a_psychoeducational_group_for_individuals_with_bipolar_disorder/links/5a560da645851547b1be74a7/A-randomized-controlled-pilot-study-of-dialectical-behavior-therapy-skills-in-a-psychoeducational-group-for-individuals-with-bipolar-disorder.pdf