What is Bipolar Disorder?
Bipolar Disorder
Bipolar disorder, once called manic-depressive illness, is a mental health condition that causes unusual shifts in mood, energy and activity levels.
There are three main types of bipolar disorder (1). All involve clear changes in mood, energy and activity, ranging from extreme highs to extreme lows. Highs can include feeling elated, irritable or energized, often with much less sleep than usual. Lows can include sadness, indifference, hopelessness and depression.
If you or someone you love is having thoughts of self-harm or is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911. If someone is in a manic episode and their behavior is putting them or others at risk, seek urgent psychiatric care.
How Common Is Bipolar Disorder?
Bipolar disorder affects about 2.8% of U.S. adults in a given year. It affects men and women about equally, and most cases involve serious impairment (2). It can start at any age, but it usually begins in the late teens or early twenties. In women, pregnancy and the period after childbirth can also be times when it first appears.
What Causes Bipolar Disorder?
There is no single known cause of bipolar disorder. The strongest evidence points to genetics and differences in brain structure. Studies have found differences in the white matter of the prefrontal cortex in people with bipolar disorder, which may contribute to some of the changes in behavior. People with a parent or sibling who has bipolar disorder are more likely to develop it themselves (3).
What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes unusually intense emotions, changes in activity level and changes in sleep, along with behaviors that are out of character. These behaviors can be harmful, and people often can’t recognize them as a problem while they’re happening.
During manic episodes, people may feel very energized, elated, jumpy or “wired.” They may need much less sleep, and their judgment and decision-making can be impaired.
During depressive episodes, people may feel down, slowed, hopeless or restless. They may have trouble concentrating, speak more slowly, lose interest in almost everything, lose interest in sex, and sleep or eat more or less than usual. These mood episodes can last days to weeks, and some people experience symptoms of mania and depression at the same time. Symptoms may also change over time.
The three main types of bipolar disorder are as follows (1). Bipolar I disorder involves manic episodes that last at least seven days or are severe enough to require hospitalization, and depressive episodes that often last at least two weeks. Bipolar II disorder involves depressive episodes and hypomanic episodes, which are less severe than the manic episodes of bipolar I. Cyclothymic disorder involves periods of milder hypomanic and depressive symptoms lasting at least two years in adults or one year in children, without meeting the criteria for the other two types.
How Does Bipolar Disorder Affect Daily Life?
Bipolar disorder can seriously affect work relationships, attendance and job performance. Missed work and disability can lead to significant lost income (4), and people with bipolar disorder often have higher healthcare costs. During severe episodes, some people harm themselves or need psychiatric hospitalization. Bipolar disorder also often occurs alongside other conditions, such as substance use disorders and eating disorders.
What Happens in the Brain With Bipolar Disorder?
Bipolar disorder appears to involve instability in how brain cells communicate. During mania, some brain regions become overactive, while regions that normally keep that activity in check don’t work as well. Research has linked mania to increased activity of the brain chemicals serotonin, norepinephrine and dopamine in areas such as the amygdala, several regions of the prefrontal cortex and the nucleus accumbens, and different areas have been linked to different manic symptoms (5).
For example, elevated or irritable mood has been linked to overactivity of the amygdala and parts of the prefrontal cortex, and impulsivity and risk-taking have been linked to prefrontal areas involved in decision-making. Reduced need for sleep has been linked to overactivity in deeper brain areas such as the thalamus and hypothalamus. Normally, regions like the orbitofrontal cortex help calm these circuits, but during mania they can’t keep up.
Some research suggests that repeated episodes may affect the brain over time, which may contribute to thinking problems between episodes (6). This is one reason consistent treatment to manage and prevent episodes is so important.
How Is Bipolar Disorder Usually Treated?
Bipolar disorder is diagnosed and treated by healthcare providers, usually a psychiatrist or psychiatric nurse practitioner. It is most often treated with mood-stabilizing medications and psychotherapy (2), and sometimes with electroconvulsive therapy (ECT) (7). Treatment is usually lifelong, and staying on medication as prescribed is one of the most important ways to prevent episodes. Transcranial magnetic stimulation (TMS) is being studied for bipolar disorder, especially for bipolar depression (8).
How the NeuroRescue Program Can Help
Bipolar disorder treatment is led by mental health professionals, and our care is designed to support that care, never replace it. At our clinic, our psychiatric mental health nurse practitioner can evaluate whether TMS may be appropriate for you. Never stop or change mood-stabilizing medication without talking with your prescriber, since doing so can trigger serious episodes.
Our chiropractic neurology care focuses on the neurological side of the picture. One of the brain’s most important jobs is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving, your muscles and joints to sense where your body is and what it’s doing, and your eyes to sense where you are in relation to everything around you. Your brain combines all of this into a picture of where you are, so you can respond to the world around you.
Many of the brain chemicals involved in bipolar disorder are produced in the brainstem, in areas that also help control eye movements, inner ear reflexes, heart rate and blood pressure, balance, coordination and walking. Research has found differences in several types of eye movements in bipolar disorder (9, 10, 11). Studies have also found differences in balance and vestibular function that can shift with mood state (12), along with differences in coordination, sensory integration and complex movement sequences (13). Our testing helps us find out whether you have difficulties in these areas.
Depending on your needs and test results, your program may include eye movement exercises aimed at specific brain regions (14); vestibular rehabilitation to address balance problems (15); light therapy, which has been studied for depression (16); and exercises in a virtual reality environment (17). The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
Our goal is to support the neurological systems that work alongside your mental health care, including balance, coordination and thinking, so you can feel more steady and capable in daily life.
Your Next Step
Living with bipolar disorder can be extremely challenging, but with the right care, many people live full and stable lives. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
References
