BiPolar Disorder & Substance Abuse
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function.
Different from the normal ups and downs that everyone goes through, the symptoms of BP disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide.
But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.
About 5.7 million American adults or about 2.6 percent of the populationage 18 and older in any given year, have BP disorder.
BP disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life.
It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated.
Like diabetes or heart disease, BP disorder is a long-term illness that must be carefully managed throughout a person’s life.
What Are the Symptoms of Bipolar Disorder?
BP disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between.
Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
It may be helpful to think of the various mood states in BP disorder as a spectrum or continuous range.
At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic.
Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state.
Symptoms of a mixed state often include agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
BP disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships.
Such problems, in fact, may be signs of an underlying mood disorder.
Anyone who talks about suicide should be taken seriously. The risk for suicide appears to be higher earlier in the course of the illness.
Therefore, recognizing BP disorder early and learning how best to manage it may decrease the risk of death by suicide.
Signs and symptoms that may accompany suicidal feelings include:
- Talking about feeling suicidal or wanting to die
- Feeling hopeless, that nothing will ever change or get better
- Feeling helpless, that nothing one does makes any difference
- Feeling like a burden to family and friends
- Abusing alcohol or drugs
- Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
- Writing a suicide note
- Putting oneself in harm’s way, or in situations where there is a danger of being killed
Do Other Illnesses Co-occur with BP Disorder?
Alcohol and drug abuse are very common among people with bipolar disorder.
Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse , and risk factors that may influence the occurrence of both BP disorder and substance use disorders.
Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.
Anxiety disorders , such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with BP disorder.
Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.
There are four types of mood episodes that can occur in bipolar disorder, each with a unique pattern of symptoms:
- Mixed episode
Signs and Symptoms of Mania
In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive.
They may also feel like they’re all-powerful, invincible, or destined for greatness. But while mania feels good at first, it has a tendency to spiral out of control.
People often behave recklessly during a manic episode—gambling away savings, engaging in the inappropriate sexual activity, or making foolish business investments, for example.
They may also become angry, irritable, and aggressive, picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior.
Common Signs and Symptoms of Mania Include:
- Feeling unusually “high” and optimistic OR extremely irritable
- Unrealistic, grandiose beliefs about one’s abilities or powers
- Sleeping very little, but feeling extremely energetic
- Talking so rapidly that others can’t keep up
- Racing thoughts; jumping quickly from one idea to the next
- Highly distractible, unable to concentrate
- Impaired judgment and impulsiveness
- Acting recklessly without thinking about the consequences
- Delusions and hallucinations (in severe cases)
Signs and Symptoms of Hypomania
Hypomania is a less severe form of mania.
People in a hypomanic state feel euphoric, energetic, and productive, but their symptoms are milder than those of mania and much less disruptive.
Unlike manics, people with hypomania never suffer from delusions and hallucinations. They are able to carry on with their day-to-day lives.
To others, it may seem as if the hypomanic individual is merely in an unusually good mood.
But unfortunately, hypomania often escalates to full-blown mania or is followed by a major depressive episode.
Signs and Symptoms of Bipolar Depression
The depressive phase of BP disorder is very similar to that of major depression. However, there are some notable differences.
When compared to major depression, bipolar depression is more likely to include symptoms of low energy. People with bipolar depression tend to move and speak slowly and sleep a lot.
They are also more likely to have psychotic depression, a condition in which they’ve lost contact with reality.
Common Symptoms of Bipolar Depression
- Feeling hopeless, sad, or empty.
- Loss of interest in things you used to enjoy
- Fatigue or loss of energy
- Physical and mental sluggishness
- Appetite or weight changes
- Sleeping too much or too little
- Concentration and memory problems
- Feelings of self-loathing, shame, or guilt
- Thoughts of death or suicide
Signs and Symptoms of a Mixed Episode
A mixed episode of BP disorder features symptoms of both mania and depression. Common signs of a mixed episode include agitation, irritability, insomnia, appetite changes, loss of contact with reality, and suicidal thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.
Symptoms of Bipolar Disorder in Children and Teens
Unlike many adults with BP disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.
Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with BP disorder.
Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
Types Of Bipolar Disorder
The course of BP disorder varies widely from person to person, with unpredictable differences in the pattern and frequency of the manic and depressive episodes.
Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes.
Some have frequent mood disruptions, while others experience only a few over a lifetime. The duration and severity of each episode also differs.
Each of the four types of BP disorder have a unique pattern of symptoms:
- Bipolar I Disorder – Mania and DepressionBipolar I Disorder is the classic manic-depressive form of the illness, as well as the most severe type of BP disorder.It is characterized by at least one manic episode or mixed episode. Although a previous episode of major depression is not required for diagnosis, the vast majority of people with Bipolar I Disorder have experienced one.The typical course of Bipolar I Disorder involves recurring cycles between mania and depression.
- Bipolar II Disorder – Hypomania and DepressionIn Bipolar II disorder, the person doesn’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.In order to be diagnosed with Bipolar II Disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime.If you ever have a manic episode, your diagnosis would be changed to Bipolar I Disorder.
- Cyclothymia – Hypomania and mild depressionCyclothymia, also known as a cyclothymic disorder, is a milder form of bipolar disorder. Like BP disorder, cyclothymia consists of cyclical mood swings.However, the highs and lows are not severe enough to qualify as either mania or major depression.To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span.Because people with cyclothymia are at an increased risk of developing the full-blown bipolar disorder, it is a condition that should be monitored and treated.
- Rapid Cycling – Frequent episodes of mania, hypomania, or depressionRapid cycling is a subtype of bipolar disorder characterized by four or more episodes of mania, hypomania, or depression within one year.The shifts from low to high can occur over a matter of days or hours. Rapid cycling can occur with any type of bipolar disorder.It usually develops later in the course of bipolar disorder, but it is sometimes just a temporary condition.
Triggers and Risk Factors for Bipolar Disorder
Research indicates that some people are genetically predisposed to bipolar disorder.
But not everyone with an inherited vulnerability develops the illness, indicating that external factors also play a role. These external risk factors are called triggers.
Triggers can set off a bipolar disorder or prolong an existing mood episode. Many episodes of mania or depression occur, however, without an obvious trigger.
- Stress – Severe stress or emotional trauma can trigger either depression or mania in someone with a genetic vulnerability to bipolar disorder. Stress can also worsen a bipolar mood episode or extend its duration.
- Major Life Event – Major life events both good and bad can trigger an episode of bipolar disorder. These events tend to involve drastic or sudden changes, such as getting married, going away to college, starting a new job, or retiring.
- Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
- Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that may induce mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
- Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
- Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.
People With Bipolar Disorder May Need Help
- Often people with BP disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
- A person with BP disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing a referral to a mental health professional.
- Sometimes a family member or friend may need to take the person with BP disorder for proper mental health evaluation and treatment.
- A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
- Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
- In some cases, individuals with BP disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
- Like other serious illnesses, bipolar disorder is also hard to spouses, family members, friends, and employers.
- Family members of someone with BP disorder often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during the depression, and the lasting consequences of these behaviors.
- Many people with BP disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA).