Nobody knows absolutely what causes bipolar disorder. Studies suggest there is a genetic component present, but DNA isn't the only reason people develop bipolar disorder. Most researchers agree that there are likely brain and environmental factors that contribute as well. When talking about biological causes, the first question is whether bipolar disorder can be inherited. This issue has been researched through multiple families, adoption, and twin studies.
This is important for genetic theories because identical twins occur when one fertilized egg splits in two, meaning that they share the same genetic material. Fraternal twins, on the other hand, come from separate fertilized eggs, so their inherited genes can be different. There is overwhelming evidence that bipolar disorder can be inherited and that there is a genetic vulnerability to developing the illness. When it comes to figuring out exactly what is inherited, the neurotransmitter system has received a great deal of attention as a possible cause of bipolar disorder. A link exists between neurotransmitters and mood disorders, and drugs that alter these transmitters also treat mood disorders:
In short, researchers are quite certain that the neurotransmitter system is at least part of the cause of bipolar disorder, but further research is still needed to define its exact role. Mood episodes in bipolar disorder can both be set off by a stressful event or circumstances, but can and frequently do occur spontaneously. How stress triggers a bipolar episode is not fully understood. But scientists do believe that the stress hormone cortisol plays a role. Stress increases the level of cortisol in the body, which causes alterations in how the brain functions and communicates. In fact, in people who have depression or bipolar disorder, cortisol levels may stay high even when stress isn't present. Stressful life events can range from a death in the family to the loss of a job, and from the birth of a child to a move. Stress may stem from a variety of experiences. It cannot be precisely defined, since one person may perceive an event as extremely stressful while another individual encountering the same event may not experience much stress.
Stressful life events can lead to the onset of symptoms in those susceptible to bipolar disorder. However, once the disorder is triggered it may progress. Once the cycle begins, psychological and/or biological processes may take over and keep the illness active. For Depressive Episodes Once someone experiences bipolar disorder, small stresses may trigger depressive episodes. Examples of bipolar depressive episode triggers include:
For Manic Episodes While triggers for manic and depressive episodes can be the same, there are some that are specific to manic or hypomanic episodes. According to a 2012 study in the Journal of Affective Disorders, unique triggers of manic or hypomanic episodes include:
In addition, the postpartum period and the use of an antidepressant, like an SSRI, may also trigger a manic or hypomanic episode. When we look for the cause of bipolar disorder, the best explanation according to research published in 2015 is what is termed the "Diathesis-Stress Model." The word diathesis, in simplified terms, refers to a physical condition that makes a person more susceptible than usual to certain diseases. Thus the Diathesis-Stress Model says that each person inherits certain physical vulnerabilities to problems that may or may not appear depending on what stresses occur in his or her life. So the bottom line is that if you have bipolar disorder, you were likely born with the possibility of developing this disorder and something in your life triggered it. However, scientists could refine that theory tomorrow. The one sure thing is that they won't give up looking for answers. Page 2
Bipolar disorder is typically a lifelong illness with episodes that are highly variable and unique to each individual. Treatment is complex and often involves more than one medication over time. Talk therapy, complementary medicine, and lifestyle modifications can also help, but psychiatric medications are the mainstay of treatment. Medications can help a person with bipolar illness manage their symptoms and function well in everyday life. A person who has bipolar disorder tends to experience extreme highs (mania) and extreme lows (depression). Certain medications help stabilize your mood so you don't experience severe highs and lows. Since drug therapy is an important component of treatment for bipolar disorder, it's important to educate yourself about the various medication options. A psychiatrist will choose which medications are likely to work best for your symptoms. At times, your medications may need to be adjusted or changed. If you have bipolar disorder and you're unhappy with the medication that you're currently on—perhaps you feel like it's not working well enough or maybe you're experiencing a side effect that you simply can't stand—remember that it's never a good idea to stop taking a medication cold turkey or change the dose of a medication without first talking to your doctor.
If you need to switch medications, your physician or psychiatrist will advise you on how to do so safely. Anticonvulsants, also known as anti-seizure medications, are sometimes used as mood stabilizers in bipolar disorder: First-generation antipsychotics, also known as typical antipsychotics, include: Atypical antipsychotics have fewer extrapyramidal side effects when compared to typical antipsychotics. But some, especially clozapine and olanzapine, carry a high risk of metabolic syndrome. Atypical antipsychotics include:
Antipsychotics (atypical and typical) are not approved for the treatment of older adults with dementia-related psychosis. The FDA issued a black box warning for this population due to an increased risk of death mostly due to pneumonia and cardiovascular events. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are commonly prescribed for major depressive disorder but can also be prescribed for bipolar depression. SSRIs include: The serotonin-norepinephrine reuptake inhibitors (SNRIs) include: Tricyclic antidepressants are an older class of antidepressants that, while effective for some people, carry a large side effect profile including heart arrhythmias and anticholinergic side effects like dry mouth, sedation, and constipation:
Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants. They work by preventing the breakdown of monoamines in the brain, like dopamine, norepinephrine, and serotonin. Examples include:
There are also antidepressants that do not necessarily fit into the above categories, like mirtazapine (Remeron), trazodone (Oleptro, Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix), and bupropion (Wellbutrin). Benzodiazepines depress a person's central nervous system and are used to treat anxiety, insomnia, and seizures. Benzodiazepines have different half-lives, meaning some are short-acting, intermediate-acting, or long-acting. They include:
There are a number of other medications used for the treatment of bipolar disorder. Some are used quite commonly but do not necessarily fit into one of the common categories of psychiatric medication. One example is lithium (Lithane, Lithobid, Lithonate, Eskalith, Cibalith-S, Duralith), which is an element and was the first treatment for bipolar disorder. Although it requires careful monitoring, it is still commonly and effectively used as a first-line mood stabilizer. On the other hand, verapamil (Calan, Isoptin), is a blood pressure medication that has been tried experimentally in the treatment of mania. Many symptoms of bipolar disorder impact emotional well-being, so psychotherapy can often be helpful. Therapy sessions should take place with trained mental health professionals who can help identify when your moods are changing, triggers that lead to depressive or manic episodes, and skills to cope with bipolar disorder. Therapy can also increase medication compliance, help you connect with others in the bipolar disorder community, and reduce any negative behaviors that affect your quality of life. There are several types of psychotherapy (talk therapy) that might be considered such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), interpersonal and social rhythm therapy (IPSRT), and family treatment. Involving loved ones in your treatment can help members of your family gain a better understanding of bipolar disorder and it can assist them in supporting your treatment. It's important to talk to your doctor before trying any alternative treatments. Herbal supplements, like St. John's Wort, could interfere with your medication or it may even trigger a manic episode. Studies have shown it may alleviate mild to moderate depression. Another complementary treatment for aspects of bipolar disorder is phototherapy, also known as lightbox therapy. It is often used to treat seasonal depression. Evidence regarding the benefits of omega-3 fatty acids or acupuncture, on the other hand, is inconsistent. There is not currently much data available supporting the effectiveness of other alternative interventions in bipolar disorder (e.g., aromatherapy, massage therapy, yoga) although they may be beneficial in terms of general self-care.
Before starting any type of alternative treatment, talk to your physician or psychiatrist. Your doctor and therapist will likely talk to you about strategies to manage your lifestyle, including:
Treatment for bipolar disorder can be initiated once you have recieved a proper diagnosis. Your physician will likely refer you to a psychiatrist or other mental health professional. Be sure to speak openly with your physician and mental health professional about your symptoms, behaviors, moods, and anything else you notice in your daily life.
Get our printable guide for your next doctor's appointment to help you ask the right questions. Bipolar disorder is best managed by a team of professionals. When those professionals work together to manage your symptoms, you'll likely be able to experience remission. With the right treatment plan, many people go for years and even decades symptom-free. Remission is about gaining stability and keeping your bipolar disorder under control, and that's what most people who have bipolar disorder are hoping for—a productive and harmonious life. Achieving stability usually requires medication as part of the treatment plan. |
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