Bipolar disorder is a mental disorder characterised by periods in which people’s well-being and vitality fluctuates, or they go into the so-called manic episodes (mania) and have episodes of depression. Then name bipolar disorder refers to the state that arises being like two opposite poles of the condition. The symptoms of the disorder usually come forward between the ages of 15 and 25. Before people are diagnosed with bipolar disorder they have sometimes had recurring depressive episodes without having gone into mania. So some people are first diagnosed with depression, but as soon as the first manic episode occurs, the diagnosis converts into a bipolar disorder. Still, not all people with bipolar disorder experience depressive episodes. Although bipolar disorder is a serious mental disorder that affects people's lives, people with bipolar disorder often show or experience no symptoms between illness cycles and are often free of symptoms for long periods of time. Thereby, people with bipolar disorder often do well, especially if people seek help and learn about the illness and factors that affect it. Orderliness, a good night sleep and a healthy lifestyle are important. Medication is generally considered to have a good effect, both in manic periods and between them. Bipolar disorder is divided into several disorders, which are all different, but they have these fluctuations in common. You can read about the different types of bipolar disorder HERE.
Mania is a period of bipolar disorder characterised by high energy and vitality. Bipolar disorder is characterised by extreme fluctuations in well-being and mania is the high point of the fluctuations. When a person is in a mania, they are more energetic and more powerful than usual, but in some people mania may appear as increased irritability. An individual in a mania has unusually high and stable activity and energy, e.g. it is common to sleep too little and work night and day on a task without feeling tired or lacking energy. Mania has a significant disruptive effect on people's ability to handle daily life, duties and social life. People often have to be admitted to a psychiatric ward because when the mania is severe, people are at risk of getting into difficult and even dangerous situations and that has a significant disruptive impact on people's life and existence. Mania is progressively manifested, the symptoms increase and become more severe and prominent until they peak. Therefore, mania does not appear as if a button was switched on, but rather it can sneak up behind people’s back as well as their relatives.
A simplified description of being in a mania might sound like this is a desirable situation, full of energy and vitality. The reality is, however, that in a mania, people are not themselves and do and say things that they do not mean or would not normally say or do. Commonly, in a mania, people are more risk averse than usual, e.g. they might drive too fast, gamble or have an affair. It may even occur that people in a mania lose significant connection with reality and show symptoms of psychosis. (PSYCHOSIS)
When people come out of a mania, they often experience great regret and remorse for what they said or did in the mania. It is important that most people realise that what people do in a mania does not indicate who a person really is and that it is unfair to judge people based on what happens in that state. Many people think that a mania is a kind of rampant state where people show their inner person, and say and do what they really want, but that is a complete misunderstanding. That can happen to people after severe alcohol consumption but has nothing to do with mania, where people even behave completely opposite to their actual character.
Hypomania or excitability is a condition that resembles mania to a great extent but is less severe and often lasts for a shorter period. Thus, hypomania is also characterised by greater energy and force, but does not have a significant disruptive effect on people's ability to live their daily life, duties and social life. Symptoms of hypomania are not serious enough for people that are in that state to be admitted to a psychiatric ward and hypomania is never accompanied by psychosis. It is necessary that there is a great change in mood, not just that an individual is generally an energetic person. It also goes for hypomania that the situation is not desirable and can have a detrimental effect on both the person experiencing hypomania and the people around them.
DEPRESSION IN BIPOLAR DISORDER.
Depression periods are the low point in bipolar disorder fluctuations. In the majority of cases, a depressive episode follows directly after a mania. A depressive episode is a period in which many symptoms of depression occur at the same time, such as sadness, loss of interest or happiness, changes in appetite and sleep, restlessness, difficulties with concentration, and feeling worthless. Read more about depression HERE. Depression periods in a bipolar disorder are usually very serious and often last for a long time, longer than the manic period. They are often more severe than when people experience depression without having bipolar disorder. This is especially relevant if a person has just come out of a mania and has great regret for what they said or did during the mania. Depression in bipolar disorder can be associated with a high risk of suicide (SUICIDE). Especially in cases where an individual is experiencing mania and depression at the same time or the so-called "mixed state", where people are often energetic and perform quickly which can be a very dangerous condition when mixed with suicidal thoughts.
How does bipolar disorder manifest itself?
Bipolar disorder is divided into subcategories, which are characterised by fluctuations in well-being and vitality.
Bipolar I always involves at least one manic episode and most people also experience periods of depression. Hypomania may also occur but neither that nor depression is necessary for this diagnosis. You can read about how depression expresses itself HERE and that description also applies to depression in bipolar disorder. Mania is incredibly different between individuals because the symptoms are not always the same and people show different symptoms. Symptoms can also be the same but manifest in different ways. For example, mania is often characterised by increased goal-oriented behaviour (when people are working towards goals) and this can range from writing a book to trying to find a cure for cancer. The main characteristics of mania, used for the diagnosis of bipolar disorder, are:
- To be in a really good mood and feel good, often called an elevated mood. -Increased energy and power.
- Excessive optimism, inflated self-esteem or belief in one's own greatness (even a superiority complex). For example, it is common for people who experience this symptom to think that they have a special relationship with someone famous or that they have some extremely important role.
- Less need for sleep, in a mania, people often sleep very little and yet feel rested and energised after very little sleep (2-3 hours even).
- A lot of talk and more need to keep talking, people even become unable to talk to because they do not allow others to speak and jump from one thing to another so it can be difficult to follow. Sometimes people speak louder than usual, inconsistently or say extremely inappropriate things.
- Really fast thinking that can be difficult for the individual themselves to keep up with. Thoughts and ideas pile up. This is often the reason why speech can become inconsistent and very fast flowing.
- Easily interrupted, have trouble staying focused and easily draw attention to things in an environment that don't matter.
- Goal oriented behaviour, when people work diligently towards some specific goal or objectives. The goals can be in school, work or personal life.
- Irritation, uneasiness or restlessness. The irritation can be emotional or physical. People are often very fidgety and show great activity that serves no purpose (for example, moving your feet up and down continuously).
- Increased risk behaviour, e.g. driving too fast, gambling or having an affair.
- Unrealistic ideas on your own competence and abilities, when this symptom is very severe, may even manifest itself with symptoms of a psychotic order such as delusions, e.g. where people consider themselves to have supernatural abilities or experience hallucinations, such as hearing voices.
Bipolar II always involves at least one hypomania and one depressive episode. If a person is diagnosed with Bipolar II and then gets a mania that is not hypomania then the diagnosis changes to Bipolar I. Some people think that Bipolar II is like a mild version of Bipolar I, since hypomania does not cause as much disturbance and is less severe than mania. However, one cannot look at it that way, as the depressive episodes in Bipolar II can be very serious and cause great disturbance. Unlike Bipolar I, a depressive episode is necessary for the diagnosis of Bipolar II and, therefore, depression is more of a characteristic in Bipolar II and often longer and more frequent episodes than in Bipolar I. In Bipolar II, it is common that people experience symptoms of depression at the same time as hypomania and it can be expressed with depression with increased energy and irritability which is a very difficult and even dangerous state. Numbers I and II, therefore, do not represent different stages of seriousness, but only two different disorders that are similar in some respects.
You can read about how depression expresses itself HERE and that description also applies to depression in bipolar disorder. The symptoms of hypomania are the same as in mania, but they do not appear in an exaggerated way as most often last for a shorter period of time. The symptoms are not serious enough to significantly interfere with people's daily life, they are never accompanied by a psychotic disorder and admission to a psychiatric ward is not required. However, there is a significant change in activity and well-being, and people are not necessarily entirely themselves.
Health care clinics: When people seek help from professionals, the first point of contact is usually the health care clinic. The first step is to make an appointment with a doctor who can refer you to the appropriate person if the problem cannot be resolved. heilsugaeslan.is
Mental health ward emergency reception: If the situation is acute or severe, do not hesitate to reach out to the mental health ward emergency reception at Landspítali, where people with urgent mental health issues can go without having an appointment. The psychiatric ward emergency reception is located on the 1st floor of the psychiatric building at Hringbraut. The emergency reception is open from 12:00 to 19:00 on weekdays and from 13:00 to 17:00 at weekends and the telephone number is 543 4050. In case of an emergency outside these hours, you can reach out to the emergency department at Landspítali Fossvogur. landspitali.is
Psychologists' private offices: On the psychologist's website, you can search for psychologists who attend to a variety of problems, such as depression. sal.is
Psychiatrists' private offices: A number of psychiatrists conduct medical and conversational therapy for depression in their private clinics.
The bipolar team of Laugarás: The team is a selective and multidisciplinary mental health resource for individuals who have recently been diagnosed with Bipolar I, especially those individuals who have been in an acute psychiatric ward. The team offers group training and vast follow-up after discharge, and the goal of the team is to reduce the number of sick periods and admissions and have a positive impact on the course of the disease. Requests for services from the bipolar team must be submitted by a professional and must be submitted to the Laugarás assessment team. landspitali.is
A more detailed list of resources in Iceland can be found here.