What is bipolar disorder?

The word bipolar means two extremes. For the many millions experiencing bipolar disorder around the world, life is split between two different realities - elation and depression. Although there are many variations of bipolar disorder, let's consider a couple. Type 1 has extreme highs alongside the lows, while Type 2 involves briefer, less extreme periods of elation interspersed with long periods of depression. For someone seesawing between emotional states, it can feel impossible to find the balance necessary to lead a healthy life. Type 1's extreme highs are known as manic episodes, and they can make a person range from feeling irritable to invincible.

But these euphoric episodes exceed ordinary feelings of joy, causing troubling symptoms like racing thoughts, sleeplessness, rapid speech, impulsive actions, and risky behaviors. Without treatment, these episodes become more frequent, intense, and take longer to subside. The depressed phase of bipolar disorder manifests in many ways - a low mood, dwindling interest in hobbies, changes in appetite, feeling worthless or excessively guilty, sleeping either too much or too little, restlessness or slowness, or persistent thoughts of suicide. Worldwide, about one to three percent of adults experience the broad range of symptoms that indicate bipolar disorder.

Most of those people are functional, contributing members of society, and their lives, choices, and relationships aren't defined by the disorder, but still, for many, the consequences are serious. The illness can undermine educational and professional performance, relationships, financial security, and personal safety. So what causes bipolar disorder? Researchers think a key player is the brain's intricate wiring. Healthy brains maintain strong connections between neurons thanks to the brain's continuous efforts to prune itself and remove unused or faulty neural connections.

This process is important because our neural pathways serve as a map for everything we do. Using functional magnetic resonance imaging, scientists have discovered that the brain's pruning ability is disrupted in people with bipolar disorder. That means their neurons go haywire and create a network that's impossible to navigate. With only confusing signals as a guide, people with bipolar disorder develop abnormal thoughts and behaviors. Also, psychotic symptoms, like disorganized speech and behavior, delusional thoughts, paranoia, and hallucinations can emerge during extreme phases of bipolar disorder. This is attributed to the overabundance of a neurotransmitter called dopamine.

But despite these insights, we can't pin bipolar disorder down to a single cause. In reality, it's a complex problem. For example, the brain's amygdala is involved in thinking, long-term memory, and emotional processing. In this brain region, factors as varied as genetics and social trauma may create abnormalities and trigger the symptoms of bipolar disorder. The condition tends to run in families, so we do know that genetics have a lot to do with it. But that doesn't mean there's a single bipolar gene. In fact, the likelihood of developing bipolar disorder is driven by the interactions between many genes in a complicated recipe we're still trying to understand.

The causes are complex, and consequently, diagnosing and living with bipolar disorder is a challenge. Despite this, the disorder is controllable. Certain medications like lithium can help manage risky thoughts and behaviors by stabilizing moods. These mood stabilizing medications work by decreasing abnormal activity in the brain, thereby strengthening the viable neural connections. Other frequently used medications include antipsychotics, which alter the effects of dopamine, and electroconvulsive therapy, which works like a carefully controlled seizure in the brain, is sometimes used as an emergency treatment. Some bipolar patients reject treatment because they're afraid it will dim their emotions and destroy their creativity. But modern psychiatry is actively trying to avoid that. Today, doctors work with patients on a case-by-case basis to administer a combination of treatments and therapies that allows them to live to their fullest possible potential.

And beyond treatment, people with bipolar disorder can benefit from even simpler changes. Those include regular exercise, good sleep habits, and sobriety from drugs and alcohol, not to mention the acceptance and empathy of family and friends. Remember, bipolar disorder is a medical condition, not a person's fault, or their whole identity, and it's something that can be controlled through a combination of medical treatments doing their work internally, friends and family fostering acceptance and understanding on the outside, and people with bipolar disorder empowering themselves to find balance in their lives.