by Anisha Khemani – Bipolar, as the name suggests, is a behavioral disorder when the person has 2 poles and indeed it is 2 extreme poles of behavior.
The 2 phases of bipolar disorder are-
- Depression: where there may be a negative outlook on life, avoidance of social interactions, blaming yourself for everything, and hating your existence.
- Manic: where there might be sudden aggression, stubborn, extreme interactions and enthusiasm.
The complete cause of bipolar disorder is still a riddle that needs to be solved. But recent studies reveal that combinations of factors like stress, genetic, epigenetic and environmental factors can trigger this disorder [1, 2].
The process of developing bipolar disorder may involve complex interactions of genes and environmental factors, but the specific genes that contribute to this risk are not known.
Dysregulation in signal transduction pathways in neurons and imbalance in neurotransmitters like dopamine, serotonin and noradrenaline can lead to this disorder .
Noradrenalin affects activeness, enthusiasm and behavior. Excessive amounts of noradrenaline can lead to hyperactivity, euphoria, high blood pressure. Low levels can cause lack of concentration and energy, laziness and irritation.
Serotonin influences psychological as well as other body functions like sleep-wake cycle, appetite and mood regulation. Lack of serotonin can lead to excess anger and anxiety, while Dopamine controls aggression, impulse, mood, sleep etc.
Sadly, bipolar disorder is not completely curable, but medications are available for balancing the mood. Lithium carbonate drugs are prescribed to treat long- term episodes of depression and mania. Therapy and support groups can also help regulate the patient’s behavior.
At a neuronal level, lithium reduces excitatory neurotransmitters (dopamine and glutamate). Lithium decreases post synaptic G-proteins and pre-synaptic dopamine activity by down-regulating glutamate receptors and inhibiting secondary messenger systems directly. Lithium targets second-messenger systems that further modulate neurotransmission. It increases inhibitory (GABA) neurotransmitters by upregulation of GABA-B receptors at the postsynaptic level. Lithium has been shown to reduce the oxidative stress that occurs with multiple episodes of mania and depression .
In addition, electrical stimulation treatments such as ECT (Electroconvulsive therapy) give direct current of approximately 800 mA to the brain for about 80-100 ms to induce seizures. Studies show that ECT induces changes in neurotransmitters. It alters different subtypes of serotonin (5-hydroxytryptamine, 5-HT) receptors in different parts of the brain like the hippocampus which results in increase production of neurotransmitters like GABA (which prevents sleeplessness, controls anxiety and depression). ECT also decreases the number of 5-HT2A receptors (one of the subtypes of serotonin receptors), which are elevated in the depressive phase. This also induces sensitization of 5-HT3-receptors, which induces production of neurotransmitters like GABA, dopamine and noradrenalin. Thus, ECT potentially provides relief for severe depressive episodes where taking medication could be risky or ineffective.
During my early childhood, I was exposed to this disorder. I grew up seeing this disorder in my father. I saw my father having sudden changes in energy, aggression, insomnia, and then after a few months, I saw him quite depressed and very lazy.
As a child, I never understood what exactly was happening. I thought my father had 2 phases of life – a happy phase and a sad phase.
With time, these sudden mood swings started increasing, and then he was diagnosed with bipolar disorder.
I used to talk with my father on random topics even when he wasn’t willing to talk during his depression phase. I never gave up talking to him, even when he was avoiding me. I have seen my mother sleepless because my father in his manic phase used to wake up at 3.00 a.m., I have seen my brother working hard without support of my father. We can’t blame him for anything because things are not under his control, instead of blaming and complaining I embraced his presence no matter what he did, what he said, I just felt awesome seeing him around.
People dealing with patients suffering from this disorder might feel helpless and might feel like running away and giving up on that person who is suffering from this disorder, but just remember, never make them feel alone. Get involved in some sports activities or fun activities with them. You can’t take their suffering away but you can help them to deal with it.
Stay strong, stay calm, your support and will power can give strength to a person who might have lost all hope to live.
- Grunze, Heinz. “Bipolar disorder.” Neurobiology of brain disorders. Academic Press, 2015. 655-673.
- Dienes, Kimberly A., et al. “The stress sensitization hypothesis: understanding the course of bipolar disorder.” Journal of affective disorders 95.1-3 (2006): 43-49.
- Müller-Oerlinghausen, Bruno, Anne Berghöfer, and Michael Bauer. “Bipolar disorder.” The Lancet 359.9302 (2002): 241-247.
- Malhi, G.S., Tanious, M., Das, P. et al. Potential Mechanisms of Action of Lithium in Bipolar Disorder. CNS Drugs 27, 135–153 (2013).
- Kumatoshi Ishihara, Masashi Sasa, Mechanism Underlying the Therapeutic Effects of Electroconvulsive Therapy (ECT) on Depression. The Japanese Journal of Pharmacology (1999).