Bipolar Disorder Affects 140 Million People Worldwide and Presents Challenges in Diagnosis

Bipolar disorder is a chronic illness in which the individual repeatedly experiences mood swings throughout their life, alternating between periods of depression, euphoria or both together. This change is identified as mania and hypomania, the first being a phase in which there is an abnormal increase in energy, both physical and mental — lasting at least a week and can even lead to hospitalization — and the second being a milder form of this increase. of spirit.

Symptoms and diagnosis

In this sense, Doris Moreno, researcher at the Affective Disorders Program at the Department of Psychiatry at the Faculty of Medicine of the University of São Paulo (FMUSP), explains that, during these periods, there is more sociable behavior, combined with greater irritability and aggressiveness. 

On the other hand, the depressive episode in bipolar disorder lasts an average of two weeks, being characterized by intense sadness, loss of pleasure and appetite and insomnia — unlike mania and hypomania, the person sleeps poorly and is always tired. Furthermore, there is an intensification of hopeless and pessimistic thoughts which, together with low self-esteem, can lead to suicide.

According to 2019 data from the World Health Organization (WHO), bipolar affects around 140 million people worldwide and around 2.5% of the Brazilian population. Its diagnosis is carried out, most of the time, in individuals aged between 16 and 25 years, but the disorder can manifest itself from childhood to old age: “Approximately half of the patients begin to manifest the disease with a depressive episode and the other half of patients start with an episode of mania”, says professor Beny Lafer from the Institute of Psychiatry (IPQ) at FMUSP.

Therefore, the disease is divided into two types: type 1, characterized by recurrent episodes of mania and depression, in which there is overconfidence, impatience, hallucinations and delusions; and type 2, identified by occurrences of hypomania, that is, less intense euphoria, but with more acute depression. The second condition is more common than the first, which makes diagnosis even more difficult, as it is easily confused with depressive disorder and hinders the patient’s treatment. 

The specialist highlights: “The disease takes five to ten years between the onset of symptoms and diagnosis, that is, psychiatrists take a long time to make the diagnosis and, in that time, the person has already had numerous episodes of hospitalizations and suicide attempts” . Doris Moreno warns, in turn, that it is more difficult to make the diagnosis during periods of mania and hypomania, since people only seek treatment when they are depressed.

Effects and consequences

Among the main consequences for bipolar people’s personal life are the loss of jobs, difficulties in finishing studies and marital difficulties — this is linked to increased libido, sexualization and irritability. All these results lead, in most cases, to a withdrawal from the social body and excessive procrastination.

That said, a study from the University of Michigan shows that individuals with bipolar disorder are up to six times more likely to die prematurely than others and, from the age of 60, this number increases by more than two times. Furthermore, the research also highlighted that bipolar people have a risk of early death about three times higher than smokers.

Doris cites a survey carried out in Finland, which revealed that the main cause of early death in bipolar individuals is cirrhosis, responsible for half of the cases: “What draws attention is that alcohol dependence is extremely common in people on the bipolar spectrum. and may even be an aspect that differentiates bipolar depression from non-bipolar depression.” She adds that, when these people have more severe depressive symptoms, they seek relief in alcoholic beverages or other substances.

In the expert’s opinion, there are several factors that influence the confirmation of these data, including changes in sleep, smoking and alcohol and drug abuse. However, the Finnish study revealed that suicide among individuals with bipolar disorder is eight times higher than the general population, which raises a warning for patients and the people around them.

“The most serious consequence is suicide and, before that, the risk of self- and hetero-aggression. In mixed episodes, in which suffering is maximized, especially in young people, it can happen to get hurt, but thoughts of suicide can also appear”, she warns. In contrast, Doris says that, in moments of euphoria, bipolar people do not take care of their health and stop taking their medication, and, in periods of depression, due to high levels of discouragement, they do not practice the necessary hygiene and do not go to the doctor.

In this sense, Lafer highlights that patients have a high rate of comorbidities with other psychiatric conditions, such as attention deficit, and medical conditions, including cardiovascular, respiratory, autoimmune and metabolic diseases. This occurs due to an increase in oxidative stress and the use of medications that influence individuals’ weight and metabolism.

Treatment

According to the professor, the main treatments are pharmacological, based on the continuous use of medications, including mood stabilizers — especially lithium salts — anticonvulsants, antipsychotics and, during episodes of depression, antidepressants. He explains the objectives of using these medications: “We seek the remission of mania symptoms and the remission of depression symptoms, but, above all, the prevention of new relapses.” 

Doris explains: “Most of the substances used are new generation antipsychotics, with different side effects and each person will take one or more of these medications at the beginning of the disease. Those privileged people, who didn’t take many years to start treating themselves properly, are able to use just one substance.”

Another therapeutic procedure is psychotherapy, used to prevent new episodes and seek to improve quality of life, and psychoeducation, which seeks to educate the patient and their family members about the disease. “This greatly improves the prognosis and greatly reduces the number of relapses”, guarantees Lafer.

Finally, the specialist states that there is no point in just using medication and attending therapy, that is, the individual must also avoid the use of alcohol and drugs — such as caffeine — and perform physical activity. “It is also necessary for the patient to follow what I call the ‘bipolar diet’, to go to sleep at night and ‘kick’ themselves out of bed in the morning, even if they don’t want to”; she emphasizes that all of this will guarantee stability for a longer period of time.