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According to Bipolar UK, 1.3 million people in the UK have bipolar disorder. That is one in fifty people. Recent research suggests that as many as 5% of us are on the bipolar spectrum. Bipolar is one of the UK’s most common long-term health conditions. Living with bipolar increases a person’s risk of suicide by up to 20 times and on average it takes 9.5 years to receive a correct diagnosis.
Current Understanding of Bipolar Disorder
Bipolar disorder, previously called manic depression, is where a person has extreme mood swings. These include emotional highs, known as mania or hypomania, and lows, otherwise known as depression. When your mood shifts to mania, or hypomania which is less extreme than mania, you may feel euphoric, full of energy or unusually irritable or restless. When you feel depressed, you may feel sad or hopeless and you may lose interest or pleasure in activities you would usually enjoy. Symptoms of bipolar during a manic phase may include:
- Feeling incredibly high or euphoric.
- High levels of creativity, energy and activity.
- Feeling highly energetic or impulsive.
- Getting little or no sleep.
- Grandiosity, having an inflated sense of self-esteem or self-importance. A feeling of possessing special powers, talents or abilities.
- People may engage in numerous activities simultaneously and have a heightened sense of productivity. However, these activities may lack practicality or purpose.
- Difficulty engaging in one activity, becoming easily distracted.
- Experiencing racing thoughts, racing speech, or talking over people.
- Having a poor appetite and weight loss.
People experiencing this may not recognise this themselves and it may be those around them that observe this and raise concerns.
Symptoms of bipolar during the depressive stage may include:
- Feelings of sadness, tearfulness or hopelessness.
- Angry outbursts, feeling easily irritable or frustrated.
- Loss of interest or pleasure in most or all normal activities.
- Sleep disturbances, which may include insomnia or sleeping too much.
- Feeling tired or lacking energy.
- Reduced appetite and weight loss.
- Increased cravings for food and weight gain.
- Anxiety, agitation or feeling restless.
- Slower reactions, thoughts, speech or body movements.
- Feelings of being worthless or of guilt, fixating on past failures or self-blame
- Having trouble thinking, concentrating, making decisions.
- Problems with memory.
- Unexplained physical problems, which can include things like aches and pains.
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts. Please see our knowledge base for information on how to support someone who is feeling suicidal.
There are different types of bipolar disorder. Bipolar I disorder involves manic episodes that last at least seven days or are severe enough to require hospitalisation. Depressive episodes may also occur. Bipolar II disorder is characterised by a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown mania. Cyclothymic disorder involves chronic fluctuations in mood with periods of hypomania and mild depression that lasts for at least two years.
Advancements in Genetic Research
Bipolar disorder has a genetic component, which means that there is an increased likelihood of developing the condition if you have a close relative, such as a parent or sibling, with bipolar disorder. However, genetics alone do not solely determine whether someone will develop bipolar disorder. There are also other factors, such as environmental influences and life experiences, which also play a role in the development of the disorder. Having a family history of bipolar disorder does not guarantee that a person will develop the condition, and equally people without a family history can still be diagnosed with bipolar disorder.
Bipolar disorder is a complex mental health condition. The exact cause of bipolar disorder is not fully understood; however, both genetic and environmental factors are believed to play a role.
Research suggests a genetic component to bipolar disorder. Studies of families, twins and adopted individuals have provided evidence of a hereditary link. Biological factors, for example imbalances in certain neurotransmitters, such as dopamine, serotonin and norepinephrine, are thought to contribute to bipolar disorder. These imbalances can affect mood regulation.
Environmental factors such as traumatic events or drug and alcohol use can increase the risk and severity of bipolar disorder in susceptible individuals.
Research into the genetic basis of bipolar disorder has reached a turning point. Genome-wide association studies, using several thousands of samples, have produced replicated evidence for some novel susceptibility genes. A genetic study involving thousands of people with bipolar disorder has revealed new insight into the condition’s molecular underpinnings. The findings will help to create a better understanding of the causes of the condition and potential new therapies.
Neuroimaging and Brain Research
Neuroimaging is a set of techniques which are used to create images of the structure and function of the brain. These techniques allow researchers and healthcare professionals to see and understand the brain’s anatomy, activity and connectivity.
Neuroimaging techniques have been employed to investigate structural, functional and chemical changes in the brains of people with bipolar disorder. Neuroimaging has played a crucial role in advancing our understanding of bipolar disorder. The neuroimaging field is still evolving, and further research is needed in order to learn about the complexities of the disorder and therefore develop more targeted treatments. Additionally, combining neuroimaging data with genetic, environmental and clinical information can offer a more comprehensive understanding of the nature of bipolar disorder.
Some important findings from neuroimaging research in bipolar disorder include:
- Structural brain changes – this includes grey matter abnormalities. Studies have reported changes in grey matter volume in certain brain regions, including the prefrontal cortex, amygdala and hippocampus. Alterations in these areas are associated with mood regulation, the processing of emotion, and memory, which are often affected when someone has bipolar disorder. Diffusion tensor imaging studies have also revealed disruptions in white matter tracts, which suggests connectivity abnormalities in the brains of people with bipolar disorder. Disruptions in white matter integrity can have an impact on communication between different areas of the brain.
- Neurochemical abnormalities – magnetic resonance spectroscopy studies have investigated neurotransmitter levels in the brains of people with bipolar disorder. Imbalances in neurotransmitters have been reported, which has provided insights into the neurochemical basis of the disorder. Researchers are actively working towards identifying neuroimaging biomarkers that could help in the diagnosis, prognosis and treatment options for bipolar disorder. These biomarkers could help to personalise treatment approaches and enhance understanding of the underlying neural mechanisms.
- Longitudinal studies – these have provided valuable insights into the progression and changes to the brain over time. These studies contribute to our understanding of the dynamic nature of bipolar disorder and how the brain responds to different phases of the illness.
Innovative Therapies and Interventions
There are a number of innovative therapies and interventions that are being explored for the treatment of bipolar. These include:
- Light Therapy – traditionally associated with seasonal affective disorder (SAD), light therapy is being explored as a potential treatment for bipolar disorder. Exposure to bright light is thought to help regulate mood and also improve sleep patterns.
- Cognitive Remediation Therapy (CRT) – CRT is a psychosocial intervention which is aimed at improving cognitive functioning, including memory, attention and problem-solving.
- Transcranial Magnetic Stimulation (TMS) – TMS is a non-invasive procedure that uses magnetic fields in order to stimulate nerve cells in different areas of the brain. There has been some progress made in treating both depressive and manic symptoms which are associated with bipolar disorder.
- Mindfulness-based interventions – mindfulness-based therapies, such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), have shown some positive results in managing mood symptoms in bipolar disorder. Mindfulness is a technique which involves noticing what’s happening in the present moment, without judgement.
- Nutritional based interventions – research has been exploring the impact of nutrition on mental health. Some studies suggest that certain dietary modifications and supplements may be beneficial for people with bipolar disorder.
Personalised Medicine and Precision Psychiatry
Personalised medicine and precision psychiatry are approaches that aim to tailor medical treatment to the individual characteristics of each patient, including things like their genetic make-up, lifestyle and environmental factors. Personalised medicine involves tailoring treatment strategies based on the specific characteristics of someone’s condition. Some key aspects of personalised medicine in the context of bipolar disorder include:
- Genetic factors – understanding the genetic basis of bipolar disorder can help to identify specific genetic markers that may influence someone’s response to certain medications. Genetic testing can assist in predicting which medications are likely to be more effective or have fewer side effects for a particular individual. Genetic testing is a type of medical test that aims to identify changes in genes, chromosomes or proteins.
- Lifestyle and environmental factors – considering someone’s lifestyle, stress levels and other environmental factors is important in personalised medicine.
- Biomarkers – researchers are exploring the identification of biomarkers, including specific proteins or neuroimaging patterns. These can indicate the presence of bipolar disorder and help to guide treatment decisions. Biomarkers could be useful in predicting someone’s response to treatment and in monitoring how the disease is progressing.
Precision medicine is an emerging approach to treatment and prevention. It takes into account each person’s variability in genetics, environment and lifestyle. Precision psychiatry in bipolar disorder can include:
- Clinical phenotyping – precision psychiatry involves a detailed characterisation of the patient’s clinical profile, including their symptoms, cognitive functioning and psychosocial factors. This detailed phenotyping helps to tailor interventions to the specific needs of the person being treated.
- Digital health technologies – mobile apps, wearables and other digital health technologies are being used more and more in psychiatric care. These tools can help to monitor mood fluctuations, sleep patterns and other relevant pieces of information.
- Predictive analytics – advanced data analytics, including machine learning and artificial intelligence, are being used in order to identify patterns that can predict treatment responses. This allows for a more precise selection of treatment options.
These fields are still in the early stages of development, and ongoing research is important in order to continue its development. As research progresses, it is hoped that these approaches will help to develop better interventions for people with bipolar disorder.
Telemedicine and Digital Health
Telemedicine and digital health refer to different aspects of healthcare that use technology to improve patient care and access to medical services. Telemedicine involves the use of telecommunications technology in order to provide medical services to patients remotely. It enables healthcare professionals to diagnose, treat and monitor patients without having to see them in person. Telemedicine includes various technologies such as video conferencing and mobile apps. It can be useful for having consultations and follow-ups, and to manage chronic conditions.
Digital health uses digital technologies, including information and communication technologies, to support and improve healthcare delivery, patient education and health management in general. It goes beyond simply remote consultations and includes applications such as mobile health apps, wearable devices, health information systems and electronic health records, all designed to improve healthcare efficiency, patient engagement, and overall health outcomes.
While telemedicine and digital health technologies offer many advantages, it’s important to understand the potential challenges, such as ensuring the security and privacy of patient data.
Telemedicine and digital health can be used specifically for bipolar disorder by having:
- Remote consultations and therapy sessions – telemedicine allows people with bipolar disorder to consult with mental health professionals remotely. Psychiatrists and therapists can hold virtual sessions, enabling patients to receive care without the need for in-person visits. This option may reduce waiting times for access to treatment and may feel more accessible for someone who is struggling with their mental health.
- Support with medication – remote medication management and prescription services help individuals with bipolar disorder receive their prescribed medications without visiting a physical pharmacy. Digital health apps can also assist people in managing their medication schedules and provide people with reminders to take their medication.
- Online support groups – digital health platforms offer opportunities for people with bipolar disorder to connect with others, share experiences and access support groups. The sense of community this offers can contribute to improved mental well-being overall.
- Digital educational resources – telemedicine platforms often provide educational materials and resources to help people better understand bipolar disorder and manage their condition more effectively.
- Health data analytics – data collected through digital health platforms can be analysed in order to identify patterns and trends. This can contribute to the development of personalised treatment plans for people with bipolar disorder.
It is important to understand that not all aspects of bipolar management can be given solely through digital means and it may be an approach of in-person and virtual care that is needed.
The Importance of Holistic Care
Holistic care, also known as holistic health or holistic medicine, is an approach to healthcare that considers the whole person. Instead of focusing only on treating specific symptoms or isolated aspects of someone’s health, holistic care aims to look at the person as a whole and take into account the fact that various factors may be interconnected and are contributing to the person’s overall well-being. It views each person as a unique being with specific needs, acknowledging that healing can only be fully achieved when all dimensions of a person’s life are considered and nurtured.
A holistic approach is particularly important in the context of bipolar disorder and other mental health conditions. This is because it aims to:
- Address the root causes – holistic care seeks to identify and address the underlying causes of symptoms, rather than just treating the symptoms themselves. This may involve exploring whether the person has experienced trauma, whether they are under particular stress, lifestyle factors, and environmental influences that could be contributing to the development or exacerbation of bipolar disorder.
- Provide a comprehensive understanding – bipolar disorder affects various aspects of a person’s life, including their thoughts, emotions, behaviours, relationships with other people, and their physical health. Holistic care allows healthcare professionals to have a comprehensive understanding of the person’s situation, leading to better treatment overall.
- Provide individualised treatment – every person with bipolar disorder is unique, and their experiences and needs will differ, sometimes significantly. Holistic care recognises and embraces this and tailors treatment plans in order to address the specific challenges and strengths of each person.
- Enhance social support – holistic care recognises the importance of social support networks. Healthcare professionals may encourage patients to strengthen their relationships, engage in support groups, and access other social support systems.
- Improve quality of life – ultimately, the goal of holistic care for bipolar disorder is to improve quality of life. This includes managing symptoms and also promoting mental, emotional and social well-being.
- Prevent relapses – holistic care focuses on long-term well-being, aiming to prevent relapses from happening. This may involve ongoing monitoring, adjustments to treatment plans, and developing coping skills.
The future of bipolar disorder research is promising in terms of advancements in understanding how genetics and neurobiological and environmental factors contribute.
The focus on a more personalised approach to understanding and managing this complex mental health condition is important. The future of research and treatment options is moving towards holistic care models, emphasising collaboration among healthcare professionals and the active involvement of patients in managing their condition. Early intervention and prevention are also important and need to be valued, focusing on aiming to identify people at the highest risk and implementing measures in order to reduce the severity and impact of bipolar disorder. Keeping patients’ needs at the centre and promoting self-management strategies is important in empowering people with the knowledge and tools to navigate their mental health journey and access the support they need.
For further reading about getting support with mental health problems, please see our knowledge base.
The Depression and Bipolar Support Alliance provide support for anyone affected by bipolar disorder.