What Causes Bipolar Disorder?

Doctors and researchers have not yet determined the exact cause of bipolar disorder, but they have identified several risk factors that increase an individual’s likelihood of developing the condition.

• Genetic Predisposition. The prevailing scientific understanding is that there isn’t a single gene that causes bipolar disorder. However, there is a strong connection between family history of the condition and new diagnoses of the illness; those with a close relative with bipolar disorder are significantly more likely to develop the condition themselves. The current consensus is that multiple genes contribute to an increased risk for developing the disorder. External environmental factors may trigger these genes to cause the onset of the illness.
• Stress, Anxiety, or Trauma. Some research has suggested that the brains of people with bipolar disorder cannot effectively cope with stress. Chronic stress or anxiety, or a significant source of sudden trauma often coincides with the disorder’s onset, and these factors may also trigger subsequent episodes after the disorder first occurs.
• Lack of Sleep. Many sufferers of bipolar disorder experience unhealthy sleep patterns, and lack of sleep is a cause of physical stress that may contribute to the brain chemistry that causes the illness. Like other forms of stress, lack of sleep may also contribute to manic or depressive episodes after the disorder’s initial onset.
• Drugs and Alcohol. Nearly half of all people with bipolar disorder also struggle with drug or alcohol abuse. Sufferers often resort to substance abuse to cope with the effects of manic and depressive episodes, and the stress caused by the substance abuse may be a factor in triggering subsequent events. In some cases, antidepressants may also trigger episodes.

Is Bipolar Disorder Hereditary?

There appears to be some genetic component of risk for developing bipolar disorder, but the medical community has not pinpointed the specific genes that increase risk. However, there is a significant link between family history of the disorder and the disorder’s diagnosis in new patients.

• Individuals with one biological parent who has been diagnosed with the disorder have a 10-25% chance of developing the condition themselves. When both parents have been diagnosed with the disorder, the risk increases to 10-50%.
• Individuals with a sibling or non-identical twin who has been diagnosed as bipolar have a 10-25% chance of developing the disorder. If an identical twin has the disorder, the possibility of the other twin developing the disorder rises to 40-70%.
• The current consensus among researchers is that bipolar disorder is not caused by a single gene but by a coincidence of several genes; each increases the risk of developing the condition. Environmental factors likely trigger the development of the disorder even in individuals with genetic risk factors.

How is Bipolar Disorder Detected?

Early detection of bipolar disorder is critical because the illness’s onset often results in suicidal behavior and other behaviors that put the sufferer at significant risk of harm. The problem is particularly acute when the disorder manifests itself in adolescents who are less likely to seek help and are vulnerable to harmful behaviors.

Unfortunately, bipolar disorder is often misdiagnosed or ignored, and the time between the first occurrence of the disorder and a proper diagnosis may span years. The longer a sufferer lives with the illness without being diagnosed, the greater the chance that they will come to harm. The disorder is often misdiagnosed as major depression, and it is treated with antidepressants alone, a course of treatment that may be harmful to the sufferer.

Successful early detection of bipolar disorder depends on differentiating signs of the condition from other mental and physical disorders with similar symptoms. Researchers have attempted to find a pattern of symptoms that suggests that the disorder might manifest in the future, but thus far, a definitive pattern has been challenging to identify.

Lacking a way to spot a patient’s likelihood of developing the disorder, providers are encouraged to watch for symptoms such as mood swings, mania, depression, or psychotic episodes that coincide with other risk factors such as stress, anxiety, sleep problems, trauma, family history of the disorder, or drug and alcohol abuse.

How is Bipolar Disorder Diagnosed?

Proper diagnosis of bipolar disorder usually involves a combination of physical and psychiatric assessments and observation and evaluation of current symptoms. Given the link between bipolar disorder and family history, an assessment of the patient’s family mental health and medical history may be helpful, as well.

Although there is no medical test that can identify or rule out the presence of bipolar disorder, a physician will likely conduct a physical exam to exclude other medical conditions whose symptoms are often similar to those of bipolar disorder. Such conditions include lupus, HIV, and thyroid disorders.

A psychiatric assessment typically includes a session to identify symptoms, moods, and behavior patterns that could indicate bipolar disorder. The patient will most likely be asked to fill out self-assessment questionnaires, and family members may be requested to contribute questionnaires, too.

After an initial assessment, the patient may be asked to keep a diary to track moods, feelings, sleep patterns, and other relevant behaviors. The goal here is to identify patterns that are typical of bipolar disorder.

These assessments will be compared to the diagnostic criteria for bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders. Comparing these criteria will help a psychiatrist decide whether the symptoms indicate bipolar disorder or another psychiatric problem (such as borderline personality disorder, impulse control disorders, anxiety disorders, or ADHD) whose symptoms are similar to those of bipolar disorder something else entirely.

How is Bipolar Disorder Treated?

There is no known cure for bipolar disorder, and treatment plans are targeted to manage symptoms and lessen the severity of episodes when they occur. Treatment for bipolar disorder is ongoing and life-long, and sufferers need to continue treatment without interruption as directed by their healthcare providers.

Medication

Many different medications may be used to treat and manage the symptoms of bipolar disorder, and individual medication plans are dependent on the particular symptoms that a given sufferer presents.

• Mood Stabilizers. These drugs are usually used to manage manic episodes. Mood-stabilizing drugs commonly prescribed for bipolar disorder include lithium, valproic acid, divalproex sodium), carbamazepine, and lamotrigine.
• Antidepressants. These drugs are typically used to manage depressive episodes in people living with bipolar disorder. However, antidepressants used alone are known in some cases to trigger manic episodes or rapid cycling, so they are usually used in combination with mood-stabilizing or antipsychotic drugs. The medication Symbyax combines the antipsychotic drug olanzapine with the antidepressant fluoxetine and is often prescribed for bipolar sufferers.
• Antipsychotics. These drugs are usually prescribed when the symptoms of manic or depressive episodes don’t respond adequately to other medications alone. Commonly prescribed antipsychotics include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone,  or asenapine.
• Anti-Anxiety Medications. Anti-anxiety drugs such as benzodiazepines are sometimes used to treat anxiety or sleep problems in bipolar sufferers, typically on a short-term basis.

Psychotherapy

Psychotherapy and counseling are often part of the maintenance phase of treatment once the disorder’s symptoms have been successfully controlled with medications. These therapies may help the patient decrease stress and establish behaviors that help lessen the impact of symptoms. Psychotherapy alone, however, is rarely enough to control bipolar disorder and is almost always used in conjunction with medications.

Substance Abuse Treatment

Because substance abuse is often coincident with bipolar disorder, treatment of the problem is commonly part of the overall treatment plan for bipolar sufferers. Without substance abuse treatment, patients are more likely to be non-compliant with other treatments, and even when the patient is compliant, treatment of other symptoms may be less effective.

In-Patient Treatment

It is common for doctors to require hospitalization to treat bipolar disorder, especially in high-risk patients (such as pregnant women) who are experiencing an extreme manic episode. These patients are likely to engage in potentially harmful behavior and are also likely to be non-compliant with treatment plans if left on their own. In some severe cases, doctors may recommend electroconvulsive therapy (ECT) when the mania does not respond to medications.

How Does Bipolar Disorder Progress?

The initial onset of bipolar disorder often occurs when the sufferer is in their late teens or early 20s, although both earlier and later onset can happen. A quarter of those diagnosed with bipolar disorder will experience a manic state as their first symptom, but many more–nearly half–will first experience a depressive state. Because of this, the disorder is often initially misdiagnosed as depression.

After the first episode, almost all sufferers will experience more episodes, and if the disorder is left untreated, attacks are likely to become more frequent and more severe. Every individual experiences the condition differently, but a typical timeline has the second episode occurring within four years of the first and subsequent episodes occurring about once a year after that.

Episodes typically last 3-6 months, but some depressive states may linger for years. In some cases, sufferers may experience what is known as rapid cycling, in which they experience four or more episodes within a single year.

Medication may lessen the number or severity of episodes, and in some rare cases, episodes may cease altogether. However, there is no known cure for bipolar disorder, and in most cases, it must be treated as a life-long illness.

How is Bipolar Disorder Prevented?

The onset of bipolar disorder cannot be prevented, but early recognition of an episode’s signs can help the sufferer manage the oncoming episode. Recognizing an episode at the earliest possible sign can allow for prompt medical intervention, and intervention, in turn, may prevent the episode from becoming more severe.

It is vital for those diagnosed with bipolar disorder to seek regular evaluations from their mental health providers and adhere faithfully to any prescribed medication plan. Treatment of bipolar disorder typically focuses on the prevention or mitigation of future manic or depressive episodes. Proper use of medication is instrumental in preventing episodes or lessening their severity.

Bipolar Disorder Caregiver Tips

The consequences of manic and depressive episodes often affect not only the bipolar sufferer but also their family members, friends, and colleagues. Because of this, those close to the sufferer must be educated in the symptoms and effects of the disorder so that they are better able to recognize the onset of episodes, to help their loved one deal with the impact of the episode while it is in progress, and to cope with stresses that the disorder can place on relationships.

It can be helpful for family members to participate in family counseling or therapy sessions so that they can learn how to provide support to the patient.

In addition to seeking support from therapy or a support group, caregivers for someone with bipolar disorder should consider some of the following self-care tips:

• Learn as much as possible about the disorder.
• Set limits (preferably in a peaceful period between episodes) to establish what you will and will not be responsible for during the sufferer’s episodes.
• Make time for yourself away from the disorder.
• Take care of your own physical and mental health. It is not uncommon for caregivers to experience depression or to let their own healthy lifestyle suffer because of stress.

Many people with bipolar disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the conditions commonly associated with bipolar disorder:

• Most children with BPD also have ADHD.
• About half of people with bipolar disorder also have an anxiety disorder at some point in their lives.
• Panic disorder is the most common anxiety disorder in people with BPD.
• Some people with BPD also have other personality disorders, such as borderline personality disorder.

Alcoholism and substance use disorder are commonly comorbid with BPD. Nearly two-thirds of people with bipolar-I also have a substance use disorder.

Bipolar Disorder Brain Science

The causes of bipolar disorder and the nature of potentially effective treatments have remained elusive for researchers.  Recent studies have begun to shed new light on brain function and chemistry, soon to revolutionize the disorder’s diagnosis and treatment.

• Researchers have identified a difference in brain activity between people with bipolar disorder and those suffering from major depression. The study used MRI scans to look at the function of the amygdala, a part of the brain that is instrumental in processing emotion. The study found that the left side of the amygdala is less active in people with bipolar disorder than in people with depression. This finding could help lessen the misdiagnosis of depression in people who are suffering from bipolar disorder.
• Researchers have found that people with bipolar disorder have generally weaker cognitive abilities such as memory, processing speed, and executive functioning than those without bipolar disorder.
• A recent study found that people with bipolar disorder who participated in brain-training exercises designed to boost cognitive abilities saw a significant and sustained improvement in their cognitive skills. The hope is that this kind of brain training can help bipolar sufferers improve their quality of life.
• An international research team has suggested a connection between a gene called EGR3 and a protein called brain-derived neurotrophic factor (BDNF), which, in normal conditions, helps the brain react effectively to stress. Previous studies have shown that people with bipolar disorder have lower levels of BDNF during manic or depressive episodes, and this new research suggests that it may be possible to develop drugs that will improve the function of EGR3 and BDNF in bipolar sufferers.

Bipolar Disorder Research

Scientists are working on several research projects to expand on what is known about Bipolar Disorder.  The research will improve knowledge about the factors that increase the risk for Bipolar Disorder and the causes and best treatments. It will aid people living with Bipolar Disorder and their caregivers.

Title: PRAMI: A research study to understand behaviors and brain circuits related to anxiety and depression. “The goal is to learn which circuits of the brain are involved in anxiety and how these circuits might affect daily functioning.”

This study has recently added an additional treatment component: participants undergo a 12-week course of either Pramipexole medication or rTMS therapy (explained below). The study’s ultimate goal is to offer participants experiencing anxiety and depression a treatment that is alternative to ones that have failed them in the past and to apply the knowledge we gain from investigating the brain circuits involved in anxiety and depression to help personalize treatments.

Stanford Medicine invites

 anyone who has recently experienced any symptoms of anxiety and/or depression to participate (no diagnosis is required to participate).

Status: Recruiting

Stanford Medicine – Bipolar Research in the Department of Psychiatry and Behavioral Sciences

Detailed Description

Eligible participants will be asked to come in for a visit during which they complete some game-like computer tasks, undergo a non-invasive brain scan, and answer some questions about their emotional health. The entire visit takes place during one day at Stanford and lasts about 4-5 hours. A follow-up occurs 12 weeks later, from home, during which some questions on the participant’s emotional health are reviewed.

Study Population

We expect to enroll 160 individuals spanning the spectrum of anxiety and associated mood symptoms. These individuals include patients of the Gronowski Center, a community clinical psychology center in Palo Alto. We will also recruit from the community through various advertisements. Further, participants will include healthy people recruited by advertisement.

Inclusion Criteria

• Recent experiences of anxiety and/or depression
• Ages 18-50

Exclusion Criteria

• Specific psychiatric medications (case-by-case basis)
• A diagnosis of Bipolar 1 Disorder, Schizophrenia, or Obsessive-Compulsive Disorder
• Any of the following medical conditions: Parkinson’s disease; liver or kidney disease; history of epilepsy or seizures; history of cardiovascular disorders (specifically orthostatic hypotension)

For those interested in the TMS option specifically, an additional inclusion criteria is that participants have tried at least one psychiatric medication in the past that didn’t work. To inquire more about participation, you can either sign up online or contact us.

Sign up online

http://med.stanford.edu/williamslab/research/current/rad.html

Contact Stanford Medicine:

Call or text (650) 600-1609 or email rad-at-study@stanford.edu