Bipolar disorder is in the spotlight these days thanks to several celebrities—including Kanye West, Demi Lovato, Bebe Rexha, and Halsey—who have gone public with their diagnoses. These high-profile individuals are among the 5.7 million Americans affected by bipolar disorder.

While this has helped spread awareness about the mental health condition, there’s one important aspect of bipolar disorder that rarely gets mentioned—the brain. Ignoring the brain when this condition is suspected can lead to misdiagnosis, the wrong treatment, and years of needless suffering.

Here’s what you need to know about this brain-based disorder.

WHAT IS BIPOLAR DISORDER?

Bipolar disorder is a cyclic mood disorder, shifting between manic episodes and depressive episodes that are characterized by severe changes in mood, energy, and activity levels. The recent discussions in the media and on social media have brought to light some of the most common bipolar disorder symptoms.

For example, manic episodes are characterized by:

• An abnormally elevated mood
• Inflated self-esteem
• Grandiose ideas
• Racing thoughts
• A decreased need for sleep

On the other end of the spectrum, depressive episodes are associated with:

• Sad or negative moods
• Loss of interest in usually pleasurable activities
• Feelings of helplessness and hopelessness
• Decreased energy
• Suicidal thoughts and behavior

Note that you may not experience all of these symptoms of bipolar disorder. In addition, symptoms of mania and depression can range in severity.

 TYPES OF BIPOLAR DISORDER

 Experts have identified multiple types of bipolar disease, including:

• Bipolar 1 disorder (also known as bipolar I):
  This type is marked by the presence of mania, which may or may not be accompanied by depressive episodes. During manic episodes, individuals often feel excessively energized, euphoric, and highly confident. It’s common for those experiencing mania to develop grandiose ideas, initiate numerous large projects, and forgo sleep.

• Bipolar 2 disorder (also known as bipolar II)”:
  Individuals with this type typically experience both emotional highs and low moods in a cyclical pattern. However, the key distinction between these types of the disorder is that the elevated mood episodes in bipolar 2 are less intense than those in bipolar 1 and do not reach the level of full-blown mania. These episodes in bipolar 2 are referred to by mental health professionals as “hypomanic.”

• Cyclothymic disorder:
  

  People with this type experience periods of hypomanic and depressive symptoms, however they are not severe enough to meet the criteria of episodes. These individuals may have chronic mood instability. 

• Other specified or unspecified bipolar disorder:
  

  This term is used for people who experience symptoms of abnormal mood elevation but don’t meet the diagnostic criteria for other types of bipolar disorder. 

Bipolar 1 and bipolar 2 are the most common types of the condition. Knowing which type you have is critical to getting the most effective treatment. 

BIPOLAR DISORDER IN THE BRAIN

A growing body of neuroimaging research shows that people with bipolar disorder tend to have abnormal activity patterns in the brain. For example, one study on brain function in bipolar disorder revealed deficits in a trio of areas:

• Attention
• Executive function
• Emotional processing

Functional brain scans suggest that the underlying pathophysiology involves widespread neural circuits, including the prefrontal cortex and anterior cingulate cortex, as well as limbic system regions like the amygdala and ventral striatum.

Functional imaging of people during a manic episode has revealed abnormal changes in blood flow and metabolism, especially in the orbitofrontal cortex.

For over 30 years, Amen Clinics has been utilizing a brain imaging technology called single photoemission computed tomography (SPECT), which measures blood flow and activity.

For the patients at Amen Clinics and their families, seeing their brain scans helps them understand that symptoms and behaviors associated with bipolar disorder are not “mental disorders” or character flaws, rather, they’re “brain health” problems.

Unfortunately, millions of people in America who are suffering from bipolar disorder and other mental health issues don’t get the help they need due to the stigma surrounding mental health.

Reframing the discussion from mental health to brain health helps overcome that stigma because it shows that conditions are not moral, they’re medical.

For Amen Clinics patients with bipolar disorder, brain imaging has also revealed some surprising findings. For example, SPECT scans show that many people who are diagnosed with bipolar disorder also have an underlying concussion or traumatic brain injury that has never been properly diagnosed or treated.

Many of these people don’t even remember experiencing a head injury. This hidden trauma can be the result of one or more head injuries that happened months, years, or even decades earlier.

Some of the most common causes include falls (falling off a bike, falling off a ladder, or falling down a flight of stairs), vehicle accidents, or sports-related concussions. Having a brain injury can exacerbate the ups and downs of bipolar disorder.

SPECT scans can also help detect other mental health conditions that commonly co-occur with bipolar disorder. For example, research in Clinical Psychology shows that 62% of people with bipolar disorder also meet the clinical criteria for attention deficit hyperactivity disorder (ADHD), also called attention deficit disorder (ADD). Anxiety disorders and substance use disorders are also common in people with bipolar disorder.

Addressing co-existing mental health problems is a critical aspect of bipolar disorder treatment. Only when all issues are treated can you get the relief you want.

CONSEQUENCES OF MISDIAGNOSED OR MISTREATED BIPOLAR DISORDER

Without the added help of brain imaging, bipolar disorder is often misdiagnosed for other conditions, such as depression or schizophrenia.

In fact, most people experience signs of bipolar disorder for an entire decade before getting an accurate diagnosis. This can have devastating effects because following the wrong treatment plan can make symptoms worse.

When left untreated or mistreated, the condition is associated with a decrease of over 9 years in life expectancy. In addition, people with bipolar disorder are 15 times more likely to attempt suicide than the general population, and 1 in 5 people with the condition eventually take their own life.

TREATMENTS FOR BIPOLAR DISORDER

Bipolar disorder is treatable. It is generally responsive to a treatment program that is personalized to enhance brain health and that may include:

• Nutritional supplements
• Healthy nutrition
• Exercise
• Lifestyle changes
• Psychotherapy
• Medication (when necessary)

The patient population at Amen Clinics shows that healing the brain can be very helpful in reducing symptoms associated with bipolar disorder.