Early detection of bipolar disorder essential to management, but can be ‘really difficult’

Key takeaways:

• Bipolar disorder often occurs with anxiety disorders, personality disorders, substance use disorders and autism.
• Treating bipolar disorder requires multiple components, including medication and therapy.

Detecting bipolar disorder and initiating treatment early can improve outcomes for individuals, but discerning bipolar disorder from other illnesses in adolescents and young adults is not easy, according to an expert.

“Early detection is really difficult,” Kirsten W. Bolton, LICSW, program director of the Appleton residential treatment program of the McLean Hospital division of psychotic disorders, said during a webinar hosted by Anxiety and Depression Association of America. “It is a healthy developmental process for young adults or teenagers to be irritable and to have mood lability, so how do you tease apart normal teenage behavior from the signs and symptoms of bipolar disorder?”

During the webinar last month, Bolton discussed the causes of mania and common comorbidities, as well as the importance of early detection of bipolar disorder and intervention for both affected individuals and their caregivers.

What causes mania?

Bipolar disorder occurs due to a compilation of factors, Bolton said.

“I look at the first acute onset of bipolar as the perfect storm,” she said. “There are many different factors that can go into the development of bipolar disorder.”

According to Bolton, brain anatomy and structure and family history are the main factors that cause bipolar disorder.

“If you have a history of bipolar disorder or someone in your family does, keep your radar up,” she said.

Acute episodes of mania can be triggered by many different types of events, from happy, exciting ones like a wedding, graduation or international travel, to more negative events like significant loss or drug use. Other disruptions to a person’s routine can trigger mania, such as seasonal changes or starting or stopping medication. Bolton also noted she has seen quite a few young adults experience mania after returning from intense religious workshops.

“I often find that it is not usually one thing,” she said. “It is usually a cluster of events that co-occur that might trigger an acute episode.”

It can also be helpful to know what comorbidities commonly occur with bipolar disorder.

In her clinical practice, Bolton said she sees several other mental disorders that commonly overlap with bipolar disorder, including anxiety, personality disorders, autism and substance use disorders.

“In particular, in the state of Massachusetts where marijuana is legal, in the first episode psychosis program I ran for 8 years, 80% of our young adult patients had been using cannabis at the time of our first episode,” Bolton said.

Early detection, intervention

Detecting bipolar disorder early and starting treatment right away is important, Bolton noted, as the illness tends to get worse and a person’s level of functioning decreases with each episode. The key to discerning bipolar symptoms from normal teenage or young adult behavior is through finding patterns in the length and severity of episodes.

“At this point in early detection, we are not looking at full-blown symptoms,” Bolton said. “We are looking at subsyndrome symptoms — symptoms of major depression and maybe some mania or hypomania.”

The biggest risk factors for developing bipolar disorder are ADHD, anxiety, sleep disturbances and anger or irritability, she said. Family history is also a reliable predictor for bipolar disorder.

Bolton compares bipolar disorder treatment and management to a pizza with different components, or “toppings,” that make up the whole treatment plan. There are more popular “toppings,” or treatments, like medication management and behavioral therapy, and some less common “toppings,” including yoga, massage therapy or dance therapy.

“There are many, many different aspects that go into treatment and a robust recovery,” Bolton said. “Those can all go into what makes the full pizza of recovery.”