Complexities associated with bipolar disorder
Bipolar disorder, a mental health condition characterized by extreme mood swings, is often associated with several comorbid mental and physical health conditions. These co-occurring conditions can worsen the illness's course and increase health risks.
Common comorbid mental health conditions include anxiety disorders, such as generalized anxiety, panic disorder, and social anxiety, which are highly prevalent, present in around 71% of people with bipolar disorder, and can exacerbate mood episodes. Substance use disorders, including alcohol and drug misuse, affect over 50% of individuals and complicate treatment. Other common psychiatric conditions include ADHD, personality disorders, and eating disorders.
Physical health complications are also prevalent. Metabolic syndrome, including obesity and type 2 diabetes, is more frequent, affecting many with bipolar disorder (obesity ~21%, diabetes ~14%). This contributes to cardiovascular disease risk. Cardiovascular problems are significantly elevated, with a twofold increased risk of death from natural causes such as coronary heart disease. Thyroid dysfunction, especially hypothyroidism, often occurs either as a direct disorder effect or as a side effect of medications like lithium. Migraines are relatively common.
Additional risks associated with bipolar disorder include an increased risk of suicide, functional impairments in work, social, and family life, higher unemployment and social difficulties, and increased divorce rates.
To address these complications, a holistic approach is necessary. This includes pharmacological treatment with mood stabilizers, antipsychotics, and adjunctive medications, with close monitoring of side effects. Psychotherapy, such as cognitive-behavioral therapy (CBT), psychoeducation, and support for managing anxiety, substance use, and adherence, is also crucial.
Lifestyle intervention, encouraging regular physical activity, a healthy diet, and sleep hygiene, can help reduce obesity and cardiovascular risk. Substance abuse treatment, integrated programs addressing both bipolar symptoms and substance use disorder, is essential. Regular medical monitoring for metabolic syndrome, cardiovascular health, thyroid function, and diabetes is necessary. Suicide risk management, including regular assessment and crisis intervention planning, is also vital.
Experts believe that inflammation plays a role in both bipolar disorder and metabolic syndrome, and people with bipolar disorder and migraine tend to have more depressive episodes than those without migraine. Researchers propose that the shared genetic factors and the effects on the parts of the brain related to impulsivity and reward contribute to the increased risk of addiction.
Following a treatment plan for bipolar disorder may help prevent substance use disorders from developing or improve a person's outcome. People with bipolar disorder are twice as likely as the general population to have metabolic syndrome. This underscores the importance of comprehensive and ongoing care for those living with this complex condition.
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [2] National Institute of Mental Health. (2016). Bipolar disorder. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml [3] National Institute of Mental Health. (2019). Substance use disorders. Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-disorders/index.shtml [4] National Heart, Lung, and Blood Institute. (2020). Metabolic syndrome. Retrieved from https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome [5] American Heart Association. (2020). Cardiovascular disease. Retrieved from https://www.heart.org/en/health-topics/cardiovascular-disease [6] American Thyroid Association. (2016). Hypothyroidism and the elderly. Retrieved from https://www.thyroid.org/patients/thyroid-information/hypothyroidism/ [7] American Migraine Foundation. (2019). Migraine and bipolar disorder. Retrieved from https://americanmigrainefoundation.org/resource-library/migraine-and-bipolar-disorder/ [8] Substance Abuse and Mental Health Services Administration. (2018). Mental and substance use disorders among adults with serious mental illness. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_3103/ShortReport-3103.pdf
- Bipolar disorder increasingly poses a significant risk of addiction due to shared genetic factors and brain regions related to impulsivity and reward, as researchers suggest.
- Mental health conditions such as bipolar disorder and metabolic disorders like metabolic syndrome often co-occur, increasing the risk of health complications and exacerbating the course of the illness.
- In addition to mental health conditions, people with bipolar disorder are more likely to develop physical health complications, such as metabolic syndrome (obesity ~21%, diabetes ~14%), which contribute to cardiovascular disease risk and require close medical monitoring.
