Teenagers pre-disposed to bipolar disorder have certain weak neural connections, says study

A study published this month in the ‘American Journal of Psychiatry’ has found that young people at high risk of developing bipolar disorder display weakening connections between certain regions of the brain in their late teens.

The study is particularly important when it comes to deciphering early intervention because it is during adolescence that the brain is making neural pathways stronger or letting them whittle away from underuse.

In the case of teenagers, as the metamorphosis from kid brain to adult brain is still under progress – it begins from the temporal lobe at the base of the brain and continues to the prefrontal cortex, which is involved with planning and personality development – teens may find themselves relying on the amygdala to make decisions and solve problems. This little spot is associated with emotions, impulses, aggression and instinctive behaviour, explains Australian parenting website raisingchildren.net.

The research paper, as per a press release published on the website Science Direct, found that in participants who had a high genetic risk of bipolar disorder, there was a distinct reduction in connectivity between areas of the brain devoted to emotion processing (which includes the amygdala) and cognition (prefrontal lobe) during the two years between scans. This gives the scientists hope when it comes to early intervention of those predisposed to those weakening links. Scientia Professor Philip Mitchell AM, a practising academic psychiatrist with University of New South Wales (UNSW) Medicine and Health, was quoted as saying in the release, "Our study really helps us understand the pathway for people at risk of bipolar.

"We now have a much clearer idea of what's happening in the brains of young people as they grow up."

Mitchell adds that he has seen the debilitating effect of a manic disorder first hand. "We see a lot of bright, capable kids really enjoying life and then bipolar disorder can be a huge impediment to what they want to achieve. With our new knowledge about what actually happens in the brain as at-risk teenagers approach adulthood, we have the opportunity to develop new intervention strategies to either stop the condition in its tracks, or reduce the impact of the illness."

What is bipolar mood disorder?

The disorder, which affects about 45 million people worldwide as per World Health Organisation estimates, sways a person from one extreme mood to another. “Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression),” explains US-based website Mayo Clinic.

“People who have manic attacks but do not experience depressive episodes are also classified as having bipolar disorder,” adds WHO on its website.

Dr Salsa Panambron, General Practitioner at NMC Royal Medical Centre - Karama Abu Dhabi, adds: “Bipolar disorder, as it suggests, human mood is swinging from the extreme happiness pole to extreme sadness without any definable cause. The period at one pole to another can take weeks sometime to months.”

Bipolar disorder, as it suggests, human mood is swinging from the extreme happiness pole to extreme sadness without any definable cause. The period at one pole to another can take weeks sometime to months.

- Dr Salsa Panambron

“During childhood, it’s really hard to diagnose as emotions are still in developing phase but if they show these cycles for a period of time, they may be bipolar.”

Types of bipolar disorder

There are three types of bipolar disorder, the experts agree:

American psychiatric association describes the three as:

Bipolar I disorder is diagnosed when a person experiences a manic episode. During a manic episode, people with bipolar I disorder experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood. Some people with bipolar I disorder also experience depressive or hypomanic episodes, and most people with bipolar I disorder also have periods of neutral mood.

A diagnosis of bipolar II disorder requires someone to have at least one major depressive episode and at least one hypomanic episode. People return to their usual functioning between episodes. People with bipolar II disorder often first seek treatment as a result of their first depressive episode, since hypomanic episodes often feel pleasurable and can even increase performance at work or school.

People with bipolar II disorder frequently have other mental illnesses such as an anxiety disorder or substance use disorder, the latter of which can exacerbate symptoms of depression or hypomania.

Cyclothymic Disorder is a milder form of bipolar disorder involving many "mood swings," with hypomania and depressive symptoms that occur frequently. People with cyclothymia experience emotional ups and downs but with less severe symptoms than bipolar I or II disorder.

Cyclothymic disorder symptoms include the following:

For at least two years, many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomanic or depressive episode.

During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.

Symptoms of the disorder

UAE-based Priory Group recently posted a list of symptoms on Instagram that point to someone suffering from the disorder. These include:

Mania and bipolar disorder

Depression and bipolar disorder

“It is important to look out for a pattern of extreme or unexpected behaviour and a strain on personal relationships, if you believe you or someone you know may have the disorder,” warned the centre.

What causes the disorder?

UAE-based Dr Ghulam Shabbir, Specialist Neurology Prime Hospital and Prime Medical Center, explains that the exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics. Bipolar disorder is more common in people who have a first-degree relative such as a sibling or parent with the condition. Research is still going on to find the genetic cause for the condition.

These people, who are predisposed to the condition, are subjects of the study by UNSW Sydney, the Hunter Medical Research Institute (HMRI), the University of Newcastle and other international institutions. Professor Michael Breakspear, who led the team at Hunter Medical Research Institute (HMRI) and the University of Newcastle that carried out the analysis of the dMRI scans, said in a statement: “The relatives of people with bipolar disorder - especially the siblings and children - often ask about their own future risk, and this is a question of high personal concern …. This study is an important step in having imaging and genetic tests we can perform to help identify those likely to develop bipolar disorder, before they develop disabling and stressing symptoms of the disorder.”

“The significant finding of our study is that there is progressive change in the brains of young people with risk of bipolar which suggests how important intervention strategies might be," added Prof. Mitchell.

"If we can get in early, whether that's training in psychological resilience, or maybe medications, then we may be able to prevent this progression towards major changes in the brain."

How can we treat it?

Dr Shabbir explains that bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include, he says:

Medications. Often, you'll need to start taking medications to balance your moods right away.

Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.

Day treatment programmes. Your doctor may recommend a day treatment programme. These programmes provide the support and counselling you need while you get symptoms under control.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms.

- Dr Ghulam Shabbir

Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.

Hospitalisation. Your doctor may recommend hospitalisation if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilise your mood, whether you're having a manic or major depressive episode.

“The primary treatments for bipolar disorder include medications and psychological counselling (psychotherapy) to control symptoms, and also may include education and support groups,” he adds.

Have a topic you'd like us to discuss? Write in to parenting@gulfnews.com