Etiology

The exact cause of bipolar disorder is unknown. Experts believe there are a number of factors that work
together to make a person more likely to develop it.

These are thought to be a complex mix of physical, environmental and social factors.

Biological differences - people diagnosed with Bipolar Disorder have physical changes in their brain. The
significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics - It's thought bipolar disorder is linked to genetics, as it seems to run in families. It is commonly
inherited and 80% chance of acquiring it if an immediate family is diagnosed with BD. The family
members of a person with bipolar disorder have an increased risk of developing it themselves. But no
single gene is responsible for bipolar disorder. Instead, a number of genetic and environmental factors
are thought to act as triggers.

Socio Environmental Triggers

A stressful circumstance or situation often triggers the symptoms of bipolar disorder.

• the breakdown of a relationship

• physical, sexual, or emotional abuse
• the death of a close family member or loved one
• physical illness
• sleep disturbances
• overwhelming problems in everyday life, such as problems with money, work or relationships
• drugs or alcohol abuse
• These types of life-altering events can cause episodes of depression at any time in a person's life

Chemical Imbalance

There is some evidence that bipolar disorder may be associated with chemical imbalances in the brain.
The chemicals responsible for controlling the brain's functions are called neurotransmitters, and include
noradrenaline, serotonin and dopamine. There's some evidence that shows imbalances in the levels of
one or more neurotransmitters increase a person's risk in developing BD. For example, there's evidence
that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression
may be the result of noradrenaline levels becoming too low. Increase in epinephrine and nor
epinephrine causes mania and a decrease in epinephrine and nor epinephrine causes depression. Drugs
used to treat depression can potentially trigger mania.
Perinatal Factors - severe cycles of emotional states maybe more than just a postpartum moodiness. For
many women, pregnancy or postpartum might be the first time she realizes that she has bipolar mood
cycles. In pregnant and postpartum women, a bipolar depression can look just like a very severe
depression, or might be experienced as anxiety. It is very important that your mood history is reviewed
to assess whether you have had times of a persistently elevated mood, decreased need for sleep, and
periods of over-average productivity. There is a very high risk of increased severity if you are treated only
for depression, but have the potential to move into a manic or hypomanic part of your cycle.

Epidemiology

• It is commonly diagnosed in the teenage years or early 20s, specifically 17-21 y/o. It has an early
age onset but not detected right away.
• Bipolar disorder is equally prevalent in men and women with a gender ratio of 1:1.
• Subpopulation under bipolar disorder II such as dysphoric mania, mixed depressive episode,
winter depression is prevalent in women. But looking at the spectrum of depression-mania
continuum, the more depressive it is, the more it is prevalent in women.
• Rare cases of unipolar are markedly prevalent in men (manic episode without any major or
minor depression), meaning more on the manic side
• Lifetime prevalence of bipolar I disorder was lesser compare to bipolar II disorder. Bipolar I
disorder was found to be approximately 1%. Bipolar II disorder (major depression with
hypomania, but not with mania) is much higher lifetime prevalence rates of up to at least 5%,
were reported.