My recovery from manic depression has been an evolution, not a sudden miracle. – Patty Duke
What is Bipolar Disorder?
Bipolar Disorder is a mood disorder sometimes called manic-depressive illness or manic-depression, that characteristically involves cycles of depression and elation or mania. The moods can shift from high to low rapidly, or over the course of days or weeks with intervals of “normal” moods in between. These cycles are much more severe than the mood swings that everyone goes through.
Bipolar disorder often develops in the late teen or early adult years. It may be difficult to detect the onset of bipolar disorder, as the symptoms may appear to be separate problems, not pieces of a larger problem. Many people with bipolar disorder suffer for years before they are properly diagnosed.
People who have bipolar disorder experience distinct and intense emotional states called “mood episodes.” Mania is an overly joyful or excited mood, whereas a sad, hopeless state is a depressive episode. Sometimes, a mood episode contains symptoms of both mania and depression, which is called a “mixed state.”
These mood episodes bring extreme changes in energy, activity, sleep, and behavior. The signs and symptoms of depressive and manic states are described in further detail below.
What Causes Bipolar Disorder?
Doctors aren’t entirely positive what causes bipolar disorder. We do know that bipolar disorder often runs in families – children with a parent or sibling with bipolar disorder are 4-6 times more likely to develop bipolar disorder. There’s growing evidence that environmental and lifestyle choices may also have an effect on bipolar disorder.
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. Researchers are trying to find genes that may be involved in causing bipolar disorder.
Risk Factors for Bipolar Disorder:
Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:
Bipolar disorder tends to run in families. Children with a parent or sibling with the disorder have a higher chance of developing it than those without affected family members.
Identical twins don’t have the same risk of developing the illness. It’s likely that genes and environment work together in the development of bipolar disorder.
Sometimes a stressful event or major life change triggers a person’s bipolar disorder. Examples of possible triggers include the onset of a medical problem or the loss of a loved one. This kind of event can bring about a manic or depressive episode in people with bipolar disorder.
Drug abuse might trigger bipolar disorder. An estimated 60 percent of individuals with bipolar disorder are dependent on drugs or alcohol. People with seasonal depression or anxiety disorders may also be at risk for developing bipolar disorder.
Functional magnetic resonance imaging (fMRI) and positron emission technology (PET) are two types of scans that can provide images of the brain. Certain findings on brain scans may be associated with bipolar disorder. More research is needed to see how these findings specifically impact bipolar disorder and what this means for treatment and diagnosis.
Periods of high stress, such as the death of a loved one or other traumatic event may increase the risk of developing bipolar disorder.
Signs and Symptoms of Bipolar Disorder:
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.
What Are The Signs of a Depressive State?
While the following symptoms are not all experienced by each individual with bipolar disorder, these are the most common signs of a depressed state in an individual with bipolar disorder:
- Sadness and anxiety
- Loss of energy
- Feelings of guilt, hopelessness, or worthlessness
- Loss of interest or enjoyment from things that were once pleasurable
- Difficulty concentrating
- Uncontrollable crying
- Difficulty making decisions
- Increased need for sleep
- Change in appetite causing weight loss or gain
- Thoughts of death or suicide
- Attempting suicide
What Are The Signs of Mania?
Mania is much much more than just having extra energy to burn. It’s a mood disturbance that makes you abnormally energized, both physically and mentally. Mania can be severe enough to require you to be hospitalized.
Mania occurs in people with bipolar I disorder. In many cases of bipolar I, manic episodes alternate with periods of depression. However, people with bipolar I don’t always have depressive episodes.
As with any illness, the symptoms a person may experience during a manic episode vary dramatically. Here are some of the more common examples of manic behavior for those who have bipolar disorder:
- Excessive happiness, hopefulness, and excitement
- Sudden changes from being joyful to being irritable, angry, and hostile
- Restlessness, increased energy, and less need for sleep
- Rapid talk, talkativeness
- Easily distracted
- Racing thoughts
- High sex drive
- Tendency to make grand and unattainable plans
- Tendency to show poor judgment, such as deciding to quit a job
- Inflated self-esteem or grandiosity — unrealistic beliefs in one’s ability, intelligence, and powers; may be delusional
- Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)
What is Hypomania?
Hypomania is a mild-to-moderate level of mania, which includes symptoms similar to the signs of mania as listed above but tend to be less extreme. Those with bipolar disorder with hypomanic features may be misdiagnosed, as those with hypomania may attribute their elevated mood with happiness.
Hypomania is a milder form of mania. If you’re experiencing hypomania, your energy level is higher than normal, but it’s not as extreme as in mania. Other people will notice if you have hypomania. It causes problems in your life, but not to the extent that mania can. If you have hypomania, you won’t need to be hospitalized for it.
Hypomanic episodes may include the following symptoms:
- Periods of time with an especially energetic mood.
- Feeling more self-confident than normal.
- Being very talkative or speaking faster than usual.
- Feeling hyper.
- Having a hard time concentrating.
- Being more irritable or angry.
- Needing less sleep than normal.
- Having more interest in sex.
- Uncharacteristic spending sprees.
In severe cases, the person may think about ending their life, and they may act on those thoughts.
Psychosis can occur in both manic and depressive episodes during which a person may be unable to differentiate between fantasy and reality. Such as they may believe during a “high” that they are famous, or have high-ranking social connections, or that they have special powers. During a depressive episode, they may believe they have committed a crime or that they are ruined and penniless.
Symptoms of psychosis may include delusions, which are false but strongly felt beliefs, and hallucinations, involving hearing or seeing things that are not there.
Signs and symptoms of bipolar I and bipolar II disorders include other features, such as anxious distress, melancholy, psychosis, or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.
Children and teenagers with bipolar disorder are more likely to have temper tantrums, rapid mood changes, outbursts of aggression, explosive anger, and reckless behavior.
These features must be episodic rather than chronic to receive a diagnosis of bipolar disorder.
It is possible to manage all these symptoms with appropriate and consistent treatment
Types of Bipolar Disorder:
Bipolar I Disorder:
Defined primarily by manic or mixed episodes that last at least seven days or by manic symptoms so severe they require immediate hospitalization. Generally, someone with Bipolar I also has depressive episodes lasting two or more weeks. The symptoms of depression and the symptoms of mania must be a major change in normal behavior. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
Bipolar II Disorder:
Bipolar II Disorder is a mood disorder characterized by one or more periods of depression and at least one episode of hypomania, which is a milder high than the mania experienced with Bipolar Disorder.
Because they’re milder, hypomanic episodes can often go unrecognized and as a result, Bipolar II Disorder is often misdiagnosed as depression. Several studies have found that the risk of suicide is higher for those with Bipolar II than Bipolar I Disorder, likely because it’s often not diagnosed and therefore not treated properly.
However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania. A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from.
Between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives.
Cyclothymia is a mild form of bipolar disorder, in which two episodes of hypomania alternate with episodes of mild depression for at least two years. The symptoms of a person with Cyclothymic Disorder do not meet the diagnostic criteria for other types of bipolar disorder. With cyclothymia, you experience periods when your mood noticeably shifts up and down from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat down. Between these cyclothymic highs and lows, you may feel stable and fine.
Although the highs and lows of cyclothymia are less extreme than those of bipolar disorder, it’s critical to seek help managing these symptoms because they can interfere with your ability to function and increase your risk of bipolar I or II disorder.
Cyclothymia symptoms alternate between emotional highs and lows. The highs of cyclothymia include symptoms of an elevated mood (hypomanic symptoms). The lows consist of mild or moderate depressive symptoms.
Cyclothymia symptoms are similar to those of bipolar I or II disorder, but they’re less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you’re going to feel.
Treatment options for cyclothymia include talk therapy (psychotherapy), medications and close, ongoing follow-up with your doctor.
Rapid-Cycling Bipolar Disorder:
four episodes of major depression, mania, hypomania or mixed symptoms within a year. Some people with Rapid-Cycling Bipolar Disorder have one or more episodes a week or even a day. This seems to be a more common form of bipolar disorder in those who have severe bipolar disorder and may be more common in those who were diagnosed with bipolar disorder at a young age.
Bipolar Disorder NOS (Not Otherwise Specified)
In general, Bipolar NOS is most commonly ascribed when a mood disorder is characterized by depression alternating with short episodes of hypomania (a milder form of mania). Oftentimes, the mood swings are rapid, occurring within days of each other. By and large, children and adolescents are most frequently diagnosed with NOS as they will be least likely to have a previous history of mood dysfunction.
From a psychiatric standpoint, bipolar disorder NOS is taken just as seriously as any other form of mood disorder. The presumption is that there is a problem and that it will be likely to be definitively diagnosed in the future. By assigning the NOS diagnosis now, the person will be less likely to slip through the cracks should another mood episode occur.
There are no specific criteria as to when a doctor should make a bipolar NOS diagnosis. That said, the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the APA does provide examples as to when it may be appropriate:
- The person has experienced alternating manic or depressive symptoms, but the episodes are too short to meet the criteria for inclusion.
- The person has experienced both hypomania and depression, but the episodes are too short to qualify as a cyclothymic disorder.
- The person may have had multiple episodes of hypomania but no depressive episode.
- The person has had a manic or mixed episode after having been previously diagnosed with either schizophrenia or a psychotic episode.
- The person meets the criteria for bipolar disorder, but the doctor is concerned that the symptoms may be caused by recreational drugs, alcohol, or a neurological disorder.
How Often Do People With Bipolar Disorder “Cycle?”
Some people can cycle from depressed to manic in a matter of hours but for most, the cycle is a few weeks apart. Every patient is different and the cycles and signs/symptoms manifest in different ways.
A cycle is the period of time in which an individual goes through one episode of mania and one episode of depression (or hypomania and depression). As for how often these cycles occur, there is, unfortunately, no definitive answer.
The frequency and duration of cycles are as varied as the individuals who have them. A study in 1992 found that 35 percent of people with bipolar disorder had only one cycle in a 5-year period, while 1 percent of the same group went through a complete cycle about every 3 months. On average, people with bipolar will have one or two cycles yearly. In addition, there is a seasonal influence—manic episodes occur more often in the spring and fall.
This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.
Triggers in Bipolar Disease
Certain conditions are known to trigger symptoms in people with bipolar disease. Understanding these triggers—and avoiding them—can minimize symptoms and limit the number of cycles a person experiences. These include:
- Insufficient amounts of sleep
- Altercations with loved ones
- Alcohol and drug misuse
- Certain antidepressants and other medications
- A change in seasons
- Pregnancy and other hormonal conditions
- Grief over the death of a friend or family member
Possible Complications of Bipolar Disorder:
When you struggle with bipolar disorder, you may be euphoric and highly energetic one day, and anxious and sad the next. Because people with bipolar disorder bounce back and forth between manic and depressive symptoms, it can cause problems that affect every aspect of their lives. Though some people can find themselves extremely productive and creative in the manic phase, more often they are affected by distorted thinking and impaired judgment that can lead to further issues.
Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:
- Substance abuse
- Legal problems
- Financial problems or crises
- Relationship troubles
- Isolation and loneliness
- Promiscuous behavior
- Poor work or school performance
- Missed work or school
- Problems related to drug and alcohol use
- Suicide or suicide attempts
- Damaged relationships
- Poor work or school performance
Oftentimes, Bipolar Disorder is accompanied by another serious mental illness.
The combination (or the conditions alone) can sometimes lead to angry or violent behavior and, in some cases, even suicide. These disorders include:
- Depression, a generalized state of apathy, hopelessness or sadness
- Anxiety disorders, such as generalized anxiety disorder, panic disorder, paranoia, phobias, and post-traumatic stress disorder (PTSD)
- Attention-deficit hyperactivity disorder (ADHD), which can often be confused with bipolar disorder symptoms, especially in children, or can coexist with bipolar disorder
Many of the problems and conditions associated with bipolar disorder, such as drug and alcohol abuse, can often worsen symptoms of the disease. Some people find themselves suffering from guilt or low self-esteem following their behaviors when they are in the depressed phase of the condition. Understandably, this can be a troubling issue not just for patients, but for those around them who may be affected, including friends, family members, and co-workers.
How Is Bipolar Disorder Diagnosed?
The best way to be properly diagnosed with bipolar disorder is through talking with a doctor or psychiatrist, who will perform a screening and full work-up to determine a diagnosis. Keeping track of patterns in mood and overall mood are the most critical diagnostic tools. Those who have bipolar disorder are more likely to seek treatment during a depressive state rather than a manic state. It’s critical that a full medical history is sought before being diagnosed as simply “depressed.”
To determine if you have bipolar disorder, your evaluation may include:
- Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
- Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
- Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
- Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
How Is Bipolar Disorder Treated?
Once a diagnosis of bipolar disorder has been made, a treatment plan will be formed. Generally, treatment for bipolar disorder involves medication (typically a “cocktail” of medications of various types) and talk therapy will typically help bring some sense of normalcy. Learning coping mechanisms is invaluable.
Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, a social worker, and a psychiatric nurse.
Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:
- 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 programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
- 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.
- Hospitalization. Your doctor may recommend hospitalization 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 stabilize your mood, whether you’re having a manic or major depressive episode.
The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.
Proper treatment of bipolar disorder is imperative for those who struggle with bipolar disorder, as it can help control mood swings and other symptoms.
Bipolar disorder is a life-long illness, so treatment will be long-term to manage and control symptoms of the disorder.
Medications to Treat Bipolar Disorder:
Many people with bipolar disorder have to try a number of medications before a combination is found that controls the symptoms. These may include:
- Mood stabilizers. You’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
- Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
- Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
- Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep but are usually used on a short-term basis.
Living With Bipolar Disorder:
Like liver disease or diabetes, Bipolar Disorder is a chronic condition. With the help of loved ones and proper treatment, those who have Bipolar Disorder can live healthy, happy and rewarding lives.Here are some tips for living with bipolar disorder:
Make healthy choices: The first and most important thing a person with bipolar can do for him or herself is to learn to make healthy choices to minimize the symptoms and take control of your life. Healthy choices begin with medication and proper supervision by a therapist.
Proper symptom management: With proper symptom management, you will learn to hope again, you will learn to feel good and well, and that you’re able to cope with the high highs and low lows of bipolar disorder.
Become an advocate for yourself: no one knows you like, well, you. So advocate for proper treatment and take an active role in your treatment. Don’t be afraid to tell your therapist and treatment team if something isn’t working for you. Speak up. Ask questions. Advocate, advocate, advocate.
Research: Learn everything you can about bipolar disorder and examine how bipolar disorder affects you. This is a major component of treating bipolar disorder.
Be patient: while you’re ready to feel normal again, patience is key. Often finding a proper treatment, or finding a treatment that works for YOU, takes patience, time and energy. It’s okay to be frustrated by this, but frustration isn’t a reason to stop treatment.
Proper medication: follow your medication regime as it was prescribed to you. Don’t stop taking it without first talking to your doctor about your decision.
Therapy is your BFF. While medication can even out mood and manage the symptoms of bipolar disorder, therapy can help teach you proper coping techniques.
Keep tabs on your moods and your feelings: You may find it helpful to keep a “mood diary” to watch for patterns. It’s vital to watch your moods as they swing and learn about the things that trigger a manic or a depressive episode. Common triggers include:
- Financial problems
- Changing of the seasons
- Fighting with a loved one
- Lack of sleep
Turn to friends and family for support. It may be hard and shameful to admit that you have a mental illness, but the support and comfort offered by friends can make a world of difference.
Support group: Find and attend a support group for people who have bipolar disorder. Not only are these groups excellent for meeting others who have the same disorder, but you can also compare coping strategies.
Build new relationships and friendships: try community activities, emailing old friends, going out for coffee with a loved one. Social isolation and loneliness can make the mood swings of bipolar disorder worse.
Build structure into your life. Developing and following a routine (making sure it includes eating, sleeping, exercise, work, relaxing, and hanging out with friends) can really provide stability in your life.
Bedtime: make sure to go to bed at the same time each night – lack of sleep can lead to mania and it’s healthy for your body to get the proper amount of sleep it needs to function.
Reduce stress: cut off any excess stress in your life. Stress can trigger both mania and depression in those with bipolar disorder, and chances are, there’s a way to minimize some of the stress as well as developing some effective coping mechanisms for the unavoidable stresses.
Avoid self-medication: don’t self-medicate with drugs or alcohol. Many of legal AND illegal drugs can trigger episodes of mania and depression.
My Loved One Has Bipolar Disorder:
Even though only 3 percent of the population is diagnosed as bipolar, chances are you will know someone who is. The best way to handle this is to realize that they simply have brain chemicals that aren’t exactly lined up right.
As long as they are not harmful to themselves or others, simply treat these people as you would any other person. However, the highs and lows can be difficult for those who are in daily contact with the person. There are support groups and books that will be of help finding coping skills for partners of Bipolar patients. A good therapist for caregivers is never a bad thing.
It’s vital to support your bipolar loved one as he or she goes through treatment.
Be understanding – no one was born wanting to be bipolar. If your loved one is undergoing treatment, be patient and understanding as he or she adjusts to new medications.
It’s no one’s fault that your loved one has bipolar disorder.
Encourage your loved one to seek professional help. Bipolar disorder is much more manageable for those who seek – and stick with – treatment.
Accept his or her limits – episodes of mania and depression are not something that your bipolar loved one can simply control or snap out of.
Accept your own limits, too. You can’t make someone who has bipolar disorder go to treatment – recovery is in the hands of your loved one.
Find – and attend – a support group for people with bipolar disorder. Go with your loved one and ask questions.
Learn all that you can about bipolar disorder – it may explain a lot of those behaviors your loved one copes with.
Additional Bipolar Disorder Resources:
Mood Tracker is a great tool for tracking shifts in moods as well as monitoring how much sleep the patient is getting, medications they are taking, and levels of anxiety and irritability.
“How to Survive When They’re Depressed: Living and Coping with Depression Fallout” by Anne Sheffield – A must-have book for someone living with a spouse or partner who battles depression and/or bipolar disorder. This book will completely change your outlook on life and how life should look when living in a house with someone with mental illness.
Depression and Bipolar Support Alliance has education and research materials, information
Page last audited 8/2018