Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorder, once called manic depression, is a mood disorder characterized by extreme, uncontrollable mood swings. These mood changes include emotional highs like mania or hypomania (less extreme than mania) and emotional lows like depression.

Episodes of depression or mania may happen rarely or several times a year. While some patients experience mood swings during specific events like season changes, most episodes occur without a cause.

What do Bipolar Mood Swings Feel Like?

Bipolar depression may cause people to feel sad or hopeless, losing interest or pleasure in most activities. In extreme cases, individuals with bipolar depression may even wish to harm themselves or have suicidal feelings. Bipolar mania, on the other hand, causes feelings of euphoria, high energy, and unusual irritability.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy, or unusually irritable.

These mood swings can negatively affect:

• Sleep
• Energy
• Activity
• Judgment
• Behavior
• and the ability to think clearly

Episodes of mood swings may occur less or more often, depending on the complexity of the individual.  While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. Most times, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Types of Bipolar Disorder

Bipolar disorder features several types and related disorders. Each type may include mania (or hypomania) and depression. These symptoms can cause unpredictable mood and behavior changes, resulting in significant distress for the patient and their loved ones.

The most common types include Bipolar I, Bipolar II, cyclothymic disorder, and symptoms caused by certain drugs or conditions.

Bipolar I Disorder

During the mania portion of the Bipolar I mood swing, the individual will seem excessively cheerful, euphoric, and high energy. These characteristics can cause the person to be unusually chatty, enthusiastic, and willing to take big risks with their personal, professional, and/or romantic life.

Patients typically have one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In severe cases, mania may trigger psychosis and/or hospitalization.

Bipolar II Disorder

Bipolar II differs in that patients have one major depressive episode and at least one hypomanic episode but have never had a manic episode. The depressive episode will last at least 2 weeks, and the hypomanic episode will occur for at least 4 days.

The depressive episode in this type of bipolar disorder will be lengthier and more frequent than any depression experienced in someone with bipolar I. Bipolar depression may be more treatment-resistant than the depression experienced in clinical depression disorders.

Cyclothymia (Cyclothymic Disorder)

The mood shifts in cyclothymia often don’t reach the same extremes as bipolar disorders, but symptoms can still interfere with daily life. People with cyclothymia must have at least two years—or one year in children and teenagers—of multiple periods of hypomania symptoms and depressive symptoms to receive this diagnosis.

The symptoms of mood disturbances will be present for almost every day over a two-year period with no more than 2 months of being “symptom-free.” This diagnosis is often partnered with substance use disorders and sleep disorders.

Other Types of Bipolar Disorder

For some patients, bipolar and related disorders can be induced by certain drugs or alcohol. Medical conditions, such as Cushing’s disease, multiple sclerosis, or strokes, can also cause bipolar or similar symptoms.

Symptoms of Bipolar Disorder

The experience of bipolar individuals often involves an uncontrollable switch back and forth between extremely high moods (mania) and extremely low moods (depression). Certain events, seasons, health changes, or nothing can trigger this switching.

Aside from the well-known highs and lows of mania and depression, some people also experience lesser-known mixed episodes and rapid cycling. People experiencing a mixed episode may have symptoms that meet the criteria for both mania and depression simultaneously. Rapid cycling occurs when a patient experiences four or more distinct episodes of depression, mania, mixed state, or hypomania in a 12-month interval.

Mania and Hypomania Symptoms

While episodes of mania and hypomania may be described as high-energy or extreme happiness, the experience can quickly spiral into a serious disconnection from reality and dangerous behavior.

Both mania and hypomania are two distinct types of episodes. Mania typically brings more severe symptoms such as impairment in their social life, inability to maintain or keep a job, and will potentially require hospitalization. The major difference between mania and hypomania is the duration of the symptoms. Mania normally lasts about 1 week, and hypomania lasts around 4 days.

Both types of episodes include three or more of these symptoms:

• Abnormally happy, jumpy, or wired
• Increased activity, energy, or agitation
• An exaggerated sense of self-confidence and feelings of euphoria
• Decreased need for sleep
• Unusual and excessive talkativeness
• Racing thoughts and highly distractible
• Poor decision-making, like going on shopping sprees, taking sexual risks, or making foolish investments
• Hallucinations and delusions

Major Depressive Episodes

Bipolar depression sometimes comes after a period of mania, sometimes seen as a “crash” after the emotional highs. Like major depression, the symptoms of bipolar depression can interfere with work, school, relationships, and basic tasks.

A bipolar episode includes five or more of these symptoms:

• Depressed mood and feelings of sadness, emptiness, or hopelessness (depressed mood can appear as irritability in children and teens)
• Marked loss of interest or feeling no pleasure in all or almost all activities
• Significant weight loss, weight gain, or decrease or increase in appetite (failure to gain weight as expected can be a sign of depression in children)
• Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate
• Thinking about, planning, or attempting suicide

How Does Bipolar Disorder Develop?

Although the cause of bipolar disorder is still unknown, research shows that a combination of genetics and biological differences could be responsible. Individuals with bipolar have physical changes in their brains, thought to lead to these cycles of emotional imbalance.

The disorder can be inherited and is more common in people who have a first-degree relative with the condition.

Research from the Semel Institute for Neuroscience and Human Behavior (University of California) shows that genetic factors account for about 60 to 80 percent of bipolar disorder causes.

In fact, according to research from The Black Dog Institute, if one parent has bipolar disorder, there’s a 10% chance that their child will develop the illness. If both parents have bipolar disorder, the likelihood of their child developing bipolar disorder rises to 40%.

Risk Factors for Bipolar Disorder

The most common factors for increased risk of developing bipolar disorder include having a first-degree relative with bipolar disorder, periods of high stress or trauma, or substance abuse. A sudden, major life change or tragedy, such as the death of a loved one or a physical injury, can also trigger the onset. The onset of bipolar disorder typically occurs during one’s teenage years or early twenties. This is known as the age of major change, decision-making, and adapting to new environments.

There is a significant risk of suicide for all individuals who struggle with the emotional rollercoaster of Bipolar disorder. According to the DSM IV, of all the completed suicides, individuals who have been diagnosed with Bipolar disorder may account for one-quarter of them.

The rate of suicide in Bipolar II disorder is slightly higher than those with Bipolar I because of the persistent depression they experience.

How Common is Bipolar Disorder?

About 2.8 percent of the adolescent and adult U.S. population have bipolar disorder, according to the National Institute of Mental Health.

Studies from Mental Health America show that about 1 in 40 American adults live with bipolar disorder, 1% of which are teenagers. Unlike many other mental illnesses, bipolar disorder affects men and women equally.

Common Comorbidities and Related Conditions

Bipolar disorder has some common comorbidities to look out for. In addition, some existing conditions can worsen bipolar disorder symptoms or make treatment less successful. The symptoms of mania can lead to substance use disorders, and the symptoms of depression may cause anxiety and/or eating disorders.

Common bipolar disorder comorbidities and related conditions include:

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug problems
• Physical health problems, such as heart disease, thyroid problems, headaches, or obesity

Bipolar Disorder and Addiction

Bipolar patients tend to have high rates of addiction.

In fact, according to the United States National Epidemiologic Survey on Alcohol and Related Conditions, people with Bipolar Type I Disorder are 5.8 times more at risk for a substance use disorder diagnosis during their lifetime, based on criteria in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). This risk increases 2.3 times, even after adjusting for other psychiatric comorbidities.

This statistic is by no means saying that all bipolar people will develop an addiction. And because the risk of addiction may be high for individuals with bipolar, preventative measures can be valuable to avoid problems in the future.

Keep an eye out for the warning signs of addiction, especially when experiencing mania, and check in with loved ones if you’re concerned about your elevated risk when in the presence of drugs and alcohol or even when considering certain medications.

Bipolar Disorder Diagnosis & Treatment

If you suspect that you or someone you love has bipolar disorder, getting a diagnosis and starting treatment might seem intimidating.

However, decades of research have gone into understanding and treating bipolar treatment, so a mental health professional can help you obtain a diagnosis and guide you through your options for managing symptoms.

Diagnosis of Bipolar Disorder

Diagnosis typically involves a psychiatric assessment with a licensed mental healthcare provider and a complete family history of existing disorders. It sometimes will include a physical exam to rule out other medical issues.

Some providers may recommend mood tracking to help identify patterns and to determine if the patient meets the DSM-5 criteria for the disorder.

How is Bipolar Disorder Treated?

As a lifelong condition, bipolar patients will require some level of treatment and management for the rest of their lives. While this may sound disheartening, it’s important to remember that many patients enjoy fulfilling, happy lives once finding a combination of medication and therapy that best suits them.

The common treatment for bipolar includes a combination of medications and psychotherapy, most often in the form of Cognitive Behavioral Therapy (CBT). This therapy helps the patient target destructive or problematic thought processes and learn how to make them more positive and productive.

The key to treatment is finding stability! It is important to learn how to manage their symptoms by predicting their mood swings and having healthy coping mechanisms. Patients need to have their “toolbox” of coping skills, mindfulness techniques, and resources ready to go at all times.

The most common types of medications used to treat bipolar disorder include:

• Mood stabilizers
• Antipsychotics
• Anti-depressants
• Anti-anxiety medications

Patients will usually receive a mood stabilizer to help lessen the severity of mood episodes, like manic and depressive cycles. Frequently used mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal).

For bipolar patients who experience psychosis, antipsychotics like olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help.

While antidepressants can treat symptoms of bipolar disorder, they may also trigger manic episodes when taken without a mood stabilizer. Some anti-depressants can also help with anxiety, and commonly used anti-anxiety medications like benzodiazepines and buspirone.

The most common issue health professionals see when treating a patient with bipolar disorder is their lack of consistency when taking their medication. Most individuals find it easy to take their medication while in a depressed mood or state. Still, their desire to take their medication during a manic or hypomanic state is much less significant. The heightened mood and confidence will cause the individual to feel that they no longer need their medication or want to take it because they may feel ‘on top of the world.’

Finding Treatment for Bipolar Disorder

Despite the stigma surrounding bipolar disorder, millions of people with the condition have found treatment options that suit their unique situation and enjoy all the amazing experiences life has to offer.

Because bipolar can cause much suffering when undiagnosed and untreated, it’s important to find the help you or a loved one needs as soon as problems arise.

Don’t wait until the situation becomes dangerous—many mental health providers are waiting and ready to help you improve your day-to-day life.