When we talk about bipolar disorder (BD), we’re referring to a mental health condition marked by drastic changes in mood (mood swings), energy and activity levels, and performance in day-to-day life. These episodes may occur several times a year or rarely. BD was formerly called manic depression, as it involves alternating periods of mania and periods of depression.
Here’s some introductory information about bipolar disorder.
Three Types of Bipolar Disorder
There are three different types of BD:
- Bipolar I disorder is characterized by manic episodes that last for seven days or longer or manic symptoms that are so severe that hospitalization is required. Episodes of depression usually occur too, and last for at least two weeks
- Bipolar II disorder involves a pattern of mildly manic (hypomanic) episodes and depressive episodes, but the mania doesn’t reach the same level of severity as in BDI. However, depressive episodes generally last longer than in BDI. For this reason, BPII isn’t considered a less severe form of BPI; it’s a distinct diagnosis.
- Cyclothymic Disorder (cyclothymia) is defined by periods of hypomania and periods of depressive symptoms lasting for two years or more in adults (1 year in children and teens). However, the symptoms don’t meet the diagnostic criteria for hypomanic or depressive episodes.
Signs and Symptoms of Bipolar Disorder
The signs and symptoms of bipolar disorder vary to some extent among different individuals, and they also vary in severity, frequency, and duration. The hallmark symptom, however, are alternating periods of extreme opposing moods, energy level, activity level, and ability to concentrate and complete tasks. These are referred to as “mood episodes.”
The symptoms of mood episodes typically last all day, every day for the duration of the episode, which generally range from a day or two to several weeks.
Common symptoms of manic episodes include:
- Feeling very up, high, wired, energized, euphoric, etc.
- Increased irritability
- Difficulty sitting still, jumpiness
- Decreased need for sleep
- Decreased appetite
- Racing thoughts and/or increased distractibility
- Speaking quickly and/or about many topics
- Trying to do multiple things at the same time
- Exercising poor judgment
- Engaging in reckless or high-risk behavior
- Inflated sense of power, importance, talent, well-being, etc.
Common symptoms of depressive episodes include:
- Feeling very down, sad, empty, hopeless, etc.
- Low energy levels
- Trouble concentrating or making decisions
- Excessive sleeping or difficulty sleeping
- Increased or decreased appetite; weight gain or weight loss
- Sluggish thoughts and/or speaking
- Feeling useless, unable to do things, etc.
- Loss of interest in socializing, activities, etc.
- Little to no sex drive
- Inability to experience pleasure (anhedonia)
- Thoughts of death or suicide
Sometimes, a person may experience manic and depressive symptoms at the same time. This is referred to as an episode with mixed features. A common way this manifests is that a person experiences feelings of deep sadness, emptiness, hopelessness, etc. while still having unusually high energy levels.
Diagnosing Bipolar Disorder
Getting an accurate diagnosis from a mental health professional is essential to managing bipolar disorder. Most often, BD is diagnosed in late adolescence or early adulthood. As is the case with many mental health conditions, it’s difficult to diagnose BD in children. They often exhibit different symptoms and patterns of behavior and don’t match diagnostic criteria well.
Diagnosis may begin with a physical exam and lab testing to rule out underlying conditions that could account for the symptoms a person is experiencing.
A licensed mental health professional, such as a psychiatrist, psychologist, or clinical social worker, completes a mental health evaluation. They consider the patient’s symptoms, experiences, and medical history to make a determination whether the diagnostic criteria for bipolar disorder have been met, as defined in the Diagnostic and Statistical Manual of Mental Disorders.
During the process of seeking a diagnosis, the patient may be asked to keep daily records of his or her mood, energy level, activities, sleep, and other aspects of daily life.
Treating Bipolar Disorder
There’s no cure for bipolar disorder, which is a lifelong condition, but it can be successfully managed once the right mix of therapies have been found for a particular person. It generally takes some trial and error to find the right medications, dosages, and other therapies that work best in any individual case while minimizing side effects.
Common treatments for bipolar disorder include:
- Mood stabilizer medications (e.g., lithium,valproic acid, divalproex sodium, carbamazepine, lamotrigine)
- Antipsychotic medications (e.g., olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, asenapine)
- Anti-anxiety medications (e.g., a benzodiazepine for short-term management of certain symptoms)
- Antidepressant-antipsychotic medications (e.g., fluoxetine-olanzapine)
- Psychotherapy (e.g., talk therapy, interpersonal and social rhythm therapy, cognitive behavioral therapy, family-focused therapy)
- Day treatment programs are sometimes necessary to get symptoms under control; hospitalization is sometimes used when a patient’s doctor believes they’re acting dangerously or may hurt themselves or someone else
- Electroconvulsive therapy (ECT), which involves a series of safe brain-stimulating procedures performed under general anesthesia
- A healthy diet and regular exercise are important lifestyle factors in managing bipolar disorder
If You’re Having Suicidal Thoughts
Some people with bipolar disorder are at risk of suicide.
If you are having thoughts of suicide or self-harm, please immediately call the National Suicide Prevention Hotline at 1-800-273-TALK (1-800-273-8255) or the National Hopeline Network at 1-800-273-TALK (1-800-273-8255).