Bipolar Disorder

What Is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.

The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there).

"Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes.

Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.

Are There Different Types of Bipolar Disorder?

There are a few types of bipolar disorder, including:

Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks.

Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.

Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.

"Unspecified" or "other specified" bipolar disorder (formerly called "bipolar disorder not otherwise specified") is now used to describe conditions in which a person has only a few of the mood and energy symptoms that define a manic or hypomanic episode, or the symptoms may not last long enough to be considered as clear-cut "episodes."

Rapid cycling is not a type of bipolar disorder, but a term used to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues.

What Are the Symptoms of Bipolar Disorder?

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

How severe it gets differs from person to person and can also change over time, becoming more or less severe.

Symptoms of mania ("the highs"):

Excessive happiness, hopefulness, and excitement

Sudden changes from being joyful to being irritable, angry, and hostile

Restlessness

Rapid speech and poor concentration

Increased energy and less need for sleep

Unusually high sex drive

Making grand and unrealistic plans

Showing poor judgment

Drug and alcohol abuse

Becoming more impulsive

Less need for sleep

Less of an appetite

Larger sense of self-confidence and well-being

Being easily distracted

During depressive periods ("the lows"), a person with bipolar disorder may have:

Sadness

Loss of energy

Feelings of hopelessness or worthlessness

Not enjoying things they once liked

Trouble concentrating

Forgetfulness

Talking slowly

Less of a sex drive

Inability to feel pleasure

Uncontrollable crying

Trouble making decisions

Irritability

Needing more sleep

Insomnia

Appetite changes that make you lose or gain weight

Thoughts of death or suicide

Attempting suicide

What Are the Causes of Bipolar Disorder?

There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.

For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.

What Are Bipolar Disorder Risk Factors?

When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.

Men and women are equally likely to get it. Women are somewhat more likely than men to go through "rapid cycling," which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.

Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes.

A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders.

Some things that make you more likely to have bipolar disorder include:

Having a family member with bipolar disorder

Going through a time of high stress or trauma

Drug or alcohol abuse

Certain health conditions

Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.

How Is Bipolar Disorder Diagnosed?

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.

Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

If you have just been diagnosed with bipolar disorder, you might feel frightened. The future may seem terribly uncertain. What will this mean for your life, your family, and your job?

But getting an accurate diagnosis is actually good news. It means you can finally get the treatment you need. People with bipolar disorder usually go about 10 years before being accurately diagnosed.

Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.

If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.

What Are the Treatments for Bipolar Disorder?

Bipolar disorder can be treated. It's a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.

Treatment can make a huge difference. With a combination of things -- good medical care, medication, talk therapy, lifestyle changes, and the support of friends and family -- you can feel better. Bipolar disorder -- or manic depression, as it is also still sometimes called -- has no known cure. It is a chronic health condition that requires lifetime management. Plenty of people with this condition do well; they have families and jobs and live normal lives.

Medication

Medication is the main treatment, usually involving the following:

Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium, or valproate (Depakote)

Antipsychotic drugs, such as cariprazine (Vraylar), lurasidone (Latuda), olanzapine (Zyprexa), and quetiapine (Seroquel)

Antidepressants

Antidepressant-antipsychotic drugs, a combination of an antidepressant and a mood stabilizer

Anti-anxiety medications or sleep medicines, such as sedatives like benzodiazepines

It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.

Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take.

Psychotherapy, or "talk therapy," is often recommended, too. There are several different types. Options can include:

Interpersonal and social rhythm therapy (IPSRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.

Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.

Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.

Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode.

Other treatment options for bipolar disorder can include:

Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.

Acupuncture. There’s some evidence that this complementary therapy may help with the depression caused by bipolar disorder.

Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example, their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.

Lifestyle changes may also help:

Get regular exercise.

Stay on a schedule for eating and sleeping.

Learn to recognize your mood swings.

Get support from friends or groups.

Keep a symptom journal or chart.

Learn to manage stress.

Find healthy hobbies or sports.

Don’t drink alcohol or use recreational drugs.

Bipolar Disorder Outlook

Bipolar disorder can make you feel utterly alone. But that really isn't the case. More than 2 million adults in the U.S. are coping with bipolar disorder right now.

It's important not to blame yourself for your condition. Bipolar disorder is a physical illness, not a sign of personal weakness. It's like diabetes, heart disease, or any other health condition. Nobody knows what causes bipolar disorder, but for many people, it is a very manageable condition.

The important thing is to focus on the future. Living with bipolar disorder can be tough. But don't let it hijack your life. Instead, take action and regain control of your health. With dedication and the help of your health care providers, you can feel better again.

For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.

Ongoing treatment is more effective than dealing with problems as they come up.

The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.

Bipolar Disorder and Suicide

Some people who have bipolar disorder may become suicidal.

Learn the warning signs and seek immediate medical help for them:

Depression (changes in eating, sleeping, activities)

Isolating yourself

Talking about suicide, hopelessness, or helplessness

Acting recklessly

Taking more risks

Having more accidents

Abusing alcohol or other drugs

Focusing on morbid and negative themes

Talking about death and dying

Crying more, or becoming less emotionally expressive

Giving away possessions

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