Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a mental health condition where people alternate between having an elevated mood (mania) and depression. Manic episodes are when people have high energy and feel very happy. They don’t need to sleep, and have risky behaviors. In depressive episodes, people feel very sad, don’t feel any joy, and lack energy. In the past, bipolar disorder was known as manic depressive disorder.

There are three main types of bipolar disorder. They vary based on if the mania or depression occurs more often and on how severe the symptoms are.

• Bipolar disorder I: Periods of intense mania with some periods of depression, or having mania and depression at the same time.
• Bipolar disorder II: Periods of depression and periods of less intense mania (called hypomania). This is less disruptive to a person’s life.
• Cyclothymic disorder: Periods of low mood with hypomania.

Symptoms often start during the teen or young adult years. It is a lifelong illness. If untreated, symptoms can harm friendships, relationships, and work life. But with the right treatments, including therapy and medication, people can live a healthy, stable life.

What is a person with bipolar disorder like?

Bipolar disorder is different for everyone. But most people have episodes of a depressed mood and episodes of mania. These often last weeks or months. Some people may only have a few mood episodes during their entire life. Others may have several per year.

It’s important that you work with your doctor to find the right diagnosis so it’s not mistaken for depression or other conditions. Certain medications (like high-dose steroids) and substance use (like cocaine) can cause similar symptoms.

Main symptoms of manic episodes

During a manic episode, most people feel extra happy, they may feel agitated or irritable, and have a lot of energy. A manic episode typically has at least three of the following:

• Very high self-esteem or grandiosity—feel like they are very important, talented, or powerful.
• Feel extremely hopeful and optimistic.
• Less need for sleep—waking up well-rested after only a few hours of sleep.
• Much more talkative—sometimes talking so fast it can sound like babbling.
• Racing thoughts—thoughts may jump from one topic to another without a clear connection.
• Easily distracted—attention is quickly pulled away from a task or thought by another thought or activity.
• Very goal-directed—suddenly driven to take care of tasks in your work or education.
• Random, constant movement—can’t sit still, pacing, tapping toes or fingers.
• Risky behavior—Not recognizing dangerous or harmful actions like going on shopping sprees, gambling (including investments), reckless driving, or engaging in high-risk sexual activities.

People with bipolar disorder II or cyclothymic disorder may have hypomanic episodes, where the symptoms of mania are less intense.

Main symptoms of depressive episodes

People feel sad, not able to experience pleasure, and hopeless. During a depressive episode, someone will experience at least five of the following:

• Changes in eating, either more or less hungry than usual—causing weight loss or gain.
• Changes in sleep patterns—having a hard time falling asleep or staying asleep (insomnia); sleeping more than usual (hypersomnia).
• Feeling agitated or moving slowly.
• Fatigue or low energy nearly every day.
• Excessive feeling of guilt or worthlessness.
• Not able to focus or make decisions.
• Thoughts of death—feeling that life is not worth living; suicidal thoughts.

Mixed episodes are not clearly manic or depressive. Instead, they have symptoms of both. There is a much higher risk for suicide during mixed episodes.

Other symptoms you may have

While these symptoms are not part of the diagnosis, some people experience one or more during a manic episode.

• Dressing colorfully or flamboyantly.
• Acting authoritatively.
• Very strong religious feeling or belief.
• Not recognizing that their behavior is out of the ordinary.
• Reduced pain sensitivity—people do things that normally cause pain yet they don’t feel it as intensely.
• Problems with relationships.
• Feeling like others are not treating them fairly.
• In extreme cases, paranoia and hallucinations.

Long-term complications

Without treatment, bipolar disorder can lead to unstable relationships and divorce, legal and financial problems, and job loss. It can also lead to alcohol and drug abuse, and suicide attempts. There is also an increased risk of diabetes, heart disease, and obesity.

Next steps

If you think you might be in a manic state, are having suicidal thoughts, or having a hard time taking care of yourself, call 911 or go to the emergency room. You might be admitted to the hospital for a short time to make sure you don’t harm yourself and to treat symptoms. You will meet with a psychiatrist to get the right diagnosis and treatments.

If you are feeling depressed or hypomanic but are not having suicidal or paranoid thoughts, see a mental health provider. They can help diagnose you and create a plan for treatment.

Risk factors for bipolar disorder

Like most mental health illnesses, why someone develops bipolar disorder involves many factors. Symptoms usually start in the teens or young adulthood.

• Family history: If a family member—especially a parent or sibling—has bipolar disorder or schizophrenia, you have a higher risk. About half of people with bipolar disorder have a family member with the condition.
• Stressors: Usually the first episode is triggered by a stressful life event, though what is stressful varies from person to person.

Treatment for bipolar disorder

Treatment includes medications and psychotherapy (talk therapy). Psychiatrists (doctors who treat mental health issues) prescribe medications and psychologists or other mental health professionals provide therapy. Medications are extremely helpful, especially when in the middle of a manic or depressive episode. They must be taken as prescribed to lower the risk of having another episode.

There are different kinds of medications for bipolar disorder—stabilizers, antipsychotics, antidepressants, and benzodiazepines. Your doctor will choose the medications that are best for your symptoms, medical history, and lifestyle.

Talk therapy can help you identify and change negative feelings, thoughts, and behaviors. It can help you deal with stress and create healthy routines. You can also learn how to manage symptoms so you are less likely to have a relapse.

If you have severe symptoms, you may need to be hospitalized to keep you safe. In extreme cases, when symptoms have not improved despite trying different medications, the doctor might recommend electroconvulsive therapy (ECT). This is a procedure where your brain is shocked with small electrical currents while you’re under anesthesia.

Prevention

If you have a family history of bipolar disorder or schizophrenia, talk to your doctor about it. They can help you understand symptoms to watch for and steps you can take to reduce your exposure to stressors.

If you’ve been diagnosed with bipolar disorder, you can help reduce the risk of episodes by taking your medications and continuing to see your psychiatrist and therapist. Speak to your doctors if you have any concerns about the medications. It also helps to live a healthier lifestyle. You’ll feel more stable and happy, mentally and emotionally.

• Watch out for warning signs of another episode. Keep a mood journal. And have a friend or family member keep track of when your mood and behaviors change. If you can see the early warning signs of an episode, you’ll have fewer hospitalizations and have a more stable daily life.
• Don’t drink alcohol or take drugs. Sometimes, alcohol, tobacco, and other substances feel like they’re helping in the short term. But they can make symptoms worse overall.