What Is Bipolar Disorder?
Learn the signs and symptoms of bipolar disorder, distinctions between Bipolar I and Bipolar II, options for treatment, and where to find more resources.
Bipolar disorder is a serious mental illness that is characterized by extreme mood swings, abrupt changes in energy levels, and distorted decision making. In most cases, it develops in the late teens or early adulthood — though more and more experts now accept the existence of pediatric bipolar disorder — and it is estimated to affect about 5.7 million Americans, or approximately 2.6 percent of the population. Bipolar disorder doesn’t discriminate — it affects men and women at virtually equal rates, and the disorder is found among patients of all races, social classes, and ethnic groups.
Symptoms of Bipolar Disorder
Bipolar disorder is typically split into two alternating psychological phases: mania and depression — hence the use of the term “manic depression” 30+ years ago. Each phase generally lasts several weeks or more, but can vary based on the type of bipolar disorder and other contributing factors. Symptoms of the different phases of bipolar disorder can include, but are not limited to:
Manic phases, typically the less prevalent of the two, are characterized by:
- Feelings of euphoria (30% of manias) or severe irritability (70% of manias)
- Unusually high self-esteem
- Poor judgment regarding potentially risky behaviors
- Rapid speech — often to the point where the listener is unable to follow
- Behaving aggressively or too exuberantly
- Decreased need for sleep
- Dramatic boost in sex drive
- In very extreme cases, psychosis — breaking from reality — which can include delusions or hallucinations
Depressive phases, typically far more prevalent than manic phases, are characterized by:
- Feelings of sadness, hopelessness, and apathy
- Thoughts of suicide
- Extreme feelings of guilt and regret
- Sharp decrease in energy, sometimes described as “leaden paralysis”
- Distorted appetite — either noticeably increased or diminished
- Loss of interest in favorite activities
- Noticeably poor performance in work or school
- Frequent absences from work
Essentially, the mania phase of bipolar disorder is characterized by excessively energetic moods, restlessness, recklessness, and euphoria. During this time, a patient may engage in risky behaviors like impulsive sex, compulsive gambling, or lavish spending. The patient might feel like he’s on top of the world, as if nothing can hurt him. People with bipolar disorder often say they feel most creative during manic phases. If their energy remains relatively low (called a hypomania), a manic phase can lead to a burst of positive productivity.
Mania isn’t always a positive feeling, though. Only about 30 percent of manias feel good or euphoric; in the others, high energy can quickly turn to irritation, confusion, or excessive anger. The almost-compulsive need to take risks can lead to relationship problems, job difficulties, and, in some cases, problems with the law.
The depressive phase of bipolar disorder is the opposite. The patient feels uncharacteristically sad, anxious, and racked by guilt. Low energy leads to excessive time in bed and increased sleep. People have little or no interest in hobbies, friends, or daily activities. Depression occurs more often than mania, to the point that it requires only one episode of mania to secure a bipolar disorder diagnosis. Most of the episodes and impairments come from the depressed side of the condition.
Types of Bipolar Disorder
Bipolar disorder has several subtypes, but the most common are Bipolar I and Bipolar II. Bipolar I is characterized by intense depression and manias that, in some cases, require hospitalization if left untreated.
With Bipolar II, the patient experiences a constant, low-grade depression with episodes of mania, called hypomania. Hypomania causes moderate euphoria and increased productivity. In some cases, the patient may not even realize that he is acting abnormally. Bipolar II patients are often misdiagnosed with depression, since this is the symptom they feel most of the time.
A third type of bipolar disorder, known as cyclothymic disorder, is much less dramatic in nature and can usually be managed without medication. Over time, however, symptoms of cyclothymic disorder can get worse and lead to a diagnosis of Bipolar I or Bipolar II.
Bipolar disorder not otherwise specified (NOS) is a diagnostic category for someone who shows some symptoms of bipolar disorder, but doesn’t fit neatly into any of the three main categories.
Diagnosing Bipolar Disorder
Bipolar disorder is frequently missed or misdiagnosed, which can have disastrous (and long-term) consequences — some experts estimate that up to 30 percent of people with untreated bipolar disorder eventually commit suicide. Complicating this is the fact that bipolar disorder is not an easy diagnosis to make, and your doctor should not come to a medical conclusion lightly. Extensive questioning and an in-depth symptom history are always required — as well as honest and open communication between doctor and patient. Once a correct diagnosis is reached, however, treatment can help a patient regain balance and control of his life.
To make a proper diagnosis, you and your doctor should start by carefully tracking your symptoms — noting in detail their frequency, duration, timing, and severity. Your doctor will want to eliminate the possibility of any other related medical condition or another mental disorder like schizophrenia or ADHD.
If you suspect bipolar disorder, look into your family’s medical history, since the condition tends to run in families. Studies suggest that the risk of bipolar disorder is about 10 times higher in first-degree relatives of affected patients, as compared to the general population. First-degree relatives are also about three times more likely to have a major depressive disorder, suggesting overlapping genes between the two conditions.
Diligently tracking your mood may be a good start to uncovering a bipolar diagnosis. Mood-tracking smartphone apps, like iMoodJournal, can help those who suspect they have bipolar disorder easily keep track of their ups and downs. By noting the situations or locations where moods occur, app users can identify patterns and note possible triggers for shifts from mania to depression, or vice versa. The Depression and Bipolar Support Alliance (DBSA) also has an online mood-tracking tool. If you prefer low-tech solutions, write down your mood in a daily journal — just make sure you also note other symptoms like speech patterns, energy levels, and changes in sleeping habits.
Think about bringing a family member, spouse, or close friend along to the doctor’s appointment. He or she may be able to provide an objective view of your symptoms and any possible triggers. Major life changes (like losing a loved one, going to college, or going through a divorce) can trigger a dramatic mania or depression, eventually leading to a bipolar diagnosis. Other factors like stress, lack of sleep, drug and alcohol use, the last month of pregnancy, and seasonal changes can lead to an increased risk for a bipolar episode.
Treatment Options for Bipolar Disorder
The good news: Most cases of bipolar disorder are treatable and manageable. Treatments include medication, cognitive behavioral therapy, psychotherapy, and, in those rare cases when medications do not achieve control of the episode, electroconvulsive therapy.
Medication is the most universally effective option and is, therefore, the first step in most bipolar treatment plans. Bipolar medications stabilize moods and steady the seesaw of mania/depression — allowing you to return to your daily routine and to function more or less normally. The most commonly prescribed medication is lithium, a mood stabilizer that’s been used to treat bipolar disorder for more than 60 years. Experts are still not quite sure how lithium works, but the primary hypothesis is that it interacts with neurotransmitters in your brain that contribute to both mania and depression. Other medication options include benzodiazepines, antipsychotics, or anticonvulsants, though each come with their own side effects and varying rates of efficacy.
In many cases, medication is not enough to completely control the symptoms of bipolar disorder. This is where therapy comes in, to fill in the gaps and boost the overall effectiveness of your treatment plan.
Cognitive Behavioral Therapy (CBT) is a form of talk therapy that is most often used to treat bipolar disorder. It’s based on the principle that negative thought patterns affect the way we feel, behave, and process information. By challenging these thought patterns and helping patients iron out their view of the world, CBT aims to positively affect how we feel and act.
For the rare patients who don’t respond to medication or therapy, electroconvulsive therapy is often effective and life saving. Unfortunately, ECT carries a lot of historical baggage. Ask your doctor about ECT and how it’s done in the modern era. Do not research it on the Internet; most of what you will find is inaccurate.
It’s possible that your doctor will start you on a plan that relies solely on CBT. However, the combination of medication and therapy has been most effective over time at keeping bipolar symptoms under control. With proper treatment and support, bipolar people can function normally and live fulfilling lives.