What You Need To Know About Bipolar Disorder

What is bipolar disorder?

The term "bipolar" refers to having two extremities, in this case, manic and depressive episodes. Formerly referred to as manic depression or manic depressive illness, the National Institute of Mental Health describes bipolar disorder as a mental problem with severe episodes of high and low moods, as well as changes in energy, behavior, sleep, and thinking.

Although everyone experiences mood swings, bipolar disorder involves a chronic mental health condition with extreme mood changes lasting several days, weeks, or even months.

According to the National Alliance on Mental Illness (NAMI), over 10 million people in the United States have bipolar disorder, accounting for nearly 2.8% of the general population.

Types of bipolar disorders

Although each type of bipolar disorder results in mood and energy level cycles, the two types of the disorder have their unique characteristics that differ depending on the intensity and duration of mood changes.

Type I bipolar disorder

Bipolar I disorder is considered a "standard" condition characterized by manic and depressive episodes lasting at least seven days. A manic episode often involves an extremely elevated or irritable mood. It includes increased energy, racing thoughts, rapid speech, and increased self-esteem.

A person with bipolar I may have episodes of depression or symptoms of psychosis during depressive or manic episodes. Psychosis entails losing contact with reality, leaving an individual unsure of what's real and what's not.

Common symptoms of psychosis include perceptions, where a person believes untrue things or sees or hears non-existing things. Generally, manic and depressive episodes affect a person's behavior and mood.

Type II bipolar disorder

Bipolar II disorder also involves changes in mood characterized by episodes of hypomania, which is a state of feeling increased energy, irritability, or exhilaration. Hypomania is less severe than mania because the person can typically carry on with their normal, daily functioning. Hypomania is also different from mania because there is no psychosis in hypomanic episodes.

People with bipolar II experience these periods of hypomania that last at least 4 days.  Although it is less severe than in bipolar I, depressive episodes also occur for people with bipolar II.

Cyclothymic disorder

Symptoms of cyclothymic disorder are different from bipolar I and II but involve symptoms of both depression and hypomania. Also referred to as cyclothymia, cyclothymic disorder involves changes between symptoms of depression and mania. A person with cyclothymia often experiences many periods of hypomania and depression for at least 2 years, and the person is never without symptoms for more than 2 months at a time.

Statistics

About 2.8% of US adults are diagnosed with bipolar disorder every year, with a global population of over 46 million people having the condition.1 Among the different mood disorders, people with bipolar disorder experience the highest likelihood of "severe" impairment (82.9%). Regarding gender, the prevalence of bipolar disorder is similar in both females (2.8%) and males (2.9%).¹

Generally, the first symptoms are displayed at 25 years old. People between 18–29 years old have the highest rates of developing the condition (4.7%), followed by those between 30–44 years old (3.5%). Patients aged 60 years and older have the lowest rates of developing the condition (0.7%).²

Symptoms

A person may be diagnosed with the disorder at 25 years old, but symptoms can appear during the teenage years. Like most mental health illnesses, bipolar disorder affects both males and females equally. However, it may vary in severity from person to person. With the right treatment and support, people with the condition often live productive and full lives.

Generally, people with bipolar disorder experience mania and depression symptoms at different periods of the episode. Yet, symptoms vary between individuals as some people may experience several episodes within one year, while others may have only one episode per year. Some people can go even longer in between episodes.

Bipolar disorder can affect sleep, concentration, self-esteem, and appetite. Some people with the disorder may experience physical health problems, for instance, heart attacks, migraines, or high blood pressure.

Mania or hypomania symptoms

Mania and hypomania entail elevated mood changes, but mania is relatively more intense than hypomania. Common symptoms include:

  • Impaired judgment

  • A feeling of distraction or boredom

  • Involvement in risky behaviors without a care for consequences

  • Sleeplessness, but without a feeling of tiredness

  • A sense of exhilaration or euphoria

  • Talking rapidly

  • Underperforming in school or at work

  • Heightened irritability and aggression

  • Having unrealistic plans or irrational thinking

  • Drug and alcohol abuse

  • Increased sense of well-being and self-confidence

  • Grandiosity

  • Decreased appetite

  • Becoming more impulsive

  • Excessive happiness, excitement, or hopefulness

Depressive symptoms

Typical symptoms of a depressive episode ("the lows") are:

  • Insomnia and other sleep issues

  • A sense of despair, hopelessness, and gloom

  • Irritability

  • Chronic listlessness, tiredness, and fatigue

  • Eating less or more

  • Feelings of guilt that may be misplaced

  • Physical problems or pain, which is unresponsive to treatment

  • Extreme sadness

  • Problems focusing and remembering things

  • Difficulty enjoying interests or activities that often give pleasure

  • Weight loss or weight gain

  • A sense of anxiety over minor issues

  • Urge for more sleep

  • Difficulty making decisions

  • Uncontrollable crying

  • Death or suicidal thoughts

  • Attempting suicide

Complications of bipolar disorder

Bipolar disorder can result in prolonged and extreme mood changes if left untreated. For instance, manic episodes can last for up to four months, while bipolar-related depression episodes can last for six months without ongoing treatment. A person with bipolar disorder who does not receive treatment may experience higher risks of the following:

  • Suicidal thoughts

  • Anxiety

  • Substance abuse

  • Physical health problems, such as weight gain and cardiovascular conditions

These complications also require treatment, which is typically provided at the same time as bipolar disorder treatment and support, to allow an individual to live a healthier and more productive life. For people with extreme complications, an ongoing treatment plan can help manage the disorder and its effects.

Causes

Like most mental health conditions, the precise cause of bipolar disorder remains unknown. However, researchers are studying how some factors can trigger the condition. These include a combination of physical, social, and environmental factors, including emotional stress.

Biological differences

A person with bipolar disorder may have physical changes in the brain. While the significance of these changes is not entirely known, it does help researchers investigate possible causes.

Genetics

If one person in a family has bipolar disorder, one or more other family members can be more likely to develop the condition. However, the exact genes that cause the disease remain unknown among researchers.

Risk factors for developing bipolar disorder

Although the precise cause of bipolar disorder remains unknown, certain risk factors increase the risk of developing bipolar disorder. These risk factors can trigger the first episodes of mania or depression, leading to chronic mood changes. These risk factors include:

Change in brain structure and functioning

The general structure and function of the brain differ from person to person suffering from bipolar disorder. Researchers suggest that the way neurotransmitters interact with neurons may play a role in contributing to the development of the condition.

Existing mental health issues

People with other mental conditions are more likely to develop bipolar disorder, especially when their conditions go untreated for long periods of time. Depression, anxiety, and emotional stress can lead to mental conditions that can trigger bipolar disorder in some people.

Genetics

Some people may develop bipolar disorder originating from family history. Suppose you have one or more family members, mainly a parent or sibling, diagnosed with bipolar disorder. This places you at a higher risk of developing the condition. According to researchers, several genes may result in bipolar disorder, but the specific gene remains unknown.

When and at what age bipolar disorder usually develops

Most cases of the first symptoms of bipolar disorder commence when a person is between 15–19 years old. However, most people experience severe symptoms of the condition between 20–24 years old. 

Diagnosis

If you or a loved one is experiencing extreme mood changes, it is essential to seek support or medical help. A mental health professional can determine whether you have bipolar disorder. A professional will ask various questions, such as how your moods affect your daily life, the duration of your mood changes, and its severity.

Diagnosing bipolar disorder calls for various health examinations, including physical, mental, and lab tests, to determine if you are suffering from another medical condition that could be causing symptoms. An assessment of your mental state will eventually determine if you have bipolar disorder or not. Here are some evaluations you may undergo during your diagnosis.

Physical exam

A physical exam, together with lab tests, can determine if you have underlying issues causing your symptoms. The intent is to rule out physical problems as the possible cause of your mental health concerns.

Psychiatric evaluation

Your psychiatrist conducts a thorough psychiatric assessment to understand your feelings, behaviors, and thought patterns. This may include a psychological self-assessment or questionnaire to determine your mental state. Sometimes, your psychiatrist may need a family member or friend to offer more information regarding your symptoms with your permission.

The DSM-5 criteria

Your psychiatrist may compare symptoms you are experiencing using criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is a manual published by the American Psychiatric Association used to assess and diagnose mental disorders.¹

  1. DSM-5 | American Psychiatric Association

Treatments

Bipolar disorder is a long-term problem that requires ongoing care for treatment to be effective. However, people experiencing four or more episodes yearly or those with drug and alcohol problems can have a more complex case that is harder to treat. Bipolar disorder treatment involves continuous medication, psychological therapy, and lifestyle changes to treat the condition effectively. The following are ways to treat bipolar disorder:

Medication

Several drug treatments exist to help stabilize your mood and manage bipolar disorder symptoms. A doctor may prescribe a combination of drugs to help manage the condition. Generally, a combination of these drugs can help treat bipolar disorder:

  • Mood stabilizers, like lithium

  • Antidepressants

  • Anticonvulsants to manage mania

  • Drugs to assist with anxiety and sleep

  • Second-generation antipsychotics (SGAs)

Over time, the prescribing doctor may alter medications depending on the recovery process of the patient. Some drugs have side effects that may affect individuals differently, so it is essential to consult your doctor if you experience severe side effects.

Psychotherapy and counseling

Psychotherapy and counseling are among the most effective ways to help patients with bipolar disorder relieve their symptoms and manage the condition. Cognitive behavior therapy (CBT) and other approaches can help an individual achieve the following:

  • Realize and take necessary steps to manage critical triggers, like emotional stress

  • Identify initial symptoms of mania or depression episode and take steps to manage it

  • Consider elements that maintain a stable mood for longer, like socializing, sleeping, and exercising

  • Get help from family members, colleagues, teachers, and other supportive people

Family therapy comes in handy for young people with bipolar disorder to help them manage the condition more effectively.

Hospital treatment

For people with severe bipolar disorder symptoms, a doctor may recommend hospital treatment, especially those at the risk of harming themselves or others or intending to commit suicide. If medication, therapy, or other treatment options fail, a doctor may suggest electroconvulsive therapy (ECT) to help manage the condition.

Lifestyle remedies to help manage bipolar disorder

Some lifestyle remedies exist to help manage bipolar disorder symptoms and maintain a stable mood. Common lifestyle changes that can help treat depressive and manic episodes include:

  • Maintaining a routine