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Bipolar Disorder

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What is Bipolar Disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes extreme shifts in a person’s mood, energy and ability to function. With this serious, chronic mental illness, common emotions become intensely and often unpredictably amplified. Individuals living with bipolar disorder can shift from opposite extremes – or “poles” ­ – of happiness, energy and clarity to sadness, fatigue and confusion. The periods of highs and lows are called episodes of mania and depression, and they can last from one day to months.

Cycles of high (manic) and low (depressive) are far different from typical ups and downs. Symptoms are so severe that they can lead to poor job or school performance, damaged relationships, and even suicide. Fortunately, it can be treated successfully, and many people with this disorder lead full, productive lives.

How Common is Bipolar Disorder?

According to the National Institute of Mental Health, approximately 5.7 million American adults – about 2.6 percent of the population age 18 and older – have bipolar disorder. Most often, it develops in late adolescence or early adulthood, but initial symptoms can emerge in childhood or not till later in life. Unfortunately, because of its irregular patterns, some individuals may suffer for years before it is properly diagnosed or treated. Bipolar disorder is equally prevalent in men and women.

Signs and Symptoms

Mania is a state of excessive energy and excitement, of being abnormally “revved up.” Someone in a manic state may have racing thoughts, talk too fast/too much, have little need for sleep, or believe they can do or accomplish anything. It can also be identified by extreme irritability, agitation and/or euphoria. On the other side, when an individual experiences symptoms of depression they feel extremely sad, hopeless and loss of energy. Bipolar disorder may also be present in a mixed state, in which one experiences both mania and depression at the same time.

Not everyone’s symptoms are the same and the severity of mania and depression can vary. Bipolar disorder can be present even when mood swings are less extreme. The bipolar spectrum includes people who experience hypomania, less severe than full-blown mania. Without proper treatment, people with hypomania may develop severe mania or depression.

What distinguishes bipolar disorder from other disorders such as depression is the occurrence of at least one episode of abnormal mood elevation such as mania or hypomania. People living with bipolar disorder typically struggle more during depressive episodes, which tend to be more frequent and last longer than manic or hypomanic episodes.

Manic episodes are characterized by:

  • Increased energy, activity and restlessness
  • Excessively high, overly happy, euphoric mood
  • Abnormal irritability and jumpiness
  • Racing thoughts, jumping from one idea to another
  • Intense imagination
  • Lack of concentration and distractibility
  • Minimal need for sleep
  • Overconfidence in one's abilities and powers
  • Engaging in reckless behaviors, such as impulsive sex or shopping sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs—cocaine, alcohol and sleep medications
  • Provocative, intrusive or aggressive behavior
  • Denial that anything is wrong

Depressive episodes are characterized by:

  • An extended sad, anxious or empty mood
  • A sense of hopelessness or helplessness
  • Loss of interest or pleasure in activities once enjoyed
  • Decreased amount of energy; feeling constantly tired
  • Being slowed down in movement, speech or thought
  • Inability to concentrate, remember or make simple decisions
  • Restlessness, agitation and/or irritability
  • Sleeping too much or inability to sleep
  • Change in appetite; unintended weight loss or gain
  • Chronic pain or other persistent symptoms not caused by physical illness or injury
  • Thoughts of death or suicide, or suicide attempts

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia. 

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Diagnosis

As with all types of illness, a physician must be seen to provide a proper diagnosis. After ruling out other illnesses, the doctor may recommend seeing a mental health professional, such as a psychiatrist.

Treatment

Bipolar disorder cannot be cured, but it can be treated effectively over the long term. It is important to recognize and diagnose the disorder in its earliest stages to receive optimal treatment. Effective treatment plans usually include medication, psychotherapy, education, self-management strategies and external supports such as family, friends and formal support groups. The best way to prevent relapses and reduce the severity of symptoms is to combine these elements and refine the treatment plan after assessing the individual’s response. Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

As a long-term, recurrent illness, bipolar disorder requires careful, ongoing management throughout one’s life. Proper treatment is very effective in stabilizing mood swings and related symptoms, even for those with the most severe forms. It is usually easier to control the disorder through continuous, preventive treatment. Maintaining a good relationship and communication with one’s physician may avert a full-blown episode.

Medications

Medications known as mood stabilizers are usually prescribed to help control bipolar disorder. Anticonvulsant and antipsychotic medications also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. While primary-care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Psychotherapy

When combined with medication, psychotherapy can be an effective treatment for bipolar disorder. It can provide support, education and guidance to people with bipolar disorder and their families. A licensed psychologist, social worker or counselor typically provides psychotherapy. He or she should work with the patient’s psychiatrist to track progress. The number, frequency and type of sessions are based on individual treatment needs.

Electroconvulsive Therapy (ECT)

For cases in which medication and psychotherapy do not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments.

Children and Adolescents with Bipolar Disorder

Both children and adolescents can develop bipolar disorder. Because it tends to run in families, it is more likely to affect the children of parents who have the illness, but most children with a family history of bipolar disorder will not develop the illness. Unlike many adults with bipolar disorder, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. What’s more, children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Like any illness, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. 

Co-occurring Conditions

Individuals with bipolar disorder are prone to other mental health problems, including substance abuse. When mired in depression, they may self-medicate symptoms with drugs and/or alcohol. During manic or hypomanic episodes, they may feel invincible and engage in risky behavior. However, it can become a vicious cycle, as mood symptoms are then triggered or prolonged by substance abuse. Therefore, any overall treatment plan should address the substance abuse as well as the bipolar disorder itself. 

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Sources:

National Institute of Mental Health

National Alliance on Mental Illness

American Psychological Association

The Kim Foundation

Psychology Today

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The information on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified mental health provider with any questions you may have regarding a medical condition. We do not recommend or endorse any specific tests, mental health providers, products, procedures, opinions, or other information that may be mentioned on this site. Reliance on any information provided herein is solely at your own risk.

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