Bipolar disorder, formerly called manic-depressive disorder or manic depression, is a common mental illness that can be severe and persistent. It causes a person to experience extreme highs and lows in their mood. With 4.4 percent of American adults experiencing bipolar disorder at some point in their lives, the medical community has come a long way in understanding the illness and its impact on a person’s energy level, activity, concentration and ability to carry out day-to-day tasks. Fortunately, it is possible to screen, diagnose and treat the symptoms of this disorder.

What is Bipolar Disorder?

As bipolar disorder is a brain disorder that greatly impacts a person’s mood and overall disposition, people who have bipolar disorder may find it difficult to manage their daily life. Whether it’s struggling to complete small, menial tasks at work, or maintaining close relationships in their personal lives, everyday situations pose a real challenge. There are three types of bipolar disorder and each range in severity and duration. For instance, depression caused by bipolar disorder typically lasts at least two weeks, but some individuals will have several depressive episodes and mood changes each year, while others rarely experience these shifts.  It is important to note that bipolar episodes can occur during pregnancy or even change with the seasons.

Bipolar Disorder Symptoms

There are three main symptoms that occur with bipolar disorder — episodes of mania, hypomania, and depression. While mania and hypomania are two different types of episodes, both feature the same slate of symptoms. The key difference between them is that mania is more severe than hypomania and causes more noticeable problems, including potentially triggering a break from reality (psychosis) that requires hospitalizations.

Manic & Hypomanic Episode Symptoms

Both manic and hypomanic episodes include three or more of the below symptoms:

  • Talking much more than usual 
  • Racing thoughts
  • Being distracted
  • Feeling the need for less sleep
  • Feeling abnormally upbeat, jumpy or wired
  • Increased activity levels, energy or agitation
  • Inflated sense of well-being and self-confidence 
  • Poor decision-making and increased impulsive behavior

Major Depressive Episode Symptoms

The third symptom of bipolar disorder is depression, which can severely impact a person’s daily life. A person is experiencing a major depressive episode if they are experiencing five or more of the following symptoms:

  • Severe loss of interest or feeling no pleasure in normal activities 
  • Noticeable weight loss when not trying to lose weight, weight gain, or changes in appetite 
  • Feeling sad, empty, hopeless, or teary all the time. In children/teens, this depressed mood can present as irritability 
  • Sleeping too much or not being able to sleep, as with insomnia
  • Having less energy or always feeling tired 
  • Feeling worthless or overly guilty 
  • Struggling to concentrate or make decisions 
  • Feeling suicidal or having suicidal thoughts
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While bipolar disorder can cause a person to feel depressed, this condition is not the same as getting diagnosed with depression. Bipolar disorder is marked by periods of two extremes: Mania or hypomania, the “up,” and major depressive episodes, the “down.” In contrast, depression causes moods and emotions that are always “down” without any moments of high energy.

Bipolar Disorder Causes and Risks

While the exact causes of bipolar disorder are unknown, there are a few factors that play a role, including:

  • Genetics — Bipolar disorder is more common in people who have a first-degree relative with the condition, such as a parent or sibling, and researchers continue to search for the genes that are involved in causing bipolar disorder. But just because you have family members with a history of bipolar disorder, does not mean that you will develop it. Most people who have bipolar disorder in their family history will never actually develop this mental health disorder.
  • Brain structure — There are biological differences for those that have the disorder, including physical changes to their brains. Any abnormalities in the structure or functions of your brain may increase the risk for bipolar disorder.
  • Environmental factors — Beyond your own biology and family history, environmental can contribute too. 
  • Other — Extreme stress, traumatic experiences, and physical illnesses can also influence who develops bipolar disorder. 

Types of Bipolar Disorder

According to the National Institute of Mental Health, there are three types of bipolar disorder, and all types involve very clear changes in mood. Generally speaking, moods can range from moments of extreme elation, or “up,” and periods of irritability and hopelessness, or “down.” It is important to note that bipolar II is not a “milder” form of bipolar I. Both require their own diagnosis, and while the manic episodes may not be as severe and dangerous with bipolar II disorder, there may be longer episodes of depression that cause significant harm.

The main types of bipolar disorder include:

Bipolar I disorder

Bipolar I is defined by at least one manic episode that lasts a minimum of seven days or by manic symptoms severe enough that the person needs immediate hospital care. In this instance, depressive episodes may occur as well, typically lasting at least two weeks. Episodes of depression, with mixed depressive symptoms and manic symptoms at the same time, are also possible.

Bipolar II disorder

This type of bipolar disorder takes shape as a pattern of depressive episodes and hypomanic episodes, but doesn’t include the severe manic episodes that can inhibit function characteristic of bipolar I disorder. People who have this type of bipolar disorder experience one major depressive episode that lasts at least two weeks.

Cyclothymic disorder (also called Cyclothymia)

This type of bipolar disorder is defined by cyclic periods of hypomanic symptoms as well as periods of depressive symptoms that last for at least two years (or one year in children and adolescents). However, the symptoms do not meet bipolar test requirements for a hypomanic episode or depressive episodes.

There are other signs and symptoms of bipolar I and bipolar II disorder that can include anxious distress, melancholy, and psychosis. Depending on the timing of these symptoms, a person may be diagnosed with mixed episodes or rapid cycling.

How to Diagnose Bipolar Disorder

Bipolar disorder can be difficult to diagnose because an individual’s mood swings can vary. And yet, the longer it goes untreated, the worse the disorder can get as episodes may happen more frequently or become more extreme.

As mentioned, a diagnosis of bipolar I requires a person to have either one or more manic episodes or mixed (manic and depressive) episodes. Bipolar II, on the other hand, involves one or more depressive episodes and at least one episode of hypomania. 

If a person is experiencing symptoms of bipolar disorder, it is important to see a licensed healthcare professional. Seeking professional help ensures that the person will get an accurate diagnosis and receive correct, individualized  treatment. The right treatment for bipolar disorder can make it possible for a person to lead a healthy and productive life. 

The evaluation for bipolar disorder is examined through several tests and exams and may include:

  1. Physical examination
    • A doctor may complete a physical exam as well as lab tests to determine any extenuating medical problems that could be contributing to your symptoms.
  2. Psychiatric assessment
    • A medical professional may refer you to a psychiatrist, who will talk to you about your thoughts, feelings, and behavior patterns. You may also be asked to complete a bipolar test via a psychological self-assessment. With your permission, family members or close friends may also be asked to provide information about your symptoms.
  3. Mood charting
    • If the doctor thinks that your behavioral changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. Keeping a daily record of your moods, sleep patterns, and other relevant information in a journal can help with finding the right treatment.
  4. Criteria for bipolar disorder
    • During a bipolar assessment, a psychiatrist may compare an individual’s symptoms with the criteria for bipolar and related disorders in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the DSM-5, bipolar disorder is described as “a group of brain disorders that cause extreme fluctuation in a person’s mood, energy, and ability to function.”

While the diagnosis of children and teenagers with bipolar disorder includes the same criteria as that of adults, symptoms will often have different patterns and not fit into the same diagnostic categories. Children who have bipolar disorder are also usually diagnosed with other mental health conditions such as ADHD or other behavioral problems. In these instances, a doctor’s referral to a child psychiatrist with experience in bipolar disorder is needed.

Bipolar Disorder Treatments

Since bipolar disorder is a lifelong mental health condition, treatment options focus primarily on managing symptoms. Treatment for bipolar disorder should only be determined by medical doctors with support from a psychologist and possibly a licensed therapist or social worker. The primary treatments after a diagnosis include medications and psychotherapy to control symptoms. According to the National Institute of Mental Health, common treatments can include:

Medications for Bipolar Disorder

Psychiatry

Psychiatric treatment from a licensed prescriber

Certain medications help with managing symptoms of bipolar disorder. Psychopharmaceuticals, for example, are used to help balance mood and can be used immediately after diagnosis. Some treatment plans may target sleep and anxiety, while others may seek to treat depressive episodes. This process may take some time, and a person might need to try several different medications before finding the ones that work best. Before starting a medication, it is important to:

  • Understand the risks and benefits of the medication
  • Report side effects to your doctor right away
  • Tell the doctor about any other prescription drugs, over-the-counter medications, or supplements being taken 

Once prescribed, the medication shouldn’t be stopped without first consulting a health care provider first. Medications for bipolar disorder are meant to be taken consistently, as prescribed, even once a person starts feeling better. If an individual stops taking a prescribed medication, it may actually lead to a worsening of bipolar symptoms. 

Depending on a person’s situation and unique needs, in addition to medications, symptoms of bipolar disorder can be managed with the following treatment options:  

  • Day treatment —  Day treatment programs are able to offer the necessary support for the individual as they work to control their symptoms.
  • Continuous treatment — Bipolar disorder may require lifelong treatment along with medication even when a person feels better. Skipping any kind of maintenance treatment can result in a relapse of symptoms and may result in depression or symptoms of mania. 
  • Hospitalization — If a person is behaving dangerously, psychiatric treatment at a hospital can help keep the individual calm and safe while stabilizing their mood during a manic or major depressive episode.

Bipolar Disorder Therapies

Talk therapy, or psychotherapy, can be an effective part of a person’s treatment plan. This form of treatment entails a variety of therapeutic techniques that help a person spot and change unwanted emotions, thoughts, and behaviors. It provides education, support, and a roadmap for those struggling with bipolar disorder. After seeking a diagnosis, talk therapy can become a vital part of treatment and can include several types of therapy, including:

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Interpersonal and social rhythm therapy (IPSRT)

This type of therapy focuses on the idea that a consistent routine allows for better mood management. A therapist will work with an individual to stabilize daily rhythms such as sleeping, exercise, and eating.

Cognitive behavioral therapy (CBT)

The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can be a valuable way to identify what triggers bipolar episodes.

Psychoeducation

Learning about bipolar disorder can help a person and their loved ones better understand the condition and guide them in identifying issues, making a plan to prevent relapse, and sticking with treatment.

Family-focused therapy

Community support and communication can help a person stick with their treatment and better manage the warning signs of possible mood swings.

There is still more research to be done surrounding when and how intensive therapy and treatment can best have an impact on bipolar disorder. Much of the discussion pertains to whether early interventions may be able to prevent or limit full-blown episodes.