Symptoms of Bipolar Disorder
Bipolar disorder has three episode types: mania, hypomania, and major depression. Mania and hypomania share the same symptoms but differ in severity — mania is more intense, can trigger psychosis, and may require hospitalization.
Manic & Hypomanic Episode Symptoms
Three or more of the following must be present:
- Talking much more than usual
- Racing thoughts
- Being easily distracted
- Feeling the need for less sleep
- Elevated mood: feeling abnormally upbeat, jumpy, or wired
- Increased activity, energy, or agitation
- Inflated sense of well-being and self-confidence
- Poor decision-making and increased impulsive behavior
Major Depressive Episode Symptoms
Five or more of the following must be present:
- Severe loss of interest or pleasure in normal activities
- Weight or appetite changes
- Persistent sadness, emptiness, or hopelessness (in children/teens, may present as irritability)
- Sleeping too much or too little
- Low energy or constant fatigue
- Feeling worthless or excessively guilty
- Difficulty concentrating or making decisions
- Suicidal thoughts or ideation
Types of Bipolar Disorder
- Bipolar I: Requires one or more manic or mixed episodes.
- Bipolar II: One or more depressive episodes plus at least one hypomanic episode — no full manic episodes. Not a milder form of Bipolar I; may involve longer depressive periods.
- Cyclothymic Disorder: Cycling depression and hypomania that doesn’t reach full episode severity.
Bipolar Disorder in Children & Teens
Can occur in children as young as 6, though most often diagnosed in older teens and adults. Symptoms often present differently than in adults. Co-occurring conditions (ADHD, anxiety, substance abuse) are common.
Manic Episode Signs in Children
- Intense happiness, rapid talking, short temper or irritability
- Difficulty sleeping without feeling tired; racing thoughts
- Risky behavior; difficulty staying focused
Depressive Episode Signs in Children
- Increasing anger or hostility; frequent unexplained sadness
- Excessive sleep; physical complaints (stomachaches, headaches)
- Feelings of hopelessness or worthlessness; concentration difficulties
- Changes in eating habits; thoughts about death or suicide
Diagnosis is made by a doctor or psychiatrist assessing moods, energy, behavior, and sleep — there is no blood test or brain scan. Treatment typically combines therapy, medication, or both.
Causes of Bipolar Disorder
The exact causes are unknown.
- Genetics: More common in people with a first-degree relative with the condition. Family history increases risk but does not guarantee development.
- Brain structure: Physical changes and abnormalities in brain structure or function may increase risk.
- Environmental factors: Factors beyond biology and family history can also contribute.
- Extreme stress, trauma, and physical illness: All can influence who develops bipolar disorder.
Treatment for Bipolar Disorder
Bipolar disorder is a lifelong condition — treatment focuses on managing symptoms. The most effective approach combines medication and psychotherapy, determined by medical doctors with support from a psychologist and possibly a therapist or social worker.
1. Therapy
- IPSRT (Interpersonal and social rhythm therapy): Stabilizes daily rhythms (sleep, exercise, eating) to improve mood management.
- CBT: Identifies and replaces negative beliefs and behaviors. Helps identify episode triggers.
- Psychoeducation: Helps person and loved ones understand the condition, plan to prevent relapse, and stay with treatment.
- Family-focused therapy: Builds communication and support systems to manage warning signs of mood swings.
2. Medication
Medication should not be stopped without consulting a provider — stopping can worsen symptoms. Types and doses are based on individual symptoms.
- Mood stabilizers: Most important class; commonly prescribed for manic/hypomanic episodes.
- Atypical antipsychotics: Treat both episode types and psychotic symptoms like delusions and hallucinations.
- Anticonvulsants: Often used as mood stabilizers; may be combined with an antipsychotic or lithium.
- Benzodiazepines: Short-term use to quickly control manic symptoms while other medications take effect.
Additional treatment settings:
- Day treatment programs: Intensive support for symptom control.
- Continuous treatment: Lifelong maintenance is often necessary — skipping treatment can cause relapse.
- Hospitalization: For severe or dangerous episodes to stabilize mood safely.
3. Other Treatment Options
- Talk therapy: An essential part of any bipolar treatment plan — helps identify and address thoughts and feelings contributing to symptoms.
- ECT (Electroconvulsive therapy): Brain stimulation effective when therapy and medication have not worked. Requires general anesthesia and a series of sessions.
- TMS (Transcranial magnetic stimulation): Newer brain stimulation using magnetic waves, administered while awake. Effective for depression; effectiveness for bipolar is still being researched.
4. Lifestyle & Self-Management
- Exercise regularly: Eases depression, stabilizes moods, and improves sleep.
- Journal and keep a life chart: Track daily mood, sleep, medication, and life events to spot patterns and triggers.
- Maintain a consistent sleep cycle: Sleep is a known mood stabilizer that reduces irritability.
- Eat a balanced diet: Foods high in omega-3s are beneficial. Reduce trans and saturated fats, linked to brain chemical imbalances.
- Practice calming techniques: Yoga, acupuncture, massage, and mindful meditation reduce stress and anxiety, both of which can complicate bipolar disorder.
Conditions That Can Coexist with Bipolar Disorder
- Bipolar depression: Guilt, unpredictable mood swings, irritability, extreme restlessness.
- Major depression: Often experienced during bipolar depressive episodes.
- Anxiety: Anxiety can co-occur with bipolar disorder and has various causes.
- Substance abuse: A common comorbidity; substance use can worsen manic and depressive episodes.
- ADHD: ADHD frequently co-occurs with bipolar disorder, with overlapping symptoms (impulsivity, inattention) that complicate diagnosis.
Related Disorders
- Anxiety disorders: GAD, panic disorder, and social phobias are commonly seen alongside bipolar disorder.
- PTSD: People with bipolar disorder have an increased risk of developing PTSD. Shared symptoms can make diagnosis difficult.
- Schizophrenia: Hallucinations and delusions in bipolar can be confused with schizophrenia. Having both is known as schizoaffective disorder.
Borderline personality disorder (BPD): BPD shares symptoms with bipolar (extreme emotions, impulsive behavior) but is a distinct condition. See: Borderline Personality Disorder vs. Bipolar Disorder.
