What is Bipolar Disorder and How is It Treated?
Mental Health
Bipolar disorder is a chronic (long-term) mental health condition that affects your ability to carry out daily tasks by causing intense shifts in your moods and energy levels. It can affect the way you think and behave for days, weeks, or months. Although everyone experiences mood swings from time to time, people with bipolar disorder have extreme highs and lows that are more severe, longer lasting, and harder to manage without treatment.
In this article, I’ll review what bipolar disorder is, how it’s diagnosed, and how it’s commonly treated.
What Is Bipolar Disorder?
Bipolar disorder is a mood disorder that causes significant shifts your mood. It used to be known as manic-depressive illness or manic depression. In recent years, the medical field has moved away from older terms like "manic depression" to reduce stigma and reflect a more accurate understanding of the condition.
People with bipolar disorder have intense emotional states (mood episodes) that affect their mood, energy level, and ability to function. A mood episode usually lasts from a few days to a few weeks but can last for years without treatment.
While people without bipolar disorder can have mood changes, they typically last a few hours, not several days or weeks at a time. During a mood episode in bipolar disorder, you experience symptoms every day for most of the day. In between episodes, your mood can return to a normal baseline, known as a euthymia.
The symptoms of bipolar disorder can vary from person to person depending on whether you’re having a manic episode or a depressive episode.
Manic Episode
A manic episode is when you have an abnormally elevated mood and activity level, also known as mania. A manic episode can look different from person to person with a range of symptoms, including:
- Feeling elated, high, or abnormally happy
- Increased energy
- Decreased need for sleep
- Rapid speech
- Racing thoughts
- Jumping from one idea to the next
- Sudden and drastic changes in mood (for example going from joyful to hostile)
- Restlessness
- Feeling irritable, jumpy, or wired
- Impulsive, reckless, or risky sexual behavior (for example, drug and alcohol misuse or having unprotected sex)
- Feeling unusually important or powerful
In a severe manic episode, some people can experience symptoms of psychosis (when a person loses touch with reality). They may have hallucinations (seeing or hearing things that aren’t really there) or delusions (a strongly held false belief).
Most people don’t realize anything is wrong during a manic episode and they’re not aware of the negative consequences of their actions. During a manic episode, someone might suddenly quit their job, spend large amounts of money, or act in risky ways that are normally out of character for them.
Hypomanic Episode
A hypomanic episode is a less severe form of mania. You may feel good and very productive during a hypomanic episode. In most cases, a hypomanic episode doesn’t last as long and doesn’t affect your ability to function as much as a manic episode does.
Even though hypomania isn’t as severe, friends and family may notice more drastic mood swings and unusual behavior.
Depressive Episode
During a depressive episode, you may experience low, depressed mood. You can also have other symptoms of depression, such as:
- Feeling sad, worthless, or hopeless
- Tiredness
- Appetite changes
- Difficulty concentrating
- Sleeping too much or too little
- Slow speech
- Lack of interest in activities you usually enjoy
- Thoughts of death or suicide
These symptoms can make it difficult to carry out everyday tasks, maintain relationships, and keep up at work or school. Like manic episodes, a depressive episode can last for days, weeks, or longer without treatment.
Types of Bipolar Disorder
Bipolar disorder is a broader category that includes several types. Each type of bipolar disorder differs based on the pattern of symptoms. We’ll review the different types below.
Bipolar I Disorder
People with bipolar I disorder have had at least one manic episode that lasts at least seven days. In some cases, a manic episode can be severe enough to need a hospital stay. Most people will also have separate depressive episode that lasts at least two weeks. However, a depressive episode isn’t necessary to get a diagnosis of bipolar I.
Mood episodes with a mix of mania and depression symptoms are also possible in people with bipolar I disorder. If a person experiences four or more episodes of mania or depression in one year, it’s called rapid cycling.
Bipolar II Disorder
In bipolar II disorder, people experience depressive and hypomanic episodes. In general, people with bipolar II disorder have hypomanic episodes that are less severe than the manic episodes that occur in bipolar I disorder. Most people with bipolar II disorder experience extended periods of depression. At least one hypomanic episode is required to be diagnosed with bipolar II disorder.
Although the symptoms of mania are typically less severe in bipolar II compared to bipolar I, long-term depressive episodes can often be more debilitating.
Cyclothymic Disorder
Cyclothymic disorder — also known as cyclothymia — is characterized by an unstable mood that rapidly cycles between depressive and hypomanic symptoms for a period of at least two years.
People with cyclothymic disorder may not have symptoms that are intense enough or last long enough to qualify as a hypomanic or depressive episode. They may also have periods of normal moods, but they typically last fewer than eight weeks.
Other Specified and Unspecified Bipolar and Related Disorders
This type of bipolar disorder describes people who don’t exactly meet the criteria for one of the three main types. However, they still experience periods of abnormal mood elevation and depressive symptoms.
How Common Is Bipolar Disorder?
It’s estimated that about 2.8% of adults in the United States are living with bipolar disorder. That means that about 5.7 million people are affected by this condition across all ages and backgrounds.
Most people with bipolar disorder are diagnosed around the age of 25. However, bipolar disorder can affect people of all ages. It can begin in children and teens or in middle-aged adults.
What Causes Bipolar Disorder?
Researchers haven’t found one single cause of bipolar disorder. Instead, they believe bipolar disorder can be caused by a combination of several factors that increase the risk of developing the condition or act as a trigger for the first mood episode.
Risk factors for bipolar disorder include:
- Having a parent or sibling with bipolar disorder
- Stressful or traumatic events
- Biological differences in the brain
- Alcohol or drug misuse
How Is Bipolar Disorder Diagnosed?
Bipolar disorder is diagnosed by a mental health provider, like a psychiatrist. Your primary physician may also be involved in your diagnosis by testing for other health conditions that may cause your symptoms or referring you to a psychiatrist.
Some people can have bipolar disorder for many years before they’re diagnosed. This is especially true for people with bipolar II disorder who may only seek help for depressive episodes, leaving the symptoms of hypomania to go unnoticed. It’s common for people with bipolar disorder to live without a diagnosis or proper treatment for five to 10 years after they first start experiencing symptoms.Medical Tests
A physical exam and laboratory tests can help rule out other causes of your symptoms. For example, hyperthyroidism (overactive thyroid) can cause insomnia, irritability, and anxiety. In some cases, these symptoms could be mistaken for or worsen symptoms of mania or hypomania.
Other medical conditions that can cause similar symptoms to bipolar disorder include:
- Hypothyroidism (underactive thyroid)
- Lyme disease
- Cushing’s disease
- Multiple sclerosis (MS)
- Stroke
Mental Health Assessment
A mental health assessment is performed by a mental health professional. During a mental health assessment, your psychiatrist will ask questions to get a better picture of your emotional state and ability to think and function. Some of the things you’ll talk about in a mental health assessment include:
- The types of symptoms you have
- How long your symptoms last
- How often you experience mood episodes
- How your symptoms impact your life
- Your family history
You may not receive a diagnosis of bipolar disorder right away. Your pyschiatrist may want to observe you for some time to make sure you get the correct diagnosis. You might be asked to keep a record of your moods, sleep patterns, and other symptoms for a time to help you get the right diagnosis. Other mental health conditions that can look similar to bipolar disorder include:
- Depression
- Borderline personality disorder
- Post-traumatic stress disorder
- Schizophrenia
The treatment for each of these conditions is different, so getting the diagnosis right can make a difference in how well treatment works for you.
How Is Bipolar Disorder Treated?
Medications and psychotherapy (talk therapy) are the main treatments for bipolar disorder. When these treatments don’t help, other treatments may be added to your treatment plan. Bipolar disorder is a chronic (long-term) mental health condition. That means that bipolar disorder treatment is also long-term, and you’ll continue your treatment even when you feel better.
I’ll explore common treatments for bipolar disorder.
Medications for Bipolar Disorder
Several different types of medications can be used to treat bipolar disorder. Your physician will consider several factors before recommending a medication, including:
- Your past and current symptoms
- Your physical health and other medical conditions
- Whether you’re able to become pregnant
- How likely you are to stick with your treatment plan
Some people have to try a few medications before they find the one that works best for them.
Mood Stabilizers
Mood stabilizers are medications that can help manage manic and hypomanic symptoms like rapidly changing moods, sleep problems, and racing thoughts. They work by helping to regulate the balance of neurotransmitters (chemical messengers in the brain).
There are two main types of mood stabilizers — lithium and anticonvulsants. Lithium is a naturally occurring element that’s been used as a mood stabilizer for more than 50 years. People taking lithium need regular blood tests to monitor the lithium levels in the blood.
Anticonvulsants were originally developed as antiseizure medications. Researchers have also found that it also helped people with bipolar disorder. Examples of anticonvulsants used to treat bipolar disorder include:
- Carbamazepine (Tegretol)
- Divalproex sodium (Depakote)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
Antipsychotic Medications
Some antipsychotic medications can also work as mood stabilizers. Antipsychotic medications can be taken alone or in combination with another mood stabilizer. Examples of antipsychotic medications used to treat bipolar disorder include:
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Cariprazine (Vraylar)
- Lumateperone (Caplyta)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Antidepressants
Antidepressants may be cautiously considered to treat bipolar disorder. However, antidepressant medications can sometimes cause a manic or hypomanic episode in people with bipolar disorder. Because of this, antidepressants are usually prescribed along with a mood stabilizer or antipsychotic medication. For example, a combination of the antidepressant fluoxetine and the antipsychotic olanzapine (available as the brand name Symbyax) can be used to treat bipolar disorder.
Psychotherapy for Bipolar Disorder
Psychotherapy is often used alongside medication to help manage bipolar disorder. Examples of the types of psychotherapy for bipolar disorder include:
- Psychoeducation — therapy that teaches you and your loved ones about bipolar disorder
- Interpersonal and social rhythm therapy (IPSRT) — therapy that focuses on stabilizing your daily routines, such as taking your medication and managing stress
- Cognitive behavioral therapy (CBT) — therapy that helps you identify and change unhelpful thoughts and behaviors that can contribute to mood episodes
- Family-focused therapy — therapy that involves family members in your treatment to improve communication, reduce conflict, and build a strong support system
These strategies can help you manage stress, recognize early warning signs of a mood episode, and improve your relationships.
Other Treatments
When medications and psychotherapy don’t help, other treatment options might help, such as:
- Electroconvulsive therapy (ECT) — a medical treatment that uses controlled electrical currents through your scalp while you’re under anesthesia
- Transcranial magnetic stimulation (TMS) — a therapy that uses an electromagnetic coil to pass an electric current into your brain
- Ketamine treatment — a treatment that uses a low dose of the anesthetic ketamine to provide short-term antidepressant effects
- Hospitalization — short-term care in a hospital or mental health facility may be necessary if you’re experiencing a severe depressive or manic episode
What Is the Outlook for People with Bipolar Disorder?
Living with bipolar disorder involves ongoing challenges. Medications and psychotherapy can help you reduce the frequency and severity of your mood disorders, so they’re less disruptive to your daily life. With the right treatment and support, many people with bipolar disorder can successfully manage their symptoms and lead full, meaningful lives.
