Bipolar Disorder

Written By Kyndall Pursley

Emotional ups and downs are a challenge for anyone, but when bipolar disorder causes mood swings to interfere with everyday life and responsibilities, something needs to be done.  

 

Bipolar disorder causes dramatic shifts in a person’s mood, energy, and overall ability to function. People with bipolar disorder, previously called manic depression, experience high and low moods—mania and depression.  

  • Mania and hypomania These high-energy periods include increased activity, less sleep, and racing thoughts. Symptoms of mania are much more intense than those of hypomania and can last for a week or more.  

  • Depression Symptoms may include a low mood, lack of energy, increased sleep, and sluggishness. 

If left untreated, bipolar disorder usually worsens and can disrupt a person’s relationships and make it difficult to work or go to school. Fortunately, with early identification of symptoms and a good treatment plan, many people live well with the condition. 

Each year, an estimated 7 million adults in the US—about 2.8% of the adult population—experience bipolar disorder that leads to disruptions at work, school, or home. While the median age of onset for bipolar disorder is about 25 years old, the condition can appear much earlier in life, and it is common among those aged 13 through 18.  

According to the National Institute of Mental Health, there are two types of bipolar disorder: 

  • Bipolar I disorder is defined by having one or more manic episodes that last for at least 7 days or by symptoms (see below) so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression mixed with manic symptoms are also possible.  

  • Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. Hypomanic episodes are less severe than the manic episodes in bipolar I disorder. 

Signs and symptoms 

People with bipolar disorder experience long periods of unusually intense emotion that affect sleep and daily activities. These episodes are much more extreme than everyday mood and behavior changes, and can include the following:  

Mania/hypomania 

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems in all areas of life. Mania may also trigger a break from reality (psychosis) and require hospitalization. For hypomania, symptoms need to last only 4 days in a row. Hypomanic symptoms do not lead to the major problems in daily functioning that manic symptoms commonly cause. 

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

  • Abnormally upbeat, jumpy, or wired 

  • Increased activity, energy, or agitation 

  • An exaggerated sense of well-being and self-confidence (euphoria) 

  • Decreased need for sleep 

  • Unusual talkativeness 

  • Racing thoughts 

  • Distractibility 

  • Impulsiveness or poor decision-making — for example, going on buying sprees, taking sexual risks, or making foolish investments 

Major depressive episode 

A major depressive episode includes symptoms severe enough to cause noticeable difficulty in day-to-day activities. An episode includes five or more of these symptoms:

  • Depressed mood, such as feeling sad, empty, hopeless, or tearful (Can appear as irritability in children and teens) 

  • Marked loss of interest or feeling no pleasure in most or all activities 

  • Significant weight loss when not dieting, changes in appetite, or weight gain 

  • Either insomnia or sleeping too much 

  • Either restlessness or slowed behavior 

  • Fatigue/loss of energy 

  • Feelings of worthlessness or excessive or inappropriate guilt 

  • Decreased ability to think or concentrate, or indecisiveness 

  • Thinking about, planning, or attempting suicide 

Sometimes people have both manic and depressive symptoms in the same episode. This is called an episode with mixed features, during which people may feel very sad, empty, or hopeless while also feeling extremely energized. 

Treatment 

The good news? Bipolar symptoms commonly improve with treatment. Left untreated, the symptoms of bipolar disorder are bound to get worse. Diagnosing it and beginning treatment early is important.

A mixture of medications, psychotherapy, and self-care can help most people living with bipolar disorder control their mood swings and other symptoms. Because bipolar disorder is a chronic illness in which mood episodes typically recur, ongoing preventive treatment is strongly recommended.  

Medications 

Different types of bipolar disorder may respond better to different medications, and side effects can vary, so it may take time working with a doctor to discover the best medicines and combinations. Whatever is prescribed, it is important not to make changes without the knowledge of a prescribing doctor.

Lithium is a common and effective medicine used to limit the extreme emotional highs and lows of bipolar disorder. Medications used to treat seizures are also effective mood stabilizers. Antipsychotics are commonly used to treat manic or mixed bipolar episodes and are often paired with other medications, including mood stabilizers. Antidepressants can be helpful in treating bipolar disorder, but need to be monitored closely, as some can trigger mania.

Psychotherapy

A National Institute of Mental Health clinical trial showed that patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive a combination of several intensive psychotherapy interventions, including the following: 

  • Cognitive behavioral therapy (CBT) helps change the negative thinking and behavior associated with depression. The goal of this talk therapy is to recognize negative thoughts and to teach coping strategies. 

  • Family-focused therapy helps people with bipolar disorder, and their family members, learn about the illness and carry out a treatment plan.

  • Psychotherapy focused on self-care and stress regulation helps a person improve self-care, recognize patterns leading to the onset of symptoms and to manage stress.

Self-care 

In addition to medication and professional help, here are some ways to help manage this illness from the National Alliance on Mental Illness: 

  • Identify stressors and triggers. People, places, jobs, and even holidays can play a big role in mood stability. Understanding these triggers can help prevent a serious mood episode. 

  • Avoid drugs and alcohol. These substances can disturb emotional balance and interact negatively with medications. When struggling with depression and mania, drugs and alcohol can seem like attractive options to help “slow down” or “perk up,” but the potential damage can derail recovery. 

  • Establish a routine. Committing to a daily routine can help prevent depression and mania from taking control. Setting and maintaining a regular daily schedule will help minimize emotional swings. Fitting exercise into the routine is a good strategy for regulating body rhythms. 

  • Learn from past episodes. Symptoms often follow specific patterns that can be studied and prepared for. Accepting support from family members or friends who can recognize early symptoms is important.

  • Form healthy relationships. Family, friends, and faith connections can all be powerful sources of support that help stabilize a person’s moods. An outgoing friend might encourage more involvement with social activities. A more relaxed friend may provide a steady calm that can help keep feelings of mania under control.

 

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Kyndall Pursley
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