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 condition 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 “mood 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
  • Elevated Mood: 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

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 Risk Factors

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. These three types of bipolar disorder include bipolar I disorder, bipolar II disorder, and cyclothymic disorder (cyclothymia). 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. Learn more about the different types of bipolar disorder.

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.

Common Co-occurring Conditions (Bipolar + Other Conditions)

Bipolar disorder often co-occurs with other conditions, ultimately making treatment and management much more difficult. Some of the following additional conditions can potentially lessen the effectiveness of treatment or worsen symptoms of bipolar.

  • Bipolar depression — While bipolar disorder and depression are two separate conditions, bipolar depression can occur during depressive episodes. It often presents as feelings of guilt, unpredictable mood swings, irritability, or feelings of extreme restlessness. Sometimes speaking slowly, gaining weight, and sleeping more than normal is also experienced.
  • Major depression — While bipolar disorder and depressive disorder are two separate conditions, major depression is often experienced during bipolar depressive disorders.
  • Anxiety — Anxiety has various causes and can coexist with bipolar disorder.
  • Substance abuse — Substance abuse and addiction is a common comorbidity for those with bipolar disorder. In addition, when using substances, more extreme manic and depressive episodes can occur.
  • Attention deficit hyperactivity disorder (ADHD) — Often bipolar disorder and ADHD occur simultaneously. Making it particularly challenging is the fact that many symptoms overlap between the two disorders. For example, impulsivity and inattention are major symptoms of both disorders.

Related Disorders

Many people experience additional disorders that are related to bipolar disorder. Sometimes the coexistence of multiple conditions or disorders can lead to misdiagnosis or difficulty diagnosing or creating treatment plans for bipolar disorder.

  • Anxiety disorders — Anxiety disorders are common with bipolar disorder. Types of anxiety disorders that are often present in those who also have bipolar disorder include general anxiety disorder (GAD), panic disorder, and social phobias.
  • Post traumatic stress disorder (PTSD) — Research shows that people who have bipolar disorder have an increased chance of developing the psychiatric disorder post traumatic stress disorder (PTSD). While they are two distinct mental health diagnoses, they share several common symptoms that can make diagnosis and treatment sometimes difficult.
  • Schizophrenia — The hallucinations and/or delusions often experienced by someone with bipolar disorder can make it easy to confuse the condition with schizophrenia. That said, it is possible to have both disorders. When this occurs, it’s known as schizoaffective disorder.
  • Borderline personality disorder — While borderline personality disorder (BPD) and bipolar disorder can have an overlap in symptoms — including extreme emotions and impulsive behavior — the disorders are actually quite different. BPD has a significant impact on how someone feels and thinks about themself and others in their life. For a more in-depth understanding of the two, learn more about borderline personality vs. bipolar disorder.

When To Seek Help

Because bipolar disorder is a lifelong mental health condition, it’s important to understand that medical treatment will be necessary at some point. Once diagnosed, a treatment plan will be established by a doctor, psychologist, therapist, or other provider. It’s essential to follow the plan as suggested or directed.

Often people who have bipolar disorder don’t realize when an episode is becoming so disruptive it’s beyond their control. If bipolar symptoms of mania or depression worsen, or if treatment is no longer effective, reaching out to a doctor should be the first step taken.

Any time thoughts of suicide or self-harm are present, immediate intervention should take place.

Emergency resources can include:

  • Going to the nearest Emergency Room
  • Calling a suicide hotline
  • Reaching out to a doctor or therapist
  • Calling 911

Bipolar Disorder in Children & Teens

Bipolar disorder is most often diagnosed in older teenagers and adults, but it can occur in children as young as 6 years old. Pediatric bipolar disorder is complex and can be difficult to diagnose.

Symptoms

Symptoms of bipolar disorder in children and teens vary depending on manic vs depressive episodes.

Manic episode signs & symptoms:

  • Intense happiness
  • Talking rapidly
  • Short temper or irritability
  • Difficulty sleeping but not feeling tired
  • Risky behavior
  • Difficulty staying focused
  • Having racing thoughts

Depressive episode signs & symptoms:

  • Being increasingly angry or hostile
  • Frequently feeling sad for no reason
  • Sleeping a lot
  • Complaining about pain (stomachaches and headaches)
  • Feeling hopeless or worthless
  • Difficulty concentrating
  • Change in eating habits
  • Thinking about death or having suicidal thoughts

Diagnosis

There isn’t a brain scan or blood test for bipolar disorder. A doctor or psychiatrist will assess a child’s moods, energy levels, behavior, and sleep patterns to determine a bipolar disorder diagnosis.

Treatment options

Treatment plans can include therapy, medication, and a combination of the two.

Co-occurring conditions

There are several co-occurring conditions that are seen with bipolar disorder in children and young teens. Attention deficit hyperactivity disorder (ADHD), anxiety disorders, and substance abuse are all common.

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

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 bipolar disorder 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

Common Types of Medications Used in Bipolar Disorder Treatment

Medication is likely going to be an important component of any bipolar disorder treatment plan. When used in conjunction with therapy and other techniques, it can be possible to manage bipolar disorder with the right medication. Types of bipolar disorder medications and doses will be based on an individual’s specific symptoms.

  • Mood stabilizers — Mood stabilizers are commonly prescribed to treat bipolar disorder during manic or hypomanic episodes. These are often considered to be one of the most important medications to treat bipolar disorder.
  • Atypical antipsychotics — Used to treat both types of episodes (manic and depressive), atypical antipsychotics can be an effective form of treatment for both long- and short-term plans. Additionally, they can be used to treat psychotic symptoms like delusions, hallucinations, and mania symptoms.
  • Anticonvulsants — Anticonvulsants can be prescribed either on their own or with the combination of an antipsychotic drug or lithium. Many anticonvulsants are recognized as a type of mood stabilizer.
  • Benzodiazepines — Though not usually a core bipolar treatment, benzodiazepines (or “benzos”) can help quickly control manic symptoms. Can be prescribed for short-term use until other mood stabilizing drugs start to take effect.

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:

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.

Other Bipolar Disorder Treatment Options

Medication isn’t the only way to treat bipolar disorder. The most effective form of treatment is going to be a combination of the right medication (or medications) and psychotherapy (also known as talk therapy). Since bipolar disorder is a lifelong mental health condition, long-term and continuous treatment is going to be important, even in cases when people are in between episodes and aren’t experiencing major manic or depressive symptoms.

Some types of treatment, in addition to medication, to treat bipolar disorder can include:

  • Talk therapy — Talk therapy (or psychotherapy) is an essential part of any bipolar treatment plan. Learn how to identify, talk about, and address thoughts and feelings that may be contributing to symptoms of bipolar disorder.
  • Electroconvulsive therapy (ECT) — ECT is a procedure that stimulates the brain and is known to help people with bipolar disorder gain significant relief from symptoms. Typically, ECT requires a series of sessions over multiple weeks, and it requires general anesthesia. When talk therapy and medication are not effective, ECT may be instrumental in relieving and treating symptoms of both manic and depressive episodes.
  • Transcranial magnetic stimulation (TMS) — TMS is another approach that’s newer than ECT. It also involves brain stimulation using magnetic waves. The difference between TMS and ECT is that TMS is administered while patients are awake, eliminating the need for general anesthesia. It’ll be administered almost every day for one month. While TMS is effective for treating depression, how well it works to treat bipolar disorder is still being researched.

Complications of Leaving Bipolar Disorder Untreated

When left untreated, bipolar disorder can develop into a significantly more severe condition. It’s not uncommon for symptoms to increase in severity, and in the most extreme cases, they can become so severe that they lead to suicide. Both manic and depressive episodes can become not only more intense, but also more frequent when an effective treatment plan isn’t put into place.

Other complications that can arise as a result of untreated bipolar disorder include:

Managing Bipolar Disorder Beyond Treatment

There are several things that in addition to medication and therapy that can help treat bipolar disorder.

  • Exercise regularly — Regular exercise can help ease depression and stabilize moods. It’s also known to improve sleep habits. All of these can be beneficial in managing bipolar disorder.
  • Journal and keep a life chart — Life charts are a way to track daily mood symptoms, sleep patterns, medication and other treatments, and major life events that may spark a bipolar episode.
  • Keep a consistent sleep cycle — Getting enough sleep is a known mood stabilizer. It can also reduce irritability and is useful in establishing healthy routines that can help manage bipolar disorder.
  • Eat a balanced and healthy diet — Eating a healthy diet, including foods high in omega-3 fatty acids, it’s always a good thing. With bipolar disorder, it can also be important to reduce the intake of any trans and saturated fats, both of which are linked to chemical imbalances in the brain.
  • Learn calming techniques — Calming techniques like yoga, acupuncture, massage therapy, and mindful meditation are all ways to reduce stress and anxiety, both of which can complicate bipolar disorder. While they can’t cure it, calming techniques are a definitive way to manage bipolar symptoms. They can be an extremely valuable part of any treatment plan.

Coping with Bipolar Disorder

Though living with bipolar disorder is often a challenge, there are coping techniques that can help make it easier to manage. Bipolar disorder is a lifelong condition and will always require treatment. The most important part of coping with it is finding a treatment plan that works, and then staying on it.

Other ways to cope with bipolar disorder can include:

  • Being patient
  • Staying committed to therapy appointments
  • Taking medication as directed, even between episodes
  • Being open and honest with a therapist or doctor about symptoms and treatment options
  • Avoiding excessive alcohol and drug use or abuse
  • Keeping structure to daily activities — eat, sleep, and exercise regularly and on a routine
  • Learning to recognize symptoms and mood swings
  • Asking for help