Bipolar Disorder

Bipolar Disorder

Conditions - Bipolar Disorder

Bipolar disorder is a mood disorder that can cause intense changes in a patient’s mood, energy, and ability to function. These periods of intense emotional states are referred to as mood episodes because they are characterized by extreme mood swings that include frenetic highs, unrelenting lows, and every stage in-between the two.  

People with bipolar disorder often experience intense depressive episodes similar to Major Depressive Disorder. In addition to depressive episodes, bipolar disorder causes another type of episode called mania. 

Episodes of mania (also called manic episodes) can be roughly described as the extreme opposite of depression, often with a euphoric or irritable mood and markedly increased energy. Interim periods of relatively balanced mood between these episodes are known as euthymia.

Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.8% of the U.S. population, annually. The condition has also been known as manic depression in the past.

Although bipolar disorder is a lifelong condition, it is possible to manage symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling.

Impact of Bipolar Disorder

Bipolar disorder can cause cyclical changes in mood that may last for days, weeks, or even months without treatment. These mood swings can interrupt your ability to carry out daily functions by affecting your sleep, energy, activity, judgment, behavior, and ability to think clearly.

Manic Episodes

When the mood shift results in extremely energized, elated, or irritable behavior, it is usually identified as a manic episode. During a manic episode, you may experience abnormally elevated or irritable moods, as well as extreme elevation in activity level, self-destructive behavior, energy, racing thoughts, and talkativeness. 

You may also experience a decreased need for sleep. Rather than just having difficulty sleeping, this causes you to feel as if you don’t need sleep or need very little sleep to still feel energized and awake. 

During a manic episode, people may be uninhibited about indulging in risky activities. This can lead to significant physical, financial, personal, or professional harm if someone does not receive proper treatment. Symptoms like delusions and hallucinations can sometimes occur in more severe cases.

Less severe manic episodes may be classified as hypomanic episodes. 

Depressive Episodes

Feelings of intense sadness, low enthusiasm for activity, indifference, or hopelessness characterize depressive episodes. During a depressive episode, people are likely to lose interest in most activities and experience other symptoms of depression, such as extreme fatigue, change in appetite, and feelings of inadequacy and worthlessness. 

Depressive episodes in Bipolar Disorder are often indistinguishable from those caused by Major Depressive Disorder. For most people with bipolar disorder, depression is actually the most frequent symptom. Because of this, bipolar disorder is often misdiagnosed as unipolar depression (like Major Depressive Disorder).

In some cases, bipolar patients may be more aware of their frequent depression but may not have recognized (or may be unable to recognize) signs of mania, which stems from bipolar disorder. 

In these situations, they may be treated for unipolar depression instead of bipolar depression. Some of the medications used for unipolar depressioncan make the symptoms of bipolar disorder significantly worse. Determining the right diagnosis is critical in the treatment of mood disorders. 

Mixed Episodes

Sometimes, patients with bipolar disorder have a mix of both manic and depressive symptoms. When this happens, it may be classified as a mixed episode. 

During a mixed episode, you may feel depressed and hopeless but also impulsive and disinhibited. This can be a dangerous combination, especially if you are experiencing suicidal thoughts. Compared to pure mania or depression, mixed states have the highest risk for suicide.

Symptoms of Bipolar Disorder

With bipolar disorder, depending on the type of episode you experience, your symptoms will change. 

Symptoms of a Manic Episode

Symptoms of a Depressive Episode

Uncharacteristically jumpy or wired, more active than usual, or extremely irritable

Feeling low, restless, sad or numb

Feelings of euphoria

Feeling hopeless or worthless, or thinking about death or suicide

Very distracted with racing thoughts

Trouble making decisions or concentrating, thoughts may be slowed

Feeling energized to do many things at once

Feeling unable or unmotivated to do even simple things

Increased risk-taking behavior that may be self-destructive, increased interest in sex, increased indulgent in pleasurable activities

Lack of interest in almost all activities, even activities you used to enjoy

Highly talkative, with a need to discuss lots of things

Disinterest in socializing or feeling unable to find anything to say

Reduced need for sleep, feeling awake and energized without sleeping for multiple nights or after sleeping only a few hours each night

Too much sleep or too little sleep, difficulty falling asleep or staying asleep,  often feeling tired regardless of the amount of sleep you get

Causes of Bipolar Disorder

Although the exact cause of bipolar disorder is not clear, it is believed that any of the following factors may be involved.

Genetic Predisposition

Bipolar disorder is considered one of the most inheritable psychiatric conditions and is seen to run in families. People with a relative in their immediate family with bipolar disorder have an increased risk of the condition. 

More than two-thirds of people with bipolar disorder have at least one close biological relative with the same condition. There is no single gene for bipolar disorder - instead, it is thought to be caused by a combination of genetic factors. 

Differences in Brain Chemistry and Structure

People with bipolar disorder appear to have physical changes in their brains. Research identifies subtle differences in the average size or activation of some brain structures in people with bipolar disorder. 

Additionally, bipolar disorder is thought to be caused by an imbalance of neurotransmitters, which impact brain chemistry. Medications that treat bipolar disorder work by altering levels of neurotransmitters, which may support this theory. 

Emotional and Environmental Triggers

Stressful or traumatic events can trigger manic or depressive episodes. Examples include the death of a loved one, a severe illness, divorce, or financial problems.

Certain medications or substances have also been linked to triggering manic or depressive episodes. For example, many antidepressant medications have been linked to a higher risk for manic episodes or causing more frequent depressive episodes.

Studies have found that substance use, both regular use and first-time use of certain substances, is strongly associated with the onset of manic or depressive episodes. Substances can also cause these types of symptoms in people without bipolar disorder. 

Types of Bipolar Disorder

There are three types of bipolar disorder. These are characterized by the frequency and differences in the manic, hypomanic, and depressive episodes you experience.

Bipolar I Disorder

People with Bipolar I Disorder have had at least one manic episode. For a bipolar I diagnosis, your manic episodes must last at least seven days or be severe enough to need hospitalization. 

Mania may sometimes be preceded or followed by a hypomanic or major depressive episode. However, the occurrence of a depressive episode is not mandatory for Bipolar I diagnosis. 

It is also possible for patients with Bipolar I to experience a mix of manic and depressive symptoms. 

Bipolar II Disorder

Bipolar II Disorder is often thought of as a less severe form of Bipolar I Disorder, although there are some other differences. Rather than having a manic episode, people with Bipolar II experience at least one hypomanic episode. 

Hypomanic episodes are characterized by the same types of symptoms that exist in manic episodes, except you may have fewer of these symptoms, and they are less intense. In addition to a hypomanic episode, people diagnosed with Bipolar II Disorder must also have at least one major depressive episode.  

Bipolar II Disorder can be more debilitating than Bipolar I Disorder because chronic depression tends to be more frequent. 

Cyclothymic Disorder

When a patient has chronically unstable states of mood, they may be diagnosed with Cyclothymic Disorder. 

Like Bipolar II Disorder, the cyclothymic disorder has mood episodes similar to hypomania and depression, although these symptoms are less severe than other types of Bipolar Disorder. Even so, cyclothymia can be debilitating because the symptoms are more chronic and pervasive. 

People with Cyclothymic Disorder may also have brief periods of euthymia (stable state without intense mood fluctuations), but they typically last fewer than eight weeks.

Other Specified or Unspecified Types

This classification is used when bipolar symptoms do not align with any of the above types of bipolar disorder. 

These patients may experience periods of clinically significant abnormal mood elevation and may be diagnosed with other specified or unspecified bipolar disorders. 

Bipolar Disorder Diagnosis

Bipolar disorder typically manifests and can be diagnosed during late adolescence (teen years) or early adulthood. All types of Bipolar Disorder are usually diagnosed before the age of 30, with the average age of diagnosis being slightly more in Bipolar II than Bipolar I. In some cases, symptoms of bipolar disorder, especially cyclothymia, may present during childhood.

Diagnosing bipolar disorder involves

  • Thorough physical exam
  • Detailed medical history for the patient and their immediate family
  • Details about your symptoms
  • Blood tests or other tests to rule out other conditions (e.g., thyroid disease)
  • Mental health evaluation

The type of bipolar disorder is confirmed after assessing the pattern of symptoms and their effect on daily life during mood episodes. Bipolar Disorder can be difficult to diagnose because the symptoms overlap with multiple other psychiatric disorders. 

As with all diagnoses, your Options MD psychiatrist will carefully rule out other illnesses to ensure the accuracy of your diagnosis and the efficacy of your treatment plan.  

Treatment for Bipolar Disorder

Although the symptoms can vary over time, bipolar disorder requires lifelong treatment, even when you’re not experiencing mood episodes. 

During periods of mood stability, it may seem as though you no longer need to take your prescribed medications. However, discontinuing treatment most often leads to a return of severe and debilitating symptoms.

The condition is manageable with an appropriate, long-term treatment plan. 

An effective treatment plan may include a combination of the following therapies.

Get the Help You Need for Bipolar Disorder

Options MD can help you get the treatment you need. Our team of psychiatry experts has access to over 200 different science-backed, cutting-edge treatment options. We will work together to determine the most appropriate treatment option for you. 

We also started the largest community of people with severe and treatment-resistant depression. It is a safe, collaborative, and supportive place to learn about better medication options and leading-edge treatments. Join today to get access to qualified doctors and find friendship and support.

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