What is bipolar disorder?
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Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. Bipolar disorder is also known as bipolar disease or manic depression.
People with bipolar disorder may have trouble managing everyday life tasks at school or work, or maintaining relationships. There’s no cure, but there are many treatment options available that can help to manage the symptoms. Learn the signs of bipolar disorder to watch for.
Bipolar disorder facts
Bipolar disorder isn’t a rare brain disorder. In fact, 2.8 percent of U.S. adults — or about 5 million people — have been diagnosed with it. The average age when people with bipolar disorder begin to show symptoms is 25 years old.
Depression caused by bipolar disorder lasts at least two weeks. A high (manic) episode can last for several days or weeks. Some people will experience episodes of changes in mood several times a year, while others may experience them only rarely. Here’s what having bipolar disorder feels like for some people.
Bipolar disorder symptoms
There are three main symptoms that can occur with bipolar disorder: mania, hypomania, and depression.
While experiencing mania, a person with bipolar disorder may feel an emotional high. They can feel excited, impulsive, euphoric, and full of energy. During manic episodes, they may also engage in behaviour such as:
- spending sprees
- unprotected sex
- drug use
Hypomania is generally associated with bipolar II disorder. It’s similar to mania, but it’s not as severe. Unlike mania, hypomania may not result in any trouble at work, school, or in social relationships. However, people with hypomania still notice changes in their mood.
During an episode of depression you may experience:
- deep sadness
- loss of energy
- lack of interest in activities they once enjoyed
- periods of too little or too much sleep
- suicidal thoughts
Although it’s not a rare condition, bipolar disorder can be hard to diagnose because of its varied symptoms. Find out about the symptoms that often occur during high and low periods.
Bipolar disorder symptoms in women
Men and women are diagnosed with bipolar disorder in equal numbers. However, the main symptoms of the disorder may be different between the two genders. In many cases, a woman with bipolar disorder may:
- be diagnosed later in life, in her 20s or 30s
- have milder episodes of mania
- experience more depressive episodes than manic episodes
- have four or more episodes of mania and depression in a year, which is called rapid cycling
- experience other conditions at the same time, including thyroid disease, obesity, anxiety disorders, and; migraines
- have a higher lifetime risk of alcohol use disorder
Women with bipolar disorder may also relapse more often. This is believed to be caused by hormonal changes related to menstruation, pregnancy, or menopause. If you’re a woman and think you may have bipolar disorder, it’s important for you to get the facts. Here’s what you need to know about bipolar disorder in women.
Bipolar disorder symptoms in men
Men and women both experience common symptoms of bipolar disorder. However, men may experience symptoms differently than women. Men with bipolar disorder may:
- be diagnosed earlier in life
- experience more severe episodes, especially manic episodes
- have substance abuse issues
- act out during manic episodes
Men with bipolar disorder are less likely than women to seek medical care on their own. They’re also more likely to die by suicide.
Types of bipolar disorder
There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.
Bipolar I is defined by the appearance of at least one manic episode. You may experience hypomanic or major depressive episodes before and after the manic episode. This type of bipolar disorder affects men and women equally.
People with this type of bipolar disorder experience one major depressive episode that lasts at least two weeks. They also have at least one hypomanic episode that lasts about four days. This type of bipolar disorder is thought to be more common in women.
People with cyclothymia have episodes of hypomania and depression. These symptoms are shorter and less severe than the mania and depression caused by bipolar I or bipolar II disorder. Most people with this condition only experience a month or two at a time where their moods are stable.
When discussing your diagnosis, your doctor will be able to tell you what kind of bipolar disorder you have. In the meantime, learn more about the types of bipolar disorder.
Bipolar disorder in children
Diagnosing bipolar disorder in children is controversial. This is largely because children don’t always display the same bipolar disorder symptoms as adults. Their moods and behaviours may also not follow the standards doctors use to diagnose the disorder in adults.
Many bipolar disorder symptoms that occur in children also overlap with symptoms from a range of other disorders that can occur in children, such as attention deficit hyperactivity disorder (ADHD).
However, in the last few decades, doctors and mental health professionals have come to recognize the condition in children. A diagnosis can help children get treatment, but reaching a diagnosis may take many weeks or months. Your child may need to seek special care from a professional trained to treat children with mental health issues.
Like adults, children with bipolar disorder experience episodes of elevated mood. They can appear very happy and show signs of excitable behavior. These periods are then followed by depression. While all children experience mood changes, changes caused by bipolar disorder are very pronounced. They’re also usually more extreme than a child’s typical change in mood.
Manic symptoms in children
Symptoms of a child’s manic episode caused by bipolar disorder can include:
- acting very silly and feeling overly happy
- talking fast and rapidly changing subjects
- having trouble focusing or concentrating
- doing risky things or experimenting with risky behaviours
- having a very short temper that leads quickly to outbursts of anger
- having trouble sleeping and not feeling tired after sleep loss
Depressive symptoms in children
Symptoms of a child’s depressive episode caused by bipolar disorder can include:
- moping around or acting very sad
- sleeping too much or too little
- having little energy for normal activities or showing no signs of interest in anything
- complaining about not feeling well, including having frequent headaches or stomachaches
- experiencing feelings of worthlessness or guilt
- eating too little or too much
- thinking about death and possibly suicide
Other possible diagnoses
Some of the behaviour issues you may witness in your child could be the result of another condition. ADHD and other behavior disorders can occur in children with bipolar disorder. Work with your child’s doctor to document your child’s unusual behaviours, which will help lead to a diagnosis.
Finding the correct diagnosis can help your child’s doctor determine treatments that can help your child live a healthy life.
Bipolar disorder in teens
Angst-filled behaviour is nothing new to the average parent of a teenager. The shifts in hormones, plus the life changes that come with puberty, can make even the most well-behaved teen seem a little upset or overly emotional from time to time. However, some teenage changes in mood may be the result of a more serious condition, such as bipolar disorder.
A bipolar disorder diagnosis is most common during the late teens and early adult years. For teenagers, the more common symptoms of a manic episode include:
- being very happy
- “acting out” or misbehaving
- taking part in risky behaviours
- abusing substances
- thinking about sex more than usual
- becoming overly sexual or sexually active
- having trouble sleeping but not showing signs of fatigue or being tired
- having a very short temper
- having trouble staying focused, or being easily distracted
For teenagers, the more common symptoms of a depressive episode include:
- sleeping a lot or too little
- eating too much or too little
- feeling very sad and showing little excitability
- withdrawing from activities and friends
- thinking about death and suicide
Diagnosing and treating bipolar disorder can help teens live a healthy life. Learn more about bipolar disorder in teenagers and how to treat it.
Bipolar disorder and depression
Bipolar disorder can have two extremes: up and down. To be diagnosed with bipolar, you must experience a period of mania or hypomania. People generally feel “up” in this phase of the disorder. When you’re experiencing an “up” change in mood, you may feel highly energized and be easily excitable.
Some people with bipolar disorder will also experience a major depressive episode, or a “down” mood. When you’re experiencing a “down” change in mood, you may feel lethargic, unmotivated, and sad. However, not all people with bipolar disorder who have this symptom feel “down” enough to be labeled depressed. For instance, for some people, once their mania is treated, a normal mood may feel like depression because they enjoyed the “high” caused by the manic episode.
While bipolar disorder can cause you to feel depressed, it’s not the same as the condition called depression. Bipolar disorder can cause highs and lows, but depression causes moods and emotions that are always “down.” Discover the differences between bipolar disorder and depression.
Causes of bipolar disorder
Bipolar disorder is a common mental health disorder, but it’s a bit of a mystery to doctors and researchers. It’s not yet clear what causes some people to develop the condition and not others.
Possible causes of bipolar disorder include:
If your parent or sibling has bipolar disorder, you’re more likely than other people to develop the condition (see below). However, it’s important to keep in mind that most people who have bipolar disorder in their family history don’t develop it.
Your brain structure may impact your risk for the disease. Abnormalities in the structure or functions of your brain may increase your risk.
It’s not just what’s in your body that can make you more likely to develop bipolar disorder. Outside factors may contribute, too. These factors can include:
- extreme stress
- traumatic experiences
- physical illness
Each of these factors may influence who develops bipolar disorder. What’s more likely, however, is that a combination of factors contributes to the development of the disease. Here’s what you need to know about the potential causes of bipolar disorder.
Is bipolar disorder hereditary?
Bipolar disorder can be passed from parent to child. Research has identified a strong genetic link in people with the disorder. If you have a relative with the disorder, your chances of also developing it are four to six times higher than people without a family history of the condition.
However, this doesn’t mean that everyone with relatives who have the disorder will develop it. In addition, not everyone with bipolar disorder has a family history of the disease.
Still, genetics seem to play a considerable role in the incidence of bipolar disorder. If you have a family member with bipolar disorder, find out whether screening might be a good idea for you.
Bipolar disorder diagnosis
A diagnosis of bipolar disorder I involves either one or more manic episodes, or mixed (manic and depressive) episodes. It may also include a major depressive episode, but it may not. A diagnosis of bipolar II involves one or more major depressive episodes and at least one episode of hypomania.
To be diagnosed with a manic episode, you must experience symptoms that last for at least one week or that cause you to be hospitalised. You must experience symptoms almost all day every day during this time. Major depressive episodes, on the other hand, must last for at least two weeks.
Bipolar disorder can be difficult to diagnose because mood swings can vary. It’s even harder to diagnose in children and adolescents. This age group often has greater changes in mood, behaviour, and energy levels.
Bipolar disorder often gets worse if it’s left untreated. Episodes may happen more often or become more extreme. But if you receive treatment for your bipolar disorder, it’s possible for you to lead a healthy and productive life. Therefore, diagnosis is very important. See how bipolar disorder is diagnosed.
Bipolar disorder symptoms test
One test result doesn’t make a bipolar disorder diagnosis. Instead, your doctor will use several tests and exams. These may include:
- Physical exam. Your doctor will do a full physical exam. They may also order blood or urine tests to rule out other possible causes of your symptoms.
- Mental health evaluation. Your doctor may refer you to a mental health professional such as a psychologist or psychiatrist. These doctors diagnose and treat mental health conditions such as bipolar disorder. During the visit, they will evaluate your mental health and look for signs of bipolar disorder.
- Mood journal. If your doctor suspects your behaviour changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. The easiest way to do this is to keep a journal of how you’re feeling and how long these feelings last. Your doctor may also suggest that you record your sleeping and eating patterns.
- Diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an outline of symptoms for various mental health disorders. Doctors can follow this list to confirm a bipolar diagnosis.
Your doctor may use other tools and tests to diagnose bipolar disorder in addition to these. Read about other tests that can help confirm a bipolar disorder diagnosis.
Bipolar disorder treatment
Several treatments are available that can help you manage your bipolar disorder. These include medications, counselling, and lifestyle changes. Some natural remedies may also be helpful.
Recommended medications may include:
- mood stabilisers, such as lithium (Lithobid)
- antipsychotics, such as olanzapine (Zyprexa)
- antidepressant-antipsychotics, such as fluoxetine-olanzapine (Symbyax)
- benzodiazepines, a type of anti-anxiety medication such as alprazolam (Xanax) that may be used for short-term treatment
Recommended psychotherapy treatments may include:
Cognitive behavioural therapy
Cognitive behavioural therapy is a type of talk therapy. You and a therapist talk about ways to manage your bipolar disorder. They will help you understand you're thinking patterns. They can also help you come up with positive coping strategies.
Psychoeducation is a kind of counselling that helps you and your loved ones understand the disorder. Knowing more about bipolar disorder will help you and others in your life manage it.
Interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics can help you manage your disorder.
Other treatment options
Other treatment options may include:
- electroconvulsive therapy (ECT)
- sleep medications
There are also some simple steps you can take right now to help manage your bipolar disorder:
- keep a routine for eating and sleeping
- learn to recognise mood swings
- ask a friend or relative to support your treatment plans
- talk to a doctor or licensed healthcare provider
Other lifestyle changes can also help relieve depressive symptoms caused by bipolar disorder. Check out these seven ways to help manage a depressive episode.
Natural remedies for bipolar disorder
Some natural remedies may be helpful for bipolar disorder. However, it’s important not to use these remedies without first talking with your doctor. These treatments could interfere with medications you’re taking.
The following herbs and supplements may help stabilise your mood and relieve symptoms of bipolar disorder:
- Fish oil. A 2013 study Trusted Source shows that people who consume a lot of fish and fish oil are less likely to develop bipolar disease. You can eat more fish to get the oil naturally, or you can take an over-the-counter (OTC) supplement.
- Rhodiola rosea. This research Trusted Source also shows that this plant may be a helpful treatment for moderate depression. It may help treat depressive symptoms of bipolar disorder.
- S-adenosylmethionine (SAMe). SAMe is an amino acid supplement. The research Trusted Source shows it can ease symptoms of major depression and other mood disorders.
Several other minerals and vitamins may also reduce symptoms of bipolar disorder. Here’s 10 alternative treatments for bipolar disorder.
Tips for coping and support
If you or someone you know has bipolar disorder, you’re not alone. Bipolar disorder affects about 60 million people Trusted Source around the world.
One of the best things you can do is to educate yourself and those around you. There are many resources available. For instance, SAMHSA’s behavioural health treatment services locator provides treatment information by ZIP code. You can also find additional resources at the site for the National Institute of Mental Health.
If you think you’re experiencing symptoms of bipolar disorder, make an appointment with your doctor. If you think a friend, relative, or loved one may have bipolar disorder, your support and understanding is crucial. Encourage them to see a doctor about any symptoms they’re having. And read how to help someone living with bipolar disorder.
People who are experiencing a depressive episode may have suicidal thoughts. You should always take any talk of suicide seriously.
If you think someone is at immediate risk of self-harm or hurting another person:
- Call 911 or your local emergency number.
- Stay with the person until help arrives.
- Remove any guns, knives, medications, or other things that may cause harm.
- Listen, but don’t judge, argue, threaten, or yell.
If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Bipolar disorder and relationships
When it comes to managing a relationship while you live with bipolar disorder, honesty is the best policy. Bipolar disorder can have an impact on any relationship in your life, perhaps especially on a romantic relationship. So, it’s important to be open about your condition.
There’s no right or wrong time to tell someone you have bipolar disorder. Be open and honest as soon as you’re ready. Consider sharing these facts to help your partner better understand the condition:
- when you were diagnosed
- what to expect during your depressive phases
- what to expect during your manic phases
- how you typically treat your moods
- how they can be helpful to you
One of the best ways to support and make a relationship successful is to stick with your treatment. Treatment helps you reduce symptoms and scale back the severity of your changes in mood. With these aspects of the disorder under control, you can focus more on your relationship.
Your partner can also learn ways to promote a healthy relationship. Check out this guide to maintaining healthy relationships while coping with bipolar disorder, which has tips for both you and your partner.
Living with bipolar disorder
Bipolar disorder is a chronic mental illness. That means you’ll live and cope with it for the rest of your life. However, that doesn’t mean you can’t live a happy, healthy life.
Treatment can help you manage your changes in mood and cope with your symptoms. To get the most out of treatment, you may want to create a care team to help you. In addition to your primary doctor, you may want to find a psychiatrist and psychologist. Through talk therapy, these doctors can help you cope with symptoms of bipolar disorder that medication can’t help.
You may also want to seek out a supportive community. Finding other people who’re also living with this disorder can give you a group of people you can rely on and turn to for help.
Finding treatments that work for you requires perseverance. Likewise, you need to have patience with yourself as you learn to manage bipolar disorder and anticipate your changes in mood. Together with your care team, you’ll find ways to maintain a normal, happy, healthy life.
While living with bipolar disorder can be a real challenge, it can help to maintain a sense of humor about life. For a chuckle, check out this list of 25 things only someone with bipolar disorder would understand.
Understanding bipolar disorder
Most people have emotional ups and downs from time to time. But if you have a brain condition called bipolar disorder, your feelings can reach abnormally high or low levels.
Sometimes you may feel immensely excited or energetic. Other times, you may find yourself sinking into a deep depression. Some of these emotional peaks and valleys can last for weeks or months.
There are four basic types of bipolar disorder:
- bipolar 1 disorder
- bipolar 2 disorder
- cyclothymic disorder (cyclothymia)
- other specified and unspecified bipolar and related disorders
Bipolar 1 and 2 disorders are more common than the other types of bipolar disorder. Read on to learn how these two types are alike and different.
Bipolar 1 vs. bipolar 2
All types of bipolar disorder are characterized by episodes of extreme mood. The highs are known as manic episodes. The lows are known as depressive episodes.
The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type.
A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode (a period that’s less severe than a full manic episode).
A person with bipolar 1 may or may not experience a major depressive episode, while a person with bipolar 2 will experience a major depressive episode.
What is bipolar 1 disorder?
You must have had at least one manic episode to be diagnosed with bipolar 1 disorder. A person with bipolar 1 disorder may or may not have a major depressive episode. The symptoms of a manic episode may be so severe that you require hospital care.
Manic episodes are usually characterized by the following:
- exceptional energy
- trouble concentrating
- feelings of euphoria (extreme happiness)
- risky behaviors
- poor sleep
The symptoms of a manic episode tend to be so obvious and intrusive that there’s little doubt that something is wrong.
What is bipolar 2 disorder?
Bipolar 2 disorder involves a major depressive episode lasting at least two weeks and at least one hypomanic episode (a period that’s less severe than a full-blown manic episode). People with bipolar 2 typically don’t experience manic episodes intense enough to require hospitalisation.
Bipolar 2 is sometimes misdiagnosed as depression, as depressive symptoms may be the major symptom at the time the person seeks medical attention. When there are no manic episodes to suggest bipolar disorder, the depressive symptoms become the focus.
What are the symptoms of bipolar disorder?
As mentioned above, bipolar 1 disorder causes mania and may cause depression, while bipolar 2 disorder causes hypomania and depression. Let’s learn more about what these symptoms mean.
A manic episode is more than just a feeling of elation, high energy, or being distracted. During a manic episode, the mania is so intense that it can interfere with your daily activities. It’s difficult to redirect someone in a manic episode toward a calmer, more reasonable state.
People who are in the manic phase of bipolar disorder can make some very irrational decisions, such as spending large amounts of money that they can’t afford to spend. They may also engage in high-risk behaviors, such as sexual indiscretions despite being in a committed relationship.
An episode can’t be officially deemed manic if it’s caused by outside influences such as alcohol, drugs, or another health condition.
A hypomanic episode is a period of mania that’s less severe than a full-blown manic episode. Though less severe than a manic episode, a hypomanic phase is still an event in which your behavior differs from your normal state. The differences will be extreme enough that people around you may notice that something is wrong.
Officially, a hypomanic episode isn’t considered hypomania if it’s influenced by drugs or alcohol.
Depressive symptoms in someone with bipolar disorder are like those of someone with clinical depression. They may include extended periods of sadness and hopelessness. You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like. Other symptoms include:
- trouble concentrating
- changes in sleeping habits
- changes in eating habits
- thoughts of suicide
What causes bipolar disorder?
Scientists don’t know what causes bipolar disorder. Abnormal physical characteristics of the brain or an imbalance in certain brain chemicals may be among the main causes.
As with many medical conditions, bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, your risk of developing it is higher. The search continues for the genes which may be responsible for bipolar disorder.
Researchers also believe that severe stress, drug or alcohol abuse, or severely upsetting experiences may trigger bipolar disorder. These experiences can include childhood abuse or the death of a loved one.
How is bipolar disorder diagnosed?
A psychiatrist or other mental health professional typically diagnoses bipolar disorder. The diagnosis will include a review of both your medical history and any symptoms you have that are related to mania and depression. A trained professional will know what questions to ask.
It can be very helpful to bring a spouse or close friend with you during the doctor’s visit. They may be able to answer questions about your behaviour that you may not be able to answer easily or accurately.
If you have symptoms that seem like bipolar 1 or bipolar 2, you can always start by telling your doctor. Your doctor may refer you to a mental health specialist if your symptoms appear serious enough.
A blood test may also be part of the diagnostic process. There are no markers for bipolar disorder in the blood, but a blood test and a comprehensive physical exam may help rule out other possible causes for your behaviour.
How is bipolar disorder treated?
Doctors usually treat bipolar disorder with a combination of medications and psychotherapy.
Mood stabilisers are often the first drugs used in treatment. You may take these for a long time.
Lithium has been a widely used mood stabiliser for many years. It does have several potential side effects. These include low thyroid function, joint pain, and indigestion. It also requires blood tests to monitor therapeutic levels of the drug as well as kidney function. Antipsychotics can be used to treat manic episodes.
Your doctor may start you on a low dose of whichever medication you both decide to use in order to see how you respond. You may need a stronger dose than what they initially prescribe. You may also need a combination of medications or even different medications to control your symptoms.
All medications have potential side effects and interactions with other drugs. If you’re pregnant or you take other medications, be sure to tell your doctor before taking any new medications.
Writing in a diary can be an especially helpful part of your treatment. Keeping track of your moods, sleeping and eating patterns, and significant life events can help you and your doctor understand how therapy and medications are working.
If your symptoms don’t improve or get worse, your doctor may order a change in your medications or a different type of psychotherapy.
What is the outlook?
Bipolar disorder isn’t curable. But with proper treatment and support from family and friends, you can manage your symptoms and maintain your quality of life.
It’s important that you follow your doctor’s instructions regarding medications and other lifestyle choices. This includes:
- alcohol use
- drug use
- stress reduction
Including your friends and family members in your care can be especially helpful.
It’s also helpful to learn as much as you can about bipolar disorder. The more you know about the condition, the more in control you may feel as you adjust to life after diagnosis.
You may be able to repair strained relationships. Educating others about bipolar disorder may make them more understanding of hurtful events from the past.
Support groups, both online and in person, can be helpful for people with bipolar disorder. They can also be beneficial for your friends and relatives. Learning about others’ struggles and triumphs may help you get through any challenges you may have.
The Depression and Bipolar Support Alliance maintains a website that provides:
- personal stories from people with bipolar disorder
- contact information for support groups across the United States
- information about the condition and treatments
- material for caregivers and loved ones of those with bipolar disorder
The National Alliance on Mental Illness can also help you find support groups in your area. Good information about bipolar disorder and other conditions can also be found on its website.
If you’ve been diagnosed with bipolar 1 or bipolar 2, you should always remember that this is a condition you can manage. You aren’t alone. Talk to your doctor or call a local hospital to find out about support groups or other local resources.