What to know about bipolar disorder

A person with bipolar disorder will experience changes in mood, energy, and levels of activity that can complicate daily living.

Bipolar disorder can cause serious disruption to a person’s life, but the impact varies from individual to individual. Most people with this disorder live a complete and healthy life, with adequate care and support.

Bipolar disorder affects more than 10 million people in the United States, or around 2.8 per cent of the population, according to the National Alliance on Mental Illness (NAMI).

A person should obtain a diagnosis on average about the age of 25, but symptoms may begin during the teenage years or later in life. Equally it affects both males and females.

What is bipolar disorder?

A person with bipolar disorder may experience “highs” and “lows” in quick succession.
A person with bipolar disorder may experience “highs” and “lows” in quick succession.

The National Institute of Mental Health describes the primary symptoms of bipolar disorder as alternating high and low mood episodes. Changes in energy levels, sleep habits, focusability, and other features can have a significant effect on the actions, job, relationships, and other aspects of a person’s life.

At some point, most people experience changes in mood, but those linked to bipolar disorder are more severe than normal changes in mood, and other symptoms may develop. Many may experience insanity, including delusions, hallucinations, and paranoia.

The person’s mood can be stable for months or years between episodes, particularly if they follow a treatment plan.

Treatment enables many people with bipolar disorder to work, study, and live a full and productive life. When treatment does make a person feel better, however, they can avoid taking their medication. The symptoms may then return.

Some aspects of bipolar disorder may be beneficial for an individual. We may find we are more sociable , talkative and creative during an elevated mood.

And it is unlikely that an elevated mood will persist. And if it does, it can be difficult to keep an eye on or follow strategy through. It can make pursuing a project through to the end challenging.

Symptoms

Symptoms differ across individuals according to the International Bipolar Association. An episode can last for several months or years, for some people. Others can experience “highs” and “lows” simultaneously, or in rapid succession.

The person would have four or more episodes within a year in the bipolar disorder called “rapid cycling.”

Hypomania, or mania

Hypomania and mania are moods which are large. Mania is more intense than hypomania.

Symptoms can include:

  • impaired judgment
  • feeing wired
  • sleeping little but not feeling tired
  • a sense of distraction or boredom
  • missing work or school
  • underperforming at work or school
  • feeling able to do anything
  • being sociable and forthcoming, sometimes aggressively so
  • engaging in risky behavior
  • increased libido
  • feeling exhilarated or euphoric
  • having high levels of self-confidence, self-esteem, and self-importance
  • talking a lot and rapidly
  • jumping from one topic to another in conversation
  • having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
  • denying or not realizing that anything is wrong

Many people with bipolar disorder may spend a lot of money, use recreational drugs, drink alcohol and participate in dangerous and unsafe behaviors.

Depressive symptoms

During an episode of bipolar depression, a person may experience:

  • a feeling of gloom, despair, and hopelessness
  • extreme sadness
  • insomnia and sleeping problems
  • anxiety about minor issues
  • pain or physical problems that do not respond to treatment
  • a sense of guilt, which may be misplaced
  • eating more or eating less
  • weight loss or weight gain
  • extreme tiredness, fatigue, and listlessness
  • an inability to enjoy activities or interests that usually give pleasure
  • difficulty focusing and remembering
  • irritability
  • sensitivity to noises, smells, and other things that others may not notice
  • an inability to face going to work or school, possibly leading to underperformance

In severe cases, the individual may think about ending their life, and they may act on those thoughts.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

Psychosis

If there is a very intense “high” or “low” episode the person may experience psychosis. We may have trouble distinguishing between fantasy and reality.

Psychosis signs during a high include hallucinations, which include hearing or seeing things that are not true, and delusions, which are false but deeply held beliefs, according to the International Bipolar Foundation. A person experiencing delusions might believe they are well-known, have high-ranking social ties, or have special powers.

They might feel that they have committed a crime during a depressed or “low” episode, or that they are broken and penniless.

All of these symptoms can be managed with appropriate treatment.

Types of bipolar disorder

One patient can be diagnosed with one of three specific forms of bipolar disorder. Symptoms appear on a spectrum, according to NAMI, and differentiating between types is not always clear-cut.

Bipolar I disorder

For a diagnosis of bipolar I disorder:

  • The individual must have experienced at least one manic episode.
  • The person may have had a previous major depressive episode.
  • The doctor must rule out other disorders, such as schizophrenia and delusional disorder.

Bipolar II disorder

Bipolar II disorder involves periods of hypomania, but depression is often the dominant state.

For a diagnosis of bipolar II disorder, a person must have had:

  • one or more episodes of depression
  • at least one hypomanic episode
  • no other diagnosis to explain the mood shifts

The individual with hypomania will feel good and work well, but they will not be stable in their mood and there is a possibility that depression may follow.

Sometimes people believe that the bipolar II condition is a milder type. But for others it’s just different. As NAMI suggests, people with bipolar II disorder can experience episodes of depression more frequently than those with bipolar I disorder.

Cyclothymia

The United Kingdom’s National Health Service ( NHS) notes that cyclothymia has similar characteristics to bipolar disorder, but it is separately classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Hypomania and depression are involved but the changes are less severe.

Nevertheless, cyclothymia may affect the daily life of a person, and treatment may be provided by a doctor.

Diagnosis

A physician will diagnose bipolar disorder using the criteria set out in DSM-5.

The National Institute of Mental Health (NIMH) states that a person would have had symptoms for at least 7 days or less if the symptoms were serious enough to warrant hospitalization in order to obtain a diagnosis of bipolar I disorder. We may have even suffered a depressive illness that lasted for at least 2 weeks.

A person should have undergone at least one period of hypomania and depression in order to get a diagnosis of bipolar II.

A doctor may perform a physical exam and some diagnostic tests, including tests on blood and urine, to help rule out other causes.

Diagnosing bipolar disorder can be difficult for a doctor, as people are more likely to seek treatment with a depressed mood than a high mood. As a result, separating it from depression can be difficult for them.

If the person has psychosis, their condition may be misdiagnosed as schizophrenia by a doctor

Other problems of bipolar disorder may include:

  • use of drugs or alcohol to cope with symptoms
  • post-traumatic stress disorder (PTSD)
  • anxiety disorder
  • attention-deficit hyperactivity disorder (ADHD)

NIMH advises health care providers to look into the past of the individual for symptoms of mania, to prevent misdiagnosis. For susceptible people certain antidepressants may cause mania.

A person who is diagnosed with bipolar disorder has a condition that lasts for life. We can enjoy long stable periods but will still live with the condition.

Learn more on the bipolar disorder and schizophrenia here.

Treatment

Treatment aims at stabilizing the mood of the patient and the the severity of the symptoms. The goal is to help the person work efficiently in daily life.

Treatment involves a combination of therapies, including:

  • medication
  • counseling
  • physical intervention
  • lifestyle remedies

It can take time to get a proper diagnosis and find an effective treatment, as individuals respond differently and symptoms vary widely.

Drug treatment

Drug therapies can aid in mood improvement and symptom control. Sometimes a doctor can recommend a mixture of:

  • mood stabilizers, such as lithium
  • antidepressants
  • second-generation antipsychotics (SGAs)
  • anticonvulsants, to relieve mania
  • medication to help with sleep or anxiety

With time the doctor might need to change the prescription. Many medications have adverse effects, which may have various effects on individuals. When a person has questions about their drug treatment, they should talk with their doctor.

A person must:

  • tell the doctor about any other mediations they are using, to reduce the risk of interactions and adverse effects
  • follow the doctor’s instructions regarding medication and treatment
  • discuss any concerns about adverse effects, and if they feel the treatment is working
  • continue taking medication unless the doctor says it is safe to stop
  • bear in mind that the drugs can take time to work

If the person discontinues their treatment, symptoms may worsen.

Psychotherapy and counseling

Psychotherapy can help relieve symptoms and prepare an individual to manage bipolar disorder.

Through cognitive-behavior therapy (CBT) and other approaches, the individual can learn to:

  • recognize and take steps to manage key triggers, such as stress
  • identify early symptoms of an episode and take steps to manage it
  • work on factors that help maintain a stable mood for as long as possible
  • engage the help of family members, teachers, and colleagues

Such measures will help a person to maintain good ties at home and at work. A doctor can prescribe family counseling for children and teens suffering from bipolar disorder.

Hospital treatment

Many people will need to spend time in the hospital if there is a risk that they may injure themselves or others.

A doctor can prescribe electroconvulsive therapy ( ECT) if other therapies have not worked.

Lifestyle remedies

Many lifestyle decisions can help relieve symptoms and maintain a stable mood. They include:

  • maintaining a regular routine
  • following a healthful and varied diet
  • establishing a regular sleep pattern and taking steps to prevent sleep disturbance
  • getting regular exercise

Some people use supplements but discussing this with a doctor first is essential. Some alternative therapies can interfere with bipolar disorder drugs. They can worsen symptoms.

Causes

A combination of factors tends to cause bipolar disorder.

Genetic Factors: Bipolar disorder is more common in people with the disease as a family member. A number of genetic features may be involved.

Biological traits: Research suggests that neurotransmitter or hormone imbalances which affect the brain can play a role.

Environmental factors: Life events such as violence, mental stress, a “significant loss,” or another traumatic event in a susceptible individual that cause an initial episode.

Outlook

Bipolar disorder is a mental health condition that is relatively normal but severe, involving changes in mood, energy levels and focus along with other symptoms.

This can seriously ruin a person’s life, but treatment will improve the outlook drastically.

Treatment does not fully remove mood swings but working together with a physician may make symptoms more manageable and improve quality of life.

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