What is bipolar disorder?
Previously known as manic-depressive illness, or manic depression, bipolar disorder or bipolar mood disorder, is a psychological condition (brain/mental disorder) that results in extreme emotional reactions in the form of mood changes consisting of emotional lows, known as depression, and emotional highs, known as hypomania or mania (more extreme than hypomania).
The main difference between hypomania and mania is that the moods are measured according to the duration of the symptoms and the effects these symptoms may have and not the extent of the feelings of elation / happiness expressed by the patient.
The condition also causes shifts in energy, ability to perform everyday tasks and changes in activity levels. If someone is diagnosed with bipolar disorder or have a loved one or friend who has it, you may notice that it can be difficult to maintain personal relationships, unusual irritability is also common, or heightened happiness. These extreme mood swings often affect behaviour, sense of judgment, clarity of thinking and sleep.
In feeling depressed, the sufferer may feel hopeless or sad, or may even lose the pleasure they once felt in certain activities. When the person with bipolar disorder feels unusually happy (hypomanic) or extremely happy (manic), they experience bouts of euphoria. These mood swings can occur rarely, occasionally or often. Bipolar mood swings are often referred to as ‘episodes’, and the sufferer may experience emotional signs or symptoms between these episodes, or may not feel or show any unusual emotional behaviour between them.
Many people tend to confuse bipolar disorder with borderline personality disorder. However, the two conditions are different in that bipolar episodes tend to be intermittent and not continuous, while borderline personality disorder has symptoms that are ongoing and constant. Although the conditions both share similar symptoms in mood shifts and issues with impulse control, bipolar disorder is characterised more by mood episodes that are depressive or on the opposite scale, manic. The condition has breaks in between the episodes where the mood is often balanced or emotions are mid-range. Whereas borderline personality disorder has a pattern of behaviour that is constant.
Is it important to note that bipolar disorder is a condition that lasts for a person’s entire life, and although there is no cure, there are ways to keep mood swings under control through psychotherapy, which includes seeing a psychologist on a regular basis and of course, through medication, which involves taking certain drugs that help lessen the extreme mood swings and manage them better.
The disorder has several types, each one of them involves defined mood, activity and energy changes. These range from episodes of feeling happy, elated and energised – these are known as episodes that are manic, and then moving to depressive episodes where one feels extremely sad, down or hopeless. When a manic episode is less severe, this is known as a hypomanic episode.
This article explores and explains all that you need to know about this condition, how to deal with it, what causes it, what its symptoms are and treatment. It is important to be educated on bipolar disorder should you wish to know how to cope with it and understand it better. Please keep in mind that this information is intended to serve as a guideline and is not a professional medical opinion, if that is what you are seeking, then consult with your doctor or psychologist.
What are the types and symptoms of bipolar disorder?
As discussed, bipolar disorder has several different types, each one with its own defining symptoms and characteristics.
The most common types are explained as follows:
This type of bipolar (being one of the two types that are seen to be most commonly diagnosed) was once known as manic depression. It is defined by manic episodes, having occurred in the last seven days, or by symptoms that are severely manic that the affected person may need immediate professional care. Depressive episodes tend to also occur in this type and last around two weeks or more. It is also possible for episodes of depression and mania appear simultaneously.
To be categorised as a bipolar I sufferer, the manic episode experienced, which is characterised by an irritable mood, elevation or expansive behaviour will be clearly different to the sufferer’s normal behaviour. This lasts about seven days. If left untreated, they may end up being hospitalised. It is also possible that the mania in some cases triggers a break from what is real and what is not, this is seen in more severe cases and is known as psychosis.
This type is actually four times more common than bipolar I. It is defined by manic symptoms that are significantly less severe, are not linked to psychosis and as there is no occupational or social dysfunction. Hypomania also occurs for a shorter duration of time and hospitalisation is not generally required for treatment. These symptoms are referred to as hypomanic symptoms.
To help you to remember the difference between the two main types of bipolar disorder, type one is defined as mania and type two is hypomania. Just for a quick recap, mania is far more severe than hypomania, ‘hypo’ being a prefix that means beneath or below. However, this type is not merely a milder kind or form of type one, but rather a separate diagnosis entirely. It is easy to remember the difference in noting that the symptoms of hypomania are not severe enough that they cause a significantly marked impairment in social or even occupational functioning, they also do not require for the patient to be hospitalised as they are not associated with psychosis.
Being less prominent, these symptoms tend to hold more difficulty in being diagnosed. If the condition goes undiagnosed and without treatment, this type is likely to evolve into mania and manic depression will develop. Manic depression is defined as one episode of either mania or hypomania having occurred at some point during the patient's life.
With this type, the patient may experience an episode of hypomania that lasts for about four days.
The rarer types of bipolar disorder are explained as follows:
Rarer types of bipolar disorder consist of two additional types that are not as common as the above-mentioned ones. These include:
Cyclothymia / Cyclothymic disorder
For those who have this type of bipolar condition, episodes vary in mania and depression, but they will frequently fluctuate between the two ends of the emotional spectrum (or poles, hence the name “bipolar”) – with the sufferer being either happy and sad. In cyclothymic disorder, symptoms are far less severe than the common types of bipolar disorder and one may have a few months in a row where moods tend to stabilise. It is also possible to function normally without treatment or medication, however, if left undiagnosed and the condition progresses, it may develop into one of the two main types.
For a patient to be diagnosed with cyclothymic disorder, they will have experienced periods that include both depressive and hypomanic symptoms, and they will not meet all criteria required for major depression, mania or hypomania to be diagnosed.
These episodes of mood swings last over two years of shifting through happiness and depression in adults, and one year in teenagers and children.
Rapid-cycling bipolar disorder
With this type of bipolar disorder, changes in mood swings occur quicker than the other types. The sufferer may experience more than four episodes of mania, depression, hypomania or a mixture of these symptoms in the period of a year.
The diagnosis of bipolar can happen at any age, but it is typically diagnosed during the teenage years or in one’s early 20s. The symptoms tend to vary from each person, and can also change over time.
A person who has bipolar disorder is likely to go through periods of expressing and feeling intense emotion. This can result in changes in sleep patterns, energy levels falling and rising and exhibiting unusual behaviour. As mentioned earlier, these are known as ‘episodes’, or ‘mood episodes’. These episodes can vary between different people and have a distinct difference from one’s normal personality (baseline personality).
These episodes are also known to include both depressive and manic symptoms. This is referred to as a ‘mixed feature episode’. When experiencing this, one may feel empty, hopeless or sad and also feel energised at the same time.
One may also experience less severe symptoms known as hypomania. In an episode like this the sufferer may feel energised and productive, and while these changes in personality may not be noticeable to the person concerned, it is likely that friends and family will notice these changes. It is best to seek medical attention if this is the case, so as to prevent hypomania developing into mania if one does not learn how to deal and cope with mood swings. Manic episodes are easier to detect personally without an input from others, whereas someone suffering from hypomania may just put their symptoms down to mood variations.
The symptoms can be further elaborated on as follows:
Hypomania and mania
These are two very distinct and different types of bipolar episodes. However, they share the same symptoms. Mania is known to be more severe than hypomania and it results in far more noticeable issues at school, work and in one’s social life, it is also known to cause problems in relationships. Hypomania is less noticeable and far less severe, but when closely observed, the characteristic changes in mood are able to be identified.
Hypomanic and manic episodes are known to include at least three of the following symptoms:
- Being jumpy, wired or unusually upbeat
- Decreased need to sleep
- Being unusually talkative
- Being easily distracted
- Increased energy or agitation
- Inability to make good decisions – the sufferer is likely to make bad decisions in going on shopping sprees they can’t afford, undertaking in sexual activities that are risky, giving away personal possessions on a grand scale or investing money in foolish investments.
Major episode of depression
An episode of this extent is known to be noticeable enough to cause difficulties in everyday life such as school, work, social gatherings and relationships. An episode of major depression is likely to include at least five of the following symptoms:
- Being in a depressed state in feeling empty, sad, tearful or hopeless. In teens and children, these moods can come across as irritability
- Feeling little or no pleasure in any activities. Experiencing a significant loss of interest in activities that once made one feel happy.
- Losing a large amount of weight that is not achieved through dieting. If children cannot gain weight it is often a mark of depression.
- Wanting to sleep all the time or not sleeping at all (insomnia).
- Feeling a slowed sense of behaviour or restless.
- Feeling fatigued and experiencing a loss of energy.
- Feeling worthless or guilty for no reason.
- Not being able to think straight or concentrate. Feeling indecisive.
- Having suicidal thoughts.
Other symptoms of bipolar disorder
Symptoms and signs of the two main types of bipolar disorders may also include other symptoms such as:
The symptoms’ timing may be diagnosed as rapid cycling or mixed. The symptoms of bipolar disorder can also occur with a change in season or during pregnancy.
Symptoms in teens and children
It can be difficult for bipolar symptoms to be diagnosed in teens and children. It is also sometimes difficult to tell the difference between normal mood changes due to a stressful or traumatic event, or if the symptoms are due to a mental health issue apart from bipolar disorder.
The episodes of hypomania or mania may be distinct in teens and children, with the patterns of mood swings differing from adults with the condition. The moods are also likely to rapidly change during each episode, with some children having periods between the episodes without any symptoms.
The most noticeable and prominent symptom of bipolar disorder may be due to the fact that the bipolar mood swings tend to differ drastically from the sufferer’s usual mood swings. For example, it is a well-known fact that teenagers love to sleep late, however, if you notice that their sleeping patterns have shifted from just sleeping into wanting to sleep all day for a number of days, it might be worth having a doctor look into it.
When you should see a doctor
It is often the case that when someone has bipolar disorder, they don’t realise how their emotional instability plays a disruptive part in their daily life and on the relationships with loved ones. Some people thoroughly enjoy the feeling of euphoric cycles and their increase in productivity and overlook the emotional crashes that can follow after this.
However, if someone is experiencing any of the aforementioned symptoms, such as mania or depression, then it is best to consult with a doctor or psychologist. This is a condition that without treatment, cannot improve, specifically if they do not realise they have it. Getting treatment will help to suppress symptoms and control them.
When to seek emergency help
If you or someone you know is experiencing suicidal thoughts, you should seek immediate medical attention. This includes thoughts of self-harm as this may escalate if left untreated.
What are the causes of bipolar disorder?
The cause of bipolar is not yet known. However, there are a number of factors involved, these include:
- Genetics – If you have a relative of the first degree, being either a parent or sibling, who has been diagnosed with the condition, research suggests that your chances of having the condition are increased. However, research is still being conducted as to whether genes have a direct role to play in the disorder. However, some studies have shown that in identical twins, one has been diagnosed as bipolar, with the other not showing any symptoms of the condition. Hence, more research is still to be done so as to confirm if genes do in fact play a prominent role.
- Biological differences – If you have bipolar disorder, your brain will show physical changes. How significant these changes are is still unknown, but further research done can help to identify the causes.
What are the complications of bipolar disorder?
If bipolar disorder is left untreated, it can lead to more severe issues that can impact the sufferer’s life, these include:
- Drug and alcohol abuse
- Damage to relationships
- Poor performance at school or work
- Financial or legal issues
Further complications tend to appear when bipolar disorder develops with other illnesses:
Some of the symptoms of bipolar disorder are very similar to those of other illnesses. This can make it difficult for a doctor to make an accurate diagnosis. It is common for some people to have bipolar disorder as well as another illness at the same time. These illnesses include:
- Substance abuse
- Eating disorders
Those with bipolar disorder, are at a higher risk of developing the following:
- Heart disease
- Other physical illnesses
Other related conditions may include the following:
ADHD and Anxiety
Attention-deficit hyperactivity disorder, known as ADHD and anxiety disorders are commonly diagnosed in those with bipolar disorder. This is due to the fact that sufferers may experience difficulty in concentrating which is linked to ADHD during a bipolar episode, or experience anxiety.
If someone experiences episodes of depression or mania that are severe, these episodes may also include delusions or hallucinations. This is known as psychosis, or rather, psychotic symptoms. These tend to match the affected person’s extreme mood. Examples are as follows:
- If psychotic symptoms are experienced during a depressive episode, one may believe that they are ruined, have no hope in life and are penniless. They may even think that they have committed a felony or crime when in reality they’ve done nothing wrong.
- If psychotic symptoms are experienced during a manic episode (one with extreme happiness), the affected person may believe that they are rich, have special powers or some other kind of elaborate belief.
Because of this those who have bipolar disorder and experienced psychosis, may be misdiagnosed with schizophrenia.
Those with bipolar disorder may misuse drugs or alcohol, have issues with relationships, and even perform badly at work or school. The sufferer may not be able to recognise these issues as signs of a mental illness, being bipolar disorder.
How is bipolar disorder diagnosed?
Proper treatment and diagnosis are able to assist the affected person in leading a productive and healthy life. It is advised that the sufferer speaks to a doctor to a mental health professional such as a psychologist, as the first step to diagnosis and treatment. A doctor is likely to conduct a physical exam in order to determine if the person has bipolar disorder or another condition.
Diagnosing bipolar patients can often be a complicated process for doctors. This is due to the fact that mood swings tend to vary from person to person. The condition is even more difficult to diagnose in teenagers and children.
To be diagnosed with a manic episode, symptoms will last for about a week, with the symptoms being experienced every day for that week, and one may even need to be hospitalised.
For depressive episodes to be diagnosed, symptoms will persist for about two weeks.
**Note to doctors and medical professionals: If someone has bipolar disorder, they tend to seek medical help during a depressive episode, as opposed to a hypomanic or manic one. Therefore, an in-depth medical history of the patient is required so as to not misdiagnose the person with depression. If someone has depression, they do not experience episodes of mania, but they may express some manic symptoms occasionally, this is referred to as major depressive disorder with mixed features.
A typical evaluation for bipolar disorder can include:
A physical examination
This includes lab tests in order to identify if there are any other medical issues that may be the cause of the symptoms.
A psychiatric assessment
This is when a doctor refers a patient to a psychiatrist to talk about their emotions, feelings and behavioural issues. It is likely that the psychiatrist will also request that a self-assessment or psychological questionnaire be filled in. If the patient allows it, loved ones and friends may also provide the psychiatrist with information about them and their moods.
A mood chart
This is a daily record of sleep patterns, moods as well as other factors that the sufferer will need to keep track of in order to assist in achieving a concrete diagnosis.
Criteria required for a bipolar disorder diagnosis
A patient’s symptoms may be compared with criteria for bipolar and other disorders that can be related by a trained psychiatrist. These criteria are known as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).
Diagnosis in children
The diagnosis of bipolar disorder in teenagers and children often includes the same criteria used in adults, however, the symptoms of younger people often include differentiating patterns and do not always fit into the categories in order to ensure an accurate diagnosis.
Another factor is that children who are bipolar are often diagnosed with the wrong mental condition such as ADHD or with a behavioural issue – this makes the diagnosis process more complicated. It can sometimes be best for one to go to a child psychiatrist who specialises in mental disorders.
What is the treatment for bipolar disorder?
In order to ensure that the affected person receives the best treatment, it is advised that the opinion and diagnosis of a doctor or medical professional who specialises in mental health conditions – often known as a psychiatrist is sought.
Bipolar disorder, being a lifelong condition, needs treatment that is able to manage the symptoms thereof.
These treatments may include:
Medications are often given immediately to help balance mood swings and improve the person’s everyday life.
Being a lifelong condition, a bipolar sufferer will need to continuously take medications, even when having a ‘happy’ period. This is known as maintenance treatment. If this is not done, the risk a relapse of symptoms or developing severe depression or mania increases.
One may need to be hospitalised if experiencing suicidal thoughts, wanting to inflict self-harm or psychosis. This helps the sufferer to stay in a stable environment, be under constant monitoring where they will also be kept safe and calm.
Day treatment program
Some bipolar patients may be put on a day treatment program that provides counselling and support in order to control and deal with their symptoms. This is known as outpatient care in which patients are treated under a physician’s supervision and monitoring.
Treatment for substance abuse
Those having issues with drug or alcohol addiction may need to treat these through a clinic or rehabilitation centre in order to help manage bipolar disorder. Once the sufferer begins to deal with these addictions, it will be easier to combat bipolar symptoms as they will not be heightened or triggered through drug or alcohol use.
A mental health professional may also recommend that a bipolar patient joins a support group. This helps the person to not feel alone in the condition, to know what to expect and how to deal with certain symptoms.
Bipolar medications explained
We touched on medications earlier in saying that they are often administered right away in order to help the patient to get bipolar related mood swings under control and bring about some kind of normalcy to the sufferer’s life. However, in order to fully cover this section in-depth, we will look at the specific medications used, their side effects and what they are used for.
These are able to control hypomanic and manic episodes. Some examples include:
- Lithobid (lithium)
- Depakene (valproic acid)
- Depakote (divalproex sodium)
- Carbamazepine (Tegretol, Equetro and others)
- Lamictal (lamotrigine)
For those who experience symptoms of mania or depression that are persistent, regardless of the treatment and other medications, doctors may prescribe an antipsychotic drug. These include:
- Zyprexa (olanzapine)
- Risperdal (risperidone)
- Seroquel (quetiapine)
- Abilify (aripiprazole)
- Geodon (ziprasidone)
- Latuda (lurasidone)
- Saphris (asenapine)
One of these may be prescribed with a mood stabiliser.
A doctor may prescribe an antidepressant to help manage episodes of depression. Caution is often taken when these are prescribed as they may trigger additional manic episodes. These are normally given with a mood stabiliser or an antipsychotic.
Antidepressant - antipsychotic
Symbyax is a medication that combines the antipsychotic olanzapine with the antidepressant fluoxetine in order to work as a treatment for depression as well as a mood stabiliser.
The medication benzodiazepine is able to help with anxiety and improve sleep. However, these are normally used on a short-term basis.
Getting the right medication
Finding the right mix of medication that works for the affected person is often a process of trial and error. The upside is that if one of the medications does not work, then there are a number of others to try. This is a process that requires patience and weeks or even months to wait for the medication to be in full effect. A doctor is likely to only change one medication at a time to relieve some of the symptoms and side effects associated with the currently administered meds. If the patient’s symptoms change, the previously prescribed medication may also need to be adjusted.
Side effects that are mild can often be improved through adjusting medication or dosages in finding the right ones that work for the patient. If medication side effects become bothersome, then it is advisable to speak to a healthcare professional about an adjustment.
As with most other prescribed medications, patients should never adjust their own medication or stop taking it. This can result in more side effects such as withdrawal or a severe relapse.
Pregnancy and medications
Some medications for bipolar disorder are known to result in birth defects and are able to be passed through a mother’s milk ducts when breastfeeding her baby. Some of these include valproic acid as well as Divalproex – both of which should not be used when one is pregnant or breastfeeding.
It is also likely that contraceptive pills used for birth control lose their efficiency when taken with bipolar medications.
If the patient is a female who suffers from bipolar disorder, it is advisable to discuss options of treatment with regard to pregnancy with their doctor, and specifically disclose if they are pregnant, think they might be or would like to be in the near future. And if they do not want to get pregnant, they will have to explore other options of contraception.
This is an important part of the treatment for bipolar disorder. There are several types of therapy, and it can be provided in family, group or individual settings. The types of therapy include:
- IPSRT (interpersonal and social rhythm therapy) – This type of therapy focuses on stabilising daily rhythms, such as waking up, sleeping and meal times. It creates a consistent routine in order to help with the management of moods. This helps to create an environment of stability.
- CBT (cognitive behavioural therapy) – This type of therapy focuses on identifying negative and unhealthy behaviours in order to replace them with healthier and more positive ones. This treatment allows the person with bipolar disorder to learn what triggers bring about these episodes and assists in creating strategies that will enable them to manage stress and deal with situations that are upsetting.
- Psychoeducation – This type of therapy educates the patient, their family and loved ones to understand bipolar disorder more effectively in order to be able to identify what the issues are, put preventative measures in place and give support in dealing with the condition in helping the sufferer’s family to understand what they are going through.
- Family-focused therapy – This type of therapy involves the patient’s family in order to help them to stick to a treatment plan and allow loved ones to be able to recognise potential triggers and mood swings. Relationships can often take a toll in the life of a bipolar person, specifically if they or their loved ones do not know they have the condition. Loved ones may think the person is simply acting out, depressed or stressed without knowing that they have a serious mental condition. This can result in them distancing themselves from the sufferer’s behaviour due to the fact that they don’t understand the associated mood swings and other symptoms. In order to prevent this, it is best for a bipolar sufferer to be correctly diagnosed, and then to have assistance in educating and involving their loved ones in their treatment and recovery.
Other options of treatment
Other options of treatment are dependent on the patient’s needs. These treatments are known to include ECT, which is the abbreviation for electroconvulsive therapy. In this type of therapy, electric currents pass through the brain in order to trigger a small and brief seizure. This creates a change in the chemistry of the brain and is sometimes able to reverse the symptoms of a number of mental disorders, bipolar disorder being one of them. This is often the solution when other means of treatment are not effective and the patient is not able to take antidepressants due to health reasons, it is also a viable option if he/she has suicidal thoughts.
Treatment in teenagers and children
Treatments for younger people are decided for the specific case at the time, including what the symptoms are, the possible side effects of the medication and the individual patient. Treatment is generally known to include:
- Psychotherapy – This kind of therapy when used in the initial stages of bipolar disorder can often stop the symptoms returning. This helps young adults and children to create a routine and manage the disorder in order to bring stability to their daily lives. It also helps to develop skills to cope with stressors, improve learning difficulties, aid in resolving social issues, and help in strengthening communication and relationships. It is also able to help to treat in drug and alcohol abuse in teenagers. This treatment involves going to daily or weekly sessions with a psychologist or psychiatrist.
- Medications – Teens and children who have bipolar disorder are normally given the same medication as adults. However, there is a lack of research done on the side effects of said medication in children and teens, so safety is assumed based on research done in adults.
- Support – This involves doctors or psychiatrists working with teachers, parents and friends in order to encourage the support of loved ones, identify triggers and stressors and provide the much-needed care.
- Psychoeducation - This is a form of treatment that includes learning about the symptoms of bipolar and how they are different from a child’s normal behaviour that is part of their personality development and how to detect and differentiate between the two types of behaviours.
Research is lacking in the field of alternative medicine, sometimes referred to as integrative medicine and the use of it with bipolar disorder. If the sufferer does, however, decide to choose to go the non-traditional route of treatment, there are some precautions that should be taken into consideration:
- Do not stop taking the medication the doctor has prescribed as alternative treatment should not be seen as a substitute for regular medication. The patient should also still attend all of their therapy sessions and not skip any.
- It is best to be honest with health professionals and tell them what exactly the patient’s alternative treatments are or what they would like to try.
- Always beware of what potential danger there is in taking alternative treatments as they are often not regulated in the way that prescription medication is.
How to deal with bipolar disorder?
Tips for support and coping with the condition
There are over 60 million people in the world who have been diagnosed with bipolar disorder, and quite possibly more due to inaccurate diagnosis.
If you or a loved one is diagnosed with the condition, your first step should be educating yourself on all there is to know about it in terms of what to expect, warning signs to look for as well as support and coping techniques.
There are a number of resources and behavioural therapies available, with more and more surfacing daily. It is important to know that bipolar disorder is a commonly diagnosed condition and doctors are constantly providing new medication and therapy techniques to help sufferers in dealing with it. If after reading this article, you think you or a loved one may have the disorder, then you should seek immediate professional advice. Once you learn more about it, are correctly medicated and attend therapy sessions, you will start to note a significant difference in the symptoms and side effects of the condition.
When someone is bipolar their episodes of mania or hypomania are often good enough to rule out the episodes of depression, otherwise known as the ‘lows’. There may be days when the person gets in their car and drives to the beach or a theme park or takes friends on a shopping spree. These are then often followed by feelings of self-doubt or hopelessness, it is on these ‘down days’ that someone may want to take their own life.
Everyone experiences bipolar differently. There is no telling how long the episodes will last, it could be a day or a month. However, these bouts of emotional ups and downs are likely to form patterns with certain triggers – when these triggers can be identified, it makes the condition easier to treat and deal with. If you are at all unsure as to whether the condition is present or not in either yourself or a loved one, it is best to immediately seek professional help.
When consulting with a doctor, a person will need to be as open and honest as possible in order for him/her to provide a diagnosis that is as accurate as possible. This will ensure the best possible outcome from treatment.
Whether you or a loved one is suffering from bipolar disorder, you are not alone in dealing with this, remember to keep learning all that you can in order to provide support, identify triggers and learn to cope with this condition.