Bipolar is a mental health disorder defined by unusually extreme and/or rapidly changing ups and downs in mood, thinking, and functioning. These mood swings, called episodes, are much more severe than a simple bad or good mood. Bipolar disorder can cause very intense emotions, impaired thinking, and behaviors that can have severe consequences on health, finances, employment, and relationships. The symptoms can be very disruptive and harmful.
A person with bipolar disorder experiences unusually intense shifts in:
- mood
- energy and activity levels
- ability to concentrate
- everyday functioning
- sleep
- behavior
Symptoms
Bipolar disorder used to be called manic depressive, and those terms are used today to describe the mood episodes. Signs and symptoms vary in type and intensity from person to person.
Mania/hypomania
Manic episodes, or mania, are episodes of extremely “up” behavior. At first, the energetic up of a manic episode can seem like a good thing if it produces energy and productivity, but it doesn’t stop there. It can become an uncontrollable high that results in increasingly erratic and even dangerous behavior. Mania can even lead to suicide.
Manic behaviors:
- More energetic than usual
- Alertness, doesn’t seem to need sleep
- Elated, overconfident attitude
- Expresses a grandiose sense of self, feels powerful, important, invincible
- Very productive, non-stop activity
- Jumpy, agitated
- Decreased appetite, doesn’t eat
- Talks very fast, has difficulty staying on topic
- Racing thoughts
- Risky behavior, poor judgment (gambling, drug and alcohol abuse, risky sexual behavior)
- Irritable, easily triggered, can lead to rage
Hypomania is a milder form of mania. A person experiencing hypomania may be more productive and upbeat and believe they are behaving normally. Those close to them, however, may recognize their change in behavior or mood.
Depressive episodes
Depressive episodes are extreme, sometimes debilitating lows that can lead to self-harm and even suicide.
Depressive behaviors might be:
- Feeling sad, empty, or indifferent
- A sense of worry and hopelessness
- Sluggish behavior, talking slowly
- Restlessness
- Trouble sleeping
- Increased appetite, resulting in weight gain
- Forgetfulness
- Feeling like they have nothing to offer or say
- Trouble concentrating
- Inability to make decisions
- Unable to complete tasks
- Lack of interest in activities
- Loss of sex drive
- Inability to feel pleasure (called anhedonia)
- Thoughts of death, suicidal
Types of bipolar
There are several types of bipolar disorder, but they all have mania or hypomania in common. The bipolar diagnosis is based on the type and severity of episodes, length of time experiencing cycles of episodes, and whether there are possible external causes like medical conditions or drugs.
There is no physical test for bipolar disorder. Before making a diagnosis, however, your doctor may perform a physical exam and order lab tests to rule out other issues first. The patient’s history of episodes will help determine the type of bipolar disorder they experience.
- Bipolar 1 — is defined as having at least one manic episode severe enough to last a week and one or more episodes of hypomania or major depression. A manic episode may trigger psychosis (losing contact with reality, but generally not even aware of it) and can be severe enough to require hospitalization.
- Bipolar 2 — is defined as having at least one episode each of major depression and hypomania, but no manic episodes or psychosis.
- Cyclothymic disorder (cyclothymia) — is a type of bipolar that causes many periods of depressive symptoms and hypomania over a period of at least two years. Moods are unstable, but symptoms are not as severe as major depression or a manic episode.
- Other — also called unspecified bipolar, means that a person has episodes of elevated moods but doesn’t clearly fit the diagnostic requirements for bipolar 1, 2, or cyclothymia.
Causes
We don’t know the exact cause of bipolar disorder, but certain factors may make one more likely to develop it:
- Genetics — You are more likely to have bipolar disorder if a parent or sibling has it, suggesting a genetic factor.
- Brain differences— There is some evidence that the brains of those who have bipolar disorder may have structural and functional differences, but this is still unproven.
- Stressful event — A significant event like illness, financial issues, or the death of a loved one can trigger an episode of depression or mania.
Treatment
Bipolar disorder is best managed through a combination of talk therapy and medication. Symptoms may come and go, but bipolar is a diagnosis for life. Managing symptoms and cycles is a lifelong job, even on those days when you feel fine.
Treatment might include:
- Psychotherapy — Known as talk therapy, psychotherapy helps identify harmful behaviors, emotions, and thought patterns and develop techniques for dealing with them when they occur.
Different types of psychotherapy used to treat bipolar disorder include:
- Cognitive behavioral therapy
- Psychoeducation
- Interpersonal and social rhythm therapy (IPSRT)
- Family-focused
- Medications — Medications might include mood stabilizers, antipsychotics, antidepressants, anti-anxiety medications, and others to promote sleep. Everybody responds differently to medications, so it can take some trial and error to find the right treatment. It is essential to take medications exactly as prescribed and to never stop a medication without a doctor’s guidance.
- Brain stimulation therapies — In severe cases, or if medications are not an option, electroconvulsive therapy (ECT) may be used. ECT uses electrical currents to change brain chemistry to decrease or reverse symptoms.
Self-care
How you treat yourself and manage your symptoms on a day-to-day basis is also a critical part of your overall treatment plan. The better you know yourself, the better you can manage your symptoms. Some positive steps you can take for yourself include:
- Regular exercise — Aerobic exercise improves depression and anxiety, helps regulate sleep, and promotes overall health.
- Mood chart — Tracking daily symptoms, treatment, exercise, sleep, and notable events can help you pinpoint patterns and triggers to help you better manage them.
- Support — Having friends, family members, or support groups to turn to can make a positive difference in your day-to-day management of symptoms and stress.
- Planning — Be prepared. Write out your daily routine, a plan for managing episodes, and contact information for people who can help during an episode. Share a copy with your healthcare provider and a supportive friend or family member.
- Avoid alcohol and drugs — Self-medicating with drugs or alcohol may be tempting, but only makes symptoms worse. Drugs and alcohol can also trigger episodes.
- Routine — Organizing your day around a routine can help reduce stress and keep your moods stable. A sleep routine is especially important, as sleep issues are common with bipolar, and lack of sleep can make symptoms worse.
Complementary therapies
Complementary therapies are non-traditional therapies that can be used along with medical treatments to improve your symptoms. Some popular complementary therapies for bipolar are:
- Stress management — Stress is a common trigger of bipolar episodes. Stress management techniques like meditation, yoga, or massage therapy can help to reduce stress and anxiety, decreasing bipolar symptoms.
- Diet — While there is no specific bipolar diet, a healthy diet of whole grains, lean protein, low-fat dairy, and plenty of fruits and vegetables is a good plan. The average American diet high in sugar, sodium, and unhealthy fats is linked with serious health conditions like obesity, heart disease, and some cancers. Recent research also suggests that healthy gut bacteria can help bipolar symptoms by boosting your immune system and affect stress hormones and neurotransmitters. A healthy diet promotes healthy gut bacteria.
- Herbal supplements — Some herbal supplements have shown positive effects on bipolar symptoms in some studies. As promising as that may sound, there has not been enough research on most to ensure they are safe to use. Before taking herbal supplements, it’s important to talk to your healthcare provider. Some supplements have known side effects like insomnia and nausea. Others can interact badly with medications you may be taking. Some can even trigger episodes.
Bipolar disorder is personal
Bipolar is not one-size-fits-all. No two people will experience bipolar exactly the same or respond to treatment the same. But many people with bipolar disorder will find the right treatment, support system, and strength to manage their symptoms and live happy, productive lives.
If you or someone you love are struggling with the symptoms of bipolar disorder, talk to your healthcare provider. If you don’t have a healthcare provider, visit the National Alliance on Mental Illness (NAMI) website to find support.
