Bipolar disorder is a chronic mental illness resulting in unstable moods that cycle between depression (feeling low) and mania (feeling elated) [1]. Medical professionals can treat bipolar symptoms with medication and talking therapies.

What is bipolar disorder?

Bipolar disorder, previously known as manic depression, is characterized by dramatic mood swings between the two ‘poles’: depression and mania.

Bipolar depression symptoms include feeling low or hopeless, changes to your appetite and sleep patterns, and withdrawal from your usual activities and relationships. On the other hand, signs of mania include having lots of energy, having delusional or grand ideas, and making uncharacteristic, risky, and impulsive decisions such as binge drinking or spending money excessively [2].

Living with unmanaged bipolar disorder can negatively impact your daily life, including your employment, finances, relationships with family and friends, and physical health. If you have bipolar disorder, you might not realize that you are unwell, preventing you from seeking help. However, medical professionals can manage bipolar disorder with proper treatment and support [3].

Types of bipolar disorder

There are three main types of bipolar disorder, including [2][5]:

Bipolar I disorder

At least one episode of mania lasting longer than one week, and you probably have had periods of depression.

Bipolar II disorder

At least one episode of hypomania and one major episode of depression, making it more common for you to have depression than mania.

Cyclothymia

With cyclothymia, your moods move quickly between symptoms of depression and mania but will not be as extreme.

Symptoms of bipolar disorder

The main symptom of bipolar disorder is mood instability, as moods cycle between periods of depression, hypomania, or mania.

Depression cycle

Depression symptoms include: [2][5]

  • Feeling negative and hopeless
  • Feelings of worthlessness or guilt, like you are to blame for everything
  • Feeling tired or unmotivated
  • Being irritable or angry
  • Isolating yourself
  • Difficulty sleeping or sleeping more than usual
  • Lack of self-care, such as limited attention to personal hygiene
  • Loss of interest in things that used to give you pleasure
  • Not being able to concentrate
  • Reduced sex drive
  • Changes to your appetite
  • Crying frequently
  • Thoughts that you would be better off dead or plans to harm yourself

Symptoms of a major depressive episode

A major depressive episode is defined by the severity of symptoms and how long they last. A major depressive episode can last between two weeks and six months and causes symptoms that disrupt your life at work or school, relationships or hobbies, and social life. Suicidal thoughts are common during a major depressive episode.

Manic cycle

Manic symptoms include: [2][5]

  • Not wanting to sleep
  • Feeling very energetic
  • Being irritable
  • Not wanting to eat
  • Being impulsive
  • Feeling important and having grand ideas and plans
  • Having racing thoughts and talking very quickly
  • Having delusional thoughts or hallucinations
  • Engaging in uncharacteristically risky behaviors and activities such as binge drinking or unprotected sex
  • Making impulsive decisions that can have disastrous consequences (e.g., traveling to another country without telling family or spending a large amount of money)

    Hypomania cycle

    Symptoms of hypomania:

    Hypomania is a milder version of mania, lasting less than a week (usually four days or less), whereas mania can last 14 days or more. Hypomanic symptoms are more manageable than manic symptoms.

    People with bipolar disorder experience extreme shifts between these different symptoms of depression and mania. Mood states can last a couple of days or several months [5]. The length and intensity of your mood states will depend on the type of bipolar disorder and can also vary from person to person.

    Diagnosing bipolar disorder

    People with bipolar disorder are usually diagnosed in their late adolescence or early twenties. A doctor or psychiatrist will diagnose you with bipolar disorder after taking a comprehensive history and asking questions about your past and current moods, behaviors, and medications [6]. It is essential to be honest with your doctor so they can make an accurate diagnosis.

    Based on your symptoms, you will be diagnosed with [4]:

    Bipolar I disorder

    You will have had at least one manic episode. However, you do not have to previously have had a depressive episode, though you will likely have had one.

    Bipolar II disorder

    You will have had at least one hypomanic episode and a major depressive, but you will not have had a manic episode.

    Cyclothymic disorder

    You will have had hypomanic or depressive symptoms for at least two years. Still, these symptoms do not meet the criteria for diagnosing either a major depressive episode or hypomania.

    Diagnosing bipolar disorder in children or teenagers

    Children and teenagers are rarely diagnosed with bipolar disorder as it can be hard to tell whether their symptoms are caused by an underlying mental health condition or are just the result of normal mood swings in their developmental stage. The most common signs of bipolar disorder in children and teenagers are severe mood instability, irritability, and depression that is out of character. Moods can also shift more rapidly in children and adolescents [6].

    Causes of bipolar disorder

    Genetic or biological risk factors

    There is limited evidence that there are specific causes of bipolar disorder. However, there is evidence of risk factors that make it more likely that you will develop it [7]. These are genetic or biological risk factors.

    A family history of bipolar disorder is a demonstrated risk factor for a higher likelihood of developing bipolar disorder. Although no specific gene has been identified with bipolar disorder, you are more likely to develop bipolar disorder if a parent or close relative has it. In addition, you are more at risk if a parent has developed it early.

    Environmental risk factors

    Stressful life events, such as bereavement or losing a job or home, may lead to developing bipolar disorder. In addition, childhood maltreatment or sexual abuse are also associated with an increased risk of severe symptoms.

    Prescribed medication or substance misuse

    Early antidepressants or substance misuse are associated with an increased risk of developing bipolar disorder.

    Prevention of bipolar disorder

    There is no way to prevent bipolar disorder. However, you can stop symptoms from worsening by recognizing that you are unwell and seeking diagnosis and early treatment [7]. If you have a family history of bipolar disorder, it is worth keeping an eye on it and talking to your doctor.

    If you are concerned that you may have bipolar disorder, seek help from a medical professional. Do not wait for things to get worse.

    You can prevent relapses by continuing to take your medication, looking after yourself, and developing a relapse prevention plan (more later).

    If you have a family history of bipolar disorder and have had an episode of mania, talk to your doctor before you take anti-depressants, as they can trigger a manic episode [7].

    Treatment for bipolar disorder

    Effective treatment options for bipolar disorder include medications, talking therapies, and lifestyle changes. In addition, different bipolar symptoms require different responses, and a patient may take various medications to manage different phases of the illness [3][8].

    Medications

    Mood stabilisers

    Mood stabilizers prevent and manage depressive and manic episodes and reduce dramatic shifts in mood. Lithium is the commonly prescribed medication for bipolar symptoms. For example, lithium, valproate, lamotrigine, or gabapentin.

    Antidepressants

    Long-term antidepressants can help those who have regular depressive episodes. Antidepressants are often prescribed with an antipsychotic to prevent mania symptoms. For example, tricyclic, selective serotonin reuptake inhibitors (SSRIs), or mirtazapine.

    Antipsychotics (first and second generation)

    Anti-psychotic medications prevent or minimize manic or psychotic symptoms, including hallucinations. Can be oral or injected as immediate-release or depot

    Adjunctive medications

    Some medications are prescribed for a limited time to manage short-term symptoms. These include antidepressants to manage depression or sedatives to manage anxiety or insomnia.

    Talking therapies

    Talking therapies help you think about ways to live with and manage your bipolar symptoms. There are different types of talking therapy that might help:

    Cognitive behavioral therapy

    A structured approach where you work with a therapist to change how you cope with specific problems that you identify. Usually, in around ten weeks, you will challenge your thoughts and feelings and develop alternative coping strategies.

    Family focussed therapy

    It is an approach that works with the person with bipolar disorder and their close family to create a recovery-orientated family environment that improves everyone’s wellbeing.

    Psychotherapy

    A longer process, usually lasting a year or more, with a trusted therapist who helps you identify and process trauma through exploring your life history.

    Group therapy

    With the help of a therapist who facilitates, this approach encourages peer support in groups.

    The type of therapy that is right for you will depend on your situation and diagnosis.

    Other treatments

    Electro Convulsive Therapy (ECT) is where an electric current is passed through your brain to induce a seizure while under general anesthetic. ECT can be effective, but it is only used to treat severe episodes of depression or mania that have not responded to other treatment plans.

    Self-care for bipolar disorder

    Self-care helps manage bipolar disorder, and you must work out what enables you to stay healthy and well. Involving family and friends in your care or therapy sessions can be helpful, especially as you might not realize when you are relapsing. Joining a self-help group, either online or in person, may also help.

    Looking after your general health and wellbeing can prevent bipolar symptoms from developing. Lifestyle or dietary changes such as eating healthy food, getting enough sleep, avoiding stress, and regular exercise can help you manage your symptoms.

    Prescribed medications can have side effects such as weight gain, so diet and exercise are essential.

    It may help to keep a recovery and relapse plan and share copies with your close friends and family. The plan will include information under headings such as ‘what keeps me well,’ ‘signs that I am not well,’ and ‘what to do if I am not well.’

    Helping someone with bipolar disorder

    There are many ways you can help a loved one with bipolar disorder. First, you can educate yourself to understand the illness and what symptoms to look for. You can be part of their recovery and relapse prevention plan or support them during a self-help group.

    If the person is depressed, you can help them with everyday tasks like washing, shopping, cleaning, getting out of the house, or keeping them company even if they feel low. Look out for suicidal behavior and encourage them to seek help.

    If a person has symptoms of hypomania or mania, you can support them to seek help and reflect on risky or impulsive behavior. In addition, people often feel shame and guilt after episodes of mania, so you can offer them reassurance and support and not judge them.

    Frequently asked questions about bipolar disorders

    How common is bipolar disorder?

    2.8% of the US population has bipolar disorder, which means it is not an uncommon mental illness. Percentages of bipolar disorder are similar between men (2.9%) and women (2.8%) [9].

    How long does bipolar disorder last?

    Bipolar disorder is a chronic mental illness that usually has long-lasting effects and requires ongoing attention. However, medical professionals can manage it well with correct treatments, including medication or talking therapies, and self-care.

    Bipolar Disorder vs. Depression – What is the difference?

    Bipolar disorder is characterized by mood swings between severe depression and mania or hypomania. People experiencing symptoms of major depression, but no episodes of hypomania or mania, do not have bipolar disorder but may be diagnosed with major depressive disorder instead.

    Mania vs. hypomania- what is the difference?

    Mania and hypomania share many of the same symptoms. However, mania is more serious than hypomania and lasts longer. Hypomania usually lasts no longer than four days and includes elevated mood, feelings of euphoria, being restless, or being unable to sleep. Mania can last 14 days or more and is more likely to result in hallucinations, grandiose ideas, and poor decisions with negative consequences.

    Resources:

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    2. Goodwin, F. K., & Lieberman, D. Z. (2010, August 13). Clinical Features and Subtypes of Bipolar Disorder. Bipolar Disorder, 8–16. https://doi.org/10.1002/9780470661277.ch2
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    6. Bipolar Disorder in Children and Teens. (n.d.). National Institute of Mental Health (NIMH). Retrieved October 1, 2022, from https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens
    7. Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., Birmaher, B., Tohen, M., & Suppes, T. (2018, May). Early Intervention in Bipolar Disorder. American Journal of Psychiatry, 175(5), 411–426. https://doi.org/10.1176/appi.ajp.2017.17090972
    8. Shah, N., Grover, S., & Rao, G. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, 59(5), 51. https://doi.org/10.4103/0019-5545.196974
    9. Table 2. 12-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort 1 (n=9282). (2007, July 18). NCSR (by Sex and Age). Retrieved September 9, 2022, from https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_12monthprevgenderxage.pdf