Diagnosing and Treating Bipolar Disorder

Bipolar disorder is a complex mental health condition that affects mood, energy levels, and the ability to function in everyday life. It causes intense emotional states, known as mood episodes, that range from depressive lows to manic highs. Understanding this disorder and how it is diagnosed, along with the available treatment options for bipolar disorder, supports effective management and improves quality of life.

What is Bipolar Disorder?

Bipolar disorder (BPD) is a mental health condition characterized by intense mood swings that include emotional highs (mania or hypomania) and lows (depression). According to the World Health Organization (WHO), an estimated 40 million people live with BPD, and it is equally present in men and women ^[1]. 

What sets bipolar disorder apart from normal mood fluctuations is the severity and duration of mood episodes. A person’s mood swings are not just shifts in feeling but episodes that can last weeks or months and interfere significantly with daily life. Whereas normal emotions come and go based on life circumstances, bipolar episodes often occur without a clear reason and can cause a person to struggle with maintaining relationships and completing essential daily tasks ^[2]. 

Historically, people with bipolar disorder were misunderstood, stigmatized, or institutionalized. Today, it is increasingly recognized as a manageable medical condition.

Risk factors for BPD include ^[2]: 

• Genetics and Family History: A person with a first-degree relative with bipolar disorder has a significantly increased risk of developing the condition. 
• Brain Structure and Function: Brain imaging shows differences in brain structure, especially in areas related to emotional regulation. 
• Trauma, Abuse, or Prolonged Stress: Individuals diagnosed with BPD report a higher number of stressors and greater emotional reactivity.
• Substance Abuse: BPD can increase a person’s risk of developing substance use disorder and vice-versa.

How Bipolar Disorder is Diagnosed

The process for diagnosing bipolar disorder typically involves two steps. Clinicians first diagnose mood episodes, such as mania, hypomania, or depression, then diagnose the disorder itself ^[3]. 

Psychiatrists and psychologists use various tools and comprehensive psychiatric evaluations to make a diagnosis.

The diagnostic process for BPD includes:

• A detailed personal and family mental health history
• Clinical interviews and symptom checklists
• Assessment of mood patterns, energy levels, and sleep habits
• Exclusion of other medical conditions or substance use that could mimic symptoms
• Mood charting or standardized questionnaires such as the Mood Disorder Questionnaire (MDQ) to gather additional insights that support a diagnosis ^[4]

Types of Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), provides the official criteria for diagnosing bipolar disorders, falling under three main diagnoses: bipolar I, bipolar II, and cyclothymia. Each type is defined by the pattern and severity of mood episodes ^[3]. 

Bipolar I disorder 

This type of BPD is diagnosed when at least one manic episode occurs, lasting at least one week or requiring hospitalization. Depressive episodes typically follow, although they are not necessary for the diagnostic criteria ^[3].

Bipolar II disorder 

Bipolar II involves at least one major depressive episode and one hypomanic episode. Hypomania is sometimes easily overlooked or mistaken for periods of high productivity or improved mood. Unlike bipolar I, patients with bipolar II do not experience full manic episodes ^[3]. 

Cyclothymic disorder (cyclothymia) 

This type of BPD features numerous periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a major depressive or hypomanic episode. These symptoms persist for at least two years in adults and one year in younger populations ^[3].

Sometimes, bipolar disorder does not fit neatly into one of these categories. For example, a person might have cyclothymic symptoms that have not lasted two years. The DSM-5-TR labels this as “other specified bipolar and related disorder” or “unspecified bipolar and related disorder” ^[3]. 

Symptoms of Bipolar Disorder

Each type of bipolar disorder presents with different but sometimes overlapping symptoms, and those symptoms can help determine the best treatment options. Looking for patterns in behaviors and the timing of episodes helps mental health professionals make an accurate diagnosis. The severity of mood episodes also helps to determine what type of bipolar disorder a person is experiencing ^[5]. 

Mania

• Elevated or irritable mood and persistent goal-directed behaviors
• Episodes last at least one week
• Causes obvious impairment

Hypomania

• Elevated or irritable mood and persistent goal-directed behaviors
• Lasts at least four days
• Does not cause marked impairment

Depression

• Depressed mood or loss of interest in life
• Depression lasts at least two weeks
• Causes impairment and distress

Mixed

• Includes both manic and depressive symptoms
• Mixed mania lasts at least one week or causes a hospitalization
• Mixed hypomania lasts at least four days with both depressive and hypomanic symptoms
• Mixed depression lasts at least two weeks with additional manic symptoms
• Causes marked and obvious impairment

Treating Bipolar Disorder

Bipolar disorder is not curable, but it is highly manageable. Timely and effective treatment helps stabilize symptoms and improve quality of life. Treatment may include: 

Medications

Stabilizing medications are often beneficial treatment options for bipolar disorder when taken long-term and as prescribed. They include: 

• Lithium is one of the most effective and widely studied medications for managing manic and depressive episodes. However, it has several possible side effects and a small safety window ^[6].  
• Anticonvulsant or anti-seizure medications, including carbamazepine extended-release and lamotrigine, are prescribed as mood stabilizers for bipolar disorder. Sodium Valproate, which is also known as Depakote, is an option for patients who have difficulty with lithium therapy ^[6]. 
• Medications known as selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of the depressed phase of bipolar disorders. Anticonvulsants such as lamotrigine and atypical antipsychotics like quetiapine and lurasidone are other mood stabilizers ^[6].

Psychotherapy

Psychotherapy plays a valuable role in helping patients manage triggers and build coping strategies. It provides a safe, structured environment where patients can explore thoughts and behaviors while learning new skills.

Some common evidence-based approaches with psychotherapy for bipolar disorder include ^[7]:

• Cognitive Behavioral Therapy (CBT): Helps challenge negative thought patterns and promote healthier behaviors.
• Interpersonal and Social Rhythm Therapy (IPSRT): Focuses on stabilizing daily routines and interpersonal relationships.
• Dialectical Behavioral Therapy (DBT): Teaches mindfulness and learning how to tolerate and live with emotional pain. 
• Family-Focused Therapy (FFT): Engages families to improve communication and support.

Other Therapies

In addition to medication and psychotherapy, other treatments help to support long-term stability. They include:

• Lifestyle modifications: Sleep, meditation, exercise, and avoiding drugs or alcohol ^[7].
• Psychoeducation: Teaching families to recognize early warning signs of bipolar disorder and manage triggers ^[7].
• Electroconvulsive therapy (ECT): Controlled electrical currents applied to the brain for severe episodes that do not respond to other treatments ^[8].

Long-Term Bipolar Disorder Management

Effective long-term management of bipolar disorder requires a comprehensive approach that addresses both mental and physical health. The diagnosis often coexists with other health diagnoses, including migraines and metabolic conditions (obesity, for example), diabetes, and cardiovascular disease ^[1]. 

Long-term health management strategies to better control these conditions and improve quality of life include: 

• Participating in a regular physical exercise program
• Following a healthy eating plan and monitoring food intake
• Remaining aware of any weight gain side effects associated with certain antipsychotics and adjusting medications with a healthcare provider, as needed
• Scheduling regular doctor’s visits to monitor cholesterol, blood pressure, and blood glucose levels

Besides physical health risks, people with BPD often develop additional mental health and developmental issues, which can be linked to the same root causes or the ups and downs of the disorder itself ^[9]. The exact reason for this is not fully understood, however, research shows an increased risk for these mental health conditions in people with bipolar disorder:

• Substance abuse disorder
• Eating disorders, and especially bulimia nervosa and binge eating 
• Obsessive-compulsive disorder (OCD)
• Attention deficit hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD)

Psychiatric, physical, and mental health conditions may negatively impact health and well-being for people living with BPD. Simultaneously treating both the bipolar disorder and the coexisting diagnosis can reduce the likelihood of developing complications and support long-term health management ^[9]. 

Living Well With Bipolar Disorder

Recognizing the symptoms of bipolar disorder and understanding the diagnostic process are significant steps toward early intervention and effective care. A timely, accurate diagnosis allows mental health professionals to develop a personalized treatment plan that incorporates the patient’s goals and supports long-term stability. This, in turn, leads to a higher quality of life. 

Once shrouded in stigma, bipolar disorder is considered a manageable condition today. With evidence-based approaches for diagnosis and treatment, people living with this disease can lead fulfilling, balanced lives. Ongoing support from healthcare providers and loved ones plays a powerful role in helping people to reach this goal and thrive.