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Bipolar Disorder

Daughter reading to her aging father on a couch and smiling

Bipolar disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals) mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manic depression, which are older terms.

What is Bipolar Disorder?

Everyone has normal fluctuations in their mood based on what they are experiencing day to day. However, in bipolar disorder, these fluctuations are exaggerated, severe, and interfere with a person's daily functioning.

Bipolar disorder is a chronic mood disorder characterized by extreme changes in a person's behavior, mood, concentration, and energy level. These changes are episodic in nature and can occur over the course of several days or a week. The severity, duration, and type of symptoms that are present help to classify episodes as manic, hypomanic, or depressive.

During a manic episode, a person might feel much happier than usual or be irritable, act more impulsively or irrationally, and have a heightened level of energy that is noticeable by others. During a hypomanic episode, a person might experience similar symptoms characteristic of manic episodes, however, hypomania is less severe and shorter in duration than mania.

During a depressive episode, a person might feel more down or sad than normal, hopeless, unmotivated, and indifferent. Frequently, “depressed” is used to describe someone who appears sad, and “depression” can be categorized as either unipolar depression or bipolar depression.

Unipolar depression is associated with depressive episodes seen with a diagnosis of major depression disorder (MDD). Bipolar depression is associated with depressive episodes seen with a diagnosis of bipolar disorder.

Symptoms of bipolar disorder tend to develop and start in late adolescence or a person's early 20s. Less frequently, bipolar disorder is diagnosed in children or early adolescence. Bipolar disorder has a strong genetic component, meaning a family history of bipolar disorder, especially in first-degree relatives, increases a person's risk for developing the disorder.

If someone has symptoms of mania, hypomania, depression, or a mix of these symptoms, their symptoms should be evaluated further by a health care provider.

What are the symptoms of bipolar disorder?

Some symptoms of a manic episode include:

  • Feeling much happier than usual, elated, or extremely irritable
  • Heightened level of energy
  • Decreased need for sleep
  • Talking fast about a variety of subjects
  • Racing thoughts
  • Acting more impulsively or irrationally

Symptoms of a depressive episode include:

  • Feeling persistently sad, down, or depressed
  • Loss of interest in favorite activities or hobbies
  • Insomnia or sleeping excessive amounts
  • Difficulty concentrating
  • Low level of energy or fatigue
  • Feelings of worthlessness or hopelessness
  • Thoughts of death or suicide or attempting suicide

How is bipolar disorder treated?

It is important to note that symptoms of bipolar disorder are similar to those seen in other psychiatric disorders (e.g., schizophrenia, unipolar depression) and also other health conditions (e.g., thyroid disease), which can make bipolar disorder difficult to diagnose.

Therefore, if a person believes they are experiencing symptoms of bipolar disorder, they should speak with a psychiatrist or a health care provider, who can then refer them to a psychiatrist. A psychiatrist can diagnose bipolar disorder and recommend a targeted treatment with medications, psychotherapy, or both depending on the type of active symptoms present.

The most common medications used to treat bipolar disorder are mood stabilizers and antipsychotics. Mood stabilizers are often used to treat acute mania or hypomania because they help level out exaggerated fluctuations in mood and behavior, and some mood stabilizers have been shown to decrease the risk of suicide in people diagnosed with bipolar disorder.

It is important for a person to tell their health care provider what other treatment or medication they are currently taking, including prescription medications, dietary supplements, and over-the-counter medications. Their health care provider can then help determine which treatment would be the most helpful for their symptoms while not interfering with their current medications.

Psychotherapy, often referred to as “talk therapy,” is typically used in conjunction with medications when treating bipolar disorder. For example, interpersonal and social rhythm therapy (ISRT) is a type of therapy based on the idea that changes in daily routines and habits can trigger mood episodes in a person with bipolar disorder.

ISRT is designed to help a person improve their mood by understanding and working with their social rhythm (i.e., daily routine and habits) and circadian rhythm with the intention of minimizing potential impacts those disruptions might have on a person's everyday functioning.

Untreated symptoms of bipolar disorder can be detrimental to daily functioning as well as increase a person's risk of suicide. Bipolar disorder is a chronic disorder, and symptoms may fluctuate over time. However, to prevent recurrent episodes of mania, hypomania, and depression, it is important to continue treatment and to avoid stopping treatment without talking to your doctor first.

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If you are in a mental health crisis and in need of immediate help, please call 988 or seek care at your closest emergency room.