All of us experience changes in our moods. Some days we might feel irritable and frustrated; other days, we’re happy and excited. However, individuals with bipolar disorder experience severe mood swings that impair their daily life and negatively affect their relationships.
Approximately 2.6 percent of American adults have bipolar disorder (formerly called manic depression and manic depressive disorder), according to the National Institute of Mental Health. These mood swings include “highs” (mania), when individuals feel either on top of the world or on edge, and “lows” (depression), when they feel sad and hopeless. Suicide attempts are common in bipolar disorder, especially during depressive episodes.
Bipolar disorder can be effectively treated with medication and psychotherapy. With proper treatment, individuals with bipolar can lead fulfilling, productive lives. This is why it’s so important to recognize the symptoms and see a mental health professional for an evaluation.
What Causes Bipolar Disorder?
There is no single cause for bipolar disorder. Indeed, like all psychological disorders, bipolar disorder is a complex condition with multiple contributing factors, including:
- Genetic: Bipolar disorder tends to run in families, so researchers believe there is a genetic predisposition for the disorder. Scientists also are exploring the presence of abnormalities on specific genes.
- Biological: Researchers believe that some neurotransmitters, including serotonin and dopamine, don’t function properly in individuals with bipolar disorder.
- Environmental: Outside factors, such as stress or a major life event, may trigger a genetic predisposition or potential biological reaction. For instance, if bipolar disorder was entirely genetic, both identical twins would have the disorder. But research reveals that one twin can have bipolar, while the other does not, implicating the environment as a potential contributing cause.
What Are the Different Types of Bipolar Disorder?
- Bipolar I is considered the classic type of bipolar disorder. Individuals experience both manic and depressive episodes of varying lengths.
- Bipolar II involves less severe manic episodes than bipolar I; however, their depressive episodes are the same.
- Cyclothymia is a chronic but milder form of bipolar disorder, characterized by episodes of hypomania and depression that last for at least two years.
- Mixed episodes are ones in which mania and depression occur simultaneously. Individuals might feel hopeless and depressed yet energetic and motivated to engage in risky behaviors.
- Rapid-cycling bipolar individuals experience four or more episodes of mania, depression or both within one year.
What Are the Risk Factors for Bipolar Disorder?
Risk factors include having:
- Cyclothymia (see definition above). About half of individuals with cyclothymia will experience a manic episode.
- Any other psychological disorder
- A family history of bipolar or other psychological disorders
- Alcohol and substance abuse
- Medication interactions. For instance, antidepressants may trigger mania.
- Major life changes
- Severe stress
Symptoms of Bipolar Disorder
There are four possible bipolar states:
- A mixture of mania and depression (called a “mixed episode”).
Mood states are highly variable. Some people can experience mood changes in one week, while others can spend months or even years in one episode.
What Does Mania Look Like?
- Feelings of euphoria and elation or irritability and anger
- Impulsive, high-risk behavior, including grand shopping sprees, drug and alcohol abuse and sexual promiscuity
- Aggressive behavior
- Increased energy and rapid speech
- Fleeting, often grandiose ideas
- Decreased sleep (typically the individual doesn’t feel tired after as few as three hours of sleep)
- Decreased appetite
- Difficulty concentrating; disorganized thoughts
- Inflated self-esteem
- Delusions and hallucinations (in severe cases)
What Does Hypomania Look Like?
Hypomania is less severe than a full-blown manic episode. Hypomanic individuals can seem pleasant, friendly, energetic and productive. Though it doesn’t sound problematic, increasing hypomania can lead to risky behaviors and full mania.
What Does Depression Look Like?
- Feelings of hopelessness and sadness
- Inability to sleep or sleeping too much
- Loss of interest in formerly enjoyable activities; loss of energy (sometimes to the point of inability to get out of bed)
- Changes in appetite and weight
- Feelings of worthlessness and inappropriate guilt
- Inability to concentrate or make a decision
- Thoughts of death and suicide
What Does a Mixed Episode Look Like?
Mixed episodes involve simultaneous symptoms of mania and depression, including irritability, depressed mood, extreme energy, thoughts of suicide and changes in sleep and appetite.
A Note about Suicide
Because of the high suicide risk in those with bipolar disorder, it’s important to note the warning signs. In addition to those mentioned in the depression symptoms above, others include:
- Withdrawing from loved ones and isolating oneself
- Talking or writing about death or suicide
- Putting personal affairs in order
- Previous attempts
For more information about suicide, check out Frequently Asked Questions about Suicide.
How Is Bipolar Disorder Diagnosed?
There are no medical tests to diagnose bipolar disorder. However, a psychologist, psychiatrist or other trained mental health professional can diagnose the disorder by conducting a face-to-face clinical interview. Your clinical interview will include detailed questions about your and your family’s medical and mental health history and your symptoms.
What Treatments Exist for Bipolar Disorder?
Bipolar disorder can be effectively managed with a combination of medication and psychotherapy to help in reducing both the number of episodes and their intensity. Treatment also can help prevent future episodes if the individual is willing to work on personal issues and develop healthy habits.
What Kinds of Medication Are Used for Bipolar Disorder?
- Mood stabilizers. These medications are prescribed to help stabilize manic symptoms, prevent future episodes and reduce suicide risk. The most well-known of these is lithium, which is effective in 60 to 80 percent of manic and hypomanic episodes. Anticonvulsant (or anti-seizure) medications also have mood stabilizing effects. These include valproate (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin) and topiramate (Topamax).
Every medication has its own set of potentially serious side effects. For instance, Lamictal can cause Stevens-Johnson syndrome, a potentially fatal skin disease, though this is rare and is entirely avoidable by careful, slow dose titration.
- Atypical antipsychotics. The newest medications, atypical antipsychotics were originally developed to treat psychosis (a symptom of schizophrenia). Like the mood stabilizers above, atypical antipsychotics help to control mood swings. These seven medications are commonly prescribed for bipolar: aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), clozapine (Clozaril) and olanzapine/fluoxetine (Symbyax).
Contrary to popular belief, these medications aren’t without significant side effects, including rapid weight gain, high cholesterol and risk for diabetes, which occurs most commonly with olanzapine and clozapine. In some cases, atypical antipsychotics have been associated with a life-threatening condition known as diabetic ketoacidosis (DKA).
In June 2004, the U.S. Food and Drug Administration (FDA) requested that all companies who manufacture atypical antipsychotics include a warning about the elevated risk for hyperglycemia and diabetes (see here ).
In addition, several organizations, including the American Diabetes Association and American Psychiatric Association, have published recommendations for doctors on how to treat patients taking these medications. For more information, read the press release at the American Diabetes Association website.
- Calcium-channel blockers. Used to treat angina and high blood pressure, these medications — including verapamil (Calan, Isoptin, Verelan) and nimodipine (Nimotop) — also have mood stabilizing effects. They have fewer side effects than other bipolar drugs but aren’t as effective.
- Combination therapy. When one medication isn’t working, a doctor might prescribe two mood stabilizers or a mood stabilizer along with an adjunctive medication to treat symptoms such as anxiety, hyperactivity, insomnia and psychosis. For example, Xanax (alprazolam), a fast-acting benzodiazepine, typically is taken for two weeks before mood-stabilizing medication starts to work. Antidepressants might be prescribed for patients who are in a depressive phase, but research suggests they aren’t effective, can trigger mania and exacerbate episodes long term.
Psychotherapy is a crucial component of long-term bipolar disorder management. Even when your mood swings are under control, it’s still important to stay in treatment.
Several different psychotherapeutic methods have proved to be effective in treating bipolar disorder.
- Cognitive behavioral therapy (CBT) helps individuals develop strategies to cope with their symptoms, change negative thinking and behavior, monitor their moods and predict their mood to try to prevent a relapse.
- Interpersonal and social rhythm therapy is a combination of interpersonal therapy and CBT. This newer treatment focuses on circadian rhythms to help clients establish and maintain routines and build healthier relationships.
- Psychoeducation teaches individuals about their disorder and treatment and gives them the tools to manage it and anticipate mood swings. Psychoeducation also is valuable for family members.
How Else Can I Manage Bipolar Disorder?
- Take your medication.
- See a therapist regularly.
- Learn more about bipolar disorder and its treatment
- Participate in online communities or in-person support groups
- Adopt healthy habits, including exercising, practicing stress management techniques, eating healthy, avoiding alcohol and drugs, getting seven to eight hours of sleep and avoiding any potential triggers.
What Do I Do Next?
By starting to learn about bipolar disorder, you’ve already taken a significant first step. If you’d like to learn more, check out our detailed guide here.
If you think you or a loved one has bipolar disorder, it’s important to be evaluated by a trained mental health professional. To find a therapist in your area, use a search engine such as this one, or check with your primary care physician or community mental health clinic for referrals.
Tartakovsky, M. (2009). Bipolar Disorder Fact Sheet. Psych Central. Retrieved on March 11, 2014, from http://psychcentral.com/lib/bipolar-disorder-fact-sheet/0001561
Last reviewed: By John M. Grohol, Psy.D. on 8 Jan 2014
Published on PsychCentral.com. All rights reserved.