Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a long-term mental health condition. Previously referred to as manic depression, the mood disorder causes intense changes in mood, thinking, behavior and energy levels.

Changes in mood can last for hours, weeks or even months. The mood shift can interfere with your ability to carry out daily tasks.

There are different types of bipolar disorder, in which you experience changes in mood referred to as manic or hypomanic episodes and depressive episodes. People with bipolar disorder also have periods without these episodes when their mood is normal. This is called euthymia.

Are there different types of bipolar disorder?

Bipolar I disorder: If you have bipolar I disorder, you will have experienced at least one episode of mania, that has lasted at least a week, or been severe enough that you needed medical support. Those with bipolar I can experience episodes of both depressive and manic symptoms.

Bipolar II disorder: Those with bipolar II will experience hypomanic and depressive episodes, but not full manic episodes in the way that those with bipolar I disorder do. Bipolar II disorder can be more debilitating due to chronic depression.

Cyclothymic disorder: Cyclothymic disorder causes a chronically unstable mood. People with the condition have both mild depression and hypomania for two years or more. They may also have short (less than 8 weeks) periods of normal mood.

Some people may not be diagnosed with any of the above types of bipolar disorders, but still experience periods of abnormal mood elevation. These are referred to as unspecified or specified bipolar disorder.

Who is affected by bipolar disorder?

Anyone can be affected by bipolar disorder. Onset is usually around age 25, but sometimes it can affect children and older adults.

Bipolar disorder affects both men and women but can affect them in different ways. Women may change mood quicker, referred to as rapid cycling, and may experience more depressive episodes than men.

What are the symptoms of bipolar disorder?

The main sign of bipolar I disorder is a manic episode lasting more than a week. The main sign of bipolar II disorder and cyclothymia is hypomanic episodes. However, those with bipolar disorder may experience both depressive and manic/hypomanic episodes.

There may not be a set pattern to these episodes, and one doesn’t always follow the other. Some people also experience a mood state more than once, followed by a period of normal mood, before experiencing another change. Changes in mood can span weeks months, or years. The severity of mood episodes is different for everyone.

Manic episodes: This is a period of an abnormally irritable or elevated mood, or drastic changes in your thoughts, energy levels, emotions and activity levels. You feel highly energized and the changes in your behavior and activity are noticed by others. Some may develop psychotic symptoms, like hallucinations or delusions. Signs of manic episodes include:

• Excessive happiness and excitement
• Increased energy
• Increased impulsivity
• Making grand plans
• Psychosis
• Racing thoughts
• Rapid speech
• Reckless behavior
• Restlessness
• Sudden mood changes.

Hypomania isn’t as severe as manic episode and doesn’t affect daily life as much. However, those around you may notice a change in your mood or activity levels. Hypomania is often followed by a period of severe depression.

Depressive episodes: This is a period of very low mood. You may lose interest in daily activities or experience feelings of worthlessness. You may also feel tired and notice a change in appetite. Symptoms of depressive episodes include:

• Change in appetite
• Crying uncontrollably
• Difficulty concentrating
• Excessive sleep
• Feeling hopeless or worthless
• Increased need for sleep
• Insomnia
• Irritability
• Lack of motivation
• Low energy/fatigue
• Overwhelming sadness
• Suicidal thoughts
• Uncontrollable crying.

A mixed episode will include both depressive and manic symptoms together.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known, but doctors believe there is a genetic link. Many people with bipolar disorder have one or more close relative who has the condition.

Other factors that may be linked to bipolar disorder include:

• Brain changes: Research has shown that there are subtle differences certain brain structures in those with bipolar disorder.
• Environmental factors: A traumatic or stressful event (for example, death or divorce) may be involved in the development of bipolar disorder.

How is bipolar disorder diagnosed?

Diagnosing bipolar disorder begins with a physical examination and an in-depth discussion on your medical history, your symptoms, life experiences and family history. Blood tests may be performed to help rule out other conditions.

A specialist will then perform a mental health evaluation to determine if you have experienced at least one episode of hypomania or mania. They will then review your symptoms, their pattern, and the impact they are having on your life, to determine which type of bipolar disorder you have.

Those with bipolar disorder are sometimes incorrectly diagnosed with schizophrenia, due to the presence of hallucinations during manic episodes. It is also sometimes misdiagnosed as borderline personality disorder, as they two conditions have similar symptoms.

How is bipolar disorder treated?

Bipolar disorder is a long-term condition, but it can be effectively treated in many people. It can take a long time to find the most effective treatment, which may be discouraging, but committing to a treatment plan is very important.

Treatment may include a combination of the following:

• Psychotherapy: Called talk therapy, this aims to help identify and change emotions and behaviors that are troubling. There are many different types of psychotherapy.
• Medications: There are different types of medication to take which address the symptoms of bipolar disorder, including mood stabilizers, neuroleptics and antidepressants.
• Self-management strategies: Learning how to identify the early symptoms of a mood episode, or the triggers of an episode, can be very helpful.
• Supportive lifestyle changes: Many things, such as exercise and meditation, can help to support treatment.
• Electroconvulsive therapy: Used when medication isn’t effective, this involves applying an electric current to the brain to induce a seizure.