David Baxter PhD
I Think This Is Bipolar Disorder: Are All the Factsby Margarita Tartakovsky, M.S., PsychCentral.com
February 11, 2021
We all experience the sunups and sundowns, the revolving seasons of moods. But what if the scenery didn’t follow a consistent, steady shift? What if the warm light disappeared suddenly and the seasons cycled in hyperlapse or slo-mo? This is how many with bipolar disorder can feel.
Bipolar disorder overview
People with bipolar disorder experience changing moods, thoughts, behaviors, and energy levels that may impair daily life and negatively affect their work and social functioning.
Take heart: The condition is treatable.
As many people as Colorado’s entire population — around 5.7 million U.S. adults — live with bipolar disorder. The average onset of bipolar disorder is about 25 years old, but it can show up in early childhood or later adulthood.
Women tend to develop bipolar disorder later than men. Though it’s almost even, slightly more males develop bipolar disorder than females.
|Gender differences in bipolar disorder||Males||Females|
|More shifts in mood based on seasonal patterns||✓|
|More frequent depressive episodes, mixed mania, and rapid cycling||✓|
|More episodes of mania throughout lifetime||✓|
|More prevalent bipolar II||✓|
|More dual diagnosis with other medical or psychiatric disorders||✓|
|More dual diagnosis with a substance use disorder||✓|
|More cases of delayed diagnosis or intermittent treatment|
(often due to pregnancy, breastfeeding)
Bipolar disorder was formerly called manic depression or manic depressive disorder. About 83% of people with bipolar disorder experience significant impairment in daily activities in a given year.
Mood episodes will depend on the type of bipolar disorder that’s diagnosed. These can include “highs” (mania), when you feel like you’re on top of the world or on edge, or “lows” (depression), when you feel hopeless or full of despair, with or often without reason. Suicidal thoughts or intent are common in bipolar disorder, especially during depressive episodes.
Bipolar disorder can be managed with medication and psychotherapy. When you find the right treatment plan, you or your loved one can lead a fulfilling, productive life. This is why it’s important to identify the symptoms and consider talking with a mental health professional for an evaluation.
The symptoms of bipolar disorderTypically, bipolar disorder is associated with two predominant moods: mania and depression. So symptoms generally fall under one or both categories.
Bipolar I requires only a manic episode. However, people living with bipolar II will have a form of mania along with depression.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are several symptoms people living with bipolar disorder may experience.
Symptoms of maniaTo be diagnosed, a combination of some symptoms below would be severe enough to disrupt social or work functions and might require hospitalization.
A mental health professional would look for any 3 or more of the following abnormally amped up or irritable mood indicators lasting at least 1 week and present for most of the day.
- inflated self-esteem
- operating “full steam” on just a few hours of sleep
- more talkative than usual
- racing thoughts or endless fountain of ideas
- easy distractibility
- seem to be “on a mission,” i.e., goal-directed activity either interpersonally, on the job, or at school, or even sexually
- fidgety, absentmindedly picking, pacing, or adjusting clothing — known clinically as “psychomotor agitation“
- engaging in activities that have a high probability of a bad outcome
Hypomania is slightly differentSymptoms for hypomania are similar to mania but different only in that:
- A diagnosis could be determined after only 4 consecutive days of 3 or more of the symptoms, each lasting the majority of the day.
- Though symptoms could last longer, the imposing mood fluctuation(s) are noticeable to others but not deeply disruptive to work, school, or social life.
Depressive episode symptomsTo be diagnosed, a mental health professional would look for 5 or more of the following to be experienced during a single 2-week period.
Symptoms would have to be noticeably different from your normal disposition and disruptive of your life, perhaps requiring hospitalization. A caveat: Whatever symptoms are persisting have to include one of the first two in the list to be diagnosed:
- feeling empty, hopeless, or sad all day, every day for 2 weeks
- obvious lack of interest in nearly every daily activity, especially favorites or habits
- noticeable weight loss or weight gain without intention
- insomnia nearly every day
- observable fidgety, absentmindedly picking, pacing, or adjusting clothing — or the opposite — visible slowing of speech, thought processes, actions, and reactions without the use of substances
- significant fatigue, almost every day
- unbidden feelings of guilt or worthlessness
- not wanting to live, with or without necessarily wanting to die
- indecisiveness or concentration issues that persist daily
- recurring thoughts of death
- suicide thoughts, intent, or attempt
What you feel and what the doctor calls itOftentimes, you or a loved one has tried to express feelings only to be shut down by a confidant. What’s been building is dismissed as “emotions,” a “phase,” or harsher condescending labels. Perhaps after seeking help, you’re overwhelmed by all the terms and acronyms clinicians throw around or give you “more information on.” Take a look at this key to bipolar disorder terms.
|You feel||Clinicians call it||How they explain it|
|Unprompted overactivity inside your mind and with your body. It may feel like a “high” compared to a depressive episode, but it’s a euphoria that climbs into an unpredictable intensity.|
From incessant thoughts to feeling bound-up energy even with little sleep. Fidgety, agitated, easily irritable.
|Mania||A distinct period of persistently elevated, larger-than-life, or irritable mood.|
Can also include abnormally objective-directed behavior or energy lasting at least a week.
|Unprompted energy or agitation.|
It’s not completely like mania; maybe not as noticeable to others and doesn’t spur legitimate social, legal, academic, or work consequences.
|Hypomania||The prefix hypo- means “under.” Symptoms of hypomania are just under the threshold of intensity than those of manic symptoms.|
|Far deeper than “sad.”|
Like you just can’t shake the melancholy. You’re feeling so low, and negative thoughts seem to cloud your thinking, even slow your movements. Dark thoughts hang over your head.
|Depression||A state of persistent hopelessness, malaise, and lack of interest, lasting at least 2 weeks.|
|Like you’ve been thrown in a human catapult of max energy (good- or bad-feeling) that can launch you beyond control. Each can last as short as a full week or longer. Not always chased or kicked off by a low lasting at least 2 weeks.|
Social, legal, academic, or work consequences of the mood shifts have been legitimate enough to alarm you or loved ones.
|Bipolar I||Manic episodes of varying lengths. May or may not include depressive episodes.|
|Like you’ve been on a merry-go-round of unprompted energy or agitation and depressing lows. Each can last as short as a week or longer.|
It’s enough for others to notice, but doesn’t often spur legitimate social, legal, academic, or work consequences.
|Bipolar II||Hypomanic (less severe mania|
in intensity, not duration)
and depressive episodes of varying lengths.
|Depressive and overactive moods feel less like a merry-go-round of episodes, and more like one distinct saga followed by a polar opposite scenario.|
Now that you think about it, these experiences have lasted upward of 2 years.
|A chronic but milder form of bipolar disorder, wherein episodes of hypomania and depression last for at least 2 years.|
|Like that “laugh to keep from crying” adage come to life. Except you feel as though you’re doing both on the inside for days, weeks, or months at a time.||Mixed episodes||A condition in which mania and depression occur simultaneously.|
Individuals might feel hopeless and depressed, yet energetic and motivated to engage in behaviors that may have harmful outcomes.
|Like people just don’t get it.|
You’re experiencing things with your senses others say aren’t really happening.
Or, your thoughts may come out jumbled and people might be saying they’re not rational, but you know what you believe!
|Psychosis||A symptom of an overarching condition, be it mental or medical.|
Inclusive of hallucinations and delusions.
Causes of bipolar disorderThere’s no single cause for bipolar disorder that’s been discovered as of yet. As with all psychological conditions, bipolar disorder is complex with multiple contributing factors, including:
- 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 one twin can have the condition, while the other doesn’t, implicating environment as a potential contributing cause.
- Biological. Some chemical messengers (neurotransmitters) — including serotonin and dopamine — may not function properly in individuals with bipolar disorder.
- Genetic. Some chemical messengers (neurotransmitters) in the brain — including serotonin and dopamine — may not function properly in people with bipolar disorder.
A note on genetic predisposition“Our family just has ____ disorder.”
Genetics play a hand in developing some health or mental conditions, but that’s not the end of the story. Epigenetics is the study of how inherited differences in your DNA have — or have not — manifested in you. That means predispositions that run in your family line can stay inactive within you, or if they have shown early signs, possibly be reversible.
Read about childhood abuse, complex trauma and epigenetics.
Risk factors for bipolar disorder onsetThere are at least a handful of risk factors for bipolar disorder, including:
- any other psychological disorder
- a family history of bipolar disorder or other psychological disorders
- major life changes, coupled with a recessive gene for bipolar disorder
- severe stress, paired with latent genes for bipolar disorder
- in recent years, what’s called adverse childhood events (ACEs)Trusted Source have been linked to bipolar disorder
- Alcohol or substance use often taken to soothe or numb symptoms actually linked to untreated bipolar disorder, in a troubling cycle of trigger-maltreatment.
- Medication interactions. For instance, there’s a contentious debate and much study surrounding the possible link between antidepressants and manic episodes.
Signs of suicide riskBecause of the high suicide risk in people with bipolar disorder, it’s important to note the 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
Diagnosing bipolar disorderTypically, a psychologist, psychiatrist, or other mental health professional can diagnose the disorder by conducting a face-to-face clinical interview. You or your loved one’s clinical interview will include detailed questions about you and your family’s medical and mental health history, and your symptoms.
Read why accepting a diagnosis of bipolar disorder is so difficult—and what actually helps.
Emerging research has found reduced levels of a nerve growth component consistent in people with bipolar disorder or depression, compared to individuals without either condition.
Hope for a blood test
With more affirming research, a blood test in the future may help diagnose bipolar disorder.
Treating bipolar disorderBipolar disorder can be effectively managed with medication, psychotherapy, and a routine to help reduce both the number of episodes and their intensity.
Medication for bipolar disorder
Mood stabilizersThese medications are prescribed to help stabilize manic symptoms, prevent future episodes, and reduce suicide risk. Mood stabilizers are the most commonly prescribed medications for bipolar disorder.
The most well-known of these is lithium, which seems to be effective for most people who experience mania or hypomania episodes.
Other commonly prescribed medications for bipolar disorder include anticonvulsant (or antiseizure) medications because they can also have mood-stabilizing effects. These medications include:
- valproate (Depakote)
- carbamazepine (Tegretol)
- lamotrigine (Lamictal)
- gabapentin (Neurontin)
- topiramate (Topamax)
Atypical antipsychoticsAtypical antipsychotics were originally developed to treat psychosis. Like the mood stabilizers above, atypical antipsychotics may help to manage mood episodes. These medications are commonly prescribed for bipolar disorder (as well as Major Depression):
- cariprazine (Vraylar)
- aripiprazole (Abilify)
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- ziprasidone (Geodon)
- clozapine (Clozaril)
- olanzapine/fluoxetine combination (Symbyax)
Calcium channel blockersThese meds are used to treat angina and high blood pressure, but they may also be prescribed off-label for bipolar disorder. This is because they can have mood stabilizing effects with less side effects, though since they’re really not that effective, they’re not often used. Calcium channel blockers include:
- verapamil (Calan, Isoptin, Verelan)
- nimodipine (Nimotop)
Combination therapyWhen one medication isn’t working, a treatment team might prescribe two mood stabilizers or a mood stabilizer along with a complementary medication to treat symptoms such as anxiety, hyperactivity, insomnia, or psychosis.
For example, in the past, Xanax (alprazolam) may have been prescribed for 2 weeks before mood stabilizing medications start to work.
However, many prescribers are now leaning toward use of antipsychotics, since benzodiazepines like Xanax have a high risk for withdrawal and dependence.
PsychotherapyPsychotherapy is a cornerstone component of long-term bipolar disorder management. Even when your mood episodes feel under control, it’s still important to stay in treatment. Several therapy 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 moods, and predict moods to try to encourage progress.
- Interpersonal and social rhythm therapy is a combination of interpersonal therapy and CBT. This newer treatment focuses on wake-sleep cycles (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 changing moods. Psychoeducation also is valuable for loved ones.
What’s recommended for my bipolar disorder toolkit?Once you have a diagnosis, there are steps you can take to ease the condition. Here’s what clinicians suggest:
- Take your prescription medication.
- See a therapist regularly.
- Continue educating yourself about bipolar disorder and its treatment, as research is continually evolving.
- Participate in online communities or in-person support groups.
- Stay consistent with healthy habits including:
- stress management techniques
- eating healthily
- avoiding alcohol and substances not prescribed to you
- getting 7 to 9 hours of sleep
- avoiding any potential triggers
Next stepsBy starting to learn about bipolar disorder, you’ve already taken a pivotal first step. If you think you or a loved one has bipolar disorder, it’s important to be evaluated by a mental health professional. To find a therapist in your area, use a search engine such as this one, or speak with your primary care physician or community mental health clinic for referrals.
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- López-Zurbano S., et al. (2019). Gender differences in bipolar disorder.