Bipolar Disorder: Symptoms, Types, and Treatment

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Bipolar disorder, earlier known as manic depression, is a mental illness in which your mood, energy, and ability to think clearly fluctuate a lot. To be sure, everyone experiences low- and high-moods now and then, given the ups-and-downs we encounter in life, but what is different in bipolar disorder is that they experience dramatically high and low moods, known as mania or hypomania and depression. Symptoms of bipolar disorder include feeling sad or hopeless and loss of interest in activities which were once pleasurable, during the low-mood phase; with the onset of high mood, you may feel euphoric, highly energetic or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings can occur multiple times a year or rarely. Bipolar disorder responds well to treatment and most such people go on to live normal lives. Its prognosis is better, compared to that of schizophrenia and schizoaffective disorder. (Mayo Clinic Staff, n.d.)

Bipolar disorder is uncommon in children. Though it can occur in the teens, its typical onset is around the age of 25. Its incidence is around 2.5% in the US, with men and women affected in equal numbers. (NAMI, 2017) But, speaking of worldwide incidence, “the conventional figure of 1 percent for bipolar disorders in the general population is being challenged, there are now convincing data that this group of disorders may account for 5 percent of the population and up to 50 percent of all depressions.” (Sadock, et al., 2017)

A symbol of bipolar disorder
Bipolar disorder (Picture credit: https://www.talkspace.com)

Bipolar Disorder Symptoms

The symptoms of bipolar disorder may vary and so can their intensity. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods—sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.

Some people with severe episodes of mania or depression may have psychotic symptoms such as delusions and hallucinations. Typically, these psychotic symptoms mirror a person’s extreme mood. The presence of psychotic symptoms may lead to the wrong diagnosis of schizophrenia. (NAMI, 2017)

Mania

At least one episode of mania or hypomania is necessary for the diagnosis of bipolar disorder. Hypomania is a milder form of mania without psychotic symptoms. People with hypomania can often function well in social situations or at work. Manic or hypomanic episodes can occur many times throughout one’s life, or only rarely.

An elevated mood of mania may seem appealing, especially if it follows depression, but the “high” soon becomes uncomfortable or uncontrollable, leading to more irritability, more unpredictable behavior, and impaired judgment. A manic episode can lead to people behaving impulsively, making reckless decisions and taking unusual risks, with unawareness of the negative consequences of their actions. Suicide is an ever-present risk in manic states. (NAMI, 2017)

Both a manic and a hypomanic episode include three or more of these symptoms (Mayo Clinic Staff, n.d.) (NIMH, 2016):

  • Euphoria – Exaggerated sense of well-being and self-confidence
  • Abnormally upbeat, jumpy or wired
  • Feel very “up,” “high,” or elated
  • Increased activity, energy
  • Decreased need for sleep
  • Unusual talkativeness about a lot of different things
  • Racing thoughts
  • Distractibility
  • Be agitated, irritable, or “touchy”
  • Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Depression

This can be so debilitating that people may be unable to get out of bed. There can be sleeplessness or excessive sleep. You may feel overwhelmed even when making minor decisions such as what to eat for dinner. You can become obsessed with feelings of loss, personal failure, guilt or helplessness, often leading to thoughts of suicide. These symptoms impairing your ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. (NAMI, 2017)

An episode includes five or more of these symptoms (Reddy, 2019):

  • A depressed mood most of the day, either self-reported or observed by others
  • No interest or pleasure in many activities nearly every day
  • Decrease or increase in appetite and weight
  • Lack of sleep or too much sleep every day
  • Restlessness or slowing down, observable by others
  • Fatigue or loss of energy
  • Feelings of worthless or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts about death or plans and attempts to commit suicide

Sometimes, a mood episode includes symptoms of both manic and depressive symptoms, an episode with mixed features. They may feel very sad, empty, or hopeless, while at the same time feeling extremely energized. Sometimes, mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. In this episode, an individual may feel very good, be highly productive, and function well. The person may feel that everything is normal, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, these people may develop severe mania or depression.

Other Symptoms of Bipolar Disorder

They may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. Bipolar disorder symptoms can be associated with pregnancy and can be seasonal.

Symptoms in Children and Teens

To call it euphoria in a child, it should exceed that which a typically developing child experiences in a very exciting situation, such as going to Disneyland, and true grandiosity should be distinguished from developmentally appropriate fantasy or oppositional behavior. Grandiosity or euphoria should occur at the same time as other manic symptoms (e.g., decreased need for sleep, increased goal-directed activity), i.e., so-called mood-congruent. Decreased need for sleep should be differentiated from more typical insomnia, whereby youth would prefer to sleep and may nap during the day. When possible, clinicians should see a child when the parent states that the child is exhibiting manic behavior.

Data about a child’s symptoms and behavior is necessary from multiple informants including parents and other significant caregivers, such as teachers, and with the child seen repeatedly over time. Prospective daily mood ratings and commonly available technology may help, including cell phone camera recordings of manic or depressive behavior, so that clinicians and parents can achieve a shared understanding of target behaviors and symptoms. Clinicians must balance concerns about over- and underdiagnosis of bipolar disorder. Careful follow-up is particularly warranted in youth with a family history of bipolar disorder. (Thapar & Pine, 2015, p. 861)

Types of Bipolar Disorder

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. (NAMI, 2017) (Mayo Clinic Staff, n.d.) (NIMH, 2016) They are:

  1. Bipolar Disorder I—in this, manic episodes last at least 7 days, or manic symptoms are so severe that immediate hospitalization is needed. Psychosis could occur. Depressive episodes could occur as well, typically lasting at least 2 weeks, though an episode of depression is not necessary for a diagnosis. Episodes with mixed features are also possible.

  1. Bipolar Disorder II—in this, full-blown manic episodes do not occur. It is characterized by a pattern of depressive episodes and hypomanic episodes. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. Individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

  1. Cyclothymic Disorder (also called cyclothymia)—in this, many periods of hypomania, as well as many episodes of depression, occur, lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.

  1. Other Specified and Unspecified Bipolar and Related Disorders—here, the bipolar disorder symptoms do not match the three categories listed above, but the person still experiences periods of clinically significant abnormal mood elevation. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.

Causes of Bipolar Disorder

No single cause of bipolar disorder has yet been discovered. Several factors are believed to contribute to the development of bipolar disorder, including (NAMI, 2017) (Mayo Clinic Staff, n.d.) (NIMH, 2016):

  • Genetics. Bipolar disorder tends to run in families. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. However, it is possible that only one of the twins may suffer from bipolar disorder.
  • Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.
  • Brain structure and function. Subtle differences in the average size or activation of some brain structures can be identified in brain scans of people with bipolar disorder.

Treatment of Bipolar Disorder

Bipolar disorder is treated and managed in several ways:

  • Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.
  • Self-management strategieslike education and recognition of an episode’s early symptoms.
  • Psychotherapy, such as Cognitive behavioral therapy (CBT), Interpersonal and social rhythm therapy (IPSRT), Psychoeducation, and Family-focused therapy.
  • Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic).
  • Other treatment approaches: In treatment-resistant depression, electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be tried.
  • Complementary health approaches, such as aerobic exercise, meditation, can support, but not replace, treatment.

Medications for Bipolar Disorder

Medications may include:

  • Mood stabilizers. These are needed to control manic or hypomanic episodes. Examples include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
  • Antipsychotics. If symptoms of depression or mania persist in spite of treatment then you may need an antipsychotic drug along with a mood stabilizer. Antipsychotic drugs include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help.
  • Antidepressants. An antidepressant is needed to control depression symptoms. The antidepressant is usually prescribed along with a mood stabilizer or antipsychotic because an antidepressant can trigger a manic episode.
  • Antidepressant-antipsychotic. A combination of the antidepressant fluoxetine and the antipsychotic olanzapine (Symbax) works as a depression treatment and a mood stabilizer.
  • Anti-anxiety medications. Benzodiazepines can allay anxiety and improve sleep but are usually used on a short-term basis.

Finding the Right Medication

Finding the right medication for you will likely take trial and error. Exercise patience, since some medications need weeks to months to take full effect. Medications may also need to be adjusted as your symptoms change.

Medications and Pregnancy

A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to the baby. Certain medications, such as valproic acid and divalproex sodium, are contraindicated in pregnancy.

References

Mayo Clinic Staff, n.d. Bipolar Disorder. [Online]
Available at: https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
[Accessed 3 Sep 2019].

NAMI, 2017. Bipolar Disorder. [Online]
Available at: https://www.nami.org/learn-more/mental-health-conditions/bipolar-disorder
[Accessed 3 Sep 2019].

NIMH, 2016. Bipolar Disorder. [Online]
Available at: https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
[Accessed 3 Sep 2019].

Reddy, D. S., 2019. All You Need to Know About Depression. [Online]
Available at: https://depressionpedia.org/all-you-need-to-know-about-depression/
[Accessed 3 Sep 2019].

Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.

Thapar, A. & Pine, D., 2015. Rutter’s Child and Adolescent Psychiatry. 6th ed. West Sussex: Wiley Blackwell.

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Summary
Bipolar Disorder: Symptoms, Types, and Treatment
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Bipolar Disorder: Symptoms, Types, and Treatment
Description
Bipolar disorder is a mood disorder with alternating episodes of mania or hypomania and depression. Treatment is usually effective.
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DepressionPedia.org
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