We all have our ups and downs, but with bipolar disorder (once known as manic depression or manic-depressive disorder) these peaks and valleys are more severe. Bipolar disorder causes serious shifts in mood, energy, thinking, and behavior from the highs of mania on one extreme, to the lows of depression on the other.
More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they can interfere with your job or school performance, damage your relationships, and disrupt your ability to function in daily life.
During a manic episode, you might impulsively quit your job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.
The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood.
The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed resulting in unnecessary suffering. Since bipolar disorder tends to worsen without treatment, it’s important to learn what the symptoms look like. Recognizing the problem is the first step to feeling better and getting your life back on track.
There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.
- Bipolar I disorder. You’ve had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
- Bipolar II disorder. You’ve had at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode.
- Cyclothymic disorder. You’ve had at least two years or one year in children and teenagers of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
- Other types. 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.
Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.
Although bipolar disorder can occur at any age, typically it’s diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.
Mania and hypomania
Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Poor decision making, for example, going on buying sprees, taking sexual risks or making foolish investments
Major depressive episode
A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:
- Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
- Marked loss of interest or feeling no pleasure in all or almost all activities
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
- Either insomnia or sleeping too much
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Thinking about, planning or attempting suicide
Other features of bipolar disorder
Signs and symptoms of bipolar I and bipolar II disorders 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. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.
Symptoms in children and teens
Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.
Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.
The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.
Causes of bipolar disorder
Bipolar disorder is a common mental health disorder, but it’s a bit of a mystery to doctors and researchers. It’s not yet clear what causes some people to develop the condition and not others.
Possible causes of bipolar disorder include:
If your parent or sibling has bipolar disorder, you’re more likely than other people to develop the condition (see below). However, it’s important to keep in mind that most people who have bipolar disorder in their family history don’t develop it.
Your brain structure may impact your risk for the disease. Abnormalities in the structure or functions of your brain may increase your risk.
It’s not just what’s in your body that can make you more likely to develop bipolar disorder. Outside factors may contribute, too. These factors can include:
- extreme stress
- traumatic experiences
- physical illness
Each of these factors may influence who develops bipolar disorder. What’s more likely, however, is that a combination of factors contributes to the development of the disease.
Bipolar disorder treatment
Several treatments are available that can help you manage your bipolar disorder. These include medications, counseling, and lifestyle changes. Some natural remedies may also be helpful.
Recommended medications may include:
- mood stabilizers, such as lithium (Lithobid)
- antipsychotics, such as olanzapine (Zyprexa)
- antidepressant-antipsychotics, such as fluoxetine-olanzapine (Symbyax)
- benzodiazepines, a type of anti-anxiety medication such as alprazolam (Xanax) that may be used for short-term treatment
Recommended psychotherapy treatments may include:
Cognitive behavioral therapy
Cognitive behavioral therapy is a type of talk therapy. You and a therapist talk about ways to manage your bipolar disorder. They will help you understand your thinking patterns. They can also help you come up with positive coping strategies.
Psychoeducation is a kind of counseling that helps you and your loved ones understand the disorder. Knowing more about bipolar disorder will help you and others in your life manage it.
Interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics can help you manage your disorder.
Other treatment options
Other treatment options may include:
- electroconvulsive therapy (ECT)
- sleep medications
There are also some simple steps you can take right now to help manage your bipolar disorder:
- keep a routine for eating and sleeping
- learn to recognize mood swings
- ask a friend or relative to support your treatment plans
- talk to a doctor or licensed healthcare provider
Other lifestyle changes can also help relieve depressive symptoms caused by bipolar disorder.