What You Need To Know About Bipolar Disorder

We all have times when we feel happy or sad. A death in the family can cause profound grief and winning a sports competition can lead to joy. Still, some people have severe, dramatic shifts in mood that can take them by surprise. Even though it's not their fault, their brains can shift from deep depression to unsettling highs.

Key Takeaways: Bipolar Disorder

• Bipolar disorder is a mood disorder marked by extreme highs and lows. It involves episodes of mania (elevated mood, high energy, impulsive behavior) and depression (sadness, fatigue, hopelessness), which can significantly impact daily life.
• Symptoms vary widely but often include major changes in sleep, behavior and thinking. During manic episodes, individuals may feel euphoric, talk rapidly, need little sleep and engage in risky behavior, while depressive episodes mirror severe depression.
• The exact cause of bipolar disorder is unknown, but genetics and brain chemistry play a role. Bipolar disorder often runs in families, though environmental factors like trauma, stress or substance use can also trigger episodes.
• Bipolar disorder is a lifelong but treatable condition. Treatment typically includes mood-stabilizing medications, therapy and ongoing support, along with consistent care and lifestyle management.

How Common Is Bipolar Disorder?

According to the National Institute of Mental Health, about 5.7 million Americans ages 18 and older have bipolar disorder, a kind of mood disorder. On average, people with bipolar disorder have their first episode of mania or depression in their late teens or early 20s, while the median age is 25.

What Are Symptoms Of Bipolar Disorder?

Bipolar disorder comes in different forms, including bipolar disorder type I and bipolar disorder type II. Symptoms can span from somewhat troubling to severe or even life-threatening. Some people go through dramatic mood swings that can quickly change in a single day, week, or several times a year -- a condition called rapid cycling bipolar disorder. Others may have scattered episodes of intense highs or lows between long periods of relatively calm moods.

Mania

"The hallmark of a typical bipolar disorder or type I bipolar disorder is what we call an episode of mania," said Kenn Vattathara, MD, a board-certified psychiatrist with the Franciscan Physician Network Behavioral Health Munster. "When people get that elevated mood, they become almost euphoric. They can have just a lot of increased activity, heightened energy, and that needs to be present for at least a week, pretty much every day and is really noticeable to everybody around this individual."

Along with that definite heightened mood and energy, other symptoms of bipolar disorder include:

Significantly Increased Self-Esteem/Grandiosity

"There's kind of this real inflated kind of sense of self, a distinct abnormal presentation that an individual typically would not have," Dr. Vattathara said.

Lack Of Sleep

"You can see a decreased need for sleep," Dr. Vattathara said. “In fact, with bipolar disorder type I, a classic manic episode that lasts more than a week, folks can go for days or sometimes weeks with no sleep.”

Talkative Behavior

"Somebody who's typically in a manic episode can be very, very talkative, so much so that folks might have a difficult time tracking the conversation," Dr. Vattathara said. "They're speaking very quickly. They'll describe to me sometimes, like they can't kind of keep up with their thoughts. They may have a subjective sense that their thoughts are just going on and on but they'll try to keep up. This situation is what we call a flight of ideas. For example, they may start talking about one subject and then switch to another subject which goes into something else. They'd be very hyper, distractible, and just show a lot of increased activity."

Impulsive Or Reckless Behaviors

"It becomes problematic also when people become a little loose with their judgment. There can be impulsivity with spending, spending sprees, kind of heightened sexual interest," Dr. Vattathara said. "Mania is a really distinct, at least week-long episode of multiple of those symptoms."

Depression

A person with bipolar disorder who becomes depressed will feel much like anyone else with severe depression. Possible signs include feelings of sadness and hopelessness along with guilt, anxiety, fatigue, irritability, and trouble eating or sleeping.

"When we talk about bipolar depression, we're talking about the other pole of being high, which is being low, and it becomes important to differentiate a major depressive disorder from somebody that has these manic or hypomanic episodes, because the treatment is different,” Dr. Vattathara said.

What Causes Bipolar Disorder?

Nobody exactly knows what causes bipolar disorder. Chemical imbalances in the brain definitely play a role, but it's hard to say where those imbalances start. Bipolar disorder runs in families, and most experts believe that people are born with a tendency to be bipolar. But family history isn't everything. It's possible for one identical twin to be bipolar while the other twin isn't. Experts believe that outside forces, including traumatic life events, serious losses or drug abuse, can push some people over the edge.

How Is Bipolar Disorder Diagnosed?

Doctors can order physicals and blood tests to check on overall health, but the only way to diagnose bipolar disorder is to get a full account of a person's symptoms and family history. People evaluated for the disorder should expect to answer many questions about their feelings, behaviors, and overall state of mind.

How Is Bipolar Disorder Treated?

"Bipolar disorder is a disease that if you have that diagnosis made, you'll manage it for your life," Dr. Vattathara said. "It's certainly manageable through medications and therapy and sometimes hospitalizations if it's needed as well. But it's really important to treat these symptoms."

Mood stabilizer medications used to treat bipolar disorder include lithium, valproic acid (Depakene), Divalproex (Depakote) and lamotrigine (Lamictal). Antipsychotic medications can act as mood-stabilizing medications as well. Often treatment of bipolar disorder is a matter of trial and error until the doctor and patient find the drug that works best.

In addition to medication, many people with bipolar disease benefit from regular counseling, including cognitive behavioral therapy. A study reported in the Archives of General Psychiatry found that intensive psychotherapy was more effective than brief therapy for the illness: patients who received it were more likely to get well and stay well.

How Can People With Bipolar Disorder Help Themselves?

If you have bipolar disorder, make sure to keep all of your doctor appointments, and don't skip your medications. That's easy to do when you're feeling fine, but it can be a real struggle if you are feeling very high or very low. If you have unpleasant or worrisome side effects from the medication, consult your doctor immediately; they should be able to adjust the medication or find an alternative.

It's good to have a support person handy or some system you can rely on to take your medications on time, even for those times when you may not feel like it. If you start feeling manic or depressed, tell your doctor and other people you trust who can help you in your daily life. You should avoid drinking and illegal drugs since they can cloud your thinking or trigger an episode. They may also interact poorly with the medication you're taking to control your moods.

You may find a bipolar support group helpful. Organizations like the Depression and Bipolar Support Alliance and the National Alliance for the Mentally Ill have ongoing support groups throughout the country. Perhaps most importantly, reach out for help if you start thinking about suicide. Call a family member, a doctor, or 988, the national suicide hotline. Or just get yourself to the emergency room, whatever it takes to escape that suicidal desire and live for another day. With so many treatment options for bipolar disorder, there's a good chance that adjusting your medication will change the way you feel for the better.

Listen To The Podcast

Franciscan Physician Network psychiatrist Besty Rosiek, MD, discusses bipolar disorders, their symptoms and treatment, in an episode of the Franciscan DocPod podcast.