My recovery from manic depression has been an evolution, not a sudden miracle. - Patty Duke
What is Bipolar Disorder?
Bipolar Disorder is a mood disorder sometimes called manic-depressive illness or manic-depression, that characteristically involves cycles of depression and elation or mania. The moods can shift from high to low rapidly, or over the course of days or weeks with intervals of "normal" moods in between. These cycles are much more severe than the mood swings that everyone goes through.
Bipolar disorder often develops in the late teen or early adult years. It may be difficult to detect the onset of bipolar disorder, as the symptoms may appear to be separate problems, not pieces of a larger problem. Many people with bipolar disorder suffer for years before they are properly diagnosed.
Those with bipolar disorder experience distinct and intense emotional states called "mood episodes." Mania is an overly joyful or excited mood, whereas a sad, hopeless state is a depressive episode. Sometimes, a mood episode contains symptoms of both mania and depression, which is called a "mixed state."
These mood episodes bring extreme changes in energy, activity, sleep and behavior. The signs and symptoms of depressive and manic states are described in further detail below.
What Are The Signs of a Depressive State?
While the following symptoms are not all experienced by each individual with bipolar disorder, these are the most common signs of a depressed state in an individual with bipolar disorder:
- Sadness and anxiety
- Loss of energy
- Feelings of guilt, hopelessness, or worthlessness
- Loss of interest or enjoyment from things that were once pleasurable
- Difficulty concentrating
- Uncontrollable crying
- Difficulty making decisions
- Increased need for sleep
- Change in appetite causing weight loss or gain
- Thoughts of death or suicide
- Attempting suicide
What Are The Signs of Mania?
As with any illness, the symptoms a person may experience can vary dramatically. Here are some of the more common examples of manic behavior for those who have bipolar disorder:
- Excessive happiness, hopefulness, and excitement
- Sudden changes from being joyful to being irritable, angry, and hostile
- Restlessness, increased energy, and less need for sleep
- Rapid talk, talkativeness
- Racing thoughts
- High sex drive
- Tendency to make grand and unattainable plans
- Tendency to show poor judgment, such as deciding to quit a job
- Inflated self-esteem or grandiosity -- unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
- Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)
What is Hypomania?
Hypomania is a mild-to-moderate level of mania, which includes symptoms similar to the signs of mania as listed above, but tend to be less extreme. Those with bipolar disorder with hypomanic features may be misdiagnosed, as those with hypomania may attribute their elevated mood with happiness.
Hypomanic episodes may include the following symptoms:
- Periods of time with an especially energetic mood.
- Feeling more self-confident than normal.
- Being very talkative or speaking faster than usual.
- Feeling hyper.
- Having a hard time concentrating.
- Being more irritable or angry.
- Needing less sleep than normal.
- Having more interest in sex.
- Uncharacteristic spending sprees.
Types of Bipolar Disorder:
Bipolar I Disorder:
Defined primarily by manic or mixed episodes that last at least seven days or by manic symptoms so severe they require immediate hospitalization. Generally, someone with Bipolar I also has depressive episodes lasting two or more weeks. The symptoms of depression and the symptoms of mania must be a major change in normal behavior.
Bipolar II Disorder:
Bipolar II Disorder is a mood disorder characterized by one or more periods of depression and at least one episode of hypomania, which is a milder high than the mania experienced with Bipolar Disorder.
Because they’re milder, hypomanic episodes can often go unrecognized and as a result Bipolar II Disorder is often misdiagnosed as depression. Several studies have found that the risk of suicide is higher for those with Bipolar II than Bipolar I Disorder, likely because it’s often not diagnosed and therefore not treated properly.
Bipolar Disorder - Not Otherwise Specified (NOS)
Bipolar Disorder may not always follow a particular pattern. It can include reoccurring hypomanic episodes without any signs of depression or rapid swings between mania and depression. In these cases it’s called Bipolar Disorder: Not Otherwise Specified (NOS).
Cyclothymic Disorder - mild form of bipolar disorder, in which two episodes of hypomania alternate with episodes of mild depression for at least two years. The symptoms of a person with Cyclothymic Disorder do not meet the diagnostic criteria for other types of bipolar disorder.
Rapid-Cycling Bipolar Disorder - four episodes of major depression, mania, hypomania or mixed symptoms within a year. Some people with Rapid-Cycling Bipolar Disorder have one or more episodes a week or even a day. This seems to be a more common form of bipolar disorder in those who have severe bipolar disorder and may be more common in those who were diagnosed with bipolar disorder at a young age.
How Often Do People With Bipolar Disorder "Cycle?"
Some people can cycle from depressed to manic in a matter of hours but for most, the cycle is a few weeks apart. Every patient is different and the cycles and signs/symptoms manifest in different ways.
What Causes Bipolar Disorder?
Doctors aren't entirely positive what causes bipolar disorder. We do know that bipolar disorder often runs in families - children with a parent or sibling with bipolar disorder are 4-6 times more likely to develop bipolar disorder. There's growing evidence that environmental and lifestyle choices may also have an effect on bipolar disorder.
How Is Bipolar Disorder Diagnosed?
The best way to be properly diagnosed with bipolar disorder is through talking with a doctor or psychiatrist, who will perform a screening and full work-up to determine a diagnosis. Keeping track of patterns in mood and overall mood are the most critical diagnostic tools. Those who have bipolar disorder are more likely to seek treatment during a depressive state rather than a manic state. It's critical that a full medical history is sought before being diagnosed as simply "depressed."
How Is Bipolar Disorder Treated?
Once a diagnosis of bipolar disorder has been made, a treatment plan will be formed. Generally treatment for bipolar disorder involves medication (typically a "cocktail" of medications of various types) and talk therapy will typically help bring some sense of normalcy. Learning coping mechanisms is invaluable.
Proper treatment of bipolar disorder is imperative for those who struggle with bipolar disorder, as it can help control mood swings and other symptoms.
Bipolar disorder is a life-long illness, so treatment will be long-term to manage and control symptoms of the disorder.
Medications to Treat Bipolar Disorder:
Many people with bipolar disorder have to try a number of medications before a combination is found that controls the symptoms. These may include:
- Mood-Stabilizers are generally the first choice of medications to treat bipolar disorder. These may be continued for years.
- Atypical Antipsychotic Medications are occasionally used to treat some of the symptoms of bipolar disorder and often combined with other medications.
- Antidepressants are often utilized to treat the symptoms of depression, and are often combined with mood stabilizers.
Living With Bipolar Disorder:
Like liver disease or diabetes, Bipolar Disorder is a chronic condition. With the help of loved ones and proper treatment, those who have Bipolar Disorder can live healthy, happy and rewarding lives.
Read more about coping with bipolar disorder.
Here are some tips for living with bipolar disorder:
The first and most important thing a person with bipolar can do for him or herself is to learn to make healthy choices to minimize the symptoms and take control of your life.
Healthy choices begin with medication and proper supervision by a therapist.
With proper symptom management, you will learn to hope again, you will learn to feel good and well, and that you're able to cope with the high highs and low lows of bipolar disorder.
Become an advocate for yourself - no one knows you like, well, you. So advocate for proper treatment and take an active role in your treatment. Don't be afraid to tell your therapist and treatment team if something isn't working for you. Speak up. Ask questions. Advocate, advocate, advocate.
Learn everything you can about bipolar disorder and examine how bipolar disorder affects you. This is a major component of treating bipolar disorder.
Be patient - while you're ready to feel normal again, patience is key. Often finding a proper treatment, or finding a treatment that works for YOU, takes patience, time and energy. It's okay to be frustrated by this, but frustration isn't a reason to stop treatment.
Follow your medication regime as it was prescribed to you. Don't stop taking it without first talking to your doctor about your decision.
Therapy is your BFF. While medication can even out mood and manage the symptoms of bipolar disorder, therapy can help teach you proper coping techniques.
Keep tabs on your moods and your feelings. You may find it helpful to keep a "mood diary" to watch for patterns. It's vital to watch your moods as they swing and learn about the things that trigger a manic or a depressive episode. Common triggers include:
Turn to friends and family for support. It may be hard and shameful to admit that you have a mental illness, but the support and comfort offered by friends can make a world of difference.
Find and attend a support group for people who have bipolar disorder. Not only are these groups excellent for meeting others who have the same disorder, you can also compare coping strategies.
Build new relationships and friendships - try community activities, emailing old friends, going out for coffee with a loved one. Social isolation and loneliness can make the mood swings of bipolar disorder worse.
Build a structure into your life. Developing and following a routine (making sure it includes eating, sleeping, exercise, work, relaxing, and hanging out with friends) can really provide stability in your life.
Make sure to go to bed at the same time each night - lack of sleep can lead to mania and it's healthy for your body to get the proper amount of sleep it needs to function.
Cut off any excess stress in your life. Stress can trigger both mania and depression in those with bipolar disorder, and chances are, there's a way to minimize some of the stress as well as developing some effective coping mechanisms for the unavoidable stresses.
Don't self-medicate with drugs or alcohol. Many of legal AND illegal drugs can trigger episodes of mania and depression.
My Loved One Has Bipolar Disorder:
Even though only 3% of the population is diagnosed as bipolar, chances are you will know someone who is. The best way to handle this is to realize that they simply have brain chemicals that aren't exactly lined up right.
As long as they are not harmful to themselves or others, simply treat these people as you would any other person. However, the highs and lows can be difficult for those who are in daily contact with the person. There are support groups and books that will be of help finding coping skills for partners of Bipolar patients. A good therapist for caregivers is never a bad thing.
It's vital to support your bipolar loved one as he or she goes through treatment.
Be understanding - no one was born wanting to be bipolar. If your loved one is undergoing treatment, be patient and understanding as he or she adjusts to new medications.
It's no one's fault that your loved one has bipolar disorder.
Encourage your loved one to seek professional help. Bipolar disorder is much more manageable for those who seek - and stick with - treatment.
Accept his or her limits - episodes of mania and depression are not something that your bipolar loved one can simply control or snap out of.
Accept your own limits, too. You can't make someone who has bipolar disorder go to treatment - recovery is in the hands of your loved one.
Find - and attend - a support group for people with bipolar disorder. Go with your loved one and ask questions.
Learn all that you can about bipolar disorder - it may explain a lot of those behaviors your loved one copes with.
Additional Bipolar Disorder Resources:
Mood Tracker is a great tool for tracking shifts in moods as well as monitoring how much sleep the patient is getting, medications taken, and levels of anxiety and irritability.
National Alliance on Mental Illness -dedicated to improving the lives of individuals and families affected by mental illness.
"How to Survive When They're Depressed: Living and Coping with Depression Fallout" by Anne Sheffield - A must-have book for someone living with a spouse or partner who battles depression and/or bipolar disorder. This book will completely change your outlook on life and how life should look when living in the house with someone with mental illness.
Child and Adolescent Bipolar Disorder Foundation: EXCELLENT site that advocates for youth with depression and bipolar and is highly respected for its scientifically credible information.
Depression and Bipolar Support Alliance has education and research materials, information about steps to recovery, tools for managing mental illness, and tips for family members.