What Is Bipolar Disorder? 

What Is Bipolar Disorder?

What Is Bipolar Disorder?
Everyday Health
Bipolar disorder is a mood disorder that causes extreme shifts in a person's mood and energy level. It affects an estimated 2.8 percent of adults in the United States each year, according to the National Institute of Mental Health (NIMH).

 A person with bipolar disorder may experience periods with an extremely elevated or irritable mood (called manic episodes, or mania) as well as episodes of depression.

These shifts are more severe than the typical changes in mood that affect everyone. They can involve impaired thinking and behavior and can affect your ability to function day to day.

Types of Bipolar Disorder

Each of the main types of bipolar disorder tend to cause intense mood changes between periods of typical mood and regular ability to function, according to the American Psychiatric Association (APA).

Your doctor will diagnose your form of the condition on the basis of the length, frequency, and pattern of episodes.

Here’s a look at each of the four types of bipolar disorder:

  • Bipolar 1 is marked by manic episodes. Some people with bipolar 1 also experience major depressive episodes, along with periods of neutral mood.
  • Bipolar 2 is characterized by major depressive episodes, as well as bouts of hypomania (a less-severe form of mania) and in-between periods of a neutral mood.
  • Cyclothymia is a milder form of bipolar disorder involving less-severe hypomanic and depressive episodes that alternate for at least two years in adults and at least one year in children and teens, according to Mayo Clinic.

  • Other specified and unspecified bipolar and related disorders is a diagnosis given when a person doesn’t meet the criteria for any of the other types of bipolar disorder but still experiences periods of a significant, abnormal elevation in mood, according to the National Alliance on Mental Illness (NAMI).

Signs and Symptoms of Bipolar Disorder

The symptoms and severity of bipolar disorder can vary based on the type of the condition, but here are common signs:

Manic or Hypomanic Episodes

Manic episodes involve a distinct and observable change in mood and functioning. They also may be severe enough to result in problems in your daily activities or to require hospitalization to prevent harm to yourself or others, according to the APA.

A manic episode consists of at least one week of abnormally and persistently elevated or irritable mood, with increased energy. A manic episode may also trigger a break from reality (psychosis), including hallucinations or delusions, per the APA. In addition, three of the following symptoms must also be present:

  • Talking rapidly or more often than usual
  • Decreased need for sleep and feeling energetic despite getting less sleep than usual
  • Feeling easily distracted
  • Racing thoughts that are hard to control
  • Increased goal-directed activity such as starting several projects at a time
  • Increased risky behaviors such as heavy spending, reckless driving, or reckless sex

A hypomanic episode is similar but not as intense or disabling. It’s shorter in duration, lasting at least four days, according to the APA.

Major Depressive Episodes

According to the APA,

having five or more of the following symptoms every day over a two-week period (including one or both of the first two symptoms) constitutes a major depressive episode:
  • Deep sadness or depressed mood
  • Loss of interest in regular activities you normally enjoy
  • Significant changes in weight or appetite
  • Changes in sleep
  • Restlessness or fatigue
  • Slowed movements or speech
  • Feelings of emptiness, guilt, or worthlessness
  • Trouble concentrating
  • Thoughts of suicide

Causes and Risk Factors of Bipolar Disorder

Researchers aren't sure what exactly causes bipolar disorder, but there appears to be an association between the condition and genetics, brain structure, and brain function.

Bipolar disorder often runs in families. Approximately 80 to 90 percent of people with the condition have a relative who has bipolar disorder or depression, according to the APA.

 But having a family history of bipolar disorder doesn't mean that it will definitely affect you.

The genetic components thought to be at work are complicated, but certain gene mutations appear to be involved in the development of the condition. In a review published in the journal Biological Psychiatry, researchers found 36 gene mutations that could contribute to bipolar disorder.

Epigenetics — how your behaviors and environment affect how your genes work, according to the Centers for Disease Control and Prevention (CDC) — may also play a role.

 But according to recent research, more studies are needed in order to fully understand how epigenetics contributes to bipolar disorder.

Studies using brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), have attempted to reveal how the brains of people with bipolar disorder differ from the brains of healthy people or those with other mental disorders.

In neuroimaging studies, researchers have identified changes in the connectivity of brain regions — prefrontal, parietal, and limbic — responsible for functions like emotional processing, emotional regulation, and reward processing among people with bipolar disorder.

The prefrontal cortex governs the brain's executive functions, such as problem-solving and decision-making. Other studies using neuroimaging have found brain differences between those with bipolar 1 and bipolar 2.

People with a history of other mental health disorders — including anxiety, attention deficit hyperactivity disorder (ADHD), and borderline personality disorder — appear to be at an increased risk of developing bipolar disorder, though these links are still being studied.

A number of symptoms or situations that result from bipolar disorder can also be triggers for the disorder. Changes in sleep patterns, blowout arguments with coworkers or loved ones, high stress or traumatic events, alcohol abuse, certain medication interactions, shifts in season, and the hormonal changes of pregnancy can all put you at a greater risk of a manic or depressive episode.

How Is Bipolar Disorder Diagnosed?

Bipolar disorder was officially known as manic depression until the 1980s, when mental health professionals changed the name of the illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the guide that mental health professionals use to assist in diagnosis.

They felt the term “bipolar disorder” more accurately described the condition and its symptoms, according to previous research.

 Some also contend that the older term carries a stigma in popular culture, and that both “manic” and “depression” are now used to describe everyday feelings and emotions. As a result, bipolar disorder is now the preferred term and the one that healthcare professionals use in diagnosis.

That said, it can be difficult to recognize the extent to which mood swings affect your quality of life, which is important information for diagnosis.

The Mayo Clinic notes that some people with manic symptoms may enjoy the euphoric feelings and highs of productivity, but the fallout often may have financial, legal, or relationship consequences.

Diagnosis typically involves these components, according to Mayo Clinic:

  • A physical exam
  • A psychiatric evaluation
  • Mood charting, or keeping daily records of your moods and sleep patterns
  • Comparing your symptoms with the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR)
There is no single bipolar disorder test, but blood tests and neuroimaging may be used to rule out other conditions, according to the NIMH.

Bipolar symptoms can sometimes resemble those of other disorders, which can make it challenging to properly diagnose the condition, per the NIMH.

Diagnosing Bipolar Disorder in Kids and Teens

In children and teens, symptoms of bipolar disorder may be especially hard to distinguish from normal mood changes and behaviors.

Children and teens in a manic episode may be irritable and short-tempered, have trouble sleeping and staying focused, and engage in risky behaviors, the NIMH states. Those experiencing a depressive episode may also be irritable, have stomachaches and headaches, experience changes in eating habits, have little energy and interest in activities they usually enjoy, or have thoughts about death and suicide, per the NIMH.

Check in with your doctor if your child is having mood swings that seem more severe or significantly different from their usual ups and downs.

Diagnosing Bipolar Disorder in Women

Although bipolar disorder is equally prevalent in men and women, the disorder appears to have some gender-related differences. Research suggests that bipolar disorder in women typically presents with rapid cycling and depressive polarity. Perhaps the most significant distinction between men and women with bipolar disorder involves reproductive health and choices, as treatment for pregnant women with bipolar disorder can be challenging.

Treatment and Medication Options for Bipolar Disorder

Treatment for bipolar disorder may involve a combination of mood-balancing medication, psychotherapy, brain stimulation therapies, and certain lifestyle changes and complementary health approaches, according to Mayo Clinic.

In some instances, hospitalization may be necessary. But in many cases, outpatient treatment of bipolar disorder is successful, per Mayo Clinic.

If you’re afraid you or a loved one might hurt themselves or attempt suicide, it’s important to seek emergency medical help by dialing 911 for emergency medical services or 988 to reach the 988 Suicide and Crisis Lifeline.

Medication

Commonly prescribed medications for bipolar disorder, according to Mayo Clinic, include:

  • Mood Stabilizers These medications are prescribed to help manage manic symptoms. Medicines like lithium (Lithobid), divalproex sodium (Depakote), valproic acid (Depakene), and lamotrigine (Lamictal) fall under this category.
  • Antipsychotics Your doctor may add an antipsychotic drug to your treatment regimen if your manic or depressive symptoms persist, despite treatment with other medications. This class of medications includes risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and lurasidone (Latuda).
  • Antidepressants These medicines are sometimes prescribed to help manage depressive episodes. But they’re usually prescribed alongside a mood stabilizer or an antipsychotic because taking antidepressants alone could potentially trigger manic episodes for some people with bipolar disorder.
  • Anti-Anxiety Medication If you’re struggling with anxiety or sleep, your doctor may prescribe you a short-term course of anti-anxiety drugs called benzodiazepines to help you feel better.

These drugs can have a variety of side effects, and finding the right drug therapy can be challenging and take some time. It’s important, though, not to stop taking your medication without talking to your doctor, even if you’re feeling better. Doing so can cause withdrawal symptoms, or your symptoms may worsen or come back, per Mayo Clinic.

Psychotherapy

In conjunction with medication, your doctor will likely recommend some form of psychotherapy or counseling. Some common options for bipolar disorder, per Mayo Clinic, are:

  • Cognitive Behavioral Therapy (CBT) During CBT sessions, a therapist will help you identify your triggers for mood episodes and develop behavioral strategies for managing them.
  • Interpersonal and Social Rhythm Therapy (IPSRT) This form of therapy focuses on stabilizing your daily rhythms, including wake times, bedtimes, and mealtimes. Consistent routines are thought to help balance moods in people with bipolar disorder.
  • Family Therapy In this form of therapy, you and your family members can learn to develop healthy communication strategies, which can help with managing your condition. Through family therapy, your loved ones can also learn about your triggers and how to recognize the warning signs of a mood episode.

Brain Stimulation Therapies

To provide support in addition to medication and psychotherapy, your doctor might recommend you try brain stimulation therapies, such as electroconvulsive therapy or deep brain stimulation, according to NAMI.

During brain stimulation therapies, doctors directly and safely stimulate the brain via electricity, magnets, or implants, per NAMI.

Disparities and Inequities in Bipolar Disorder

Research has shown several differences in the diagnosis and treatment of bipolar disorder between Black people and white people.

For instance, research supports that bipolar disorder is more likely to be misdiagnosed as schizophrenia among Black people than white people.

 As a result, Black people are also less likely to be treated for bipolar disorder than white people.
Other reasons Black people with bipolar disorder are less likely to be diagnosed and treated, according to Mental Health America, include:

  • Mistrust of the U.S. medical system due to previous mistreatment, such as in the 40-year U.S. Public Health Service Syphilis Study at Tuskegee, during which nearly 400 Black men with syphilis were intentionally denied treatment
  • Stigma around mental illness in Black communities
  • Underrepresentation of providers who share the same cultural backgrounds as Black patients or are able to provide culturally competent care (meaning care that meets the needs of patients’ own cultural values, behaviors, and beliefs)
  • Greater likelihood of relying on family or religious communities for help rather than mental health professionals
  • Lack of health insurance coverage

  • Tendency to talk about physical health issues rather than mental health symptoms

Lifestyle Changes and Prevention for Bipolar Disorder

Making certain lifestyle changes may also be necessary, such as staying away from drugs and alcohol, avoiding certain foods, like those containing caffeine, or making sure you’re exercising regularly, per Mayo Clinic.

Although there’s no way to prevent bipolar disorder, seeking treatment at the earliest sign of this condition — and sticking to that treatment in the long term — can help you manage the symptoms and improve your prognosis, according to Mayo Clinic.

Seeking out educational resources and a community of support can help you understand how to live with the condition and cope with symptoms.

For example, the Depression and Bipolar Support Alliance (DBSA) offers in-person and online support groups for people with bipolar disorder and their loved ones to share what they’re going through.

Bipolar Disorder Prognosis

While symptoms can intensify and subside during different windows of time, bipolar disorder is a lifelong condition that typically doesn’t go away on its own. But with consistent treatment, those affected can manage its symptoms.

Complications of Bipolar Disorder

Bipolar disorder can increase your risk for other health and life issues, according to Mayo Clinic,

 such as:

Many people with bipolar disorder also have other mental health conditions, according to NIMH, such as:

The Takeaway

  • Bipolar disorder affects an estimated 2.8 percent of U.S. adults each year. It’s characterized by extreme shifts in a person’s mood that often present as periods of mania and/or depression.
  • There are four types of bipolar disorder, and each features mood-related episodes interspersed with typical mood functioning.
  • There is no single diagnostic test for bipolar disorder and also no cure for the condition. However, with consistent treatment under the care of a medical professional, people with bipolar disorder can often manage symptoms effectively.

FAQ

What are the different types of bipolar disorder?
There are four types: Bipolar 1 involves at least one manic episode. Bipolar 2 is characterized by at least one major depressive episode and one episode of hypomania. Cyclothymia is a milder form, and in a fourth “unspecified” type, a person may have abnormal mood elevations but doesn't fit the criteria for one of the other aforementioned types.
Symptoms of mania (bipolar 1) include extreme energy, distractibility, irritability, or recklessness. Depression in both bipolar 1 and 2 can include deep sadness, trouble concentrating, hopelessness, and thoughts of suicide.
Experts don't know exactly what causes bipolar disorder, but research suggests it’s connected to genetics and the structure and function of the brain. Environmental factors may also play a role.
Research suggests that bipolar disorder can have a hereditary component. It’s common for people who are diagnosed with bipolar disorder to have a family history of it. But having a family history of bipolar disorder doesn’t mean you are likely to personally develop it.
Manic depression was the original name for the disorder, but mental health professionals changed the name to bipolar disorder in the 1980s to better reflect its symptoms. Bipolar disorder is now the preferred term and is officially used in diagnosis.

Resources We Trust

EDITORIAL SOURCES
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Eric R. Williams

Eric R. Williams, MD

Medical Reviewer

Eric Williams is the associate dean of student affairs and career advising and associate professor of neuropsychiatry and behavioral science at the University of South Carolina Sch...

Brian P. Dunleavy

Author

Brian P. Dunleavy is a writer and editor with more than 25 years of experience covering issues related to health and medicine for both consumer and professional audiences. As a jou...