Bipolar Disorder (Manic Depression)
Bipolar disorder is a mental condition that causes a person to fluctuate between mania and depression. It is characterized by unusual shifts in mood and energy levels.
Bipolar disorder is also sometimes called “manic-depressive illness.”
Symptoms of bipolar disorder can gravely diminish a person’s quality of life. These symptoms are different from the normal highs and lows that everyone experiences at times. Bipolar disorder can damage relationships, hinder performance at work or school, cause dangerous or risky behavior, and even lead to suicidal thinking.
But bipolar disorder can be treated and managed. People with this condition can lead full lives, usually with the aid of medication and ongoing therapy.
Bipolar I Disorder
The main symptom of bipolar I disorder is one or more manic episodes or mixed episodes that are not explained by another medical condition, and that are not the result of medications or other substances.
Bipolar II Disorder
The main symptom of bipolar II disorder is the occurrence of one or more major
depressive episodes accompanied by at least one hypomanic episode. Symptoms
cause significant distress or impairment in work, at school, or in other personal
Frequently, people with bipolar II disorder do not recall their manic episodes.
Cyclothymic disorder causes mood swings that are less severe than those of bipolar I or bipolar II. Symptoms include rapid changes in mood. It is more common in people who have their first episode at a younger age.
Bipolar Disorder Not Otherwise Specified
Someone may be diagnosed with this classification of bipolar disorder if he or she has too few symptoms or has symptoms that do not last long enough to meet the diagnostic criteria for other bipolar disorders.
Rapid-Cycling Bipolar Disorder
This is the diagnosis given when a person has had rapid changes in mood—with four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.
The exact cause of bipolar disorder is not known. But research has revealed some potential factors:
Bipolar disorder seems to run in some families, but having a relative with bipolar disorder does not mean that you will have the condition. Researchers have located some genes that are linked to bipolar disorder.
Brain imaging and other types of studies are helping uncover differences in the brains of people with bipolar disorder. The significance of these differences is still uncertain. But some notable discoveries have been made. For example, some people with bipolar disorder have blood-flow and structural differences in parts of the brain that regulate mood and impulse control.
Neurotransmitters are naturally occurring chemicals in the brain and nervous system. They facilitate the communication between cells. In examining people with bipolar disorder, researchers have found hindered production and function of neurotransmitters that play important roles in mood regulation.
- Children with a parent or sibling who have been diagnosed with bipolar disorder (compared with those with no family history of it) are four to six times more likely to develop the illness (NIMH).
- One study found that 20 percent of adolescents suffering from major depression developed bipolar disorder within five years of the onset of depression (NIMH).
- The World Health Organization lists bipolar disorder as the sixth leading cause of disability in the world.
- The median age of onset for bipolar disorder is 25 years, although the illness can appear as early as childhood or as late as 50 (NIMH).
- Almost half of all sufferers experienced onset before age 25 (Kessler, et al.).
- Individuals who are widowed, separated, or divorced have a greater likelihood of developing bipolar I disorder than people who are married or living with a partner (Kessler, et al.). (This may reflect the negative impact that early onset bipolar disorder can have upon the capacity to maintain intimate relationships.)
The symptoms of bipolar disorder depend on whether a person is in a manic phase or a depressed phase. These phases may last from days to months. In rare cases, manic and depressed symptoms occur at the same time or in fast succession. This is called a mixed episode.
A manic phase is marked by elevated mood and poor impulse control. A person in a manic episode might exhibit:
- increased energy
- unusual talkativeness
- racing thoughts
- little need for sleep
- inflated self-esteem
One of the most dangerous symptoms of mania is the practice of reckless behavior, including:
- unprotected sexual encounters
- binge drinking or drug use
- reckless spending
A depression episode is marked by debilitating feelings of sadness. A person in a depression episode might exhibit:
- uncontrollable crying
- feelings of worthlessness or hopelessness
- excessive guilt
- sleep disturbances (either oversleeping or inability to sleep)
- eating disturbances (either eating too much or too little)
- withdrawal from friends and family
In bipolar disorder, suicide is a significant risk, occurring in 10 to 15 percent of people (Center for Quality Assessment and Improvement in Mental Health). Suicidal thoughts and attempts are more likely to happen when the individual is in a depressed state. Other forms of self-harm, such as self-mutilation, are also common in people with bipolar disorder.
Seek emergency medical care if you or a loved one is experiencing suicidal thoughts.
To diagnose bipolar disorder, a mental health specialist will conduct an in-depth psychological evaluation and ask about thoughts, feelings, and mood changes. He or she may ask the patient to create a mood chart—a daily record of the person’s mood, sleep patterns, and other factors that can help with diagnosis. This will help the specialist determine whether the patient meets the criteria for a form of bipolar disorder.
A doctor may also conduct a physical examination to rule out any conditions that could be causing symptoms similar to those of bipolar disorder.
Bipolar disorder requires lifelong treatment, even when the affected person feels fine. A psychiatrist or other mental health professional skilled in treating bipolar disorder usually leads treatment.
A treatment plan may include a combination of medication, therapy, and other treatments that may be necessary, such as rehabilitation from substance abuse. Hospitalization may be necessary if a person is behaving dangerously, feeling suicidal, or becoming detached from reality.
Psychiatrists typically recommend medication as a first step, to balance moods and control symptoms as quickly as possible. Once symptoms are managed, maintenance treatment is needed to manage bipolar disorder in the long term. Maintenance treatment is very important. Without it, risk of relapse is higher, and there’s a greater chance that minor mood swings can turn into full-blown mania or depression.
Some people with bipolar disorder benefit greatly from psychiatric treatment at a hospital. In a hospital setting, a patient can get help stabilizing his or her mood in a safe environment. Other options to consider are partial hospitalization or day treatment programs, which provide support and or counseling until symptoms are under control.
A number of drugs are used to treat bipolar disorder, including mood stabilizers, antidepressants, and drugs that relieve anxiety. Depending on the type of bipolar disorder and the person’s individual symptoms, medical history, and overall health, he or she may be prescribed any one or a combination of these drugs. Some of the most commonly prescribed medications for bipolar disorder include:
- Antipsychotics, such as: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel)
Treatment plans for bipolar disorder will usually include one or more types of therapy:
- Psychotherapy is a vital part of bipolar disorder treatment, because it can give a patient the skills to identify and manage bipolar triggers, replace unhealthy behaviors with positive ones, manage problems in school or at work, and develop healthier relationships.
- Cognitive behavioral therapy (CBT) is a common form of individual therapy for bipolar disorder. In cognitive behavioral therapy, a therapist helps someone with bipolar disorder identify episode triggers and ways to manage them. CBT can also be helpful in identifying unhealthy beliefs and behaviors and replacing them with healthy ones. This type of therapy can also help people manage stress and cope with difficult situations.
- Psychoeducation can help a person and his or her loved ones understand bipolar disorder and recognize warning signs of mood swings.
- In family therapy, a psychologist or other type of therapist provides counseling to the bipolar disorder patient and his or her loved ones. It can help family members learn how to reduce stress, improve communication, resolve conflicts, and identify stressors that trigger bipolar symptoms.
- Group therapy provides a forum to communicate with and learn from others with bipolar disorder. A patient might be able to learn tips for managing stress, building better relationships, and coping better in school or at work.
- Interpersonal therapy helps a person identify and resolve problems in relationships.
- Social rhythm therapy helps a person identify and resolve problems with his or her daily routine.
During electroconvulsive therapy (ECT), mild and controlled electric currents are delivered to the brain while the patient is under general anesthesia. Researchers do not fully understand how ECT works. The electric currents that are delivered to the brain may cause changes in brain chemistry that stabilize mood.
ECT is often recommended for patients who have severe episodes of depression, who feel suicidal, or who have not seen improvements with other treatments. It is also an option for pregnant women who cannot take medications for their mania or depression symptoms. ECT should be performed only at centers with professionals skilled in its use.
Although there is no cure for bipolar disorder, ongoing treatment can manage the condition and prevent symptoms. But even with proper treatment, mood changes may occur, especially for someone who has a mental illness in addition to bipolar disorder. Treatment tends to be more effective when medical professionals supervise it.
Written by: the Healthline Editorial Team
Medically reviewed by George Krucik, MD, MBA