Bipolar Disorder

A Discussion of Signs, Symptoms, and Treatments

The Background

You just failed a big test and are pretty bummed about it. Or, you’re going through a bad breakup and feeling pretty down. We’ve all been there. In day-to-day life, everyone experiences ups and downs every now and then. Eventually, time passes on and our mood becomes better and we become “ourselves” again. Unlike the normal population, individuals living with bipolar disorder cycle through extreme mood swings that cause disruption to daily life.

Bipolar Disorder. Manic Depression. Bipolar Affective Disorder. All three terms are synonymous with each other and the name of a mental health disorder affecting approximately 3% of the American population. The classic symptoms of bipolar disorder are the periodic changes in mood, alternating between periods of elevated mood (mania or hypomania) and periods of depression. If you are living with bipolar disorder, you may feel energetic, abnormally happy, and make reckless decisions during manic states. During depressive states, you may feel the overwhelming urge to cry, experience feelings of hopelessness, and have a negative outlook on life. Hypomania is a less severe form of mania, where you generally feel  pretty good – with a better sense of well-being and productivity.

With bipolar disorder, you don’t just feel “down in the dumps;” your depressive state may lead to suicidal thoughts that change over to feelings of euphoria  and endless energy. These extreme mood swings can occur more frequently – such as every week – or show up more sporadically – maybe just twice a year. There is also no defined pattern to the mood swings. One does not always occur before the other – and the length of time you are in one state or the other varies as well. The good news is that there are a number of treatments that can keep your moods in check – allowing you to live a productive life.

Rates of bipolar disorder in men and women are about equal and the typical onset of symptoms occur around 25 years of age. There are many types of bipolar disorder; three of the most common include Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder. Bipolar I Disorder is characterized by the occurrence of at least one manic episode, preceded or followed by a hypomanic or major depressive episode. Manic episodes may be so severe they significantly disrupt your daily functioning or may trigger a break from reality (psychosis). If you are suffering from Bipolar I Disorder, you may require hospitalization. If you are living with Bipolar II Disorder, you experience at least one major depressive episode lasting two weeks or more and at least one hypomanic episode lasting at least four days. But, you will not have experienced a manic episode.  Cyclothymic disorder is characterized by at least two years of multiple occurrences of hypomania symptoms and depressive symptoms – these symptoms are less severe than hypomanic episodes and major depressive episodes. During this time, symptoms present themselves at least half of the time and are constant for at least two months.

Signs and Symptoms

Because there are many different stages of bipolar disorder, the signs and symptoms vary from person to person and from type to type. Presented below are the most common signs and symptoms of bipolar disorder, categorized by emotional state.

Manic Symptoms

According to the DSM-5, a manic episode is characterized by a distinct and abnormal state of elevated, expansive, or irritable mood occurring for at least one week. The manic episode is persistently driven by a goal-directed behavior or energy. A hypomanic episode is a distinct and abnormal state of elevated, expansive, or irritable mood that lasts for at least four consecutive days.

If you have been diagnosed as suffering from bipolar disorder, you may experience any of the signs and symptoms during a manic period:

  • long period of feeling “high” – an overly elated, happy, and outgoing mood
  • feeling extremely irritable
  • being easily distracted
  • having racing thoughts
  • talking very fast
  • jumping from one thought to another when talking
  • taking on a lot of new projects
  • restlessness
  • boundless energy
  • sleeping very little
  • not feeling tired
  • unrealistically believing you can do something
  • engaging in impulsive, pleasurable, and high-risk behaviors (e.g., poor financial investments, sexual indiscretions, shopping sprees)
  • inflated self-esteem
  • feelings of grandiosity
  • increased agitation
  • increased goal-directed activity
  • high sex drive
  • making grand and unattainable plans
  • detachment from reality – psychosis that may include delusions or hallucinations

Manic behaviors interfere with functioning at school or work, in social situations, and in relationships. These behaviors occur on their own – they do not occur due to alcohol or drug use, a medical illness, or a side effect of a medication.

Depressive Symptoms

The depressive side of bipolar disorder is characterized by a major depressive episode resulting in a depressed mood or loss of interest or pleasure in life. If you are living with bipolar disorder, during depressive states, you may experience some of the following signs and symptoms:

  • feeling sad, tearful, hopeless, or empty for the majority of the day on a daily basis
  • no pleasure or interest in day to day activities
  • weight fluctuations – including significant weight loss or weight gain
  • sleep disturbances – sleeping too much or other sleep problems, such as insomnia
  • restlessness or slowed behaviors
  • suicidal thoughts, planning, or attempts
  • feelings of guilt and worthlessness
  • inability to concentrate
  • indecisiveness
  • loss of energy
  • feelings of fatigue
  • psychosis – being detached from reality; delusions or hallucinations
  • loss of interest in activities you once enjoyed
  • anxiety
  • uncontrollable crying

Depressive behaviors can interfere with school or work, family or personal relationships, and social functioning. If you are suffering from bipolar disorder and undergoing a depressive episode, it is not the result of substance abuse, medications, an underlying medical condition, or stressful situation – such as grieving the loss of a loved one.

What is Causing It? How is it Diagnosed?

If you are suffering from bipolar depression, you may be wondering what it is that caused this condition. What are the risk factors? Like most mental illnesses, there is not one single cause that scientists can pinpoint to tell you why you are suffering from bipolar disorder. But, it appears genetics are likely to account for around 60-80% of the risk for developing bipolar disorder – indicating the key role heredity plays in this condition. Your risk of developing bipolar disorder is also increased significantly if you have a first-degree relative suffering from this mental state.

Environmental factors also have shown a connection to bipolar disorder – and they likely interact with genetic predispositions to catapult the onset of the disorder. What this means is that if you are living with bipolar disorder, it was probably a mixture of genes and a life event that triggered the disorder to present itself in your everyday life. You may have suffered from some type of traumatic event or abuse or a troubling and/or stressful interpersonal relationship of some type.

If you believe you are experiencing signs and symptoms of mania or depression, go see your doctor. Oftentimes, it is  your family or co-workers who are first to recognize signs and symptoms of bipolar disorder. If you are suffering from this condition, you may be reluctant to seek help at first – mostly because you are not able to notice how disruptive the disorder is on your life. And, you may enjoy feeling euphoric. However, it is important to treat this condition so you can manage your emotional states and live a productive, full life. Bipolar disorder will not go away on its own and you are likely to live with this condition for the rest of your life. However, with the right treatment plan, you can live a good life.

Your doctor or mental health provider will assess you physically to rule out any underlying medical conditions that may be causing your manic or depressive states. If no underlying medical conditions present themselves, you are likely to be referred to a mental health provider for further diagnosis.

Your mental health provider will  perform a series of psychological assessments to gather additional information about your condition. These assessments will aid your mental health provider in diagnosing the presence of this condition in your life and also determine which type of bipolar disorder you may be suffering from.

What are the Treatment Options?

Medications and psychotherapy are the most commonly prescribed treatment plans for people suffering from bipolar disorder. And the success rate of these treatment plans are great if followed correctly and consistently.

Lithium for Bipolar

If you are living with bipolar disorder, you have likely been prescribed a number of different medications. The most common medications used to treat this condition include mood stabilizers, antidepressants, and atypical antipsychotics. The most often first course of drug therapy is the prescription of mood stabilizers. Lithium is one of the most well-known and effective mood stabilizers for individuals affected with bipolar disorder. You may also be prescribed an anticonvulsant for use as a mood stabilizer. Atypical antipsychotics are often combined with antidepressants to treat bipolar disorder. Because the use of antidepressants can trigger hypomanic or manic states, you will likely take an antidepressant with a mood stabilizer to even out emotions.

Psychotherapy has also been an effective tool for people living with bipolar disorder. Cognitive behavioral therapy will help you learn how to change negative or harmful thoughts or behaviors. Family-focused therapies involve your family members and focus on teaching coping strategies, communication counseling, and problem-solving techniques. Psychoeducation has also been a powerful therapy tool to teach individuals living with bipolar disorder about their condition and how to treat it. This education allows you to notice trigger points and impending mood swings so you can seek treatment before a full-blown episode occurs. Interpersonal and social rhythm therapy (IPSRT) is used often in treating bipolar disorder as well – as this form of psychotherapy focuses on the stabilization of daily rhythms – sleep, wake, mealtimes – to introduce consistent routines to better manage moods.

In severe cases, you may need to be hospitalized for your own safety and well-being. This may result from severe states of mania or depression leading to psychosis, risky behaviors, or thoughts of suicide.

If you are living with bipolar depression, it is important to follow your treatment plan. Pay attention to warning signs or triggers – this can help you seek additional treatment, talk with your counselor or mental health provider, and prevent the onset of a full attack. Avoid drugs and alcohol, and take your medication as prescribed – even on days you feel fine. Following your treatment plan, educating yourself about your disorder, and engaging in prevention techniques will positively contribute to your overall well-being and life satisfaction.

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