Everything you need to know about symptoms, treatments, risk factors, and relapses so that living with bipolar depression is a little more manageable.
Whether you’ve just been diagnosed with bipolar depression, suspect you may have it, or someone in your family has it, you may be wondering what the next steps are and what this label really means. We’ve talked to the experts, read the research, and listened to people who have bipolar describe what it’s really like. Here, we’re going to share with you everything we’ve learned along the way including an as-told-to story from a couple facing the challenges of bipolar disorder and how they deal, a report on new treatments, and a piece describing what the symptoms feel like dispelling the common misconceptions.
Let’s start with what it means to have a bipolar disorder diagnosis. Bipolar disorder is a condition that essentially hijacks your moods. (We’ll get more into how in a sec.) Just under 3 percent of the U.S. population has bipolar, though many of those people (up to 40 percent) were first diagnosed with depression. That’s because people who have bipolar disorder experience a lot of the same symptoms as those who are depressed. The difference is, when you have bipolar, you’ll also have episodes of mania (sometimes called hypomania, if it’s less extreme). Because the manic episodes are the key distinguishing factor from regular depression, up until recently, bipolar disorder was referred to as manic depression.
Types Of Bipolar
Not all bipolar is the same. There are three types:
Bipolar I: Periods of severe mood episodes from mania to depression, which may require hospitalization.
Bipolar II: Periods of less severe mood episodes from a milder form of mood elevation, involving episodes of hypomania that alternate with periods of depression.
Cyclothymic disorder: Moods cycle between brief periods of hypomanic symptoms and brief periods of depressive symptoms. Neither are as extreme or long-lasting as with Bipolar I or Bipolar II.
Symptoms of Bipolar
Bipolar is almost like two diseases in one. To be diagnosed you need to have both manic symptoms and depressive ones. But, even still, the depressive symptoms are far more frequent than the manic ones. For those who have bipolar I, the depressive symptoms outpace the manic ones 3:1. And, for bipolar II, there are even more depressive episodes—it’s 40:1. This explains why so many people with bipolar are misdiagnosed with depression at first.
Depressive symptoms related to bipolar are may include:
Loss of interest
Significant weight loss
Inability to concentrate
Manic symptoms related to bipolar may include:
Abnormally talkative, sometimes jumping from topic to topic
Feeling like you don’t need as much sleep
Poor decision-making and risk-taking
Being easily distracted
Irritable or impatient
Overly self-confident, feeling grandiose
Why Bipolar Is Tricky To Diagnose
Bipolar disorder may go unrecognized for up to a decade. Misdiagnosing it as depression is part of the reason. But the fact that there isn’t a single, definitive test that says, “yep, you have bipolar” also contributes to it slipping through the cracks. Doctors have to rely on how their patients describe the way they’re feeling. (Or how their loved ones describe it.)
This isn’t to say it’s arbitrary. There is a screening called the Mood Disorders Questionnaire (MDQ), which was developed to assesses lifetime history of mania and hypomania. It’s a simple checklist of 13 symptoms and a couple of questions about timing and severity.
Like with other disorders, psychiatrists and researchers are starting to recognize that bipolar can be thought of as a spectrum, not just a series of symptoms where you either check the box or you don’t. Different people can experience bipolar in very different ways, whether that means the ratio of depressive cycles to manic ones, having mixed episodes (where you feel both euphoric and down), or the ways the symptoms manifest. For some people, pressured speech may be the giveaway of a manic phase, for another it may be risky behavior.
Suicide Risk And Bipolar
One of the biggest concerns with bipolar is suicide. The numbers are pretty astounding: Someone with bipolar has a 30 percent chance of attempting suicide over the course of their lives. There’s been some debate over if the risk is higher for bipolar I, but most of the research shows it’s about the same for both bipolar I and bipolar II. One aspect of bipolar that does seem to increase suicide risk is having “mixed-features specifier,” where you feel the highs and lows at the same time.
If you have bipolar or someone you love has bipolar, get help if you notice the following:
Feeling more depressed than usual
Lack of interest in activities once enjoyed
Shame or humiliation
Talking about suicide or saying their lives have no purpose
Feeling like a burden or stuck
Isolating from others
Giving away possessions or writing a will
For a full list of signs and how to help, click here.
Bipolar Differences in Men and Women
For the most part, men and women have the same symptoms, and one gender isn’t more likely to have bipolar. Still, there are some distinct differences. One example is women with bipolar are three times more likely to get migraines than men. They’re also more likely to have depressive episodes and have more rapid cycling. Click here to read more about the gender differences.
Risk Factors for Bipolar
Genetics are a big factor. Having a sibling or parent with the disorder ups your chances, but it’s not the only indicator. Traumatic events and drug or alcohol use may also contribute. Some new research shows that people with bipolar may have slightly different brain structures (see below). There’s also a connection between pregnancy and bipolar. It seems that pregnancy and the act of giving birth can trigger postpartum bipolar disorder in some women. And, between 50 percent and 70 percent of women with bipolar disorder will experience a recurrence after a new baby, according to findings in the American Journal of Psychiatry.
Bipolar is a chronic mental illness but it doesn’t have to dominate your life. Medication can level out your moods. And, since everyone responds differently to medications it can be a bit of trial and error before you find the right one. Generally, there are three types of medication:
Anti-psychotics These are usually prescribed right away because they work immediately, but they’re not necessarily going to be the long-term treatment plan.
Mood stabilizers This category includes medicine like lithium, which has the strongest evidence of long-term benefits.
Anti-depressants These are somewhat controversial for two reasons: they focus just on the depressive episodes and some research has found they’re no more effective than a placebo.
Non-prescription therapy is also really important, including family therapy. It helps everyone understand what’s happening and why. There are also lifestyle changes that make a big impact:
Getting regular sleep. Not getting enough sleep can set off a manic episode, but any kind of disrupted sleep routines should be a flashing warning light that you might be about to go into either a depressive or manic episode.
Eating well. There is a lot of research on how food can affect your mood.
Managing stress. Stress can be a trigger, so it’s helpful to have tools like meditating or practicing yoga.
Sticking to a routine: Taking your meds on a regular schedule, going to therapy, and trying to keep your days as predictable as possible will help keep your mood in check.
In addition, there are some newer complementary therapies being researched that are showing major promise, some could even help patients decrease their medication doses. Click here to read about them.
Part of the frustration for people with bipolar is the relapse rate. You can be doing everything right, taking your medication, going to therapy, exercising, and still the conservative estimates that you’ll have a relapse are 73 percent within five years. To decrease your odds, take your medicine, avoid triggers, chart your moods (try apps like Daylio or Mod Tracker), and do something as soon as you notice a major mood shift. It’s much easier to get back on course if you get help early.
People With Bipolar May Also Have
If you have bipolar, you’re also more likely to abuse drugs and alcohol. This could be the result of self-medicating or the effect of big risk-taking during the euphoric phase. There are a cluster of other psychiatric illnesses that often go along with bipolar: 21 percent of people with bipolar also have panic disorder and 21 percent also have obsessive-compulsive disorder.
Your Brain on Bipolar
Intuitively it seems like there has to be something different about the bipolar brain. And, it turns out, there is. Magnetic resonance imaging has shown what scientists call a reduction of critical thickness in the ventrolateral prefrontal cortex. This is the area of the brain that assesses risk and could explain why people with bipolar don’t process dangerous situations the same way. The left side of the amygdala (see that little yellow dot, below), is kind of like the command central of emotion regulation, and it’s less active in someone with bipolar. A third distinction between normal and bipolar brains came from a study out of Canada. The research team found that in people with bipolar disorder, certain parts of the hippocampus are smaller than they are in both people with major depressive disorder and in people without mood disorders. And, they didn’t stop there, they found that the reductions in size were most severe among patients with bipolar I disorder.