Watch & Learn: Bipolar Disorder
"An estimated 2.8% of U.S. adults over 18 had bipolar disorder in the past year. Bipolar disorder among adults was equally distributed between males (2.9%) and females (2.8%). An estimated 4.4% of U.S. adults experience bipolar disorder at some point during their lives." -- National Institute of Mental Health (NIMH)
Bipolar disorder is a serious chronic or episodic mental disorder. It can cause unusual, often extreme, fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder is sometimes is called manic-depressive disorder or manic depression, which are older terms for the disorder.
Everyone has ups and downs, but bipolar disorder is has a range of mood changes that include extreme high or extreme lows. During manic episodes, someone might feel extremely happy, irritable, or “up,” and become very active, feel invincable, and super talkative. On the other hand, depressive episodes may make them feel sad, indifferent, or hopeless, in combination with a very low activity level. Some people have hypomanic episodes, which are like manic episodes, but less severe and troublesome.
Most of the time, bipolar disorder develops or starts in late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come and go, bipolar disorder usually requires lifetime treatment and is not curable, but is manageable. Bipolar disorder can be an important factor in suicide, job loss, and family discord, but proper treatment can lead to good outcomes.
Risk Factors
The exact cause of bipolar disorder is unknown. However, research suggests that there is no single cause. Instead, a combination of factors may contribute to bipolar disorder.
Genes
Bipolar disorder often runs in families, and research suggests that this is mostly explained by heredity—people with certain genes are more likely to develop bipolar disorder than others. Many genes are involved, and no one gene can cause the disorder. But genes are not the only factor.
Some studies of identical twins have found that even when one twin develops bipolar disorder, the other twin may not. Although people with a parent or sibling with bipolar disorder are more likely to develop the disorder themselves, most people with a family history of bipolar disorder will not develop the illness.
Brain Structure and Function
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
Bipolar Diagnosis
To diagnose bipolar disorder, a doctor or other health care provider may:
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Complete a full physical exam.
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Order medical testing to rule out other illnesses.
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Refer the person for an evaluation by a psychiatrist.
A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. Some people have bipolar disorder for years before it is diagnosed. This may be because:
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Bipolar disorder has symptoms in common with several other mental health disorders. A doctor may think the person has a different disorder, such as schizophrenia or (unipolar) depression.
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Family and friends may notice the symptoms, but not realize that the symptoms are part of a more significant problem.
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People with bipolar disorder often have other health conditions, which can make it hard for doctors to diagnose bipolar disorder.
Treatment
Treatment helps many people, even those with the most severe forms of bipolar disorder. Doctors treat bipolar disorder with medications, psychotherapy, or a combination of treatments.
Medications
Certain medications can help control the symptoms of bipolar disorder. Some people may need to try several different medications and work with their doctor before finding the ones that work best. The most common types of medications that doctors prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium can help prevent mood episodes or reduce their severity when they occur. Lithium also decreases the risk for suicide. Additional medications that target sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan.
Talk with your doctor or a pharmacist to understand the risks and benefits of each medication. Report any concerns about side effects to your doctor right away. Avoid stopping medication without talking to your doctor first.
Psychotherapy
Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can offer support, education, skills, and strategies to people with bipolar disorder and their families. Psychotherapy often is used in combination with medications; some types of psychotherapy (e.g., interpersonal, social rhythm therapy) can be an effective treatment for bipolar disorder when used with medications.
Other Treatments
Some people may find other treatments helpful in managing their bipolar symptoms, including:
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Electroconvulsive therapy is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. This type of therapy is usually considered only if a patient’s illness has not improved after other treatments (such as medication or psychotherapy) are tried, or in cases where rapid response is needed, as in the case of suicide risk and catatonia (a state of unresponsiveness), for example.
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Regular vigorous exercise, such as jogging, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. Check with your doctor before you start a new exercise regimen.
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Keeping a life chart, which records daily mood symptoms, treatments, sleep patterns, and life events, can help people and their doctors track and treat bipolar disorder.
Not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder. Talk to your doctor before taking any supplement. Certain medications and supplements taken together can cause serious side effects or life-threatening drug reactions. Visit the National Center for Complementary and Integrative Health for more information.
Bipolar Disorder
Suicide
Types of Bipolar Disorder
There are three basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior or increased activity levels (manic episodes) to very sad, “down,” hopeless, or low activity-level periods (depressive episodes). People with bipolar disorder also may have a normal (euthymic) mood alternating with depression. Four or more episodes of mania or depression in a year are termed “rapid cycling.”
Bipolar I Disorder
Bipolar I Disorder is defined by manic episodes that last at least seven days (most of the day, nearly every day) or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features (having depression and manic symptoms at the same time) are also possible.
Bipolar II Disorder
Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
Cyclothymic Disorder
Cyclothymic Disorder (also called cyclothymia) is defined by persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults and for one year in children and teenagers.
Other Types of Bipolar Disorder
Other Specified and Unspecified Bipolar and Related Disorders is a category that refers to bipolar disorder symptoms that do not match any of the recognized categories.
Potential Co-Occuring Conditions
Many people with bipolar disorder also may have other mental health disorders or conditions such as:
Psychosis
Sometimes people who have severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:
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Someone having psychotic symptoms during a manic episode may falsely believe that he or she is famous, has a lot of money, or has special powers.
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Someone having psychotic symptoms during a depressive episode may believe he or she is financially ruined and penniless or has committed a crime.
Anxiety Disorders & Attention Deficit Hyperactivity Disorder (ADHD)
Anxiety disorders and ADHD often are diagnosed in people with bipolar disorder.
Misuse of Drugs or Alcohol
People with bipolar disorder are more prone to misusing drugs or alcohol.
Eating Disorders
People with bipolar disorder occasionally may have an eating disorder, such as binge eating or bulimia.
Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. For example, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosed with schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moods and other symptoms of bipolar disorder. Street drugs sometimes can mimic, provoke, or worsen mood symptoms.
Looking at symptoms over the course of the illness (longitudinal follow-up) and the person’s family history can play a key role in determining whether the person has bipolar disorder with psychosis or schizophrenia.
Want to learn more?
Here are some downloadable articles and fact sheets from the National Institute of Mental Health (NIMH) you might like:
Bipolar Disorder
This brochure describes the signs and symptoms, risk factors, and treatment options for bipolar disorder (also known as manic-depressive illness), a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. [En español]
Bipolar Disorder in Children and Teens
This brochure provides information about bipolar disorder in children and teens including its causes, signs and symptoms, diagnosis, treatment options, and how to help and support a child or teen who has bipolar disorder. [En español.]
Bipolar Disorder in Teens and Young Adults: Know the Signs
This infographic presents common signs and symptoms of bipolar disorder in teens and young adults. [En español]