Bipolar, formerly known as manic depression, is characterized by mood dysregulation resulting in one or more episodes of abnormally increased energy level, mood, and cognition, that alternate with one or more depressive episodes. Bipolar has been subdivided into three main types: bipolar I, bipolar II, and cyclothymia.
Bipolar affects approximately 2.6% of the adult population in the United States. Although bipolar symptoms can emerge at any time, the typical age of onset is between 18 and 25. Bipolar affects men and women equally. There are some factors that increase the risk of bipolar including:
- Genetic factors: A family history of bipolar is one of the strongest risk factors. Most available research states that bipolar is not caused by a single gene, but rather multiple genes that act in combination with environmental factors.
- Environmental factors: Bipolar is more common in high-income countries. Additionally, stress can trigger a bipolar episode.
Clinically, elevated moods are defined as mania, and in milder cases, hypomania. People experiencing manic or hypomanic episodes also commonly experience depressive episodes, or mixed episodes, where aspects of both mania and depression occur at the same time. Episodes may be separated by periods of “normal” mood but, in some individuals, mania and depression may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as hallucinations and delusions and may require hospitalization to prevent harm to oneself or others.
The manic phase may last one week or more and is characterized by increased energy and an elevated or irritable mood that is present for most of the day. Diagnosis requires the presence of three or more of these symptoms:
- Inflated ego and/or self-esteem (false beliefs in special abilities, delusions of grandeur)
- Increase in goal-directed activity
- Racing thoughts/flight of ideas
- Decreased need for sleep
- Pressured, rapid speech
- Reckless behavior(s) such as sexual promiscuity and excessive spending
- Increased distractibility
Symptoms of hypomanic episodes are similar, but tend to be shorter in duration, lasting four days or more. Psychotic symptoms are not present during hypomanic episodes, and the symptoms are not so severe as to require hospitalization. Hypomanic symptoms are common among all the bipolar diagnoses, but manic episodes are symptomatic solely of bipolar I.
The depressive phase of bipolar includes at least five symptoms of major depression that last for at least two weeks, including:
• Depressed/sad mood that is present for most of the day
• Diminished interest or pleasure in activities
• Changes in weight and/or appetite
• Changes in sleep (insomnia or hypersomnia)
• Fatigue/loss of energy
• Psychomotor agitation (restlessness or other increased motion) or depression (slowing down of movement)
• Difficulty remembering, making decisions, and/or concentrating
• Feelings of worthlessness or guilt
• Recurrent thoughts of death/suicidal thoughts
Unlike previous editions, the fifth edition of the Diagnostic and Statistical Manual (DSM) presents bipolar and related conditions in a separate chapter from the one addressing depression, helping to distinguish the depressive symptoms of bipolar from major depression.
The three primary bipolar diagnoses are bipolar I, bipolar II, and cyclothymia. Bipolar II was once regarded as a milder condition than bipolar I, but it is now recognized as an entirely separate diagnosis, one in which an unstable mood markedly impairs a person's ability to function at school or at work, and longer depressive episodes are common. Cyclothymia may be indicated when a person experiences symptoms of hypomania and depression over a two-year period that do not meet the criteria for a hypomanic or major depressive episode.
The DSM also identifies several related conditions within the chapter on bipolar, including substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder.
While bipolar cannot be cured, it can be managed effectively. Psychotherapy can help people with bipolar by teaching them how to recognize triggers so they can understand or possibly avoid them, decrease negatively expressed emotions, and practice healthy coping skills. Finding a therapist or counselor with whom you can establish a healthy therapeutic relationship may help develop some of the following skills for managing bipolar:
- Sleep hygiene
- Mood journaling
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- Building positive, supportive relationships
- Managing stress effectively
- Relaxation techniques
- Developing a healthy daily routine
- Creating an emergency plan to deal with relapse
Some types of psychotherapy such as family-focused and cognitive behavioral therapies are effective in preventing relapses. Although the research clearly demonstrates that bipolar often has an organic ideology, psychotherapy has been proven to be an effective treatment.
Medication is commonly used in the treatment of bipolar. Some regularly prescribed medications include:
- Mood stabilizers: These medications stabilize a person’s mood in order to avoid the highs and lows typically associated with bipolar. Lithium is one example of a mood stabilizer. Lithium has potentially serious side effects, though; people taking this medication are encouraged to have their blood monitored regularly.
- Anticonvulsants: These medications are typically used to treat seizures, but have been found to be effective in mood stabilization as well. Potential side effects of these medications include risk of suicidal thoughts and behaviors. People taking these medications should be closely monitored for new or worsening signs of depression.
- Atypical antipsychotics: These medications are often used in the treatment of schizophrenia, but have also been found to be effective for treating bipolar (especially manic symptoms). Examples include Zyprexa (olanzapine), Abilify (aripiprazole), Seroquel (quetiapine), and Risperdal (risperidone).
- Antidepressants: Antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) can be used to treat depressive symptoms of bipolar. However, use of these medications can cause a manic or hypomanic episode. For that reason, these medications are typically used in combination with a mood stabilizer.
Medical treatment of bipolar also includes hospitalization in some cases. Hospitalization for the purpose of stabilization is typically brief. Hospitalization may be necessary if the following symptoms are present:
- Thoughts of hurting self or others
- Insomnia that persists for several days
- Inability to care for oneself
One common misconception about bipolar is that it involves wild mood swings. Often, manic periods can be subtle, especially in bipolar II. Additionally, most people with bipolar experience significantly more depression than mania. Another myth about bipolar is that it is caused by a chemical imbalance in the brain. While there is an organic component to it, bipolar is typically influenced by a variety of factors including environment and experience. Finally, it is a myth that people with bipolar cannot lead a normal life. Bipolar can be effectively managed with treatment, and many people with bipolar experience long periods of remission.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5 (5th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
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- Bipolar disorder among adults. (n.d.). National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-adults.shtml
- McManamy, J. (n.d.). True or false? The top 10 myths about bipolar disorder. National Alliance on Mental Illness. Retrieved from http://www2.nami.org/Content/ContentGroups/Home4/Home_Page_Spotlights/Spotlight_1/True_or_False_The_Top_10_Myths_About_Bipolar_Disorder.htm
- Smith, M., Segal, J., & Segal, R. (2015). Bipolar support and self-help. HelpGuide.org. Retrieved from http://www.helpguide.org/articles/bipolar-disorder/bipolar-support-and-self-help.htm
- Understanding hospitalization for mental health. (n.d.). Depression and Bipolar Support Alliance. Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=urgent_help_for_patients