Bipolar Disorder

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Introduction

What is bipolar disorder?

Bipolar disorder is a serious mental health condition that is characterized by cycling mood changes from intense mania or euphoria to episodes of depression. Bipolar disorder is classified as a mood disorder, which seriously affects a person’s mood and interferes with a person’s ability to function effectively in everyday life. Bipolar disorder occurs in equal numbers in both sexes.

During the periods of intense mania, the person has a very high level of energy, alertness and excitability with an extremely elevated mood. These periods of mania alternate with episodes of depression that includes a low energy level and overwhelming, persistent feelings of sadness and despair.

Some people with bipolar disorder may experience a combination of symptoms of mania and depression called a mixed state. In some cases, there can be a rapid shifting from symptoms of mania to symptoms of depression called rapid cycling.

There is no specific cure for bipolar disorder, but the good news is that bipolar disorder is treatable. Treatment of bipolar disorder varies depending on the severity of the condition, and your medical history, age, and general health. Treatment generally includes a combination of medications and psychotherapy.

Complications of bipolar disorder can be serious, even life threatening, and include delirium, paranoia, suicidal thoughts and, in extreme cases, suicide attempts. Seek immediate medical care (call 911) if you, or someone you are with or know, are delirious, delusional, or are having or expressing feelings of wanting to hurt or kill oneself or another person.

Symptoms

What are the symptoms of bipolar disorder?

The severity and types of symptoms of bipolar disorder vary from person to person but generally affect mood, energy and functioning. Bipolar disorder is characterized by periods of intense mania or euphoria that alternate with episodes of depression. Symptoms of bipolar disorder can seriously interfere with a person’s ability to function normally in relationships and activities of everyday life, such as work, school, social activities, and self-care.

Symptoms of the mania phase of bipolar disorder include:

  • A high level of energy
  • Exaggerated sense of well-being
  • Excitability
  • Extreme alertness
  • Extremely elevated mood
  • Extremely high levels of self-esteem and ambition
  • Impulsivity and erratic behavior
  • Insomnia
  • Racing thoughts
  • Rapid talking
  • Risk taking, such as excessive sexual behaviors, gambling, and alcohol and drug use

Periods of mania alternate with episodes of depression. Symptoms of the depression phase of bipolar disorder include:

  • Anger or irritability

  • Difficulties with memory or in making decisions

  • Fatigue

  • Loss of interest in enjoyable activities

  • Persistent sadness and/or despair

  • Physical symptoms, such as headaches and body aches

  • Sleep abnormalities, such as insomnia or a desire to sleep all the time

  • Strong feeling of guilt, helplessness, hopelessness and/or worthlessness

  • Trouble focusing and concentrating

Some people with bipolar disorder may experience what is called a mixed state, which is a combination of symptoms of mania and depression that occur at the same time. In addition, some people with bipolar disorder can experience a rapid shifting from symptoms of mania to symptoms of depression called rapid cycling.

Symptoms that might indicate a serious or life-threatening condition

In some cases, bipolar disorder can lead to serious or life-threatening complications, such as delirium, self-harm, and suicide attempts. Symptoms of bipolar disorder that should be immediately evaluated in an emergency setting include:

  • Delirium, confusion or disorientation

  • Delusions or hallucinations

  • Having or expressing suicidal thoughts or a desire to hurt oneself or others

  • Irrational behavior

  • Suicidal actions or extremely dangerous behaviors, such as playing choking games or Russian roulette, or overdosing on drugs

  • Violent or threatening behavior

Seek immediate medical care (call 911) or if you or someone you are with or someone you know has any of these symptoms.

Causes

What causes bipolar disorder?

The exact cause of bipolar disorder is not known, but there may a genetic link to the disorder. Most people with bipolar disorder have a close relative with bipolar disorder or with depression. Bipolar disorder is also sometimes associated with an imbalance of chemicals in the brain or hormonal deficiencies.

In some cases, symptoms similar to those of bipolar disorder can be set off by certain conditions, such as sleep deprivation, thyroid disease, and the use of certain drugs, such as antidepressants, methamphetamines and steroids. In these cases, a person is not diagnosed with bipolar disorder unless symptoms do not go away with treatment of the underlying cause.

What are the risk factors for bipolar disorder?

Certain factors are thought to increase your chances of having bipolar disorder or are associated with symptoms of bipolar disorder. Not all people who are at risk will develop bipolar disorder. Risk factors include:

  • Certain structural brain abnormalities

  • Family history of bipolar disorder or depression

Treatments

How is bipolar disorder treated?

The overall treatment goal for people living with bipolar disorder is to minimize mood swings and other symptoms so that they can live functional and productive lives. Other psychiatric conditions are common among people with bipolar disorder, especially anxiety, substance abuse, eating disorders, and personality disorders. There is no cure for bipolar disorder, and treatment generally needs to be lifelong to most effectively control symptoms. The most effective treatment plans employ a multifaceted approach:

  • Psychotherapy (talk therapy) is a type of therapy in which a psychotherapist builds a relationship with a client, establishes trust, and helps a client to better cope with bipolar disorder through a variety of forms of psychotherapy, such as family therapy and behavior therapy. These techniques can help people to recognize and work through the issues associated with bipolar disorder. 

  • Medications may be prescribed to stabilize extremes of mood that occur with bipolar disorder. Medications may include mood stabilizers, such as lithium, antipsychotics and perhaps antidepressants.

  • Ongoing outpatient psychiatric and medical care is important to help monitor the effectiveness of treatment and to assess for side effects and safe levels of medications.

  • Inpatient care may be necessary in some cases in which symptoms become so serious that a person is unable to safely care for basic needs and/or has becomes suicidal or a danger to himself, herself or others. In some cases, a person may need to be legally hospitalized against his or her will. 

What are the possible complications of bipolar disorder?

Complications of bipolar disorder can be serious and even become life threatening in some cases. You can minimize the risk for serious complications of bipolar disorder by following the treatment plan you and your health care professional design specifically for you.

Complications of bipolar disorder include:

  • Decreased ability to function effectively in work, school or daily life
  • Disability
  • Paranoia
  • Poor quality of life
  • Sleep disturbances
  • Social isolation
  • Suicidal thoughts or actions
  • Self-harm
  • Violent behavior
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 15
  1. Bipolar Disorder in Adults. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml#pub6
  2. Bipolar Disorder. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
  3. Bipolar disorder. FamilyDoctor.org.  http://familydoctor.org/familydoctor/en/diseases-conditions/bipolar-disorder.html
  4. Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord 2010; 126:1.
  5. Sala R, Goldstein BI, Morcillo C, et al. Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population. J Psychiatr Res 2012; 46:865.
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