Bipolar Disorder

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What is bipolar disorder?

Bipolar disorder (formerly known as manic depression or manic-depressive illness) 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, a condition that 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, which can include 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 quick shifting from symptoms of mania to symptoms of depression called rapid cycling.

There is no specific cure for bipolar disorder, but the condition can be treated and managed effectively. 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 is delirious, delusional, or are having or expressing feelings of wanting to hurt or kill oneself or another person.

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.

A specific diagnosis of bipolar disorder (bipolar I, bipolar II, or cyclothymic disorder) is determined by the type and severity of symptoms a person experiences.

Manic Episode Symptoms

A manic episode must last at least one week to be considered part of a bipolar disorder diagnosis. Symptoms must be severe enough to interfere with normal function, including work, home life, and social activity, and must mark a clear change from the person’s typical behavior.

Symptoms of the mania phase of bipolar disorder include:

  • A high level of energy

  • Decreased need for sleep

  • Distractibility

  • Euphoria or severe irritability or anger

  • Exaggerated sense of well-being

  • Excitability

  • Extreme alertness

  • Extremely elevated mood

  • Extremely high levels of self-esteem and ambition

  • Impulsivity and erratic behavior

  • Increased activity, such as multitasking on many projects at once

  • Insomnia

  • Psychosis, including hallucinations or delusions

  • Racing thoughts

  • Rapid talking

  • Risk-taking, such as excessive sexual behaviors, gambling, and alcohol and drug use

Hypomanic Episode Symptoms

In a hypomanic episode, symptoms of mania are less severe and do not interfere with day-to-day functioning. In fact, hypomanic episodes may be mistaken for enjoyable periods of energy and productivity, causing a delay in a bipolar disorder diagnosis until a person experiences a more severe manic or depressive episode.

Major Depressive Episode Symptoms

Periods of mania alternate with episodes of depression. For a diagnosis of bipolar disorder, symptoms of a major depressive episode must last at least two weeks and include five or more of these symptoms (at least one of which is intense sadness or loss of interest in previously enjoyed activities):

  • Anger or irritability

  • Difficulties with memory or in making decisions

  • Fatigue

  • Increased or decreased appetite

  • 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

  • Thoughts of self-harm, including suicide. If you or someone you know is experiencing suicidal thoughts, contact your doctor or call the National Suicide Prevention Lifeline at 1-800-273-8255.

  • 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 know has any of these symptoms.

What are the different types of bipolar disorder?

Doctors classify bipolar disorder into three primary types, based on the types of symptoms and episodes a person experiences:

  • Bipolar I disorder, in which a person experiences at least one manic episode, a period of extreme energy or irritability that lasts at least one week. Most people diagnosed with bipolar I disorder experience periods of neutral mood, and others can also have depressive or hypomanic episodes.

  • Bipolar II disorder, in which a person experiences at least one major depressive episode and one hypomanic episode. People with bipolar II disorder often have additional mental conditions, such as anxiety or substance abuse, which can intensify the symptoms of depressive or hypomanic episodes.

  • Cyclothymic disorder, a milder form of bipolar disorder in which a person experiences frequent emotional swings and changes in mood, but none that are severe enough to be diagnosed as bipolar I or bipolar II disorder. People are diagnosed with cyclothymic disorder if they experience several of these periods for at least half of a two-year period, and have not gone more than two months at a time without symptoms.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known, but there may be a genetic link to the disorder. Experts say 80 to 90% of 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 and 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

Tips for preventing and managing bipolar 1 manic episodes

Because the cause of bipolar disorder is not known, it is not possible to prevent the onset of the condition or lower your risk of developing it. However, for people who have been diagnosed with bipolar I disorder, there are steps you can take to help prevent and manage manic episodes.

Preventive care for manic episodes includes:

  • Taking your medication as prescribed by your doctor

  • Learning your triggers for a manic episode (such as caffeine, stress, drinking, or drug use) and working to avoid them

  • Keeping a daily journal of your mood

  • Maintaining a consistent routine each day, to help stabilize your mood

  • Getting enough sleep

  • Eating a healthy, nutritious diet

  • Exercising regularly

It is also a good idea to work with your friends and family to build an action plan so they know how best to support you if a manic episode does occur.

What are the diet and nutrition tips for bipolar disorder?

While no specific foods can prevent or treat bipolar disorder, maintaining a healthy diet is beneficial for everyone, including people with mood disorders. Proper nutrition helps improve sleep, increase energy, and lower stress levels. These factors all contribute to a more stable mood, which—along with your doctor’s prescribed treatment plan—reduces your risk of manic or depressive episodes.

Healthy eating habits for people with bipolar disorder include:

  • Avoiding alcohol

  • Drinking plenty of water 

  • Eating fresh fruit, vegetables, whole grains, and healthy proteins (such as poultry, soy, and fatty fish)

  • Eating three meals a day, on a consistent schedule, to keep blood sugar levels steady

  • Getting recommended amounts of vitamins and minerals, including B vitamins, folic acid, vitamin C, and zinc

  • Keeping a food journal to track how certain foods affect mood

  • Limiting caffeine, chocolate and sugar, all of which can contribute to mood changes

Because mood disorders can often occur with other mental and behavioral conditions, people with bipolar disorder may also develop eating disorders. If you have altered your eating habits (such as through severe restrictions or practices like binging and purging) or if you experience or notice dramatic changes in weight, talk to your doctor. Eating disorders require their own diagnosis, and effective treatments are available.

What are some conditions related to bipolar disorder?

People with mood disorders can have additional mental health conditions, such as anxiety, depression, or substance use disorder. In the case of substance abuse, the direct relationship to bipolar disorder is unclear, but experts agree each condition exacerbates the other.

In any person, drug and alcohol use can cause temporary symptoms that mimic those of a mood disorder. For example, someone who has taken a stimulant may exhibit the energy and euphoria of a manic episode, while someone on a depressant (such as alcohol) might experience the symptoms of someone in a depressive episode.

Mood swings are a symptom of several other conditions, and do not always indicate bipolar disorder. Other chemical imbalances in the brain, autoimmune conditions, bacterial or viral infections, and hormone disorders (such as hypo- or hyperthyroidism) can all cause changes in mood. Certain prescription medications may have side effects that include or result in mood disruptions.

Several other mental and behavioral conditions can also cause mood changes, including borderline personality disorder, intermittent explosive disorder, premenstrual dysphoric disorder, and postpartum depression. Mood swings can also be the result of conditions, such as brain tumors, dementia (including Alzheimer’s disease), head injury, menopause, pregnancy, puberty, and sleep disorders.

How do doctors diagnose bipolar disorder?

Because the primary symptoms of bipolar disorder are related to changes in mood, your primary care doctor may first rule out other possible causes for your mood swings. While imaging tests or brain scans cannot diagnose bipolar disorder, they may identify underlying conditions, such as a brain tumor or stroke, that can produce drastic disruptions in mood.

To further evaluate your mood changes, your doctor or licensed healthcare practitioner will ask you several questions related to your mood swings including:

  • When did you first notice your mood swings?

  • What moods do you experience when you have mood swings?

  • How long do your mood changes last?

  • Does anything make them better or worse?

  • Do you have any other symptoms?

  • Do you have any other psychiatric or medical problems?

  • What medications are you taking?

  • Do you drink any alcohol?

  • Are you using any illicit drugs?

If your primary care doctor rules out other medical conditions, you will likely see a psychiatrist or other mental health professional. This specialist will further evaluate your symptoms to confirm a diagnosis of bipolar disorder. From there, your doctor will use the guidelines established in the most recent Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, to determine which type of bipolar disorder you have and begin planning treatment.

How is bipolar disorder treated?

The overall treatment goal for people living with bipolar disorder is to minimize mood swings and other symptoms in order to live functional and productive lives. 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 (for example, cognitive behavioral 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.

How does bipolar disorder affect quality of life?

Even with effective treatment, bipolar disorder is a challenging diagnosis that alters your day-to-day life. Lifestyle changes, such as healthy eating, exercise, quality sleep, and a consistent routine help people with bipolar manage their symptoms, but they also require focus and discipline to maintain.

Taking medication as prescribed is also an essential component of a bipolar disorder treatment plan, which may result in side effects that become difficult to manage. If that is the case, talk to your doctor about alternative treatment options for bipolar disorder. Never stop medication on your own.

People who are undergoing treatment for mania may be apprehensive when they feel happy or their mood is positive, concerned it may be an early warning of a manic episode. For some, this causes anxiety about whether someone with bipolar disorder can be “truly happy.” However, experts note that mania is also accompanied by rapid thinking, impulsive behavior, and extreme irritability. Typical feelings of happiness without these additional symptoms do not necessarily signal an oncoming period of mania.

Because bipolar disorder is often misunderstood, other people may feel discomfort or uncertainty when around someone living with the condition. This can place an added burden on the person who has bipolar disorder, during a time when they need the support of friends and family more than ever. It is important to communicate with those close to you so they can understand what bipolar disorder is, what helps you manage symptoms, and the best ways for them to help.

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 of serious complications of bipolar disorder by following the treatment plan you and your healthcare professional design specifically for you.

Complications of bipolar disorder include:

  • Decreased ability to function effectively in work, school or daily life
  • Delirium (mental confusion)
  • Disability
  • Paranoia
  • Poor quality of life
  • Sleep disturbances
  • Social isolation
  • Suicidal thoughts or actions
  • Self-harm
  • Violent behavior

If you or someone you know is experiencing suicidal thoughts, contact your doctor or call the National Suicide Prevention Lifeline at 1-800-273-8255.

Does bipolar disorder shorten life expectancy?

Unfortunately, research shows that bipolar disorder can shorten a person’s life expectancy significantly—by 10 to 25 years—compared to people without the condition. This shortened life expectancy is the result of several factors:

  • Co-existing conditions: Research shows that people with bipolar disorder have higher rates of chronic conditions, such as diabetes and heart disease, are more likely to be obese, and have higher risks of stroke and cancer.

  • Less access to quality healthcare: People with bipolar disorder may have difficulty holding a job, which in turn may result in lack of insurance coverage.

  • Medication side effects: The drugs that are necessary to manage bipolar disorder symptoms can increase a person’s risk of diabetes, heart disease, kidney problems, obesity, and thyroid disorders—all of which can shorten life expectancy. However, for people with bipolar disorder, the potentially life-saving benefits of these medications often outweigh the risks.

  • Reckless behavior: Someone experiencing a manic episode may engage in risky and impulsive behavior, such drinking heavily, using drugs, or driving recklessly, which can lead to serious injury or fatal accidents.

  • Suicide: People living with bipolar disorder are 10 times more likely to die by suicide than those without the condition. If you or someone you know is experiencing suicidal thoughts, contact your doctor or call the National Suicide Prevention Lifeline at 1-800-273-8255.

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2021 May 4
    THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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