Bipolar disorder

Bipolar disorder

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Types of bipolar disorder

There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is defined by the appearance of at least one manic episode. You may experience hypomanic episodes, which are less severe than manic episodes, or major depressive episodes before and after the manic episode. This type of bipolar disorder affects people of all sexes equally.

Bipolar II

People with bipolar II experience one major depressive episode that lasts at least 2 weeks. They also have at least 1 hypomanic episode that lasts about 4 days. According to a 2017 review, this type of bipolar disorder may be more common in women.

Cyclothymia

People with cyclothymia have episodes of hypomania and depression. These episodes involve symptoms that are shorter and less severe than the mania and depression caused by bipolar I or bipolar II disorder. Most people with this condition only experience no mood symptoms for 1 or 2 months at a time.

Your doctor can explain more about what kind of bipolar disorder you have when discussing your diagnosis.

Some people experience distinct mood symptoms that resemble but don’t quite align with these three types. If that’s the case for you, you might get a diagnosis of:

• other specified bipolar and related disorders
• unspecified bipolar and related disorders

Rapid cycling is not a type of bipolar disorder, but a term used to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues. 

Causes 

Scientists don’t yet know the exact cause of bipolar disorder. But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions — more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesn’t necessarily mean you’ll also develop it.

Other factors that scientists think contribute to the development of bipolar disorder include:

Changes in your brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition.

Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.

Symptoms

To receive a diagnosis of bipolar disorder, you must experience at least one period of mania or hypomania. These both involve feelings of excitement, impulsivity, and high energy, but hypomania is considered less severe than mania. Mania symptoms can affect your day-to-day life, leading to problems at work or home. Hypomania symptoms typically don’t. Some people with bipolar disorder also experience major depressive episodes, or “down” moods. These three main symptoms — mania, hypomania, and depression — are the main features of bipolar disorder. Different types of bipolar disorder involve different combinations of these symptoms.

Bipolar I symptoms

A diagnosis of bipolar I disorder requires:

• at least 1 episode of mania that lasts at least 1 week
• symptoms that affect daily function
• symptoms that don’t relate to another medical or mental health condition or substance use
• You could also experience symptoms of psychosis, or both mania and depression (known as mixed features). These symptoms can have more impact on your life. If you do have them, it’s worth reaching out for professional support as soon as possible (more on this later).
• While you don’t need to experience episodes of hypomania or depression to receive a bipolar I diagnosis, many people with bipolar I do report these symptoms.

Bipolar II symptoms

A diagnosis of bipolar II requires:

• at least 1 episode of hypomania that lasts 4 days or longer and involves 3 or more symptoms of hypomania
• hypomania-related changes in mood and usual function that others can notice, though these may not necessarily affect your daily life
• at least 1 episode of major depression that lasts 2 weeks or longer
• at least 1 episode of major depression, involving 5 or more key depression symptoms that have a significant impact on your day-to-day life
• symptoms that don’t relate to another medical or mental health condition or substance use
• Bipolar II can also involve symptoms of psychosis, but only during an episode of depression. You could also experience mixed mood episodes, which means you’ll have symptoms of depression and hypomania at the same time.
• With bipolar II, though, you won’t experience mania. If you have a manic episode, you’ll receive a diagnosis of bipolar I.

Cyclothymia symptoms

A diagnosis of cyclothymia requires:

• periods of hypomanic symptoms and periods of depression symptoms, off and on, over 2 years or longer (1 year for children and adolescents)
• symptoms that never meet full criteria for an episode of hypomania or depression
• symptoms that are present for at least half of the 2 years and never absent for longer than 2 months at a time
• symptoms that don’t relate to another medical or mental health condition or substance use
• symptoms that cause significant distress and affect daily life
• Fluctuating mood symptoms characterize cyclothymia. These symptoms may be less severe than those of bipolar I or II. Still, they tend to last longer, so you’ll generally have less time when you experience no symptoms.
• Hypomania may not have a big impact on your daily life. Depression, on the other hand, often leads to more serious distress and affects day-to-day function, even if your symptoms don’t qualify for a major depressive episode.

If you do ever experience enough symptoms to meet the criteria for a hypomanic or depressive episode, your diagnosis will likely change to another type of bipolar disorder or major depression, depending on your symptoms.

Diagnosis 

To diagnose bipolar disorder, your healthcare provider may use many tools, including:

• A physical exam.
• A thorough medical history, which will include asking about your symptoms, lifetime history, experiences and family history.
• Medical tests, such as blood tests, to rule out other conditions that could be causing your symptoms, such as hyperthyroidism.
• A mental health evaluation. Your healthcare provider may perform the evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist.
• To be diagnosed with bipolar disorder, you must have experienced at least one episode of mania or hypomania. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.
• To determine what type of bipolar disorder you may have, your mental health provider assesses the pattern of symptoms and how much they affect your life during the most severe episodes.
• People with bipolar disorder are more likely to also have the following mental health conditions:
• Anxiety.
• Attention-deficit /hyperactivity disorder (ADHD).
• Post-traumatic stress disorder (PTSD).
• Substance use disorders/dual diagnosis.

Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for health care providers to properly diagnose people with bipolar disorder.

People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD).

Because of this, it’s important to be honest and thorough when explaining all of your symptoms and experiences when talking with your health care provider. It can also be helpful to include a loved one who may be able to provide additional details about your mental health history in your discussions with your provider.