What Are Bipolar Disorders?
Bipolar disorders are brain disorders that cause changes in a person’s mood, energy and ability to function. Bipolar disorder is a category that includes three different conditions — bipolar I, bipolar II and cyclothymic disorder.
People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well. Bipolar disorders can be treated, and people with these illnesses can lead full and productive lives.
Bipolar I Disorder
Symptoms of Bipolar I Disorder
Bipolar I disorder can cause dramatic mood swings. During a manic episode, people with bipolar I disorder may feel high and on top of the world, or uncomfortably irritable and “revved up.“ During a depressive episode they may feel sad and hopeless. There are often periods of normal moods in between these episodes. Bipolar I disorder is diagnosed when a person has a manic episode.
A manic episode is a period of at least one week when a person is very high spirited or irritable in an extreme way most of the day for most days, has more energy than usual and experiences at least three of the following, showing a change in behavior:
- Exaggerated self-esteem or grandiosity
- Less need for sleep
- Talking more than usual, talking loudly and quickly
- Easily distracted
- Doing many activities at once, scheduling more events in a day than can be accomplished
- Increased risky behavior (e.g., reckless driving, spending sprees)
- Uncontrollable racing thoughts or quickly changing ideas or topics
The changes are significant and clear to friends and family. Symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities. Symptoms of a manic episode may require a person to get hospital care to stay safe. The average age for a first manic episode is 18, but it can start anytime from early childhood to later adulthood.
A hypomanic episode is similar to a manic episode (above) but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes and the person is still able to function.
Major Depressive Episode
A major depressive episode is a period of two weeks in which a person has at least five of the following (including one of the first two):
- Intense sadness or despair; feeling helpless, hopeless or worthless
- Loss of interest in activities once enjoyed
- Feeling worthless or guilty
- Sleep problems — sleeping too little or too much
- Feeling restless or agitated (e.g., pacing or hand-wringing), or slowed speech or movements
- Changes in appetite (increase or decrease)
- Loss of energy, fatigue
- Difficulty concentrating, remembering making decisions
- Frequent thoughts of death or suicide
Bipolar disorder can disrupt a person’s life and relationships with others, particularly with spouses and family members, and cause difficulty in working or going to school. People with bipolar I often have other mental disorders such as attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder or substance use disorder. The risk of suicide is significantly higher among people with bipolar disorder than among the general population.
Bipolar disorder can run in families. In fact, 80-90 percent of individuals with bipolar disorder have a relative with either depression or bipolar disorder. However, environmental factors can also contribute to bipolar disorder — extreme stress, sleep disruption and drugs and alcohol may trigger episodes in vulnerable patients.
Treatment and Management
Bipolar disorder is very treatable. Medication alone or a combination of talk therapy (psychotherapy) and medication are often used to manage the disorder over time. Each person is different and each treatment is individualized. Different people respond to treatment in different ways. People with bipolar disorder may need to try different medications and therapy before finding what works for them.
Medications known as “mood stabilizers” are the most commonly prescribed type of medication for bipolar disorder. Anticonvulsant medications are also sometimes used. In psychotherapy, the individual can work with a psychiatrist or other mental health professional to work out problems, better understand the illness and rebuild relationships. A psychiatrist is also able to prescribe medications as part of a treatment plan. Because bipolar disorder is a recurrent illness, meaning that it can come back, ongoing preventive treatment is recommended. In most cases, bipolar disorder is much better controlled if treatment is continuous.
In some cases, when medication and psychotherapy have not helped, a treatment known as electroconvulsive therapy (ECT) may be used. ECT uses a brief electrical current applied to the scalp while the patient is under anesthesia. The procedure takes about 10-15 minutes and patients typically receive ECT two to three times a week for a total of six to 12 treatments.
Since bipolar disorder can cause serious disruptions and create an intensely stressful family situation, family members may also benefit from professional resources, particularly mental health advocacy and support groups. From these sources, families can learn strategies to help them cope, to be an active part of the treatment and to gain support for themselves.
Bipolar II Disorder
Bipolar II disorder involves a person having at least one major depressive episode and at least one hypomanic episode (see above). People return to usual function between episodes. People with bipolar II often first seek treatment because of depressive symptoms, which can be severe.
People with bipolar II often have other co-occurring mental illnesses such as an anxiety disorder or substance use disorder.
Treatments for bipolar II are similar to those for bipolar I — medication and psychotherapy. Medications most commonly used are mood stabilizers and antidepressants, depending on the specific symptoms. If depression symptoms are severe and medication is not working, ECT (see above) may be used. Each person is different and each treatment is individualized.
Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly. People with cyclothymia experience emotional ups and downs, but with less severe symptoms than bipolar I or II.
Cyclothymic disorder symptoms include the following:
- For at least two years, many periods of hypomanic and depressive symptoms (see above), but the symptoms do not meet the criteria for hypomanic or depressive episode.
- During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.
Treatment for cyclothymic disorder can involve medication and talk therapy. For many people, talk therapy can help with the stresses of ongoing high and low moods. People with cyclothymia may start and stop treatment over time.
Physician Review By:
Ranna Parekh, M.D., M.P.H.