What is bipolar disorder?
Bipolar disorder, previously called manic depression, is a mental health condition. It causes you to have both periods of depression and periods of heightened mood.
The periods of depression can make you feel sad, hopeless, or numb, and they can stop you from taking pleasure in the activities you usually enjoy.
The periods of heightened mood can fill you with energy and make you feel euphoric, but they can also make you behave impulsively and with poor judgment. These periods of heightened mood are called hypomania, or mania if they’re severe and if you also experience psychosis – the latter is when you have problems understanding what’s real and what’s not.
These episodes of depression and hypomania/mania can occur rarely in some people, but in others, they can happen multiple times a year. They commonly last for one to two weeks but can last longer. Some people feel no symptoms between episodes, whilst others feel symptoms of mild depression or mild heightened mood.
Bipolar disorder isn’t as common as depression or anxiety, however, it’s not a rare mental disorder either. In the US, around 4.4% of adults experience bipolar disorder at some point in their lives. Additionally, 83% of cases of bipolar disorder in the US are considered serious.
What does bipolar mean?
Bipolar means two opposite extremes. The condition is called bipolar disorder because you feel two opposite extremes of mood – depression and hypomania/mania.
Bipolar disorder symptoms
People experience bipolar disorder differently and get different bipolar symptoms. The disorder commonly causes periods of depression, called depressive episodes, and periods of heightened mood called hypomania or mania. Symptoms and signs of bipolar disorder include:
Major depressive episode symptoms
The depressive episodes that happen with bipolar disorder are similar to the depressive episodes caused by major depressive disorder, usually just called depression.
With bipolar disorder, the depressive episodes typically last from one to two weeks but can last longer. They can significantly disrupt your life, make it difficult to meet your school or work responsibilities, and can strain your relationships. Bipolar depression symptoms usually involve:
- Feelings of sadness, emptiness, numbness, and hopelessness
- Feelings of inappropriate guilt and worthlessness
- A loss of interest or taking no pleasure in previously enjoyable activities
- Social isolation
- A decrease in appetite and weight loss, or an increase in appetite and weight gain
- Problems sleeping (insomnia) or excessive sleeping
- Fatigue and a loss of energy
- Problems concentrating and thinking clearly
- Thoughts of suicide and suicide attempts
Hypomania and mania episode symptoms
Episodes of hypomania, and more extreme mania, typically cause polar opposite symptoms to the periods of depression. They can be just as debilitating and just as harmful to your daily life, however. Bipolar mania symptoms typically include:
- Feeling of extreme happiness, euphoria, and high self-confidence
- High levels of energy, feeling jumpy and wired
- A decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Poor attention
- An increase in impulsiveness and poor decision making, that can lead to behaviors like shopping sprees, dangerous activities, drug use, risky sex including impromptu and unprotected sex
Episodes are categorized as manic rather than hypomanic when the symptoms are more severe and when they involve psychosis too, which is a difficulty distinguishing between what’s real and what isn’t. Bipolar mania symptoms include:
- Visual hallucinations
- Aural hallucinations, including hearing voices
- Delusional thoughts
What other features are associated with bipolar disorder?
You may experience other bipolar symptoms, including melancholy and anxious distress (anxiety coupled with tension and restlessness).
Your bipolar disorder symptoms may also cycle rapidly, where you alternate quickly between periods of depression and hypomania/mania. Some people also have mixed bipolar disorder where they feel symptoms of both depression and hypomania/mania at the same time.
Bipolar symptoms in men
Both men and women experience bipolar disorder, and they generally do so in similar ways, but there are some important differences. Men are more likely to:
- Be diagnosed earlier in life, in their teenage years, and even earlier
- Experience more severe episodes, especially the manic episodes
- Act out and be aggressive during manic episodes
- Abuse alcohol and other substances during episodes
- Commit suicide
Men are also less likely to seek medical help for their bipolar disorder.
Bipolar symptoms in women
Women with bipolar disorder are more likely than men to:
- Be diagnosed later in life, in their 20s and 30s
- Have milder episodes, particularly milder manic episodes
- Experience more depressive than manic episodes
- Have rapid cycling bipolar disorder where they have four or more depressive and manic episodes a year
- Have a higher lifetime risk of alcohol use disorder (unhealthy alcohol use that become severe over time)
- Experience other conditions alongside their bipolar disorder, like anxiety disorders, migraines, thyroid problems, and obesity
- Seek medical help for their bipolar disorder
Bipolar disorder in children
Can children be bipolar is a common question, and like adults, they can. Diagnosing bipolar disorder in children can be difficult, however.
Children with bipolar disorder experience periods of depression and hypomania/mania, like adults, but these may be harder to identify. Children are generally less able to express their feelings and emotions, meaning depressive and hypomania/mania periods may be mistaken for normal but excessive behavior, like boisterous happiness and excitement.
Bipolar symptoms in children may also be misdiagnosed as being caused by a different disorder, like attention deficit disorder (ADHD). Getting the right diagnosis is important, as it helps ensure your child gets the most effective treatment for their condition.
For bipolar disorder in children, look out for:
Symptoms of mania/hypomania in children
- Acting extremely happy and overly silly
- A short temper that leads quickly to angry outbursts
- Problems sleeping
- Trouble focusing and concentrating
- Talking quickly with rapid changes of topic
- Doing risky activities
Symptoms of depression in children
- Visible sadness that lasts over the course of days or weeks
- A loss of interest in activities they usually enjoy
- Low energy levels
- Problems sleeping or sleeping more than usual
- Eating too little or over-eating
- Frequently complaining about feeling unwell, such as having headaches or stomach aches
- Talking about death, self-harm, or suicide attempts
Bipolar disorder in teens
Bipolar in teens can also be difficult to diagnose. Periods of low and high mood are common during teenage years. Signs of bipolar disorder in teens can often be mistaken for normal teenage angst, ebullience, or mood swings.
However, if moods are more extreme, particularly if the moods occur within specific periods of time, it could be a sign of bipolar disorder. There’s no single, accepted teenage bipolar test, but getting a proper diagnosis and treatment can help your teen lead a healthier and happier life. Look out for:
Symptoms of mania/hypomania in teens
- Periods of extreme happiness
- Willful behavior and misbehaving
- Having a short temper
- Taking part in risky behavior
- Abusing alcohol
- Taking recreational drugs
- Periods of increased sexual activity
- Sleeping less, but not showing any signs of fatigue
- Problems staying focused
Symptoms of depression in teens
- Periods of visible sadness
- Social isolation
- Withdrawing from previously enjoyable hobbies and pastimes
- Problems with sleeping or sleeping excessively
- Not eating enough or eating excessively
- Talking about death, self-harm, or suicide attempts
Should you see a doctor?
If you have any reason to think that you have bipolar disorder or another mental health condition, you should see your doctor right away. Mental health isn’t self-indulgent, nor is it something you can push yourself through. See a doctor and get a diagnosis, so you can start getting the treatment you need to help you live your life more effectively with your condition.
When to get emergency help?
If you’re thinking about self-harm or suicide, you should get emergency help right away. Call 911 or your local emergency number immediately or call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
If you’re with someone who is in imminent danger of trying to commit suicide, has tried to commit suicide, or has self-harmed badly, you should get emergency help for them right away. Call 911 or your local emergency number immediately or drive them to the nearest emergency room if you’re able to.
Types of bipolar disorder
Three types of bipolar disorder are usually recognized by healthcare professionals:
Bipolar type 1
Bipolar disorder type 1 is defined as having at least one manic episode (extreme hypomania, often with psychosis) lasting at least 7 days. Usually, patients also have at least one depressive episode too, although depressive episodes aren’t necessary to be classified as bipolar 1. It’s thought that bipolar 1 affects men and women equally.
Bipolar type 2
Bipolar disorder type 2 is defined as having at least one depressive episode lasting at least two weeks, and usually one hypomanic episode that lasts at least four days. People with bipolar 2 typically cycle between depressive and hypomanic episodes but don’t have manic episodes. It’s thought that bipolar 2 is more common in women.
Cyclothymia is an unstable mood disorder. People with cyclothymia frequently experience short and mild periods of hypomania or depression, with brief periods of normal moods with no cyclothymia symptoms. The periods of normal mood usually last for only a few weeks to a couple of months.
Bipolar disorder causes
What causes bipolar disorder isn’t a question with a simple answer. Bipolar disorder is a complex condition without a clear, single cause. It’s thought that a combination of factors can cause someone to develop the condition. Bipolar causes include:
- Genetics: You’re nearly 10 times more likely to develop bipolar disorder if you have a close family member, like a parent or sibling, who also has it, showing the condition to be partly genetic. It’s likely that certain genes make you more likely to develop bipolar disorder, and the more of these genes you have, the greater your chances of having the condition.
- Life events: A range of events in your life and conditions around you can contribute to bipolar disorder. These can include traumatic and abusive experiences in childhood, high stress, and having post-traumatic stress disorder.
- Brain structure: In some cases, bipolar disorder can be caused by some types of brain damage. This damage could be caused by a head injury, a stroke, epilepsy, multiple sclerosis, or by an infection like HIV.
Is bipolar hereditary?
Bipolar disorder is partly hereditary.
The genes you inherit from your parents can make it more likely you’ll develop bipolar disorder. If a close relative has it, your chances of developing the condition are nearly ten times higher than someone without any family history.
But genes are only part of the story. They can make you more likely to develop bipolar disorder, but it’s not guaranteed. You may have a parent with the condition and not develop it, just as you may have no family history of bipolar disorder and develop it.
Risk factors for bipolar disorder
There are certain factors that can increase your chances of developing bipolar disorder. Some you can’t change, but some are under your control. People with bipolar rarely have all these risk factors, and some may have none. Risk factors may make bipolar disorder more likely, but they aren’t always involved. Bipolar disorder risk factors include:
- Having a first degree relative who has bipolar disorder, such as a parent or sibling
- Experiencing high levels of stress
- Physical illnesses
- Experiencing a traumatic event
- Abusing alcohol and/or drugs
Bipolar disorder diagnosis
Bipolar disorder can be a difficult condition to diagnose as symptoms can vary by person and it can often be mistaken for other conditions, including depression or attention hyperactivity disorder (ADHD). There’s no one bipolar disorder test. A bipolar diagnosis is usually made by a mental health professional using a range of approaches, including:
- A psychiatric evaluation: This can involve talking about emotions, thoughts, and moods in detail. You may be asked to complete a diagnostic questionnaire too where your symptoms are scored on a scale.
- Mood charting: As part of an on-going psychiatric evaluation, you may be asked to keep a log or diary of your moods, experiences, and behaviors to better understand your condition.
- A health assessment and lab tests: These may be used to see if you have any medical problems that may be causing your symptoms rather than bipolar disorder.
Bipolar disorder can be more challenging to diagnose amongst children and teenagers, as they may be less able to express their thoughts and feelings. Their symptoms are also more likely to be mistaken for extremes of normal behavior, or other conditions, like ADHD.
Generally, the same approach to diagnosis is used for children and teenagers as is used for adults, but a child psychiatrist with experience of bipolar disorder may be the most suitable professional to make a diagnosis.
Bipolar disorder treatment
A range of treatments are available for bipolar disorder. Through experimentation, you may find that some treatments are more effective for you. Your treatment plan should be decided upon and monitored by yourself and a mental health professional.
Your treatment options for bipolar disorder include:
Bipolar disorder medications
Bipolar medications can be effective treatments for many people with bipolar disorder and often form a foundation to a varied treatment plan. A range of medications are available for bipolar disorder. We’ve included a selection below as an example, but this isn’t an exhaustive list:
- Mood stabilizers: can reduce the severity of depressive, hypomanic, and manic episodes. Examples include:
- Antipsychotics: can be used if symptoms of hypomanic and manic episodes are more severe or if they’re resistant to other medications, like mood stabilizers. Antipsychotics are often used alongside mood stabilizers. Examples include:
- Antidepressants: can be used to treat depressive episodes and particularly for bipolar 2. They are often viewed as bipolar 2 medications. Examples include:
- Antidepressant-antipsychotic: a medication called Symbyax combines an antidepressant (fluoxetine) and an antipsychotic (olanzapine) to reduce symptoms of depressive, hypomanic, and manic episodes.
Choosing the right medication
Finding the medication (or combination of medications) that works best for you takes a trial and error approach.
Medications affect people differently. You may find some are more effective than others, while some may cause certain side effects. You may have to try a range of medications to find the ones that suit you best. This can take time, as it can take weeks to months for the effects of some medications to be understood.
Bipolar medication side effects
All medications can cause side effects, and this is true for bipolar medications. You may find that you don’t experience any side effects at all, or if you do, they’re mainly mild. However, more severe bipolar medication side effects can happen. Each medication has a detailed list of side effects in the leaflet that comes with it, but common side effects of bipolar medications include:
- Sexual problems (erectile dysfunction, loss of interest in sex, and problems achieving orgasm)
- Weight gain
Therapy for bipolar disorder
Therapy, sometimes psychotherapy, is an important part of bipolar treatment for most people. Bipolar therapy typically involves talking and exploring your emotions, thoughts, and experiences with a trained mental health professional. Psychotherapy for bipolar disorder can happen in one-on-one, group, or family settings.
There are different approaches to bipolar therapy, two of the most common are:
- Cognitive behavioral therapy for bipolar disorder (CBT): is a form of talk therapy that focuses on uncovering unhealthy behaviors and thought processes, particularly ones that can trigger mood changes. CBT aims to replace these thoughts and behaviors with positive, beneficial ones, and to give you ways to manage stress and other mood triggers.
- Interpersonal and social rhythm therapy (IPSRT): helps you tostabilize the daily rhythms of your life, like sleeping and waking, mealtimes, and exercise. The aim is to help you develop a consistent and effective daily routine that can help you best manage your moods.
Light therapy, also called chronotherapy or phototherapy, is a different approach to treating bipolar disorder that can be effective for some people. Rather than being an approach to talk therapy, light therapy for bipolar uses exposure to full spectrum lights to help manage a patient’s circadian rhythms. It’s most often used as a treatment for depressive episodes.
As with medications, you may have to experiment and try a range of therapeutic approaches to find the type of bipolar therapy that works best for you.
Natural remedies for bipolar
There isn’t a wealth of evidence to support the efficacy of natural remedies, also called alternative medicines, for bipolar disorder. However, some people do find them beneficial. Just make sure you talk to your doctor before taking any natural remedies in case they have known risks or could interact with your medications.
Natural treatments for bipolar disorder with some evidence of efficacy include:
- Fish oil: taken either as a supplement or by eating oily fish like tuna, salmon, and mackerel
- S-adenosylmethionine (SAMe): an amino acid supplement
- Choline: a water-soluble vitamin you can buy as a supplement
- Rhodiola rosea: a flowering plant extract that can be found in a range of supplements
- St. John’s wort: a plant extract that can be found in a wide range of supplements
Lifestyle changes to help bipolar disorder
In addition to medications, therapy, and any natural remedies you choose to take, you can make a range of lifestyle changes that can help you manage your bipolar disorder. You may like to try:
Creating a healthy daily routine: You can give your life structure and consistency and help to avoid slipping into negative behaviors by creating healthy routines. Try to wake, eat meals, get exercise, and take your medications at a set time each day. A good amount of sleep each night, regular exercise, and a well-rounded diet can help keep you healthy and may help with your condition too.
Keep a mood chart: You may be asked to do this as part of the diagnosis for your condition, but it can be a beneficial behavior to continue. Keeping a mood chart can help you stay on top of your moods and identify any patterns and triggers for your mood changes. A mood chart can become part of your healthy daily routine.
Stay on top of your medication: Make sure you take any medications exactly as directed by the doctor who prescribed them to you. Forming a daily routine can help ensure that you don’t forget to take your medication. Don’t change your medication or stop taking it without talking to your doctor first either. You should also talk to your doctor before you take any other medications or supplements, including dietary and herbal supplements, as they can interact with your medications.
Quit alcohol and recreational drugs: Alcohol and drug abuse can trigger mood changes and can make them worse. They can also encourage risk-taking and dangerous behavior when in a hypomanic/manic mood. Cutting out alcohol and any recreational drugs will likely benefit your condition.
Focus on healthy relationships: Try to surround yourself with positive people who understand your condition, who can offer support, and who don’t encourage negative behaviors or cause you stress. Try to limit time with friends and family members who aren’t a positive influence on your life.
Use the support available to you: You don’t have to manage your condition without help from others. See your doctor regularly, spend time with positive friends and family, and get extra support if you need it (see Where to get support below).
Treatment in children and teenagers
Bipolar disorder in children and teenagers is usually treated in the same way as in adults, with a mix of medication, therapy, and lifestyle changes, but with a few notable differences:
- Medication: The effectiveness and safety of most bipolar medications are less established amongst children and teenagers than adults, as most clinical trials are performed on adults. Medications may need to be used slowly in low doses to make sure they’re safe and effective.
- Therapy: Therapy may need to be conducted by a mental health professional who specializes in bipolar disorder in children and teens, as the condition can present differently. Younger people may also have different requirements and respond better to certain approaches.
- Support at school: some schools may offer support from trained teachers and school counselors. They can provide valuable help at a convenient location for your child or teenager at times when you may not be able to.
Living with bipolar disorder
The vast majority of people who have bipolar disorder have it for life. At times symptoms are better, at times they’re worse, and some people have long periods without any symptoms. However your condition progresses, you’ll need to learn to live with bipolar disorder rather than expecting to cure it.
This doesn’t mean that you can’t lead a productive and happy life with the condition. But to do this, you must understand bipolar disorder and identify how it affects you, including what triggers your mood episodes. You’ll have to stay on top of your condition, you’ll need to take your medications as directed, and take your therapy seriously. Finding the right treatments for you can take time and experimentation, but they’re well worth the effort.
You’ll also need to make use of the different forms of support available to you, like your doctor, therapists, school counselors and trained teachers, as well as other support sources.
Living with bipolar disorder can be challenging, but if you persevere and dedicate time and energy to it, you can find ways to successfully manage your condition and limit the impact it has on your life.
Bipolar disorder and relationships
Bipolar disorder can put a strain on relationships with friends, family, romantic partners, and even work colleagues. But the best policy here is openness and honesty.
Your first reaction may be to try and hide your condition, but if you want the people in your life to understand what you’re going through and why you may behave in certain ways, you need to talk to them. You should consider explaining what bipolar disorder is and what to expect from you during your mood episodes. You should also explain your treatment and how that person can help and act around you.
Conversations about bipolar disorder may be difficult, but they can help others understand you and make living with your condition less challenging for both of you.
Where to get support?
You don’t have to manage your bipolar disorder on your own. In addition to support from your doctor, mental health professionals, and any friends and family, you can get further support from a range of sources, including other people who have the condition.
If you would like additional support you can try the Depression and Bipolar Support Alliance (DBSA). The DBSA is a US organization dedicated to helping people with mood disorders like depression and bipolar disorder. They offer support groups, provide audio and video casts, and have mental healthcare facilities across America.
If you want to talk urgently, and if you’re having suicidal thoughts, you can speak to someone directly at the National Suicide Prevention Lifeline at 800-273-8255.