Bipolar disorder, once known as manic depression, features extreme mood swings that include both emotional highs and lows.
It is a long-term condition that can disrupt a person's ability to function in the workplace and in daily life.
Bipolar is also a spectrum disorder, meaning that it includes a group of linked conditions or types that have similar appearances but slight differences between them.
What is the bipolar spectrum?
There is a range of a types of bipolar disorder. Symptoms differ between them.
Bipolar disorder is a spectrum disorder. This means it involves cycling moods or mood swings that vary in degree. However, there is a wide range of other symptoms, and these can vary between individuals.
Diagnosis of the condition often refers to where an individual falls on the bipolar spectrum.
The bipolar spectrum runs from bipolar I at one end to cyclothymia and not otherwise specified (NOS) at the other.
Doctors diagnose bipolar disorder according to new edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
Diagnosis is based on the specific type of disorder.
- Bipolar I disorder: A person will have had at least one manic episode. This episode generally lasts at least 1 week, or less is the person is hospitalized, and is generally preceded or followed major depressive episodes. People with this type of bipolar typically experience severe manic episodes that can cause significant impairment in their life. Some people may need to be hospitalized due to psychosis - a serious condition where the individual loses all sense of reality.
- Bipolar II disorder: A person will experience at least one major depressive episode that lasts at least 2 weeks, and at least one hypomanic episode that lasts at least 4 days. Hypomania is where the highs are not as high as those experienced during mania. People with bipolar II disorder will never experience a manic episode.
- Cyclothymic disorder: Adults who are diagnosed with this condition have experienced 2 years of numerous periods of hypomania symptoms and periods of depressive symptoms. Children or teenagers will have experienced these symptoms for 1 year. During this period, symptoms are present at least half of the time, and they never go away for more than 2 months.
- NOS is used to describe bipolar disorders that do not fall exactly within the spectrum.
Causes of bipolar disorder
The exact cause of bipolar disorder remains unknown, but several factors may be involved.
- Biological differences, as physical changes may occur in the brain
- Imbalance in naturally occurring neurotransmitters in the brain
- Inherited traits are likely, since a person with bipolar disorder often has a relative with the condition, such as sibling or a parent
Sometimes, the condition is difficult to identify because there are different types of bipolar disorder. There are also other mood disorders with similar symptoms, which can cause confusion when making a diagnosis.
The symptoms of bipolar disorder can vary between individuals.
Each of these types of bipolar disorder can cause significant problems in an individual's daily life.
As specified by the DSM-5, the criteria for the diagnosis of manic and hypomanic episodes are as follows:
- A manic episode is a period of constant, elevated, irritable mood that lasts for at least 1 week. Persistently increased goal-directed activity or energy is also present.
- A hypomanic episode is a period of constant irritable mood that lasts for at least 4 consecutive days.
A manic period may involve:
- Heightened mood, exaggerated optimism, and self-confidence
- Excessive irritability or aggressive behavior
- Decreased need for sleep
- Racing speech or thoughts
- Impulsiveness or poor judgment
- Reckless behavior
- In severe cases, delusions and hallucinations
A period of depression may feature:
- Prolonged sadness or unexpected, unexplained crying spells
- Significant changes in appetite and sleep patterns
- Irritability, anger, worry, agitation, anxiety
- Loss of energy
- Feelings of guilt or worthlessness
- Inability to concentrate
- Unexplained aches and pains
- Recurring thoughts of death or suicide
Diagnosing bipolar disorder is further complicated because a number of conditions have similar symptoms.
Several other disorders share symptoms with bipolar, which can make diagnosis difficult for clinicians.
- Thyroid conditions
- Substance abuse
- Attention deficient hyperactivity disorder (ADHD)
- Borderline personality disorder (BPD)
- Post-traumatic stress disorder (PTSD)
These disorders, and especially personality disorders, can complicate a diagnosis.
The antidepressants that are often used to treat obsessive-compulsive disorders, as well as the stimulants used to treat ADHD, can make the symptoms of bipolar disorder worse. They can trigger a manic episode.
Diagnosis of bipolar disorder includes a physical examination, an interview, and possibly lab tests.
Mood charting with mood questionnaires is commonly used to help identify moods, sleep patterns, and other changes.
Blood tests can rule out other conditions, such as hyperthyroidism, but these tests cannot identify bipolar disorder.
The DSM-5 criteria are used to identify the presence of bipolar disorder.
Some people may not display all of the symptoms, but they must have at least one episode of mania or hypomania, which lasts for a specific period of time.
Bipolar disorder is a serious and complicated condition. Treatment needs to be handled by a trained psychiatrist.
Bipolar disorder can be treated in several ways.
- Medications such as mood stabilizers, antipsychotic medications, and antidepressants
- Psychotherapy such as cognitive behavioral therapy (CBT) or family therapy
- Electroconvulsive therapy (ECT), in which electric currents are passed through the brain
- Self-management strategies and education
Not every person will respond in the same way to medications, and some medications produce side effects. This is why it is important to be under the care of a doctor for treatment.
Cognitive behavioral therapy may be of benefit to some people with bipolar disorder.
People with bipolar can join support groups to talk to other people with the condition. Taking up hobbies and learning ways to relax and manage stress can also help.
According to the Depression and Bipolar Support Alliance, bipolar disorder affects 5.7 million American adults, or about 2.6 percent of the United States adult population every year.
The median age of onset is 25 years, but symptoms can emerge early in childhood or as late as the 40s or 50s.
If a person has at least one parent with bipolar disorder, they are between 15-30 percent more likely to develop the condition.
It is also believed that 1 in 3 children and adolescents diagnosed with depression in the U.S. may be experiencing the early onset of bipolar disorder.
With so many variations on the bipolar spectrum, it is important to pay attention to mood changes.
Bipolar disorder is often confused for depression, but it is a more complex condition.
Left untreated, it can increase the risk of suicide or suicide attempts, relationship problems, legal problems, loneliness, and an overall inability to function and lead a normal life.
Bipolar disorder is a life-long disorder, but with proper treatment and a focus on staying healthy, it can be manageable.