Bipolar disorder is a complex mental health disorder that involves dramatic shifts in mood and energy. During a high or manic episode, the person may feel full of energy and as if they they can do anything. But, severe depression may follow.
The person’s mood can range from feelings of elation and high energy to depression. There can also be disruption in sleep and thinking patterns and other behavioral symptoms.
The extremes of mood are known as manic episodes and depressive episodes.
Hypomania has symptoms of a manic episode that are less severe.
According to the National Alliance on Mental Illness (NAMI), people receive a diagnosis on average at the age of 25 years, but symptoms can appear during the teenage years, and less commonly, during childhood.
Bipolar disorder is a condition with mood swings that can range from euphoria to depression.
However, for a diagnosis of bipolar I disorder, a person only needs to have a manic episode.
In fact, a person with bipolar I disorder may never experience a major depressive disorder, despite the name bipolar.
Signs of mania
When someone has mania, they do not just feel very happy. They feel euphoric.
A person with mania may:
- have a lot of energy
- feel able to do and achieve anything
- have difficulty sleeping
- use rapid speech that jumps between topics and ideas
- feel agitated, jumpy, or “wired”
- engage in risky behaviors, such as reckless sex, spending a lot of money, dangerous driving, or unwise consumption of alcohol and other substances
- believe that they are more important than others or have important connections
- show anger or aggression if others challenge their views or behavior
Severe mania can involve psychosis, with hallucinations or delusions. Hallucinations can cause a person to see, hear, or feel things that are not there.
People may have delusions and distorted thinking that cause them to believe that certain things are true when they are not.
They may believe, for example, that they have important friends (such as the president of the United States) or that they descend from royalty.
A person in a manic state may not realize that their behavior is unusual, but others may notice a change in behavior. Some may see the person’s outlook as sociable and fun-loving, while others may find it unusual or bizarre.
The individual may not realize that they are acting inappropriately or be aware of the potential consequences of their behavior.
They may need help in getting help and staying safe.
Not everyone will have a severe manic episode. Less severe mania is known as hypomania. Symptoms are similar to those of mania, but the behaviors are less extreme, and people can often function well in their daily life.
If a person does not address the signs of hypomania, it can progress into a more severe form of the condition at a later time.
Signs of a depressive episode are the same as the symptoms of a major depressive episode.
They may include:
- feeling down or sad
- having very little energy
- having trouble sleeping or sleeping a lot more than usual
- thinking of death or suicide
- forgetting things
- feeling tired
- losing enjoyment in daily activities
- having a “flatness” of emotion that may show in the person’s facial expression
In severe cases, a person may experience psychosis or a catatonic depression, in which they are unable to move, talk, or take any action.
Although rare, bipolar disorder could occur in young children and teenagers.
Bipolar disorder is a lifelong condition. It can be present in young children, although it often does not emerge later, often in the late teens or early adulthood.
This may happen when a trigger causes clear signs of mania or depression, but often there is no clear trigger.
It can be hard to detect bipolar disorder in toddlers or young children, as children of this age often display uncontrolled behavior until they learn new ways of behaving. This has led to controversy over the diagnosis of bipolar disorder in young children.
Children with bipolar disorder may have severe temper tantrums that can last for hours, possibly with signs of aggression. These may not improve with age, as bipolar disorder makes it harder than others to learn alternative behaviors.
Parents may also notice periods of extreme happiness and silly moods in their child.
At this age, the signs of bipolar disorder may resemble those of another condition, such as attention deficit hyperactivity disorder (ADHD).
Teenagers may show some of the more common signs of bipolar disorder, especially an increase in risky behaviors, such as:
- reckless sexual activity, drug or alcohol use
- poor performance in school
- thinking more about death or suicide
It is important that any young person showing these symptoms sees a mental health professional.
Learn more here about how bipolar disorder can affect teens.
Doctors do not know exactly what causes bipolar disorder, but the following appear to play a role:
Genetic factors: A person with bipolar disorder may have a parent with the condition. However, having a parent or even a twin with bipolar disorder does not mean a person will have it.
Stress: Someone who has a genetic predisposition may experience their first episode of depression or mania during or after a time of severe stress, for example, the loss of a job or a loved one.
It is always a good idea to speak with a doctor when there is concern about severe mood swings that seem to come and go or make it difficult to work.
The best person to start with may be a primary care physician or family doctor. However, they will likely refer someone with these symptoms to a psychiatrist, or a specialist who cares for people with mental health disorders.
Someone who notices these symptoms in a friend or loved one can also speak with their doctor about their concerns. The doctor can help find local support groups or other mental health resources.
Risk-taking and thinking about suicide can pose real dangers for a person with bipolar disorder.
Whenever there is a possibility of harm or suicide, it is important to address the concern quickly and directly.
If there is an imminent risk, someone should contact the local police or suicide crisis hotline immediately.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Bipolar disorder has a number of comorbidities, or conditions that often occur alongside it.
Other mental health conditions that people might experience include:
- posttraumatic stress disorder (PTSD)
- misuse of alcohol and other substances
These can complicate the diagnosis.
It can take time to receive a correct diagnosis of bipolar disorder, as a doctor may identify one of these conditions, or a personality disorder, instead.
If the person experiences psychosis, this can sometimes lead to a misdiagnosis of schizophrenia, a mental health disorder marked by persistent hallucinations and delusions.
Treating these conditions may make it more difficult to diagnose or treat bipolar disorder. It can also take time to find a suitable medication and the correct dose for the individual.
However, once a person receives a correct diagnosis and appropriate treatment, medication can help to control the symptoms of bipolar disorder, and these related conditions usually improve as well.
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) describes
1. Bipolar I disorder
This involves periods of mania that last at least 7 days, or any duration if the person is hospitalized.
If a person experiences severe manic or depressive episodes, they may need emergency treatment in the hospital to prevent harm to themselves or to others, for example through reckless behavior.
2. Bipolar II disorder
A person with bipolar II disorder has episodes of depression and hypomania. Hypomania is less extreme than a full manic episode.
People with bipolar II disorder tend to not have full mania.
Learn more here about the differences between type I and II bipolar disorder.
3. Cyclothymic disorder
Someone with cyclothymic disorder will also have alternating periods of hypomania and depression lasting for at least 2 years.
The main difference between cyclothymic disorder and bipolar II is that the symptoms of a person with cyclothymia tend to be less severe and do not meet the criteria for hypomania and depression.
4. Other specified and unspecified bipolar disorders
A person may have bipolar disorder that does not fit within the above patterns. They may receive a diagnosis of either “other specified bipolar disorder” or “unspecified bipolar disorder,” depending on their symptoms.
In order to diagnose bipolar disorder, a healthcare provider should begin with a complete medical interview and a physical exam to rule out a physical cause for the person’s behaviors.
There is currently no blood test or imaging that can diagnose the condition, but a doctor may suggest tests to rule out other medical conditions that might have similar symptoms.
If no medical conditions or medicines are causing the symptoms, the healthcare provider will consider bipolar disorder. They may refer the person to a mental health specialist.
The best person to diagnose bipolar disorder is a psychiatrist or psychiatric nurse practitioner who specializes in the care of people with mental health disorders.
Prescribers usually treat bipolar disorder with a combination of medications and talk therapy, or psychotherapy.
Because bipolar disorder is a lifelong disease, treatment should also be lifelong.
Medications for treating bipolar disorder
- mood stabilizers, such as lithium and some antiseizure medicines
- antipsychotics, to help manage mania and psychotic symptoms
- antidepressants may be used in some cases, depending on the person’s symptoms and other considerations
It can take time to find a suitable medication and dose for the individual.
Some people discontinue their medication because it has adverse effects. If adverse effects occur, it is essential to speak to the prescriber, who may be able to change the dose or treatment. Discontinuation of medications for bipolar disorder can result in a return of symptoms.
Some people discontinue the medication because they miss the “highs” that bipolar disorder brings. They may feel they are no longer “themselves.” People with this condition may be highly creative during a manic or hypomanic phase, and they may miss this aspect of their personality.
People with bipolar disorder are
Some treatments for depression can trigger an initial manic phase in a person who has the condition. This first experience of mania may be the first sign that a person has bipolar disorder.
Counseling or cognitive behavioral therapy (CBT) can help a person with bipolar disorder, as it can make them more aware of the negative aspects of their behavior and of triggers that could sabotage their treatment, such as substance use.
Learning tips for getting enough sleep, dealing with stress, and establishing a steady work-life balance may all help to control mood changes.
If medication and talk therapy are not effective in managing the symptoms of bipolar disorder, a psychiatrist may consider electroconvulsive therapy (ECT).
In ECT, a doctor applies a controlled electric shock to certain areas of the brain in order to cause a seizure. Doctors do not know exactly how it works, but there is evidence that ECT can help to
A doctor will only recommend it if symptoms are severe, if medication and counseling do not work, or if the person is unable to take or tolerate medication.
Bipolar disorder is a lifelong disorder that can have a severe impact on the individual and their family and friends.
Getting help early and actively participating in treatment are the keys to successfully managing this condition.