A person with bipolar disorder will experience changes in mood, energy, and activity levels that can make day-to-day living difficult.
Bipolar disorder can cause severe disruption to a person’s life, but the impact varies between individuals. With appropriate treatment and support, many people with this condition live a full and productive life.
According to the National Alliance on Mental Illness (NAMI), bipolar disorder affects over 10 million people in the United States or around 2.8% of the population.
On average, a person will receive a diagnosis around the age of 25 years, but symptoms can appear during the teenage years or later in life. It affects males and females equally.
The National Institute of Mental Health describe the main symptoms of bipolar disorder as alternating episodes of high and low mood. Changes in energy levels, sleep patterns, ability to focus, and other features can dramatically impact a person’s behavior, work, relationships, and other aspects of life.
Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.
Between episodes, the person’s mood may be stable for months or years, especially if they are following a treatment plan.
Treatment enables many people with bipolar disorder to work, study, and live a full and productive life. However, when treatment helps a person feel better, they may stop taking their medication. Then, the symptoms can return.
Some aspects of bipolar disorder can make a person feel good. During an elevated mood, they may find they are more sociable, talkative, and creative.
However, an elevated mood is unlikely to persist. Even if it does, it may be hard to sustain attention or follow through with plans. This can make it difficult to follow a project through to the end.
According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession.
In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year.
Mania or hypomania
Hypomania and mania are elevated moods. Mania is more intense than hypomania.
Symptoms can include:
- impaired judgment
- feeing wired
- sleeping little but not feeling tired
- a sense of distraction or boredom
- missing work or school
- underperforming at work or school
- feeling able to do anything
- being sociable and forthcoming, sometimes aggressively so
- engaging in risky behavior
- increased libido
- feeling exhilarated or euphoric
- having high levels of self-confidence, self-esteem, and self-importance
- talking a lot and rapidly
- jumping from one topic to another in conversation
- having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
- denying or not realizing that anything is wrong
Some people with bipolar disorder may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities.
For more on the differences between mania and hypomania, click here.
During an episode of bipolar depression, a person may experience:
- a feeling of gloom, despair, and hopelessness
- extreme sadness
- insomnia and sleeping problems
- anxiety about minor issues
- pain or physical problems that do not respond to treatment
- a sense of guilt, which may be misplaced
- eating more or eating less
- weight loss or weight gain
- extreme tiredness, fatigue, and listlessness
- an inability to enjoy activities or interests that usually give pleasure
- difficulty focusing and remembering
- sensitivity to noises, smells, and other things that others may not notice
- an inability to face going to work or school, possibly leading to underperformance
In severe cases, the individual may think about ending their life, and they may act on those thoughts.
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 National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
If a “high” or “low” episode is very intense, the person may experience psychosis. They may have trouble differentiating between fantasy and reality.
According to the International Bipolar Foundation, psychosis symptoms during a high include hallucinations, which involve hearing or seeing things that are not there and delusions, which are false but strongly felt beliefs. A person who experiences delusions may believe they are famous, have high-ranking social connections, or have special powers.
During a depressive or “low” episode, they may believe they have committed a crime or are ruined and penniless.
It is possible to manage all these symptoms with appropriate treatment.
A person may receive a diagnosis of one of three broad types of bipolar disorder. According to NAMI, symptoms occur on a spectrum, and the distinction between the types is not always clear-cut.
Bipolar I disorder
For a diagnosis of bipolar I disorder:
- The individual must have experienced at least one manic episode.
- The person may have had a previous major depressive episode.
- The doctor must rule out other disorders, such as schizophrenia and delusional disorder.
Bipolar II disorder
Bipolar II disorder involves periods of hypomania, but depression is often the dominant state.
For a diagnosis of bipolar II disorder, a person must have had:
- one or more episodes of depression
- at least one hypomanic episode
- no other diagnosis to explain the mood shifts
A person with hypomania may feel good and function well, but their mood will not be stable, and there is a risk that depression will follow.
People sometimes think of bipolar II disorder as a milder version. For many, however, it is simply different. As NAMI indicate, people with bipolar II disorder may experience more frequent episodes of depression than people with bipolar I disorder.
The National Health Service (NHS) in the United Kingdom note that cyclothymia has similar features to bipolar disorder, but the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classifies it separately. It involves hypomania and depression, but the changes are less intense.
Nevertheless, cyclothymia can impact a person’s daily life, and a doctor can provide treatment.
A medical professional will diagnose bipolar disorder using criteria set out in the DSM-5.
The National Institue of Mental Health (NIMH) explain that in order to receive a diagnosis of bipolar I disorder, a person must have had symptoms for at least 7 days, or less if symptoms were severe enough to need hospitalization. They may also have had a depressive episode lasting at least 2 weeks.
To receive a diagnosis of bipolar II, a person will have experienced at least one cycle of hypomania and depression.
A doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests, to help rule out other causes.
It can be challenging for a doctor to diagnose bipolar disorder, as people are more likely to seek help with a low mood than a high mood. As a result, it can be hard for them to distinguish it from depression.
If the person has psychosis, a doctor may misdiagnose their condition as schizophrenia.
Other complications that may occur with bipolar disorder are:
- use of drugs or alcohol to cope with symptoms
- post-traumatic stress disorder (PTSD)
- anxiety disorder
- attention-deficit hyperactivity disorder (ADHD)
NIMH urge healthcare providers to look for signs of mania in the person’s history, to prevent misdiagnosis. Some antidepressants can trigger mania in susceptible people.
A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enjoy long periods of stability, but they will always live with the condition.
Treatment aims to stabilize the person’s mood and reduce the severity of symptoms. The goal is to help the person function effectively in daily life.
Treatment involves a combination of therapies, including:
- physical intervention
- lifestyle remedies
It can take time to get a correct diagnosis and find a suitable treatment, as individuals react differently, and symptoms vary widely.
Drug treatments can help stabilize mood and manage symptoms. A doctor will often prescribe a combination of:
- mood stabilizers, such as lithium
- second-generation antipsychotics (SGAs)
- anticonvulsants, to relieve mania
- medication to help with sleep or anxiety
The doctor may need to adjust the medication over time. Some drugs have side effects, and they can affect individuals differently. If an individual has concerns about their drug treatment, they should talk to their doctor.
A person must:
- tell the doctor about any other mediations they are using, to reduce the risk of interactions and adverse effects
- follow the doctor’s instructions regarding medication and treatment
- discuss any concerns about adverse effects, and if they feel the treatment is working
- continue taking medication unless the doctor says it is safe to stop
- bear in mind that the drugs can take time to work
If the person discontinues their treatment, symptoms may worsen.
Psychotherapy and counseling
Psychotherapy can help relieve symptoms and equip a person to manage bipolar disorder.
Through cognitive-behavior therapy (CBT) and other approaches, the individual can learn to:
- recognize and take steps to manage key triggers, such as stress
- identify early symptoms of an episode and take steps to manage it
- work on factors that help maintain a stable mood for as long as possible
- engage the help of family members, teachers, and colleagues
These steps can help a person maintain positive relationships at home and work. For children and teens with bipolar disorder, a doctor may recommend family therapy.
Some people may need to spend time in the hospital if there is a risk of them harming themselves or others.
If other treatments have not helped, a doctor may prescribe electroconvulsive therapy (ECT).
Some lifestyle choices can help maintain a stable mood and manage symptoms. They include:
- maintaining a regular routine
- following a healthful and varied diet
- establishing a regular sleep pattern and taking steps to prevent sleep disturbance
- getting regular exercise
Some people use supplements, but it is essential to discuss this with a doctor first. Some alternative remedies can interact with the drugs used for bipolar disorder. They may make symptoms worse.
Bipolar disorder appears to result from a combination of factors.
Genetic factors: Bipolar disorder is more common in those who have a family member with the condition. A number of genetic features may be involved.
Biological traits: Research suggests that imbalances in neurotransmitters or hormones that affect the brain may play a role.
Environmental factors: Life events, such as abuse, mental stress, a “significant loss,” or another traumatic event, may trigger an initial episode in a susceptible person.
Bipolar disorder is a relatively common but serious mental health condition that involves changes in mood, energy levels, and attention, alongside other symptoms.
It can severely disrupt a person’s life, but treatment can drastically improve the outlook.
Treatment may not eliminate mood changes entirely, but working closely with a doctor can make symptoms more manageable and maximize quality of life.