Bipolar disorder is a mental health condition that causes dramatic shifts in mood.

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Untreated bipolar disorder may interfere with someone’s ability to work, maintain relationships, and participate in other activities.

According to the National Institute of Mental Health, about 4.4% of adults in the United States experience bipolar disorder at some point in their lives.

Bipolar disorder appears to affect people of different races at the same rate. However, experts report that Black Americans face more barriers than white Americans when it comes to getting proper treatment.

“There are no differences in the prevalence of the disorder between [Black people] and [white people],” Dr. Kaja Johnson McMaster, Ph.D., told Medical News Today. Dr. McMaster is a licensed clinical psychologist at a private practice in Baltimore, MD.

“That being said, research shows there are pretty stark differences in the way having the disorder plays out,” she continued, “and this is mainly because of differences in treatment.”

Bipolar disorder causes episodes of high and low moods. During a manic or hypomanic episode, a person may feel unusually happy, excited, or irritable. During a depressive episode, they may feel sad, hopeless, or indifferent to things they usually care about.

They may have changes in their energy and activity levels, sleep patterns, and other behaviors. Some people with bipolar disorder may have psychotic symptoms, such as delusions or hallucinations.

The symptoms of bipolar disorder are generally the same across different racial groups.

“There is some evidence showing that Black people with bipolar disorder may experience psychosis more frequently than white people with the disorder,” said Dr. McMaster, “but this isn’t a consistent finding across studies.”

Some symptoms of bipolar disorder are similar to those of other conditions. This can make it harder to accurately diagnose bipolar disorder.

Misdiagnosis is common in people with bipolar disorder — particularly in Black people. In a 2018 review of research, researchers found that Black people with bipolar disorder are much more likely than white people to receive a misdiagnosis of schizophrenia.

“The risk is if you’re Black and get misdiagnosed, you don’t get the full gamut of psychotherapy and medications [for bipolar disorder],” said Dr. Stephen Strakowski, a co-author of the review article. He is also the Vice Dean of Research and Associate Vice President of Regional Mental Health at Dell Medical School at the University of Texas at Austin.

Misdiagnosis may prevent someone from receiving proper treatment for bipolar disorder, including mood stabilizing medication.

This can have serious effects on a person’s life, said Dr. McMaster. She pointed to a 1980 case series that included three Black people with bipolar disorder who had received a misdiagnosis of schizophrenia.

All three experienced disabling symptoms and frequent hospitalization. Their symptoms only improved after they received a correct diagnosis and started mood stabilizing medication.

Some research suggests that other historically marginalized groups may also face barriers to diagnosis. In one older 2003 study, researchers found that Latinos with psychotic symptoms were more likely than European Americans to receive a diagnosis of major depression.

Guidelines from the American Psychiatric Association advise healthcare professionals to treat bipolar disorder with a mood stabilizing medication. Lithium is a common mood stabilizer.

Doctors may prescribe a mood stabilizer alone, or they may combine it with other treatments, such as an atypical antipsychotic medication.

In 2014, Dr. McMaster helped conduct a study about treatment in Black and white Americans with bipolar disorder. The study found that 17% of white people with bipolar disorder had received mood stabilizers in the past year. None of the Black people had received mood stabilizers.

In a 2017 study, Dr. McMaster and colleagues compared treatment in Hispanic and non-Hispanic white people with bipolar disorder. They found that 21% of non-Hispanic white people were taking mood stabilizers. None of the Hispanic people were taking them.

Dr. McMaster and co-authors also found that Hispanic people were less likely than non-Hispanic white people to see a healthcare professional about a manic episode. They found no difference in the treatment-seeking behaviors of Black people compared with white people.

When Dr. Strakowski and colleagues reviewed the research, they found that Black people were less likely than white people to have outpatient follow-up visits after receiving a diagnosis of bipolar disorder.

“The differences in the quality of treatment that Black and white people with bipolar disorder receive are many, striking, and saddening,” said Dr. McMaster.

Racism likely contributes to treatment gaps in bipolar disorder, said Dr. McMaster.

“Disparity researchers have been very slow to arrive at this conclusion,” she told MNT, “but there seems to be good and mounting evidence that racism is a key source of the treatment differences seen among Black and white people with bipolar disorder.”

Unconscious bias and systemic racism in healthcare have persisted even as overt racism has become less tolerated, she continued.

“My recommendation to policymakers is to institutionalize anti-racism trainings among all healthcare professionals and to be sure to include mental healthcare professionals,” she said.

Using structured interviews might help limit the effects of bias during diagnosis, Dr. Strakowski said. Such tools may remind clinicians to follow each step of the diagnostic process.

“What seems to happen when faced with Black [people] is that there’s an assumption to the worse illness, schizophrenia, which is actually a diagnosis of exclusion,” Dr. Strakowski told MNT.

“Ideally, you go through all these other [potential diagnoses] before dropping to that one, but there’s a premature jump to [schizophrenia] if you’re African American,” he continued.

It is important to include historically marginalized groups in research into bipolar disorder. The review of research that Dr. Strakowski co-authored found that very few genetic studies on bipolar disorder include people of African ancestry. This limits scientists’ understanding of the condition in Black people.

Perceived discrimination in healthcare settings can also lead to mistrust. In one study, researchers found that the likelihood of reporting medical mistrust was 73% higher among non-Hispanic Black participants and 49% higher among Hispanic participants than among white participants.

This shows the need for healthcare professionals to engage in trainings to build trust and stronger relationships with their patients. Doctors also need to learn how to recognize and address structural racism and its impacts on people of color.

Bipolar disorder appears to affect people of all races. However, research suggests that Black and Hispanic people with bipolar disorder tend to receive poorer treatment than non-Hispanic white people.

“The form of the illness is the same, the brain pathology is almost certainly the same, and the treatment response, barring some differences based on your ancestry [that] can affect your drug metabolism, is the same,” said Dr. Strakowski. “What’s not the same is the care that people receive.”

Reducing bias among healthcare professionals may help close the gaps in treatment. More research is necessary to identify the best strategies for reducing bias and improving treatment outcomes in people of color.