Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme shifts in mood, energy, activity levels, and the ability to perform daily functions. There are three types of bipolar disorder: type I, type II, and cyclothymic. All types of bipolar include distinct shifts in mood, energy, and concentration levels. Moods range from manic episodes (feeling extremely energized, elated, or irritable) to depressive episodes (characterized by feeling sad, despondent, or hopeless). 
Bipolar Disorder

  • Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
  • Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
  • Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

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Symptoms of Bipolar Disorder

People with bipolar disorder experience periods of intense feeling and emotions, as well as disruption of sleep and activity levels. They may adopt uncharacteristic behaviors without realizing it or considering their negative consequences. These distinct periods of altered feeling are called mood episodes. These episodes are very different than how the person normally behaves. During an episode, the altered mood symptoms last every day for most of the day. They can also last for several days or weeks.

People having a manic episode may: People having a depressive episode may:
Feel very “up,” “high,” elated, or irritable or touchy Feel very sad, “down,” empty, worried, or hopeless
Feel “jumpy” or “wired” Feel slowed down or restless
Have a decreased need for sleep Have trouble falling asleep, wake up too early, or sleep too much
Have a loss of appetite Experience increased appetite and weight gain
Talk very fast about a lot of different things Talk very slowly, feel like they have nothing to say, forget a lot
Feel like their thoughts are racing Have trouble concentrating or making decisions
Think they can do a lot of things at once Feel unable to do even simple things
Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”)
Feel like they are unusually important, talented, or powerful Feel hopeless or worthless, think about death or suicide

Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.

Even a person with less extreme symptoms may have bipolar disorder. Some people with bipolar type II experience less severe manic episodes (known as hypomania). During hypomanic events, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Clinical Diagnosis of Bipolar Disorder

Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. People with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania. Taking a careful medical history is essential to ensure that bipolar disorder is not mistaken for major depression. This is especially important when treating an initial episode of depression as antidepressant medications can trigger a manic episode in people who have an increased chance of having bipolar disorder.

Common Co-Occurring Disorders

Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as an anxiety disorder or substance use disorder. People with bipolar disorder have an increased chance of having thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Psychosis: Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:

  • People having psychotic symptoms during a manic episode may have the unrealistic belief that they are famous, have a lot of money, or have special powers.
  • People having psychotic symptoms during a depressive episode may falsely believe they are financially ruined and penniless, have committed a crime, or have an unrecognized serious illness.

As a result, people with bipolar disorder who also have psychotic symptoms are sometimes incorrectly diagnosed with schizophrenia. When people have symptoms of bipolar disorder and also experience periods of psychosis that are separate from mood episodes, the appropriate diagnosis may be schizoaffective disorder.

Anxiety: It is common for people with bipolar disorder to also have an anxiety disorder.

Attention-Deficit Hyperactivity Disorder (ADHD): It is common for people with bipolar disorder to also have ADHD.

Misuse of Drugs or Alcohol: People with bipolar may misuse alcohol or drugs and engage in other high-risk behaviors at times of impaired judgment during manic episodes. Although the negative effects of alcohol use or drug use may be most evident to family, friends, and health care providers, it is important to recognize the presence of an associated mental disorder.

Eating Disorders: In some cases, people with bipolar disorder also have an eating disorder, such as binge eating or bulimia.

Risk Factors

Researchers are studying the possible causes of bipolar disorder. Most agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness.

Brain Structure and Functioning: Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

Treatments and Therapies

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.”

Bipolar is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Medications

Certain medications can help manage symptoms of bipolar. Some people may need to try several different medications and work with their health care provider before finding medications that work best.

Medications generally used to treat bipolar include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

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Cognitive Behavioral Therapy Treatment

Therapy can be an effective part of the treatment plan for people with bipolar disorder. There are a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Therapy can provide support, education, and guidance to people with bipolar disorder and their families.

If you or a loved one is seeking help for managing bipolar disorder, our behavioral health counselors are available 24/7 by phone: 855-997-4702