What is bipolar disorder?

Bipolar disorder (also known as manic depression) causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with your ability to function.

During a manic episode, a person might impulsively quit a job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, the same person might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.

The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting in unnecessary suffering. But with proper treatment and support, you can lead a rich and fulfilling life.

Signs and symptoms of bipolar disorder

Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.

There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

Mania

In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. They may also feel like they’re all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. People often behave recklessly during a manic episode: gambling away savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. They may also become angry, irritable, and aggressive—picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior. Some people even become delusional or start hearing voices.

Common signs and symptoms of mania include:

• Feeling unusually “high” and optimistic OR extremely irritable
• Unrealistic, grandiose beliefs about one’s abilities or powers
• Sleeping very little, but feeling extremely energetic
• Talking so rapidly that others can’t keep up
• Racing thoughts; jumping quickly from one idea to the next
• Highly distractible, unable to concentrate
• Impaired judgment and impulsiveness
• Acting recklessly without thinking about the consequences
• Delusions and hallucinations (in severe cases)

Symptoms of bipolar depression

In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse—triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and speak slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depression—a condition in which they’ve lost contact with reality—and to experience major disability in work and social functioning.

Common symptoms of bipolar depression include:

Symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Treatment for bipolar disorder

If you spot the symptoms of bipolar depression in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. Diagnosing the problem as early as possible and getting into treatment can help prevent these complications.

If you’re reluctant to seek treatment because you like the way you feel when you’re manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.

Treatment basics

Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it’s important to continue treatment even when you’re feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.

It’s best to work with an experienced psychiatrist. Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment is often difficult. For safety reasons, medication should be closely monitored. A psychiatrist who is skilled in bipolar disorder treatment can help you navigate these twists and turns.

Self-help

While dealing with bipolar disorder isn’t always easy, it doesn’t have to run your life. But in order to successfully manage bipolar disorder, you have to make smart choices. Your lifestyle and daily habits have a significant impact on your moods and may even lessen your need for medication.

Bipolar disorder and suicide

The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.

The warning signs of suicide include:

Causes and triggers

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.

External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes—either good or bad—such as getting married, going away to college, losing a loved one, getting fired, or moving.

Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.

Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

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