Do Bipolar Know What They Are Doing

Understanding the Basics of Bipolar Disorder

Medically Reviewed by Madeline Hubbard, RN, BSN

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Understanding the Basics of Bipolar Disorder

Editor's Note: If you're feeling suicidal, having thoughts about harming yourself or believe someone you know may be in danger of harming themselves, call the National Suicide Prevention Lifeline at 1-800-273-8255 to obtain confidential support. This resource is free and accessible 24 hours a day, seven days a week. TTY users can dial 711, followed by 1-800-273-8255. The organization also offers the Lifeline Chat  service for online support.

Bipolar disorder is a chronic mental health condition that was previously referred to as "manic depression." It causes frequent shifts in mood, energy and activity levels. People with bipolar disorder experience strong feelings of sadness, guilt and hopelessness during episodes of depression, and these are followed by extreme periods of happiness called mania.

Symptoms of bipolar disorder can vary from person to person in terms of severity and duration. For some people, feelings of depression and elevated moods may rotate or cycle. For others, moods might shift quickly or feelings of depression and elevated mood might alternate over a period of months. The condition can sometimes escalate and include symptoms of delusions, hallucinations and other types of psychosis that disconnect a person from reality.

Bipolar disorder impacts approximately 4.4% of adults in the United States during their lifetimes. Most commonly, symptoms begin in adolescence and young adulthood, but they may appear in childhood as well. There is no cure for bipolar disorder, and without treatment, this condition can lead to negative effects on a person's finances, relationships and even their standing with the law. However, treatment options are available to help manage symptoms and stabilize day-to-day life.

Symptoms and Warning Signs of Bipolar Disorder

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During mood episodes of bipolar disorder, people experience intense emotional and behavioral changes that last for most of the day for multiple days or weeks at a time. The symptoms that a person experiences differ during depressive episodes and manic episodes. Symptom expression can vary, but typically an individual will experience three or more of the following symptoms from these lists during each type of episode:

Depressive episodes may include:

• Feelings of sadness, emptiness or hopelessness
• Changes in sleep patterns (more or less sleep than usual)
• Increased appetite
• Forgetfulness or difficulty concentrating
• Loss of interest in or difficulty completing daily tasks
• Decreased sex drive or ability to experience pleasure
• Thoughts of death or suicide

Manic episodes may include:

• Elated mood
• Irritability
• Decreased need for sleep
• Loss of appetite
• Rapid speech and actions
• Racing thoughts
• Feelings of increased importance or power
• Changes in judgment (can often involve higher-risk behaviors like spending large amounts of money, engaging in unsafe sexual practices or impulsively making major life decisions)

It's important to keep in mind that depression and mania exist on a mood spectrum, and a person might experience changes in mood that don't quite fit the criteria for either extreme but that can still cause a disruption to their daily life. For example, "hypomania" refers to an elevated mood that may not include the extreme behavioral changes that take place during manic episodes. It's also possible to experience a mixed episode that includes symptoms from both of the above lists. Typically, someone with bipolar disorder experiences this as increased sadness or hopelessness with simultaneous increased energy or irritability.

Sometimes it's difficult for individuals to identify symptoms while they're experiencing them. A close family member or friend might point out changes in behavior that may indicate the onset of symptoms.

Causes and Risk Factors for Bipolar Disorder

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Although the precise set of causes of bipolar disorder is unknown, experts believe that a number of genetic and environmental factors are responsible. Studies show that genetics and environmental factors both play a part in the onset of symptoms. Causes may include:

• Structure of the brain: Imaging studies suggest that those living with bipolar disorder may have structural changes in certain parts of their brains that influence the way signals are conducted, impacting mood and behavior.
• Genetic changes: There's no one gene linked to bipolar disorder, but certain genes may make it more likely that someone develops bipolar disorder. This means that having a close relative with the diagnosis makes it more likely that an individual will experience bipolar disorder.
• Stress: Experiencing traumatic or highly stressful life events without adequate support may increase the likelihood of developing symptoms of bipolar disorder or trigger their onset in people who are predisposed to this disorder.
• Substance abuse: In some cases, excessive use of drugs or alcohol can act as a trigger for severe mood episodes in those who are predisposed to bipolar disorder.

There are several conditions that tend to coincide with bipolar disorder. This can complicate diagnosis and treatment. These include:

• Anxiety disorders
• Attention deficit hyperactivity disorder (ADHD)
• Eating disorders (such as binge eating disorder, bulimia nervosa or anorexia nervosa)
• Thyroid disorders
• Migraine headaches
• Heart disease

Testing and Diagnosis of Bipolar Disorder

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If you notice that you're experiencing extreme mood swings, it's important to speak with a healthcare professional. This can be your medical provider or a mental health specialist like a psychologist or a psychiatrist. These professionals can use a variety of diagnostic tools to help determine whether you're living with bipolar disorder or another condition.

• Assessment: In assessing for a mood disorder, a provider will likely ask questions about your lifestyle, relationships, family history, mood and sleep patterns, substance use and daily activities. It's important to answer these questions honestly so the provider can identify whether you're at risk. In order to be ready to answer these questions, it can be helpful to maintain a log of your mood changes and how long they last over time. Keep track of how you act and how you feel, and talk to your friends and family about whether they've noticed anything out of character or unusual in the way you've been acting.
• Blood work: After asking you a series of questions, a provider may order certain blood or urine tests to rule out any physical explanations for your mood swings, like thyroid abnormalities or substances in your system. Make sure that, when you attend your appointment, you bring information about any medications you're currently taking.

• Scans: Some brain injuries or tumors produce symptoms that are similar to bipolar disorder. If your doctor has a medical reason to suspect such a problem, they might order a CT scan or an MRI. A specialist will start to treat these types of conditions as soon as possible, and your symptoms will likely stop.

In order to be diagnosed with bipolar disorder, your symptoms must align with those listed in the Diagnostic and Statistical Manual of Mental Disorders. This is a handbook that helps healthcare professionals diagnose mental health conditions. There are four subcategories of bipolar disorder that a provider might identify during diagnosis:

• Bipolar I: Symptoms of depression lasting for at least two weeks, and accompanying manic behavior lasting for at least one week
• Bipolar II: Characterized by less severe mood swings alternating between periods of hypomania and depression — manic feelings and behaviors are not symptoms of this condition
• Cyclothymic disorder: Periods of hypomania and depressive symptoms that last for at least two years in adults — symptoms can be more subtle and may not meet criteria for manic or depressive episodes
• Not otherwise specified: Symptoms of depression, hypomania or mania that impair an individual's functioning but don't meet the pattern criteria above

Preventing and Treating Bipolar Disorder

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Bipolar disorder isn't a condition that you can necessarily prevent. You cannot control your genetics, and you cannot control many negative situations that may occur in your life. The best preventative measures are to stay informed, monitor your symptoms, find out whether mood disorders run in your family and listen to your friends or family if they point out any significant changes in your behavior. It's important to seek treatment for bipolar disorder as soon as these changes become noticeable. Without proper supportive treatment, symptoms may become worse and increase the risk of harm or hospitalization.

Treatment modalities for bipolar disorder may include one or a combination of the following:

• Psychotherapy: Several types of talk therapy exist to help support an individual in addressing disruptive emotions, thought patterns and behaviors.
• Medications: Your provider may prescribe these alone or in combination with individual therapy. A variety of psychotropic medications have the potential to be helpful in targeting the mood and sleep symptoms of bipolar disorder. It can take time to find a medication regimen that works for you, and providers may offer trials for the following types of medication:
• Antidepressants
• Anti-anxiety medications
• Mood stabilizers
• Antipsychotic medications

• Brain stimulation: Electroconvulsive therapy (ECT) is a treatment method that stimulates your brain through electrical currents and can relieve symptoms of bipolar disorder. Patients are typically under general anesthesia for this procedure, which is repeated over a period of time. Transcranial magnetic stimulation (TMS) has also been studied as a less invasive way of stimulating the brain to regulate moods.
• Day treatment or hospitalization: If symptoms are severe, intensive outpatient or inpatient treatment allows mental health professionals to monitor symptoms, adjust medications as needed and help stabilize moods in a safe environment. Most often this type of treatment is elective; hospitalization is only required if a person is an imminent danger to themself or others.

It's very important to find a trusted healthcare provider to work with in creating a treatment plan. Treatment is typically lifelong, and consistent monitoring and treatment adjustments are usually necessary to create balance and safety for you while you're living with bipolar disorder.

If you or someone you know is struggling with symptoms of bipolar disorder, the Substance Abuse and Mental Health Services Administration has a national helpline to connect people with local mental health support services and groups. Many patients experience success through support networks. By interacting with peers and discussing common problems, patients, along with their friends and family, are better able to cope with the challenges of bipolar disorder.

Resource Links:

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961

https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12852

https://www.samhsa.gov/find-help/national-helpline

https://suicidepreventionlifeline.org/

https://journals.sagepub.com/doi/full/10.1177/2045125320973790

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