Bipolar Disorder Explained: Causes, Symptoms, And Treatments

This article discusses a mental health condition and mentions suicide and suicidal ideation.

Changes in mood are normal and experienced by everyone, according to the National Institute on Mental Health (NIMH). However, when those temperament changes are extreme and affect how you think and act, it could be classified as bipolar disorder (via Cleveland Clinic). Formerly referred to as manic depression, this mood disorder interferes with the everyday life of close to six million Americans (via NIMH).

Bipolar disorder affects men and women almost equally, and symptoms generally begin around age 25 for both sexes. However, women with this illness are more likely to be misdiagnosed and treated for depression instead of bipolar disorder. Men with bipolar disorder tend to be misdiagnosed and treated as schizophrenic, according to the Depression and Bipolar Support Alliance (DBSA).

The mood changes associated with bipolar disorder often come in waves that last hours, days, or weeks. However, even though they come and go, the condition is considered chronic, and treatment is a lifetime commitment (via NIMH).

Bipolar disorder is diagnosed in two stages. The first phase is to have your mood episodes diagnosed to determine if they fall into the categories of mania, hypomania, or depression. From there, your doctor will then take steps to determine if you have bipolar disorder (via American Psychological Association).

Medical professionals use a multistep approach to properly diagnose patients with bipolar disorder (via Cognitive and Behavioral Practice). The evaluation begins with reviewing the medical histories of the patient and their immediate family. Chances of being diagnosed with bipolar become exponentially greater the closer a previously diagnosed relative is to you (via APA). The doctor will also ask several specific questions and request that you complete screening tools. These will assist your medical provider in eliminating other issues, including additional illnesses, drug addiction, and life stressors like a new job or a recent move. To ensure a proper diagnosis, doctors use a probability-based approach to identify bipolar disorder. They consider several factors, including risk factors, scale scores, and diagnostic probability of treatment need (via Cognitive and Behavioral Practice).

Everyone feels sad occasionally. However, those with bipolar disorder may experience a major depressive episode in addition to the mania required for diagnosis (via Verywell Mind). A major depressive episode lasts more than two weeks. Episodic symptoms involve feeling dejected and apathetic. To be properly diagnosed, you also must encounter a change in one of several life factors. These consist of an increase or decrease in eating, sleeping, and overall enthusiasm for life. A major depressive episode may also include issues with making decisions, feeling suicidal, and feeling worthless. Those experiencing a major depressive episode may appear angry or agitated instead of sad or depressed. Additionally, the mood changes you experience must significantly interfere with your everyday life to be considered a major depressive episode (via Psycom).

Those with bipolar disorder who experience depressive episodes report that they last up to three times as long as both manic episodes and hypomania. Doctors rule out depressive episodes in patients with other medical conditions or who take prescribed and illicit drugs (via Verywell Mind).

There are several types of bipolar disorder. Each variation has its own set of diagnostic criteria. Bipolar I requires patients to suffer from a manic episode that lasts at least a week, or that the patient requires hospitalization due to the seriousness of their symptoms (via NIMH). The manic episode often includes feelings of anger or euphoria with excess energy. Those with bipolar I may experience periods of normalcy, depression, or psychosis. However, depression and delusion are not required for diagnosis (via APA). Many patients with bipolar I are first diagnosed with major depressive disorder. Unfortunately, reaching a proper diagnosis takes up to 10 years (via Johns Hopkins Medicine). Several common conditions often accompany bipolar I. Therefore, physicians treating patients with bipolar I should watch for substance abuse, anxiety, and panic disorders.

Though both women and men with bipolar one tend to get equally diagnosed around age 20, women are prone to mania. Women with bipolar I can have more than four manic episodes a year. Additionally, pregnancy offers women another stumbling block. It's best to speak with your doctors to determine if you should continue your medication while pregnant. You risk a relapse if you stop taking your prescriptions. However, those drugs could be harmful to the unborn child.

Doctors consider cyclothymic disorder the mild form of bipolar disorder. Those with this diagnosis do not go more than two months without experiencing either hypomania or depression (via MedlinePlus). Though those with cyclothymic disorder may feel tired or wired, the lows and highs aren't intense enough to cause interruption to everyday life, but they do occur often. Patients with cyclothymic disorder experience normal moods in between mood swings (via NHS).

To be diagnosed with cyclothymic disorder, children must have symptoms for over a year, and adult symptoms must be present for at least two years (via Healthline). Cyclothymic disorder is rare. It occurs in less than one percent of men and women, and typically first presents during adolescence or young adulthood (via Psychology Today). Up to 50% of those diagnosed with cyclothymic disorder are diagnosed with either bipolar I or bipolar II. Substance abuse and anxiety disorder are also commonly diagnosed in those with cyclothymic disorder.

Medical professionals first included borderline personality disorder (BPD) as a medical diagnosis in 1980. However, many argue it should be considered a type of bipolar disorder due to its similarity (via Verywell Mind). Common behaviors that both disorders include are impulsiveness, intense emotions, and suicidal thinking (via NAMI). Like those with bipolar disorder, patients with BPD experience mood swings. The difference is that those with BPD rarely experience periods of normalcy. Instead, they are in a constant state of mood changes (via Health Matters).

An overlap in diagnosis occurs 10% of the time for those with bipolar I and 20% of the time for those with bipolar II (via Dialogues in Clinical Neuroscience). In addition, those with dual diagnoses of both disorders are often told they have bipolar first because medical professionals need additional time to identify BPD (via Healthline).

Those who experience the psychosis associated with bipolar I are easier to diagnose, as those characteristics are not associated with BPD (via NAMI). Additionally, three-quarters of those with BPD engage in self-harm (via National Education Alliance for Borderline Personality Disorder).

Lithium is one of the most common medications prescribed to treat both the mania and depression associated with bipolar disorder (via Psychiatric Times). It helps prevent symptoms and stabilize your mood. It also lowers your chances of dying from suicide, heart disease, cancer, stroke, vascular disease, and viral illnesses, all of which are seen at higher rates in those with bipolar disorder.

Another common bipolar medication is quetiapine. Sold under the brand name Seroquel, it is considered an antipsychotic and works better than lithium in patients with mixed manias and acute depressive episodes. It also helps with the anxiety and insomnia associated with bipolar disorder. Anti-depressants and anti-anxiety medications also get prescribed to those with bipolar disorder. However, because some anti-depressants trigger manic episodes, doctors may also prescribe a mood stabilizer or antipsychotic along with this class of drug. Medical providers prefer to prescribe anti-anxiety medicines for short-term use (via Mayo Clinic).

Because everyone is unique and responds to both bipolar disorder and the medicines to treat it in their own way, it takes time for your doctor to get your prescriptions just right (via Medical News Today). It often takes several tries with several different medications before the combination that works best for you is found. Additionally, it can take up to eight weeks for each drug to take full effect (via Healthline). 

One important thing to keep in mind is that the drugs prescribed for bipolar disorder are associated with a higher risk of birth defects. Consult with your physician if you get pregnant or plan to breastfeed, or if you're on birth control that might interact with your other medication.

Medical professionals believe that up to 50% of those diagnosed with bipolar disorder or another mental illness self-treat using complementary and alternative medicine (CAM). Many incorporate these treatments with their prescriptions (via Psychiatric Times).

One way to help yourself live with bipolar disorder is to stick to a schedule (via Healthline). Your day should be structured, from when you wake up to when you go to sleep. Figure out the best times and foods to eat to boost your mood. You should try to stick to your routine and stay involved in activities, even when you don't feel up to it. It's also important to get moving. Though it is unclear why or how, studies show that exercise improves depressive symptoms, as well as your daily functioning and quality of life (via Journal of Affective Disorders).

While some herbs and supplements claim to alleviate symptoms associated with bipolar disorder, evidence of their safety and efficacy is hard to find (via Psychairctric Times).

If you or someone you know needs help with mental health or is having suicidal thoughts, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), visit the National Institute of Mental Health website, or call the National Suicide Prevention Lifeline by dialing 988 or by calling 1-800-273-TALK (8255)​.