You may have described someone who was moody as “bipolar” without really meaning it. But it’s best not to use the term so lightly, because bipolar disorder involves a lot more than just being a diva from time to time.
This mental health condition (previously called manic-depressive illness or manic depression) is defined by unusual shifts in mood, energy, activity levels, concentration, and ability to engage in daily activities. It affects 2.8 percent of U.S. adults.
There are two common types of bipolar disorder:
- Bipolar I disorder: This is when a person experiences manic episodes for 7 days or more or has a severe manic episode that leads to hospitalization. They may also have a depressive episode lasting 2 weeks or more, but a depressive episode isn’t required for diagnosis.
- Bipolar II disorder: This refers to less severe manic and depressive episodes. A major depressive episode may happen before or after a less severe manic episode.
Less common forms of bipolar disorder include:
- Cyclothymic disorder (cyclothymia): This form includes moderate symptoms of hypomania and depression that last 2 years or more.
- Other: This category may apply to people whose symptoms don’t fall into the above categories. For instance, someone may experience manic or depressive symptoms related to drug or alcohol use or another medical condition.
Both types of bipolar disorder can be characterized by episodes of extreme moods — the highs are known as manic episodes and the lows as depressive episodes.
The main differences between bipolar I and bipolar II are the severity of the manic episodes caused by each type and the fact that a diagnosis of bipolar I does not require a major depressive episode.
Someone with bipolar I will experience a full manic episode — think quitting your job or gambling away your life savings.
Someone with bipolar II will experience a less severe manic episode (aka hypomania). This might mean talking so fast you can’t keep track of what you’re saying.
A manic episode must last 4 consecutive days for bipolar disorder to be diagnosed.
How do you know if someone has bipolar I disorder?
To be diagnosed with bipolar I disorder, you must have at least one major manic episode with symptoms so severe that it’s obvious something is wrong.
A manic episode is characterized by the following symptoms:
- trouble focusing
- feeling overly energetic
- trouble sleeping
- risky behaviors
- feeling euphoric
What about bipolar II disorder?
Bipolar II involves a major depressive episode that lasts at least 2 weeks, followed by at least one hypomanic episode. The hypomanic episodes usually don’t require hospitalization. A major depressive episode may precede or follow the hypomanic episode.
Since a person is more likely to seek help during a depressive episode, bipolar II can be misdiagnosed as depression. If the person isn’t showing symptoms of mania, it isn’t an obvious diagnosis.
Family and friends usually notice the shifts from depression to hypomania in a loved one.
The main differences between bipolar I and II are in the presence of mania, hypomania, and depression. Here are the details on the symptoms:
A manic episode involves more than just feeling jumpy, distracted, or invincible. It affects your daily life and requires clinical attention to help you pump the brakes.
During a manic episode, you may make irrational and risky decisions, like spending money excessively, having sex in situations you usually wouldn’t, binge-eating, or binge-drinking.
You may feel unusually powerful and attempt the unthinkable. You may even go days without sleeping or eating. Your train of thought may be all over the place, and you may talk at light speed while making little sense.
Hypomania is a milder form of mania. It’s disruptive to daily life but not to the same degree full mania is.
Still, a hypomanic episode is noticeably different from your typical state of mind. Family and friends will likely notice something is off.
Bipolar depression presents just like clinical depression: extended periods of sadness and hopelessness. You may stop feeling joy from activities you once enjoyed.
Other symptoms include:
- having trouble falling asleep, waking up too early, or sleeping too much
- eating more or less than usual, which can lead to weight fluctuations
- trouble concentrating or making decisions
- talking very slowly or feeling like you have nothing to say
- extreme tiredness or irritability
A major depressive episode must last for 2 weeks for bipolar disorder to be diagnosed.
Although we don’t know the causes, changes in the brain or an imbalance in certain brain chemicals may be among them. Scientists believe several factors may contribute, including:
- Genetics: Your chances of developing bipolar disorder increase if it runs in your family. But this isn’t a given. Even if your parents or siblings have the condition, you may not develop it.
- Stress: A particularly stressful life event, such as the death of a loved one, a divorce, or financial struggles, can trigger a manic or depressive episode.
- Brain structure or function: Although bipolar disorder can’t be diagnosed based on brain scans, researchers have found subtle differences in the average size and/or activation of some brain structures in people with the condition.
A psychiatrist or other mental health professional can diagnose bipolar disorder by reviewing your medical history and symptoms. Your healthcare provider may perform a blood test or body scan to rule out other conditions that might resemble bipolar disorder.
As mentioned above, you must experience at least one episode of mania to be diagnosed with bipolar I or one episode of hypomania to be diagnosed with bipolar II.
Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine the type of bipolar disorder you may have.
Treatment for bipolar disorder usually involves a combination of psychotherapy and medications.
These are often the first line of treatment for the condition.
Lithium is a widely used mood stabilizer that comes with some potential side effects, including joint pain, low thyroid function, and indigestion. Regular blood tests are often required to ensure healthy kidney function.
Mood stabilizers are often used in combination with an antipsychotic medication to help manage manic episodes.
Some common antipsychotic meds used to treat bipolar disorder include:
- asenapine (Saphris)
- lurasidone (Latuda)
- quetiapine (Seroquel)
- aripiprazole (Abilify)
- cariprazine (Vraylar)
- ziprasidone (Geodon)
- olanzapine (Zyprexa)
Common side effects of these include:
- dry mouth
- blurred vision
- weight gain
- muscle spasms
These may be prescribed to help manage depressive episodes. For some people, antidepressants can trigger manic episodes, so a doctor might suggest a combination of antidepressants and antipsychotics to reduce depression while stabilizing mood.
These are sometimes prescribed for people who have anxiety or sleep problems. They carry a risk of potential dependence.
Combined with medication, psychotherapy is a gold standard treatment for bipolar disorder.
Cognitive-behavioral therapy (CBT) is the most common form of psychotherapy. A therapist helps you manage your thoughts, behavior, and perceptions through one-on-one or group sessions.
In therapy, you work to understand what triggers your shifts in mood and how to change negative behaviors.
Along with medication and therapy, you may want to try writing in a diary. Taking note of your moods, energy levels, sleep patterns, diet, and important events can help you and your therapist track your progress or identify necessary treatment changes.
Your therapist may also suggest lifestyle changes around:
- drug and alcohol use
- stress reduction
- sleep schedule
Include your friends and family in your treatment plan. The more they know, the more supportive they can be. You’re not alone, and they wouldn’t want you to face this condition on your own.
National organizations like The Depression and Bipolar Support Alliance and The National Alliance on Mental Illness (NAMI) provide lots of info on bipolar disorder, including treatment options, peer support, support groups, materials for caregivers and loved ones, and personal stories from people with the condition.
Being diagnosed with bipolar disorder might feel daunting or stressful at first, but with the right treatment and support, you can manage the condition. Call your doctor or a local hospital to learn more about treatment options and support groups.
Although the term “bipolar” is commonly used as a diva-licious punchline, it actually refers to a serious condition that many people live with. If you have bipolar disorder, help is available, and you don’t have to deal with this alone.
As the medical community learns more about mental health, more treatments become available and the outlook improves. Having open communication with a treatment team and your loved ones is a promising first step. You’ve got this.