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Bipolar Disorder: Types, Symptoms, Causes, Treatment, and More

Bipolar Disorder, a condition marked by mood instability, impacts numerous people across the globe. According to recent estimates, approximately 2.8% of adults in the United States had Bipolar Disoder in the past year (1).

What is Bipolar Disorder?

Bipolar Disorder, also known as manic-depressive illness, is a mental health condition characterized by significant fluctuations in mood, ranging from periods of intense mania or hypomania to episodes of depression (2).

Key indicators of bipolar disorder include:

  • Episodes of mania and hypomania, characterized by increased energy, heightened mood, and possibly reckless behavior .
  • Episodes of depression, marked by persistent feelings of hopelessness, sadness, and a loss of interest in activities.

Bipolar disorder is diagnosed when an individual experiences a manic episode or when an individual experiences a hypomanic and depressed episode. A manic episode is marked by feelings of euphoria, impulsivity, and heightened energy levels, while a hypomanic episode is less severe (2).

Both manic and hypomanic episodes may disrupt daily functioning, although hypomania may be less severe and may not significantly disrupt daily functioning.

Depressive episodes may also cause substantial distress and may impair day-to-day activities (3).

Types of Bipolar Disorder

Bipolar Disorder, characterized by significant shifts in mood, energy levels, and activity, presents in three main forms. These variations encompass distinct episodic patterns.

  • Bipolar I Disorder entails at least 1 manic episode that may last a minimum of 7 days or any duration if it requires hospitalization due to severity. Concurrent depressive episodes may also occur but are not required for the diagnosis. A manic or hypomanic episode may also present with mixed features. Rapid cycling, defined as experiencing four or more mood episodes annually, might occur (4).
  • Bipolar II Disorder is marked by hypomanic and depressive episodes (5).
  • Cyclothymic Disorder showcases recurring hypomanic and depressive symptoms falling short of meeting the criteria for full episodes (6).

Additionally, there is a category known as “Other Specified and Unspecified Bipolar and Related Disorders,” which encompasses symptoms that do not align precisely with the aforementioned types of bipolar disorder (7).

Note: Beyond these categories, bipolar disorder exists on a spectrum, reflecting a range of mood disturbances from mild to severe.

Remember, while these descriptions provide a general overview, individual experiences with bipolar disorder may vary, and treatment approaches may need to be tailored to each person’s specific needs and circumstances. It’s recommended to consult qualified healthcare professionals for personalized advice and support.

Symptoms of Bipolar Disorder

Bipolar disorder symptoms may vary widely among individuals, making it essential to recognize the diverse range of symptoms associated with this disorder:

  • Mood Instability: Individuals with bipolar disorder may experience extreme shifts in mood, ranging from manic episodes of elevated energy and euphoria to depressive episodes marked by sadness and low energy. These mood changes can occur gradually or suddenly (8).
  • Manic Episodes: During manic episodes, individuals may feel unusually high levels of energy, engage in risky behaviors, have racing thoughts, and experience difficulty concentrating. They may also have an inflated sense of self-esteem and engage in impulsive activities like excessive spending or substance abuse (9).
  • Depressive Episodes: Depressive episodes are characterized by feelings of sadness, hopelessness, and worthlessness. Individuals may lose interest in activities they once enjoyed, have trouble sleeping or oversleep, experience changes in appetite or weight, and have difficulty concentrating or making decisions. Suicidal thoughts or behaviors may also occur during severe depressive episodes (10).
  • Hypomanic or manic episodes with mixed features: Some individuals with bipolar disorder may experience mixed features during which symptoms of mania and depression occur simultaneously or rapidly alternate. This might be particularly challenging to manage and may increase the risk of self-harm or suicide (11).
  • Changes in Activity and Energy Levels: Fluctuations in activity and energy levels are common in bipolar disorder. During manic episodes, individuals may feel unusually energetic and require less sleep, while depressive episodes may lead to fatigue and decreased activity levels (12).
  • Changes in Behavior and Thinking: Bipolar disorder may affect behavior and thinking patterns. During manic episodes, individuals may exhibit increased irritability, impulsivity, and distractibility. Depressive episodes may lead to feelings of guilt, worthlessness, and pessimism (13).
  • Psychotic Symptoms: In severe cases, bipolar disorder may be accompanied by psychotic symptoms such as hallucinations or delusions. These symptoms might occur during manic, or depressive episodes and may require additional treatment (14).
  • Cyclothymic Symptoms: Some individuals may experience milder symptoms of bipolar disorder known as cyclothymia. This condition involves fluctuations between periods of hypomanic and depressive symptoms, but the symptoms are less severe and do not meet the criteria for a full bipolar diagnosis (15).

It’s important to note that symptoms of bipolar disorder may vary widely among individuals, and not everyone will experience the same combination or severity of symptoms. Additionally, other factors such as stress, substance abuse, and medical conditions might influence the presentation of bipolar symptoms.

Manic, Hypomanic and Depressive Episodes

Understanding Bipolar Disorder requires delving into its various aspects, including the distinct episodes of mania, hypomania and depression. These phases might significantly impact individuals’ lives.

Manic Episodes

Manic episodes characterize Bipolar Disorder’s highs, where individuals undergo an intense shift in mood. Here are some key points to consider:

  • During a manic episode, individuals may experience heightened emotions such as excitement, impulsivity, euphoria, and increased energy (16).
  • Symptoms may include racing thoughts and, in some cases, hallucinations or other signs of psychosis (16).
  • Impulsive behaviors are common during manic episodes, which might range from engaging in unprotected sex to excessive spending or substance misuse (16).
  • Other impulsive actions may include sudden job resignations, spontaneous trips without informing others, impromptu investments, or reckless driving (16).
  • It’s important to note that these behaviors are not typical for the individual during periods of stable mood (16).

Hypomanic Episodes

Hypomania, often associated with Bipolar II Disorder, presents a milder form of manic behavior. Here’s what you need to know:

  • Unlike manic episodes, hypomanic episodes generally do not lead to significant consequences in daily functioning or relationships (17).
  • Psychotic symptoms are typically absent during hypomanic episodes.
  • Individuals experiencing hypomania may feel highly productive and energetic, although these mood shifts may not be immediately noticeable to others.

Understanding the experiences of individuals during manic and hypomanic episodes is essential for providing effective treatment for bipolar disorder.

Depressive Episodes

Not all individuals with bipolar disorder experience major depressive episodes (18), and the severity of symptoms may vary. Treatment for mania might sometimes result in a shift to a depressive mood state, which contrasts with the euphoria experienced during mania (19).

Unlike unipolar depression, bipolar disorder may involve both “up” and “down” mood states, while unipolar depression typically maintains a consistently low mood until treated (20). Some depressive symptoms include:

  • Fatigue and lethargy.
  • Persistent low mood accompanied by feelings of hopelessness or emptiness.
  • Loss of interest in previously enjoyed activities.
  • Changes in sleep patterns and appetite.
  • Restlessness or a sense of slowing down.
  • Difficulty concentrating, making decisions, or focusing.
  • Feelings of guilt or worthlessness.
  • Thoughts of death or suicide.

Dealing with depressive episodes might be immensely challenging for individuals with bipolar disorder. Remember, you’re not alone in this journey. Seeking support from healthcare professionals, friends, and family members might make a significant difference. If you’re experiencing distressing symptoms, don’t hesitate to reach out for help.

Bipolar Disorder Symptoms in Females vs. Males

While research indicates a roughly equal distribution of diagnoses between males and females, there are notable differences in how the disorder manifests. Understanding these distinctions may aid in accurate diagnosis and tailored treatment plans.

Note: It’s important to note the disparity between sex and gender, as they play distinct roles in the experience of bipolar disorder.
Sex refers to biological characteristics, such as chromosomes and reproductive organs (woman assigned at birth or male assigned at birth).
Gender encompasses identity and expression (transgender, genderfluid, nonbinary etc).

This difference is crucial in understanding how bipolar disorder may present differently among individuals.

Bipolar Disorder in Biological Females

When it comes to bipolar disorder in biological females, diagnosis often comes later as compared to males, typically in their 20s or 30s (21). It’s not uncommon for symptoms to first appear during pregnancy or after giving birth. Interestingly, bipolar II is more commonly diagnosed than bipolar I in this group (22).

What’s notable is that females grappling with bipolar disorder often experience less severe episodes of mania compared to their male counterparts. They also tend to experience more depressive episodes than manic ones (23). Rapid cycling, defined as experiencing four or more episodes of mania, hypomanic or depression within a year, is more prevalent among females (24). Moreover, they might contend with more co-occurring conditions.

Relapse is also a concern, with females encountering it more frequently. This is partially attributed to hormonal fluctuations linked to menstruation, pregnancy, and menopause. In bipolar disorder, relapse signifies experiencing a mood episode after a period of remission (25).

Bipolar Disorder in Biological Males

For males diagnosed with bipolar disorder, the trajectory differs somewhat. They often receive a diagnosis earlier in life (25) and tend to have more manic episodes (21, 23). Additionally, there’s a higher likelihood of comorbid substance use disorders among males with bipolar disorder. During manic episodes, aggression may be more pronounced in males compared to females (26, 27).

Understanding the nuanced differences in how bipolar disorder presents in males and females is vital for accurate diagnosis and effective treatment. Continued research into sex-specific manifestations of the disorder is crucial for advancing our understanding and enhancing support for affected individuals.

Bipolar Disorder Symptoms in Children and Teenagers

Diagnosing bipolar disorder in children and teenagers presents unique challenges due to variations in symptoms and behaviors compared to adults. It’s crucial to understand that children may not exhibit typical bipolar symptoms, and their mood shifts might not align with diagnostic criteria designed for adults. Furthermore, symptoms of bipolar disorder in youth often overlap with those of other common conditions like ADHD, adding complexity to diagnosis (28).

Symptoms of Bipolar Disorder in Children

Children with bipolar disorder may experience intense mood fluctuations resembling those in adults. While mood changes are typical in childhood, those associated with bipolar disorder tend to be more pronounced and disruptive to daily functioning (29).

Manic Symptoms:

  • Displaying elevated or irritable mood
  • Difficulty concentrating
  • Engaging in risky behaviors
  • Rapid speech and frequent topic changes
  • Sleep disturbances without feeling tired
  • Quick temper leading to anger outbursts

Depressive Symptoms:

  • Persistent sadness or frequent crying
  • Loss of interest in activities
  • Physical complaints such as headaches or stomach aches
  • Changes in sleep patterns
  • Changes in appetite
  • Feelings of worthlessness or guilt
  • Thoughts of death or suicide

It’s important to note that certain behavioral issues might indicate other mental health conditions or co-occur with bipolar disorder. Consulting with a healthcare provider who specializes in pediatric mental health may aid in accurate assessment and tracking of symptoms.

Symptoms of Bipolar Disorder in Teenagers

The hormonal changes and life adjustments during puberty contribute to heightened emotional states in teenagers (30). However, drastic mood fluctuations or extreme behaviors may signify underlying conditions like bipolar disorder, especially in late adolescence and early adulthood (31).

Manic Symptoms:

  • Risk-taking behaviors
  • Substance use
  • Elevated mood
  • Sleep disturbances
  • Irritability
  • Increased focus on sexual activities
  • Difficulty concentrating

Depressive Symptoms:

  • Pervasive sadness
  • Social withdrawal
  • Changes in sleep and appetite
  • Thoughts of death or suicide

While some behaviors, such as experimentation with substances or thoughts about sex, are common during adolescence, persistent patterns warrant attention. If mood fluctuations significantly disrupt daily life or are part of a broader behavioral pattern, professional evaluation is advisable.

Understanding the nuances of bipolar disorder symptoms in children and teenagers is essential for accurate diagnosis and effective treatment planning. Consulting with healthcare professionals specializing in pediatric mental health may provide invaluable support for families navigating these challenges.

Bipolar Disorder Causes

Bipolar disorder presents a puzzle to experts regarding its origins. While the exact causes remain uncertain, several factors are thought to contribute, including:

  • Genetic Predisposition: There appears to be a familial link in bipolar disorder, with individuals having a parent or sibling diagnosed with the condition being at a heightened risk. Studies suggest a 10% to 25% increased risk if a parent has bipolar disorder. However, it’s important to note that not everyone with a family history of bipolar disorder will develop the condition (32).
  • Environmental Influences: External factors also play a role in the development of bipolar disorder. These factors may include exposure to extreme stress, traumatic life events, or significant physical illnesses. Such environmental stressors could potentially trigger or exacerbate the symptoms of bipolar disorder in susceptible individuals (33).
  • Brain Structure and Chemistry: Variations in brain structure, chemistry, or functionality could potentially elevate the risk of bipolar disorder. Disruptions in neurotransmitter pathways and irregularities in brain function may contribute to the development of the disorder (34).

It’s important to remember that while these factors may increase the risk of bipolar disorder, they do not guarantee its development. Each individual’s experience with bipolar disorder is unique, and the interplay of various genetic, neurobiological, and environmental factors might contribute differently in each case.

Bipolar Disorder Risk Factors

Bipolar disorder typically emerges during late adolescence or young adulthood, though it may occasionally manifest in childhood. While its exact causes remain uncertain, certain factors may increase the likelihood of developing this condition (35).

Potential risk factors for bipolar disorder include:

  • Family History: Having a family member with bipolar disorder may heighten one’s susceptibility to the condition (36).
  • Substance Abuse: Drug or alcohol abuse may exacerbate the symptoms of bipolar disorder, with many individuals resorting to substance misuse during manic or depressive episodes (37).
  • Stressful Life Events: Experiencing significant stress or trauma could potentially trigger the onset of bipolar disorder (38).
  • Co-existing Health Conditions: Individuals with bipolar disorder may experience co-existing mental health challenges such as seasonal depression, anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, it’s important to note that the presence of these conditions may vary from person to person, and not everyone with bipolar disorder will experience them (39).

While these factors are associated with the disorder, it’s important to recognize the complexity of each individual’s experience. Seeking professional guidance and support is crucial for effective management and treatment.

Bipolar Disorder Diagnosis

To receive a diagnosis of bipolar disorder, individuals must undergo a psychiatric assessment and meet the criteria for a manic episode or a hypomanic and depressive episode. Both manic and hypomanic episodes are characterized by symptoms including but not imited to heightened excitement, impulsivity, and elevated energy levels (40).

In addition to mania or hypomania, individuals with bipolar disorder may also experience depressive episodes or periods of “down” moods accompanied by other depressive symptoms (41).

Diagnosis of Bipolar I Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (42), a diagnosis of bipolar I disorder necessitates:

  • At least one episode of mania lasting a minimum of 1 week or any duration if it requires hospitalization due to severity.
  • Symptoms significantly affecting daily functioning.
  • Symptoms unrelated to other medical or mental health conditions or substance use.
  • Episodes may also include symptoms of psychosis or a combination of mania and depression, referred to as mixed features.
  • While not mandatory, many individuals with bipolar I disorder also experience episodes of hypomania or depression.

Diagnosis of Bipolar II Disorder

A diagnosis of bipolar II disorder requires:

  • At least one hypomanic episode lasting 4 days or more, involving three or more hypomanic symptoms.
  • At least one major depressive episode lasting 2 weeks or longer.
  • Symptoms not attributed to other medical or mental health conditions or substance use.
  • Noticeable changes in mood and functioning during hypomania, although daily life may not necessarily be affected.

Diagnosis of Cyclothymia

A diagnosis of cyclothymia requires:

  • Periods of alternating hypomanic and depressive symptoms over 2 years or more (1 year for children and adolescents).
  • Symptoms present for at least half of the 2-year period, with no absence of symptoms for longer than 2 months.
  • Symptoms that don’t meet the complete criteria for a hypomanic or depressive episode.
  • Symptoms causing significant distress and impacting daily life.
  • Symptoms unrelated to other medical or mental health conditions or substance use.

Diagnosing bipolar disorder involves assessing a range of symptoms, from mania and hypomania to depression. Understanding the nuances of each type—Bipolar I, Bipolar II, and Cyclothymia—allows for tailored treatment and support plans, emphasizing the importance of seeking professional guidance for accurate diagnosis and management (2).

Remember, if you or someone you know is struggling with bipolar disorder or its potential risk factors, reaching out for help is a positive step towards better mental health and well-being.

Bipolar Disorder Treatment

Managing symptoms of bipolar disorder involves various treatment options, each tailored to individual needs. While none guarantees a complete eradication of symptoms, they may significantly improve quality of life. Here’s a breakdown of treatment approaches:

Medication

Managing symptoms of bipolar disorder often involves the use of various medications. It’s common for individuals to undergo a trial-and-error process, in consultation with their healthcare provider, to determine the most effective medications for their specific needs (43).

Potential medications that may be recommended include:

  • Mood stabilizers, like lithium (sold under the brand name Lithobid) (43).
  • Antidepressant-antipsychotics, like fluoxetine-olanzapine (known as Symbyax) (43).
  • Benzodiazepines, a type of short-term anti-anxiety medication (44).
  • Antipsychotics, such as olanzapine (marketed as Zyprexa) (43).

Since individuals with bipolar disorder often seek help during depressive episodes rather than manic or hypomanic phases, it’s crucial for healthcare providers to conduct a thorough medical history assessment to accurately diagnose the condition.

Patients should:

  • Discuss the potential risks and benefits of medications with their healthcare provider.
  • Promptly report any concerns regarding side effects to their healthcare provider, who may need to adjust the dosage or try a different medication.
  • Inform their healthcare provider about any current prescription drugs, over-the-counter medications, or supplements they’re taking.
  • Adhere to their prescribed medication regimen consistently, even during periods of wellness.

It’s essential to consult with a healthcare provider before discontinuing any prescribed medication, as suddenly stopping medication might exacerbate symptoms or trigger their recurrence.

Psychotherapy

Psychotherapy, also known as talk therapy, may play a crucial role in treating individuals with bipolar disorder. This approach encompasses various techniques aimed at identifying and modifying distressing emotions, thoughts, and behaviors. Some options include:

  • Cognitive Behavioral Therapy (CBT): CBT, a cornerstone in treating depression, may be particularly beneficial when tailored for addressing insomnia, which often accompanies bipolar depression. This adaptation of CBT may significantly contribute to the overall treatment plan (45).
  • Psychoeducation: Psychoeducation revolves around providing comprehensive knowledge about the condition and its management. This understanding equips individuals and their support networks with the tools to identify early signs of mood disturbances and effectively manage them (46, 47).
  • Interpersonal and Social Rhythm Therapy: This therapy focuses on regulating daily routines, including sleep patterns, eating habits, and exercise regimens. By achieving balance in these fundamental aspects of daily life, individuals may experience fewer mood fluctuations and milder symptoms over time (48).

By incorporating various therapeutic techniques, individuals might improve their quality of life and better navigate the complexities of this condition.

Other Treatment Options

In addition to traditional approaches, individuals might discover alternative treatments beneficial in managing their bipolar symptoms:

  • Light therapy: Recognized as an effective evidence-based treatment for seasonal affective disorder (SAD) (49), light therapy proves beneficial for many individuals experiencing seasonal worsening of depression or SAD during winter months. It can also be employed to address milder forms of seasonal exacerbation of bipolar depression (50).
  • Electroconvulsive therapy (ECT): This brain stimulation procedure is considered when conventional treatments fail to alleviate severe bipolar symptoms. Health care providers may contemplate ECT for cases requiring swift response, such as individuals with high suicide risk or catatonia, a state of unresponsiveness (51).

Consulting healthcare professionals and considering various therapies may lead to effective symptom management and improved quality of life.

Natural Remedies

While natural remedies may offer some relief, it’s crucial to consult with your healthcare provider before incorporating them into your treatment plan. Natural remedies could potentially interact with prescribed medications, so your doctor’s guidance is essential.

Here is one natural option that might assist in stabilizing mood and reducing bipolar disorder symptoms, when used in conjunction with medication and therapy:

  • Omega-3: Research from 2016 suggests that omega-3 supplements may have a positive impact on symptoms of bipolar I. However, a more recent study in 2021 found limited evidence supporting its effectiveness in treating depression symptoms associated with bipolar disorder (52).

Remember, before trying any other herbal or natural remedies for managing bipolar symptoms, it’s crucial to seek guidance from your healthcare provider. It’s advisable to prioritize open communication with your doctor to ensure safe and effective treatment strategies tailored to your unique needs.

Lifestyle Changes

Managing bipolar disorder involves a combination of treatments, and lifestyle changes might play a role in symptom management. Incorporating certain habits into your daily routine may help alleviate the severity of symptoms, although individual responses may vary. Here are some lifestyle adjustments that may be beneficial:

  • Balanced Diet: Consuming a well-rounded diet rich in nutrients is essential for overall health and may contribute to symptom management in bipolar disorder (53).
  • Regular Exercise: Engaging in physical activity has been associated with potential benefits in managing bipolar symptoms (54).
  • Counseling or Therapy: Regular counseling or therapy sessions may provide support and coping strategies for individuals living with bipolar disorder (55).
  • Weight Management: Maintaining a healthy weight through diet and exercise might positively impact overall well-being and potentially alleviate some symptoms (56).

While these lifestyle changes may offer some relief, it’s important to note that their effectiveness may vary from person to person. Research suggests that while they may help in symptom management, they may not be sufficient as standalone treatments.

Combining lifestyle modifications with other therapies prescribed by healthcare professionals may yield better outcomes in managing bipolar disorder.

Bipolar Disorder Prevention

While it may not be possible to prevent mood episodes entirely or prevent the disorder from developing, there are steps individuals might take to reduce the severity of episodes and lower the risk of future occurrences.

Recognizing the symptoms of bipolar disorder is crucial for early intervention. If you or someone you know is experiencing symptoms such as extreme mood fluctuations, changes in sleep patterns, or unusual energy levels, reaching out to a healthcare professional is essential.

Seeking help from a doctor or therapist as soon as symptoms are noticed might significantly improve outcomes. Encouraging loved ones to seek support and reassuring them of your understanding and assistance may also make a difference.

Building a Support Team

Managing bipolar disorder often involves a multidisciplinary approach. Building a support team that may include:

  • Your primary care physician
  • A therapist or counselor for talk therapy
  • A psychiatrist for medication management
  • Other specialists like sleep experts or alternative therapists
  • Participating in bipolar disorder support groups may also provide valuable peer support and coping strategies.

Finding Effective Treatments

Treatment for bipolar disorder varies from person to person, and it may take some trial and error to find what works best. Medications and therapies that are effective for one individual may not be as beneficial for another. This underscores the importance of open communication with your care team about treatment outcomes and preferences (57).

Exploring different treatment options and being honest about their effectiveness is key to managing the condition effectively.

Conclusion

Living with bipolar disorder might be challenging, and it’s essential to treat oneself with kindness and understanding. Remember that the condition is not a result of personal failure or weakness. Feeling frustrated when treatment doesn’t yield immediate results is normal, but practicing patience and self-compassion might make the journey more manageable.

In conclusion, managing bipolar disorder involves a combination of early intervention, seeking support from healthcare professionals, exploring various treatment options, and practicing self-compassion. While there’s no guaranteed way to prevent the disorder, proactive steps can significantly improve quality of life and reduce the impact of mood episodes.