Bipolar disorder | NAMI: National Alliance on Mental Illness

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Note:Contentincludesdiscussionsontopicssuchassuicideattemptsandmaybetriggering.   Bipolardisorderisamentalillnessthatcausesdramaticshiftsinaperson’smood,energyandabilitytothinkclearly.Peoplewithbipolarexperiencehighandlowmoods—knownasmaniaanddepression—whichdifferfromthetypicalups-and-downsmostpeopleexperience. Theaverageage-of-onsetisabout25,butitcanoccurintheteens,ormoreuncommonly,inchildhood.Theconditionaffectsmenandwomenequally,withabout2.8%oftheU.S.populationdiagnosedwithbipolardisorderandnearly83%ofcasesclassifiedassevere. Ifleftuntreated,bipolardisorderusuallyworsens.However,withagoodtreatmentplanincludingpsychotherapy,medications,ahealthylifestyle,aregularscheduleandearlyidentificationofsymptoms,manypeoplelivewellwiththecondition. Symptoms Symptomsandtheirseveritycanvary.Apersonwithbipolardisordermayhavedistinctmanicordepressedstatesbutmayalsohaveextendedperiods—sometimesyears—withoutsymptoms.Apersoncanalsoexperiencebothextremessimultaneouslyorinrapidsequence. Severebipolarepisodesofmaniaordepressionmayincludepsychoticsymptomssuchashallucinationsordelusions.Usually,thesepsychoticsymptomsmirroraperson’sextrememood.Peoplewithbipolardisorderwhohavepsychoticsymptomscanbewronglydiagnosedashavingschizophrenia. Mania. Tobediagnosedwithbipolardisorder,apersonmusthaveexperiencedatleastoneepisodeofmaniaorhypomania.Hypomaniaisamilderformofmaniathatdoesn’tincludepsychoticepisodes.Peoplewithhypomaniacanoftenfunctionwellinsocialsituationsoratwork.Somepeoplewithbipolardisorderwillhaveepisodesofmaniaorhypomaniamanytimesthroughouttheirlife;othersmayexperiencethemonlyrarely. Althoughsomeonewithbipolarmayfindanelevatedmoodofmaniaappealing—especiallyifitoccursafterdepression—the“high”doesnotstopatacomfortableorcontrollablelevel.Moodscanrapidlybecomemoreirritable,behaviormoreunpredictableandjudgmentmoreimpaired.Duringperiodsofmania,peoplefrequentlybehaveimpulsively,makerecklessdecisionsandtakeunusualrisks. Mostofthetime,peopleinmanicstatesareunawareofthenegativeconsequencesoftheiractions.Withbipolardisorder,suicideisanever-presentdangerbecausesomepeoplebecomesuicidaleveninmanicstates.Learningfrompriorepisodeswhatkindsofbehaviorsignals“redflags”ofmanicbehaviorcanhelpmanagethesymptomsoftheillness. Depression. Thelowsofbipolardepressionareoftensodebilitatingthatpeoplemaybeunabletogetoutofbed.Typically,peopleexperiencingadepressiveepisodehavedifficultyfallingandstayingasleep,whileotherssleepfarmorethanusual.Whenpeoplearedepressed,evenminordecisionssuchaswhattoeatfordinnercanbeoverwhelming.Theymaybecomeobsessedwithfeelingsofloss,personalfailure,guiltorhelplessness;thisnegativethinkingcanleadtothoughtsofsuicide. Thedepressivesymptomsthatobstructaperson’sabilitytofunctionmustbepresentnearlyeverydayforaperiodofatleasttwoweeksforadiagnosis.Depressionassociatedwithbipolardisordermaybemoredifficulttotreatandrequireacustomizedtreatmentplan. Causes Scientistshavenotyetdiscoveredasinglecauseofbipolardisorder.Currently,theybelieveseveralfactorsmaycontribute,including: Genetics.Thechancesofdevelopingbipolardisorderareincreasedifachild’sparentsorsiblingshavethedisorder.Buttheroleofgeneticsisnotabsolute:Achildfromafamilywithahistoryofbipolardisordermayneverdevelopthedisorder.Studiesofidenticaltwinshavefoundthat,evenifonetwindevelopsthedisorder,theothermaynot. Stress.Astressfuleventsuchasadeathinthefamily,anillness,adifficultrelationship,divorceorfinancialproblemscantriggeramanicordepressiveepisode.Thus,aperson’shandlingofstressmayalsoplayaroleinthedevelopmentoftheillness. Brainstructureandfunction.Brainscanscannotdiagnosebipolardisorder,yetresearchershaveidentifiedsubtledifferencesintheaveragesizeoractivationofsomebrainstructuresinpeoplewithbipolardisorder. Diagnosis Todiagnosebipolardisorder,adoctormayperformaphysicalexamination,conductaninterviewandorderlabtests.Whilebipolardisordercannotbeseenonabloodtestorbodyscan,thesetestscanhelpruleoutotherillnessesthatcanresemblethedisorder,suchashyperthyroidism.Ifnootherillnesses(ormedicinessuchassteroids)arecausingthesymptoms,thedoctormayrecommendmentalhealthcare. Tobediagnosedwithbipolardisorder,apersonmusthaveexperiencedatleastoneepisodeofmaniaorhypomania.Mentalhealthcareprofessionalsusethe DiagnosticandStatisticalManualofMentalDisorders (DSM)todiagnosethe“type”ofbipolardisorderapersonmaybeexperiencing.Todeterminewhattypeofbipolardisorderapersonhas,mentalhealthcareprofessionalsassessthepatternofsymptomsandhowimpairedthepersonisduringtheirmostsevereepisodes. FourTypesofBipolarDisorder BipolarIDisorder isanillnessinwhichpeoplehaveexperiencedoneormoreepisodesofmania.MostpeoplediagnosedwithbipolarIwillhaveepisodesofbothmaniaanddepression,thoughanepisodeofdepressionisnotnecessaryforadiagnosis.TobediagnosedwithbipolarI,aperson’smanicepisodesmustlastatleastsevendaysorbesoseverethathospitalizationisrequired. BipolarIIDisorder isasubsetofbipolardisorderinwhichpeopleexperiencedepressiveepisodesshiftingbackandforthwithhypomanicepisodes,butnevera“full”manicepisode. CyclothymicDisorderorCyclothymiaisachronicallyunstablemoodstateinwhichpeopleexperiencehypomaniaandmilddepressionforatleasttwoyears.Peoplewithcyclothymiamayhavebriefperiodsofnormalmood,buttheseperiodslastlessthaneightweeks. BipolarDisorder,“otherspecified”and“unspecified” iswhenapersondoesnotmeetthecriteriaforbipolarI,IIorcyclothymiabuthasstillexperiencedperiodsofclinicallysignificantabnormalmoodelevation. Treatment Bipolardisorderistreatedandmanagedinseveralways: Psychotherapy, suchas cognitivebehavioraltherapyandfamily-focusedtherapy. Medications, suchas moodstabilizers,antipsychoticmedicationsand,toalesserextent,antidepressants. Self-managementstrategies,likeeducationandrecognitionofanepisode’searlysymptoms. Complementaryhealthapproaches, suchasaerobicexercisemeditation,faithandprayercansupport,butnotreplace,treatment. ThelargestresearchprojecttoassesswhattreatmentmethodsworkforpeoplewithbipolardisorderistheSystematicTreatmentEnhancementforBipolarDisorder,otherwiseknownasStep-BD.Step-BDfollowedover4,000peoplediagnosedwithbipolardisorderovertimewithdifferenttreatments. RelatedConditions Peoplewithbipolardisordercanalsoexperience: Anxiety Attention-deficithyperactivitydisorder(ADHD) Posttraumaticstressdisorder(PTSD) Substanceusedisorders/dualdiagnosis Peoplewithbipolardisorderandpsychoticsymptomscanbewronglydiagnosedwithschizophrenia.BipolardisordercanbealsomisdiagnosedasBorderlinePersonalityDisorder(BPD). Theseotherillnessesandmisdiagnosescanmakeithardtotreatbipolardisorder.Forexample,theantidepressantsusedtotreatOCDandthestimulantsusedtotreatADHDmayworsensymptomsofbipolardisorderandmayeventriggeramanicepisode.Ifyouhavemorethanonecondition(calledco-occurringdisorders),besuretogetatreatmentplanthatworksforyou.   ReviewedAugust2017 CallortexttheNAMIHelpline at800-950-6264, orchatwithus, M-F,10a.m.-10p.m.ET.  Inacrisis?Callortext988. 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