Bipolar Mood Disorder
Overview
Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience. The range of mood changes can be extreme. In manic episodes, someone might feel very happy, irritable, or “up,” and there is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent, or hopeless, in combination with a very low activity level. Bipolar disorder is an episodic mental disorder (which means occurring occasionally and at irregular intervals). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.
People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behavior change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.
Symptoms & Signs
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. Episodes may last for several days or weeks.
| People having a manic episode may: | People having a depressive episode may: |
|---|---|
| Feel very “up,” “high,” elated, or irritable or touchy | Feel very sad, “down,” empty, worried, or hopeless |
| Feel “jumpy” or “wired” | Feel slowed down or restless |
| Have a decreased need for sleep | Have trouble falling asleep, wake up too early, or sleep too much |
| Have a loss of appetite | Decreased or increased appetite |
| Talk very fast about a lot of different things | Have trouble concentrating or making decisions |
| Feel like their thoughts are racing | Have trouble concentrating or making decisions |
| Think they can do a lot of things at once | Feel unable to do even simple things |
| Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex | Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”) |
| Feel like they are unusually important, talented, or powerful | Feel hopeless or worthless, think about death or suicide |
Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.
Diagnosis
Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a psychiatrist is the first step. The doctor can order medical tests to rule out other conditions and conduct an evaluation for confirming diagnosis and put an integrative treatment plan.
Bipolar and Other Conditions: Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a doctor to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as:
- Psychosis: Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood.
- Anxiety: It is common for people with bipolar disorder to also have an anxiety disorder.
- Attention-Deficit Hyperactivity Disorder (ADHD): It is common for people with bipolar disorder to also have ADHD.
- Misuse of Drugs or Alcohol: People with bipolar disorder may misuse drugs and engage in other high-risk behaviors at times of impaired judgment during manic episodes.
Treatments
Bipolar disorder symptoms commonly improve with treatment. Medication is the cornerstone of bipolar disorder treatment, while talk therapy (psychotherapy) can help many patients learn about their illness and adhere to medications, preventing future mood episodes. An effective treatment plan usually includes a combination of medication and psychotherapy.
- Medications: Medications known as “mood stabilizers” (e.g., lithium) are the most commonly prescribed type of medications for bipolar disorder. These medications are believed to correct imbalanced brain signaling. Because bipolar disorder is a chronic illness in which mood episodes typically recur, ongoing preventive treatment is recommended. Bipolar disorder treatment is individualized; people with bipolar disorder may need to try different medications before finding what works best for them.
- Psychotherapy: such as cognitive behavioral therapy, family-focused therapy, and self-management strategies like education and recognition of an episode’s early symptoms.
Since bipolar disorder can cause serious disruptions in a person’s daily life and create a stressful family situation, family members may also benefit from therapy and psycho-education. Families can learn strategies for coping, participating actively in the treatment, and obtaining support.
What Causes Bipolar Disorder?
Researchers have not discovered a single cause of bipolar disorder. Currently, they believe several factors may increase the risk of developing bipolar disorder or can act as a trigger for the first episode:
- Having a first-degree relative (a parent or sibling) with bipolar disorder
- Periods of high stress, like the death of a loved one, childhood emotional abuse or another traumatic event
- Subtle differences in the average levels or activation of some chemical signals in the brain.
- Drug misuse
Can I Stop Medication Once Symptoms Are Under Control?
Taking medication for bipolar disorder acts preventatively to help people avoid future manic or depressive episodes. Always consult with your doctor before starting or stopping any new medications.
While medication is often the first line treatment for bipolar disorder, psychological therapies, such as cognitive behavioral therapy, family-focused therapy and interpersonal therapy have been shown to help reduce symptoms and risk of future episodes.
The combination of therapy and medication is widely considered to be the most effective and enduring treatment. Experts also recommend self-help strategies, including education, sleep hygiene, symptom monitoring, meditation and maintaining good social support.
Are People with Bipolar Disorder Just Moody?
The extreme highs and lows of bipolar disorder are vastly different from mood swings or moodiness. People with bipolar disorder experience severe changes in energy, activity and sleep.
While people with bipolar disorder do experience extreme highs and lows, these are very different from the mood fluctuations we all experience. Waking up happy, getting exhausted and irritable midday and having a good evening that leaves you feeling happy again doesn't mean you have bipolar disorder. It doesn't matter how often this happens to you.
Clinicians look for groups of symptoms, not just emotions. The hallmark highs and lows of bipolar disorder are extreme, often occur out of context and last for extended periods of time. This experience can be debilitating and often requires hospitalizations