Overview

Bipolar disorder (formerly called manic-depressive illness or manic depression) causes extreme mood swings, varying from emotional highs and lows, leading to inability to carry out day-to-day tasks.

When depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly.

These episodes of mood swings can last for several days and may occur rarely or multiple times a year.

There are three main types of bipolar disorder.

  • Bipolar I Disorder— defined by manic episodes that last at least 7 days, or the symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting for at least 2 weeks.
  • Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
  • Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a manic episode and a depressive episode.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.

Sometimes people experience both manic and depressive symptoms at the same time. 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.

Co-existing/Co-morbid Disorders

Some bipolar disorder symptoms are like those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as an anxiety disorder, substance use disorder, or an eating disorder.

People with bipolar disorder have an increased chance of having thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. It is common for people with bipolar disorder to also have ADHD.

Risk Factors

There is no single cause, and it is likely that many factors contribute to a person’s chance of having the illness.

  • Brain Structure and Functioning: Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder.
  • Genetics: Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder.

Treatments and Therapies

An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.”

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Medications

Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include symptomatic medications that target sleep or anxiety. At times we have to use antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

Psychotherapy

Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Treatment may include therapies such as cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT) and family-focused therapy.
It is important to provide psychoeducation to the family members.

Other Treatment Options

Some people may find other treatments helpful in managing their bipolar symptoms, including:

Electroconvulsive Therapy (ECT): ECT is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder.

Transcranial magnetic stimulation (TMS): TMS is a newer approach to brain stimulation that uses magnetic waves.

Holistic and lifestyle changes

  • Getting regular exercise such as brisk walk, swimming, jogging etc. helps with anxiety and depression and promote sleep in addition to the physical benefits of work out
  • Yoga and anaerobic exercise have also shown beneficial effects on mental health
  • Keep a mood log
  • Be mindful of your triggers and warning signs
  • Eat healthy and nutritious diet
  • Maintain regular follow ups with your care providers
  • Take all medicines as prescribed, consult your doctor before making any medicine changes
  • Avoid misuse of alcohol or other drugs
  • Adopt good sleep habits
  • Mindful breathing