Maybe you’ve heard the term “bipolar” used to describe someone who’s moody, or who has mood swings, but this colloquial use of the term is different from bipolar disorder. Bipolar disorder, which used to be called manic depression, is a serious mental illness that causes a person to have dramatic shifts in emotions, mood, and energy levels: moving from extreme lows to extreme highs. These shifts don’t happen moment to moment, they usually happen over several days or weeks. There are a few different types of bipolar disorders, but there are some common features. First, the low moods are identical to those in a related disorder – major depressive disorder, also known as unipolar depression. Individuals with this can feel hopeless and discouraged, lack energy and mental focus, and can have physical symptoms like eating and sleeping too much or too little.
Along with these lows, the thing that sets bipolar disorders apart from unipolar depression is that individuals can have periods of high moods, which are called manic episodes or hypomanic episodes, depending on their level of severity. In a manic state, people can feel energetic, overly happy or optimistic, even euphoric with high self-esteem. On the surface, these might seem like very positive characteristics, but when an individual is in a full manic episode, these symptoms can reach a dangerous extreme. A person experiencing mania might invest all their money in a risky business venture or behave recklessly. Individuals might talk pressured speech, where they talk constantly at a rapid-fire pace, or they might have racing thoughts and might feel ‘wired,’ as if they don’t need sleep. Manic episodes can also include delusions of grandeur, for example they might believe that they are on a personal mission from God, or that they have supernatural power. They might make poor decisions without any regard for later consequences.
One way to understand these mood swings is by charting them on a graph. If Y-axis is mood, with mania and depression being on the far ends of the axis, and the X-axis is time. The average healthy individual might have normal ups and downs throughout their life, and they might even have some serious lows once-in-awhile, maybe after losing a job or moving to a new place and feeling lonely. An individual with unipolar depression though, might have the normal highs, but they might have some crushing lows that last for a long period of time and may not have an obvious trigger.
There are roughly three variations of Bipolar Disorder: the first is called Bipolar 1. These are people that have some major lows that last at least 2 weeks, and some major highs that last at least a week or require hospitalization. Untreated manic episodes can last 3-6 months. Depression is seen in most cases, but is not required for a diagnosis. The second one is called Bipolar 2, and this is when a person experiences similar lows, and has additional highs called “hypomania”, which are less severe manic episodes than we see in Bipolar 1. To qualify for a diagnosis, these hypomanic states need to last at least four days. Once again though, these symptoms generally last a few weeks to a few months. The third one is called Cyclothymia, or sometimes Cyclothymic Disorder, these individuals have milder lows, as well as milder highs, or “hypomania” like you see in Bipolar 2, and they cycle back and forth between these two quickly over a longer period of time.
Sometimes, people with bipolar disorder can show other, less common symptoms as well, for example having what are referred to as Mixed Episodes — experiencing symptoms of both depression and mania at the same time. Another symptom they might have is rapid cycling, which describes a situation where a person has four or more episodes of depression or mania within a given year. Like most mental health conditions, the exact underlying cause of bipolar disorder isn’t known, and there is no single “bipolar gene” identified, but it’s thought that there are genetic and environmental factors that play a part. For example, one interesting clue is that people with family members who have bipolar disorder are ten times more likely to have it themselves. Another clue is that some drugs and medications can trigger manic episodes, like selective serotonin reuptake inhibitors (or SSRIs).
It’s also worth mentioning that people with bipolar disorder often have other disorders like anxiety disorders, substance use disorders, ADHD and personality disorders as well — making diagnosis and treatment a real challenge. Even though there’s no cure for bipolar disorder, identifying and treating individuals is important, since there’s a real danger that the person could harm themselves or commit suicide. One of the oldest treatments is also one of the most effective treatments, and that’s lithium salts. Lithium acts as a mood stabilizer—smoothing out the highs and lows they experience. That said, it is much better at treating manic rather than depressive episodes, and so individuals who take it often must take other medications as well, which can be problematic since some antidepressants (like the SSRIs) can trigger manic episodes in individuals who are predisposed to them.
Other treatment options include antipsychotics, anticonvulsants, and benzodiazepines, but many of these — including lithium — have side effects that can be severe and lead to non-adherence, which can be dangerous for an individual. Unlike certain disorders like unipolar depression, psychological interventions, talk therapy, or cognitive-behavioral therapy, are not particularly effective in treating the manic episodes of bipolar disorder. Having said that, they can still be very helpful tools to help individuals with bipolar disorder in general, especially after a manic episode has ended. They can also help an individual handle stressful situations that might otherwise lead to a manic episode, thereby helping to prevent a potential episode in the first place.