There are four basic types of bipolar disorder, but all involve clear mood, energy, and activity changes. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep accompany mood episodes.
People having manic episodes may
People having depressive episodes may
Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This 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. Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel anything is wrong, but family and friends may recognize the mood swings and/or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.
Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. Talking with a doctor or other licensed mental health professional is the first step for anyone who thinks he or she may have bipolar disorder. The doctor can complete a physical exam to rule out other conditions. If other illnesses do not cause the problems, the doctor may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
People with bipolar disorder are more likely to seek help when depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. They may, however, experience some manic symptoms simultaneously, also known as major depressive disorder with mixed features.
Bipolar Disorder & Other Illnesses
Some bipolar disorder symptoms are similar to other illnesses, making it hard for a doctor to diagnose. In addition, many people have bipolar disorder along with other illnesses such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.
Psychosis: Sometimes, a person with severe mania or depression also has psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:
As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.
Anxiety and ADHD: Anxiety disorders and attention–deficit hyperactivity disorder (ADHD) are often diagnosed among people with bipolar disorder.
Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends, and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.
Scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, it is likely that many factors contribute to the illness or increase risk.
Brain Structure and Functioning: Some studies show how people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Learning more about these differences and new information from genetic studies helps scientists better understand bipolar disorder and predict which treatment will work most effectively.
Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, even though identical twins share the same genes.
Family History: Bipolar disorder tends to run in families. Children with a parent or sibling with bipolar disorder are much more likely to develop the illness compared with children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the illness.
Treatment helps many people—even those with the most severe forms of bipolar disorder—gain better control of their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of medication and psychotherapy. However, the depression that occurs in bipolar disorder has proven difficult to treat with conventional medications and psychotherapy. TMS and ketamine work in unique ways and can be effective treatments for bipolar depression. These treatments are more effective than conventional medications. Both ketamine and TMS address the brain areas most commonly associated with bipolar depression. Ketamine works chemically, while TMS works electromagnetically to rewire the brain, diverting regions and actions closely linked with bipolar disorder.
Medications generally used to treat bipolar disorder include:
Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track and treat bipolar disorder most effectively.