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Understanding Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Bipolar disorder (BPD) is a common mental health condition that causes large swings in a person’s moods. These mood swings are different from typical changes in mood.1,2

Bipolar disorder is also called bipolar affective disorder. It used to be called manic depression. This name described the dramatic shifts between high moods (mania) and low moods (depression) common to the illness. In addition to mood swings, BPD also affects a person’s energy levels and ability to think clearly.1,2

Seven out of 10 people with BPD are diagnosed between the ages of 15 and 25. But some people are diagnosed as a child or after the age of 45. The condition occurs equally in all genders, races, and ethnicities. It occurs at the same rate in urban and rural areas. More than 8 out of 10 cases are considered severe.1,2

Types of bipolar disorder

Doctors believe a combination of genetics, environment, and stressful life events lead to BPD. There are different types of BPD, including:1,2

  • Bipolar 1 disorder (BD-I) – Includes alternating episodes of mania, hypomania (a less severe type of mania), and depression
  • Bipolar 2 disorder (BD-II) – Features severe depression with hypomania
  • Cyclothymic disorder, or cyclothymia – Includes many periods of hypomania and less severe depression
  • Bipolar disorder, other specified or unspecified – Bipolar symptoms that do not meet other definitions

BPD can be difficult to diagnose. This is because the symptoms may be confused with those of other mental health conditions. Most people do not get an accurate diagnosis until 6 to 10 years after their symptoms begin.2

Symptoms of bipolar disorder

The most common symptoms of BPD are mania and depression. Mania involves unusually high moods and energy levels. In its most severe state, mania may include delusions or hallucinations. Delusions are strongly held beliefs that are untrue. Hallucinations are sensory perceptions of things that do not exist. Episodes of mania last for several days or longer.1,2

A person with BPD may also experience hypomania. This is less severe mania that does not include delusions or hallucinations.1

The mania stage may then cycle into depression. The depression may be so severe that the person cannot get out of bed or make basic decisions. Symptoms and their severity vary from person to person.1,2

Misdiagnosis of BPD is common. The delusions and hallucinations of severe mania may lead to a schizophrenia diagnosis. On the other hand, people in the depressive stage may be diagnosed with severe depression (major depressive disorder).2

Misdiagnosis may lead to treatments that make bipolar symptoms worse, not better. BPD usually gets worse if untreated. People with BPD have a high risk of suicide, even during manic phases.1,2

Treatments for bipolar disorder

There are effective treatments to help control bipolar symptoms. In general, most people need a combination of therapy, prescription drugs, and lifestyle changes to maintain their quality of life. Treatment ranges from hospitalization for severe episodes to maintenance treatment for less severe symptoms. But it is almost always lifelong.1,2

Talk therapy

Talk therapy may also be called counseling or psychotherapy. In therapy, a mental health professional can help a person with BPD recognize the early signs of mania or depression. Then, the person can seek treatment or extra support. A therapist can also help manage suicidal thoughts.1

Therapy can help a person process the stressful life events that can trigger bipolar episodes, too. These events may include childhood mistreatment, death of a loved one, unemployment, pregnancy, or physical disability.2

Prescription drugs and other treatments

Mood stabilizers and antipsychotic medicines are the drugs most commonly prescribed to manage bipolar symptoms. Antidepressants are prescribed, too, but less often. Electroconvulsive therapy (ECT) may be prescribed to manage mania.2

Lifestyle changes

Lifestyle plays an important role in helping a person with BPD keep their moods balanced. Stress is known to trigger episodes in 6 out of 10 people with the condition. With this in mind, some common recommendations for lifestyle changes are:1,2

  • Maintain a calm environment and a regular schedule of meals, sleep, exercise, and hobbies.
  • Eat a healthy diet, avoid caffeine, and limit alcohol.
  • Take medicines as prescribed.
  • See doctors and therapists regularly to maintain overall health.
  • Practice meditation, prayer, or relaxation techniques to relieve stress.

While lifestyle management is important, it cannot replace the role of prescription drugs and therapy in treating BPD.1,2

Bipolar disorder is a challenging condition to live with. But with treatment, it is possible to maintain your quality of life.

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