Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 7/14/2022
Do you have bipolar disorder? Has someone you love recently (or not-so-recently) been diagnosed with bipolar disorder? If the answer to either of these questions is yes, you probably have a lot of your own questions.
Bipolar disorder is an oft-misunderstood condition — a sort of catchall amateur diagnosis for people who seem “manic.” Popular culture and a regrettable last few decades of playground insults have poorly represented bipolar disorder, and that’s a shame, because the condition does not mean someone is inherently violent, mean, dangerous, erratic or “manic.”
The truth is that you likely know many more people who have bipolar disorder than you think you do — and you likely don’t notice symptoms of the condition in many of those relationships.
Whatever brought you here, we’re happy to let you know that we’ve got the answers you’re seeking. We’re also happy to start by saying that, whatever you’ve heard or seen, you can abandon the negative stigma about this mental health disorder.
Bipolar is a difficult condition to live with, but a lot of great people do just that. Chances are, you just need to get to know the condition better.
Let’s start with introductions.
Bipolar disorder is a mood disorder characterized by a rollercoaster of emotions, both high and low. Also called bipolar affective disorder, and occasionally called bipolar depression, this condition has gone by many names in the past, including manic depression. Signs of bipolar disorder generally start showing in young adulthood, between 18 and 20 years of age.
The roller coaster metaphor is a good one, if a bit overused, because it captures the sometimes-chaotic energy of the mood swings felt by people with bipolar. See, a normal person may have a good day and a bad day, but when a person with bipolar has manic symptoms or depressive symptoms, the intensity of good and bad alike is dialed to extremes.
That may mean a depressive episode is quickly followed by a manic episode, as this rapid cycling of emotional states is a common characteristic of this mental illness. People with bipolar disorder may also have hypomanic periods, which are a milder type of mania.
The extreme moods brought on by severe bipolar episodes can affect a person’s ability to think clearly, affect their judgment, make them irritable or avoidant and in extreme cases, can lead to psychosis and require hospitalization.
But don’t get scared of bipolar disorder — this condition affects at least 2.8 percent of the population in the U.S. alone. We say at least because 83 percent of these cases are classified as “severe,” meaning that many people with more mild versions of the disorder may very well go their entire lives without being diagnosed.
Note that unipolar and bipolar are different.
Bipolar disorder does not appear to have one cause, based on experts’ current understanding of the condition — which is pretty common for mood disorders. But like most other mental disorders, there are several categories of risk factors that might increase a person’s risk of developing bipolar disorder, including stress, genetics and brain health or brain function.
Stress is probably the most straightforward of these to explain — stressful events like illness, financial problems or relationship issues can trigger manic or depressive episodes, which means how a person handles stress (or doesn’t) could be a risk factor for whether they develop bipolar symptoms.
Genetics may be self-explanatory: the idea is that you may have a genetic predisposition to bipolar disorder, determined by the DNA of your immediate family. If your parents or siblings have bipolar, there’s a larger chance you might one day as well. But experts are quick to acknowledge that genetics is not an effective predictor of bipolar, as many children from families with bipolar histories never develop the disorder. One study even saw no correlation in sets of twins.
The final category — brain function and structure — is where we potentially have the most to learn (because we know the least about it). Some researchers have noted identifiable differences in the relative sizes of certain brain structures and how they activate in people with bipolar disorder versus people without the disorder.
But these differences in brain scans have not yet led to a way to diagnose bipolar, and there are currently still unanswered questions about why these differences happen.
Bipolar I is the most common type of bipolar disorder, and is characterized by those episodes of mania we mentioned. Typically, these patients will have depressive episodes as well, though a diagnosis of moderate or severe depression isn’t a requirement for diagnosis. For a diagnosis of bipolar I, manic episodes must last at least a week, or require hospitalization due to severity.
Bipolar II might arguably be called a milder form of bipolar disorder compared to bipolar I. This version of bipolar disorder is not characterized by “full” episodes of manic behavior, but instead by frequent recurring shifts between depressive episodes and manic or hypomanic ones.
You can think of this third, spin-off version of bipolar disorder as a sort of long-term or chronic version of mood shifts between depressed mood and mania. With cyclothymia, people experience mild levels of depression and mania alternating back and forth for at least two years.
That two-year symptom experience can be interrupted for a few weeks where things seem normal, before they’re back to the patterns of mood swings again.
As you might suspect, this final category of bipolar disorder subtypes is the net that catches anything that doesn’t fit into the first three categories.
Unspecified or other types of bipolar disorder occur when a patient doesn’t meet the criteria specified above, but still sees the periods of abnormal mood elevation that represent bipolar symptoms.
Bipolar is a condition that shares symptoms with many other conditions — for example, it has symptoms in common with depression, including fatigue, motivation problems, sleep loss, reckless behavior and a higher risk of substance use disorders.
But symptoms of bipolar disorder can be more specific than frequent changes between an episode of mania and an episode of depression, and commonly include:
Increased risk of suicide
Difficulting making decisions
Obsession with feelings of loss, guilt or failure
Feelings of helplessness
Impaired or poor judgment
The single most telling symptom of bipolar, however, is the oscillation between those high and low mood points — the characteristic shifts between depression and mania.
Mania may manifest as a manic episode (which could be so severe as to become psychotic and necessitate hospitalization), but it commonly appears as hypomania, a milder, psychosis-free version of those extreme highs that doesn’t fully hinder someone’s ability to function.
People suffering from hypomania may be able to function well in social and professional settings.
Manic episodes or hypomanic episodes may happen rarely, and so while one person may be visibly impaired by their bipolar disorder, another may never show signs in their daily lives at all. That’s what makes bipolar so hard to treat. Speaking of, let’s talk about treatment.
Treating bipolar disorder isn’t about making the disorder go away so much as it’s about managing the severity and frequency of mood episodes. If you can take the feelings of mania down from an 11 to a 5 on a 10-point scale, many patients will see great benefits from that.
As such, a treatment plan will be primarily about keeping patients with bipolar disorder safe, ensuring the safety of those around them if need be and otherwise reducing the frequency and severity of episodes of depression and episodes of hypomania.
In the past, mood stabilizers like lithium and carbamazepine, an anticonvulsant medication, have shown to have some benefits for patients, though treatment must be closely monitored.
The most effective treatment results from medication have been seen from combinations of mood stabilizers and antipsychotic medications like lurasidone.
Treatment for bipolar disorder is still a developing field, and some of the go-to medications for regulating bipolar disorder symptoms, like depressive symptoms, aren’t effective on their own.
For instance, there isn’t much evidence that antidepressants are valuable in treating bipolar. In addition, some experts believe antidepressants alone shouldn’t be a treatment for bipolar as they elevate the risk of triggering a manic episode.
Meanwhile, electroconvulsive therapy (what we commonly know as shock therapy) is considered extremely effective for the most treatment-resistant symptoms of bipolar, like life-threatening mania and psychosis.
Finally, there’s psychotherapy. The idea of psychoeducation — learning about bipolar — has been shown to offer significant preventative benefits for patients, and cognitive behavioral therapy and other therapy forms focused on behavioral changes have been shown to benefit daily life function and quality of life.
Regardless of which option might work for you or a loved one with bipolar disorder, that’s a recommendation that a healthcare professional should make. Which leads us to the next steps.
So you or a loved one is showing signs of bipolar disorder. What’s next in fighting this mental health condition?
There are a few things you’ll want to prioritize on your to-do list. The first is getting a formal diagnosis, which will lead to treatment options.
Cards on the table: even with advances in education and medicine, bipolar disorder still has stigma attached to it. It’s unfair, and it’s something that will hopefully continue to change, but in the meantime, it shouldn’t impact your choice to get support.
If you think you might have bipolar disorder, there’s no reason to feel ashamed. There is, however, a reason to get support.
Bipolar disorder can be effectively managed through the variety of treatment options we mentioned above, but those treatment options require the support of a mental health professional or healthcare provider to be successful.
Mental disorders aren’t something you can overcome with force of will, and trying to do so will unfairly set most people up to fail.
Want to learn more about your options? It may be time to start that conversation. Online therapy tools are a great way to do that without even leaving your home. Ready to take that step? Try our therapy today.