Bipolar disorder is a chronic psychiatric disorder characterized by episodes of elevated mood, typically alternating with episodes of depression. For most people, bipolar disorder is a lifelong condition requiring ongoing treatment. The American Psychiatric Association (APA) recognizes three primary types of bipolar disorder, which all involve distinct changes in mood, energy and activity levels. Although the different types have specific defining characteristics, there are some basic similarities. Bipolar mania manifests in manic episodes in which people feel exuberantly joyful or uncomfortably irritable. Bipolar depression manifests in depressive episodes in which people experience desperate sadness or hopelessness. The three types are as follows:
Bipolar I disorder: This is characterized by one or more manic episodes or mixed episodes (symptoms of both mania and depression) lasting at least seven days. Typically, a person will also experience periods of depression with episodes lasting at least two weeks. It is common for episodes to be so severe that immediate hospitalization is warranted.1
Bipolar II disorder: This is characterized by a pattern of one or more major depressive episodes and at least one hypomanic episode. Individuals do not experience the full-blown manic episodes that are indicative of bipolar 1. This type is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported.1
Cyclothymic disorder: This is a milder type defined by numerous alternating periods of hypomanic and depressive symptoms. The episodes generally have a duration of at least two years in adults and one year in children and adolescents. The severity of this type may change over time.1
There are several other terms commonly used to further define bipolar disorder. Cases that do not follow the above patterns are known as “not otherwise specified.” The term “rapid cycling” is used to describe four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling produces unusually frequent shifts in mood, can affect individuals with any of the three types and may be temporary.1 While mixed bipolar disorder is not a type, the term is often used to indicate people who have episodes of mania with additional symptoms of depression — or, conversely, episodes of depression with additional symptoms of mania. The APA changed its official diagnostic term from “mixed episodes” to “mixed features” in 2013.2
People with bipolar disorder experience mood episodes, unusually intense periods of emotion, changes in sleep patterns and activity levels and unusual behaviors. Symptoms are classified under manic and depressive episodes.
Like other mental illnesses, there is no single physical or lab test used to diagnosis bipolar disorder. Written guidelines exist to document the severity and number of symptoms, but a thorough clinical interview with a mental health professional is necessary for accurate diagnosis.
Untreated bipolar disorder can result in devastating consequences for the individual and those closest to them. Treatment serves multiple purposes including:
It is common for episodes to be so severe that immediate hospitalization is warranted. There are several advantages to inpatient treatment, including:
Guarding the safety of the individual and others while stabilizing the disorder
Enabling 24/7 observation and the following benefits:
Ensures an accurate diagnosis
Provides the attending psychiatrist with the opportunity to analyze the effectiveness and side effects of medication
Gives the individual a break from outside stressors, helping to facilitate stabilization and recovery
Provides intensive treatment over a short period of time, including both group and individual therapy
Although depression, anxiety and many other psychiatric disorders can often be effectively treated with psychotherapy alone, bipolar disorder treatment generally requires medication. Mood stabilizers play a key role in preventing or reducing the risk of recurring episodes. Antipsychotics and antidepressants are also commonly used in treatment.
Mood stabilizers — Lithium is one of the most commonly prescribed mood stabilizers for the treatment of bipolar disorder. Anticonvulsants such as valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro and others) and lamotrigine (Lamictal) are often effective for controlling manic and depressive episodes.8
Antidepressants — Many individuals with bipolar I disorder are prescribed antidepressant medications, in particular selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Zoloft and Prozac. An antidepressant can sometimes trigger a manic episode, so it is usually prescribed along with a mood stabilizer or antipsychotic.8
Antipsychotics — Atypical antipsychotics help reduce psychotic symptoms that often occur during a manic episode. Some antipsychotics have been approved specifically for the treatment of bipolar mania, while others primarily target bipolar depression. Antipsychotic medications such as olanzapine (Zyprexa), risperidone (Risperdal), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may be prescribed alone or in combination with a mood stabilizer. Quetiapine (Seroquel) is approved for mania and the “maintenance” treatment of bipolar disorder.8
Antidepressant-antipsychotic — Symbyax is a combination of the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. It is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.8
A large scale study of 21,000 adults treated in the U.K. for major (unipolar) depression between 2006 and 2013 yielded evidence of unintentional consequences. In this group, the most commonly prescribed antidepressants were SSRIs (35.5%); mirtazapine (9.4%); venlafaxine (5.6%) and tricyclics (4.7%). Previous treatment with certain antidepressants was associated with a 1.3% to 1.9% risk of a subsequent diagnosis of bipolar disorder and/or mania. Although this was low, further analysis revealed a 34% to 35% increased risk in individuals taking SSRIs and venlafaxine.9
Psychotherapy is often done on an individual basis, although couples and family therapy can be extremely beneficial. Understanding the disorder helps family members be more supportive and intervene when episodes occur. Since stress is often a trigger for manic episodes, therapy can help individuals learn to manage stress and keep future episodes at bay or to a minimum. Therapy can also help individuals identify mood triggers and manage symptoms when they occur.
It is common for individuals with serious psychiatric disorders to feel misunderstood, stigmatized and isolated. Group therapy provides a sense of community, the opportunity to share similar experiences and additional support for each participant. All of these elements can be beneficial to people suffering from a serious mental illness such as bipolar disorder.
Electrical currents are passed through the brain, which are thought to affect levels of neurotransmitters. ECT may be used for immediate relief of severe treatment-resistant depression. ECT is typically used in people whose symptoms do not improve with medications, those who cannot take antidepressants for health reasons or people at high risk of suicide. Physical side effects include headache and temporary memory loss.8
TMS may be an option for people who do not respond to antidepressants. The individual sits in a reclining chair with a treatment coil placed against the scalp. The coil sends brief magnetic pulses to stimulate nerve cells in the brain involved in mood regulation and depression. Typically, a person receives five treatments every week for up to six weeks.8
If you suspect you have undiagnosed bipolar disorder, talk to your doctor or set up an appointment with a psychiatrist for an evaluation as soon as possible. With proper treatment, good self-care and diligent stress management, many people with bipolar disorder live happy, fulfilling lives.
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