Bipolar Disorder: Symptoms and Treatment (Guide for Adult Patients and Loved Ones)

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Bipolar disorder is a type of mental illness characterized by significant and sometimes extreme changes in mood and behavior. Many people with bipolar disorder experience alternating periods of greatly elevated mood (called manic episodes) and greatly lowered mood (called depressive episodes). This is why bipolar disorder used to be referred to as manic depression or manic-depressive disorder.

It is normal to experience mood changes in response to positive or negative life events, or as a result of physiological changes such as hormone fluctuations. By contrast, mood changes associated with bipolar disorder are often extreme, lack any apparent cause, and can significantly alter behavior, energy levels, sleep patterns, and cognitive functioning. Additionally, these mood changes persist for weeks or months before subsiding instead of a few hours or days.

An estimated 1 in 23 adults will be diagnosed with bipolar disorder sometime in their life. Of these people, 83% will experience severe impairment. The average age of onset for bipolar disorder is around age 25. Men and women are equally as likely to develop the disorder, with no major differences observed across genders.

Symptoms and Types

Bipolar disorder can be challenging to diagnose, in part because its symptoms may be similar to those of other disorders like ADHD, depression, anxiety disorders, and conduct disorders. In some cases, symptoms may be very mild and difficult to detect; in others, they may consist of co-occurring manic and depressive qualities.

Generally speaking, a person must experience at least one manic or hypomanic episode in order to be diagnosed with bipolar disorder. Many people who have bipolar disorder also experience depressive episodes, although this is not usually a requirement for diagnosis.

Symptoms of a manic episode may include:

• Intense happiness for extended periods of time
• Extreme irritability, aggressiveness, shortness of temper, or angry outbursts
• More frequent and/or faster speech, especially speech that changes topics rapidly and resists interruption
• Racing thoughts that are difficult to control
• Increased energy levels and decreased need for sleep
• Increased activity, such as working on multiple projects at once
• Difficulty focusing on tasks or a tendency to become distracted
• Excessive interest or participation in risky activities (e.g. reckless driving, spending sprees, abusing alcohol or drugs, or high-risk sexual behaviors)
• Unrealistically high self-esteem or belief in own abilities

Symptoms of a depressive episode may include:

• Persistent sadness, hopelessness, pessimism, or feelings of emptiness
• Feelings of guilt or worthlessness
• Increased irritability, frustration, anger, or restlessness
• Decreased interest in hobbies or inability to enjoy favorite activities
• Decreased energy, fatigue, or persistent boredom
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping or problems with oversleeping
• Social isolation, poor communication skills, and difficulty with relationships
• Inability to meet work and family responsibilities
• Impulsivity or increased participation in high-risk activities
• Reduced sexual desire or problems with sexual performance
• Physical aches, pains, cramps, or digestive issues that do not have a clear physical cause and do not go away with treatment
• Thoughts or expressions of suicide or self-destructive behavior

Psychologists group bipolar disorder into three main types with slightly different symptoms:

➤ Bipolar I Disorder

Individuals with bipolar I disorder experience manic episodes that last at least seven days, with symptoms occurring every day during the episode. Many people with bipolar I also experience depressive episodes that last at least two weeks, with symptoms occurring daily during the episode. It is common for individuals with bipolar I to experience periods of normal mood between manic and depressive episodes.

➤ Bipolar II Disorder

Individuals with bipolar II disorder experience depressive episodes that last at least two weeks in addition to hypomanic episodes. Hypomanic episodes consist of less severe symptoms that do not last as long as in manic episodes. Most people with bipolar II experience periods of normal mood between depressive and hypomanic episodes.

➤ Cyclothymic Disorder (also called Cyclothymia)

Individuals with cyclothymic disorder experience alternating periods of hypomania and mild depression. This pattern must last for at least two years with symptoms never stopping for more than two months at a time. Many people with cyclothymic disorder have symptoms that are mild enough that their daily functioning is not seriously impaired.

Treatments

Bipolar disorder can be extremely challenging to live with, but it is treatable, and individuals who develop the disorder can still have full, normal lives. They just need some help managing their symptoms.

➤ Medication

Several types of psychiatric medication are commonly used to treat bipolar disorder.

Medications known as mood stabilizers are often prescribed to reduce the severity of manic and hypomanic episodes. Because these medications “flatten” the euphoric highs of a manic episode, some individuals may feel reluctant to take them. It is important for persons with bipolar disorder to understand how their manic episodes can be harmful to themselves and others, thereby increasing compliance with medication regimens.

Individuals who experience depressive episodes may be prescribed an antidepressant to manage their symptoms. However, antidepressant medications can sometimes trigger manic episodes, so they are often prescribed alongside a mood stabilizer or antipsychotic medication. Antipsychotics may be prescribed if manic and/or depressive symptoms persist despite treatment with other medications.

It may be necessary to try several different medications or a combination of medications to find a prescription that works for you. In any case, you should speak with your clinician or psychiatrist about the potential benefits and possible negative side effects before starting any medication regimen.

➤ Therapy and Skills Training

Professional therapy and counseling are typically used alongside medication to treat bipolar disorder. Treatments like individual therapy, group therapy, and skills training can help individuals learn how to manage symptoms of bipolar disorder.

Some common therapeutic practices include:

• Teaching you about bipolar disorder and what it means.
• Talking about the way you think about yourself and how these thoughts make you feel. When talking about these thoughts, the therapist may be able to help change them and help you feel differently.
• Encouraging you to pay attention to your thoughts, feelings, and behaviors and to connect those to feelings of mania or depression.
• Looking at your hobbies and interests and working on ways for you to participate in them while enjoying yourself.
• Talking about whom you feel close to and the different relationships in your life, and discussing how these relationships can create stability and ease feelings of depression.
• Guiding you through relaxation, meditation, and deep breathing techniques, and teaching you how to perform these techniques on your own.
• Coaching you on how best to take care of your personal health, including how to keep a healthy diet, get enough exercise, and maintain a consistent sleep schedule.

Supporting a Loved One with Bipolar Disorder

If you know someone who has bipolar disorder or whom you suspect may have bipolar disorder, then you might be looking for ways to help and support them. Family members, friends, and other supporters can be great sources of strength for individuals living with bipolar disorder.

The following section includes tips that can be helpful for supporting someone with bipolar disorder. Keep in mind they might not all be right for you and your loved one, but it could be useful to give them a try.

➤ Educate yourself

Stay informed about what bipolar disorder is, what it looks like, and how it can affect your loved one. Encourage them to become educated about bipolar disorder if they have not done so already.

➤ Express your support

Let your loved one know that you care about them, are concerned for their well-being, and are there to support them. This can help quiet any doubts they may have and reassure them that you are on their side.

➤ Advocate for treatment

Ask your loved one if they are seeking help for their disorder. If they are not, express to them why you think professional treatment could be helpful. Offer to help them find treatment if they would like you to.

➤ Listen

Ask how your loved one is feeling, and listen to what they tell you. Don’t try to guide the conversation too much or downplay their challenges. Sometimes people just need to be heard, and they will notice whether or not you are truly listening.

➤ Offer to help with tasks

Ask your loved one if there are any daily tasks or obligations you can assist with. This can be helpful if their disorder makes certain tasks difficult for them, or if they are short on time because of their treatment schedule.

➤ Give them space

Give your loved one space when they need it. Do not push them to talk about their disorder or treatment if they don’t want to. Avoid prying into intimate details if they seem reluctant to share with you. Respect their emotional boundaries.

➤ Involve them in plans

Invite your loved one to join in social events and gatherings, either with a group or just between the two of you. Continue to socialize with them as you have in the past. This will help reassure them that your relationship has not changed because of their disorder.

➤ Treat them with respect

Your loved one has not changed just because they are experiencing a mental health disorder. They are still the same person they were before. Treat them with the same respect and dignity you would anyone else, and do not patronize or talk down to them.

➤ Take care of yourself

Your well-being matters just as much as your loved one’s. Know your limits and seek support if you need it. Join support groups, check out community services, and seek professional guidance if you think it would be helpful. Don’t let your whole life revolve around your loved one’s condition.

➤ Don’t make assumptions

Even if you know a lot about bipolar disorder, do not make assumptions about your loved one’s experiences. Ask questions and seek to understand their situation rather than telling them what to do.

➤ Don’t criticize or blame

Criticizing your loved one’s behavior or blaming them for their situation will not help anyone. Be supportive in any way possible, and understand that they did not choose the challenges they are experiencing.

➤ Celebrate their progress

Let your loved one know that you are proud of their progress both in and out of treatment. Celebrate their “wins” and successes in recovery. Encourage them to keep going!

References

➤ American Psychiatric Association. (2021, January). What Are Bipolar Disorders? Retrieved November 2023. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

➤ Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007, July). Age of Onset of Mental Disorders: A Review of Recent Literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c

➤ Mayo Clinic. (2022, December 13). Bipolar Disorder. Retrieved November 2023. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

➤ National Alliance on Mental Illness. (2017, August). Bipolar Disorder. Retrieved November 2023. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder

➤ National Alliance on Mental Illness. (n.d.) Tips for How to Help a Person with Mental Illness. Retrieved November 2023. https://www.nami.org/Get-Involved/NAMI-FaithNet/Tips-For-How-to-Help-a-Person-with-Mental-Illness

➤ National Institute of Mental Health (n.d.) Bipolar Disorder. Retrieved November 2023. https://www.nimh.nih.gov/health/statistics/bipolar-disorder

➤ Substance Abuse and Mental Health Services Administration. (2023, April 24). For Friends and Family Members. Retrieved November 2023. https://www.samhsa.gov/mental-health/how-to-talk/friends-and-family-members