Bipolar Disorder

Condition Basics

What is bipolar disorder?

Bipolar disorder is an illness that causes extreme mood changes, from times of very high energy (manic episodes) to times of depression. But many people with bipolar disorder show only the symptoms of depression. These moods may cause problems with your work, school, family life, friendships, and how well you function.

This disease is also called manic-depression.

There is no cure for bipolar disorder, but it can be helped with medicines. Counseling may also help. It is important to take your medicines exactly as prescribed, even when you feel well. You may need lifelong treatment.

What causes it?

The cause of bipolar disorder isn't completely understood. But experts believe many factors may be involved. It tends to run in families. You are at greater risk of having bipolar disorder if a close family member has it.

What are the symptoms?

The symptoms depend on your mood swings, or "highs" and "lows." During a manic high, you may feel very happy, energetic, or on edge. During a low, you may feel sad and have trouble thinking and making decisions.

How is it diagnosed?

To find out if you have bipolar disorder, your doctor will ask how long your symptoms last and how often you have them. He or she will also ask about your family history and may do a mental health assessment. You may have other tests to make sure another problem isn't causing your symptoms.

How is bipolar disorder treated?

Bipolar disorder is treated with medicines and counseling. Medicines include mood stabilizers and antipsychotics. You may need to try several to find what works for you. Counseling can help with some of the social issues that the illness may cause. You can do a few things on your own, such as getting enough sleep.

What Increases Your Risk

If anyone in your family has been diagnosed with bipolar disorder, your risk of having it is higher. Bipolar disorder can be passed down through families.

Symptoms

The symptoms depend on your mood swings, or "highs" and "lows." During a manic high, you may feel:

• Very happy, energetic, or on edge.
• Like you need very little sleep.
• Overly self-confident.

Some people spend a lot of money or get involved in dangerous activities when they are manic. After a manic episode, you may return to normal. Or your mood may swing in the opposite direction to feelings of sadness, depression, and hopelessness.

During a depressive episode, or low, you may have:

• Trouble thinking and making decisions.
• Memory problems.
• Less interest in things you have enjoyed in the past.
• Thoughts about killing yourself.

The mood swings of bipolar disorder can be mild or extreme. They may come on slowly over several days or weeks or suddenly over a few minutes or hours. These mood swings may last for a few hours or for several months.

Symptoms based on type of bipolar disorder

The different types of bipolar disorder are based on whether a person has more severe symptoms of mania or depression.

Bipolar I.

This is the classic form of the illness. It causes episodes of mania and depression that keep coming back.

Bipolar II.

With this form, you will have depression as in bipolar I. But the manic highs are less severe. People with bipolar II have more episodes of depression than mania.

Cyclothymia.

The high and low mood swings aren't as severe as in bipolar I or bipolar II.

Bipolar, NOS (not otherwise specified).

This is diagnosed when symptoms of mania and depression aren't frequent or severe enough for bipolar I, bipolar II, or cyclothymia.

Rapid-cycling bipolar disorder.

You may have at least four episodes of depression, mania, or both within a 12-month period.

Mixed-cycling.

The symptoms of both mania and depression occur at the same time.

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What Happens

When you have bipolar disorder, you have highs and lows of mania, hypomania, and depression. In between, you may return completely to normal or you may still have some symptoms. The extreme mood changes may come on all of a sudden or appear more slowly.

During a manic episode, you may go from feeling abnormally happy and productive to behaving irresponsibly and sleeping very little. After this manic high, your mood may return to normal. Or you may feel useless and extremely sad. And you may lose interest in things you've enjoyed in the past.

At first, stress may trigger depression or mania. But as the illness progresses, mood swings may not be caused by any certain event. Without treatment, your bipolar disorder may get worse. This can cause you to move more often between mania and depression.

People with bipolar disorder may have problems with substance use, especially during manic episodes. This happens more often in men than in women.^{footnote 1} Substance use disorder may affect treatment and interfere with taking medicines as prescribed. Other disorders that may occur along with this disorder include:^{footnote 2}

These illnesses need to be treated along with bipolar disorder.

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you can't stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call a doctor now if:

• You hear voices.
• You have been thinking about death or suicide a lot, but you don't have a plan for suicide.
• You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• You have symptoms of depression or mania, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep or feeling that you don't need much sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
  • Feeling extremely happy or very grouchy.
  • Talking too fast or more than usual.
  • Being more active than usual.
  • Having trouble concentrating because of having too many thoughts at the same time (racing thoughts).
  • Acting impulsively or doing reckless things. You may spend a lot of money, drive recklessly, or get into foolish business ventures. Or you may have frequent, indiscriminate, or unsafe sex.
• You have been treated for depression for more than 3 weeks, but you aren't getting better.

Exams and Tests

Bipolar disorder can be hard to diagnose. This is because it has many phases and the symptoms overlap with other mental health conditions.

To find out if you have bipolar disorder, your doctor will ask detailed questions about your symptoms. You will be asked how long your symptoms last and how often you have them. Your doctor will ask about your family history.

Blood and urine tests, such as a test of your thyroid, may be done to make sure another problem isn't causing your symptoms. A toxicology screen looks at blood, urine, or hair for the presence of drugs.

The earlier the disease is confirmed, the sooner you can get treatment, feel better, and improve the quality of your life. This can also reduce your risk of other health problems, such as substance use disorder.

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Treatment Overview

Bipolar disorder is treatable. A treatment plan can make you feel better.

You may need to try several medicines to find the best combination.

• Most people with bipolar disorder need to take a medicine called a mood stabilizer every day.
• Antipsychotic medicine can help get a manic phase under control.
• Antidepressants are used carefully for episodes of depression. They cause some people to move into a manic phase.

Counseling is also an important part of treatment. It can help you cope with some of the work and relationship issues that the illness may cause.

You can do a few things on your own. These include being active, getting enough sleep, and learning to recognize early signs of highs and lows.

People often stop taking their medicines during a manic phase because they feel good. But this is a mistake. You must take your medicines regularly, even if you're feeling better.

Self-Care

Home treatment is important in bipolar disorder. There are many things you can do to help control mood swings. You don't have to do them all at once. Try to do one thing, such as eating a healthy diet, then add another when you can.

• Watch what you eat.

  Try to eat a healthy, balanced diet. A balanced diet includes foods from different food groups, such as whole grains, dairy, fruits, vegetables, and protein. Eat a variety of foods from each group. (For example, eat different fruits from the fruit group instead of only apples.) A varied diet helps you get all the nutrients you need. No single food provides every nutrient.

• Keep good habits.
  • Take your medicine every day as prescribed.
  • Get enough exercise. Try moderate activity for at least 30 minutes a day, every day, if you can. A brisk walk is an example of moderate activity.
  • Avoid alcohol, marijuana, and illegal drugs.
  • Limit caffeine and nicotine.
• Reduce stress, and get rest.
  • Try to control the amount of stress in your life. Ways to relieve stress include physical activity and exercise, breathing exercises, muscle relaxation, and counseling and support groups.
  • Get enough sleep. Keep your room dark and quiet. And try to go to bed at the same time every night. If you plan to travel into other time zones, ask your doctor if you should make any changes in your medicines. Ask what to do if you have a manic or depressive episode while you are away.
• Ask for help.
  • Learn to recognize the early warning signs of your manic and depressive episodes.
  • Ask for help from friends and family when you need it. You may need help with daily activities if you are depressed. Or you may need support to control high energy levels if you have a manic high.
• Know the signs of suicide.

  The signs include:

  • Drinking alcohol heavily or taking illegal drugs.
  • Talking, writing, or drawing about death, such as writing suicide notes.
  • Talking about things that can cause harm, such as pills, guns, or knives.
  • Spending long periods of time alone.
  • Giving away possessions.
  • Acting aggressive or suddenly appearing calm.

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Medicines

Medicines can help control bipolar mood swings. Your doctor will vary the amounts and combinations of your medicines based on:

• Your symptoms.
• Which type of bipolar disorder you have.
• How you respond to the medicines.

Medicine choices

Several medicines are used to treat bipolar disorder. The most common ones used are:

• Mood stabilizers, such as lithium. A mood stabilizer and an antipsychotic are recommended as the first medicines for acute manic episodes.
• Anticonvulsants. These include carbamazepine, divalproex, and valproate.
• Antipsychotics. These include aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone. They improve manic episodes.
• Benzodiazepines. An example is diazepam.

Monitoring medicines

You'll need to check in with your doctor regularly when taking medicines for bipolar disorder. You may need regular blood tests to watch the amount of medicine in your blood.

The use of antidepressants alone has been linked to an increase in manic episodes. Antidepressant treatment needs to be monitored closely to avoid causing a manic episode.

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Counseling-Based Treatment

Almost all people who have bipolar disorder need medicine. But counseling is also important. It helps you cope with work and relationship struggles related to your illness. Types of counseling include:

Try to form a long-term relationship with a counselor you like. He or she will help you recognize personality changes that show when you are moving into a mood swing. Getting early treatment can reduce the length of the high or low.

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Giving Support

Family members often feel helpless when a loved one is depressed or manic. But you can help.

• Be sure your loved one uses his or her medicine.

  Encourage the person to take prescribed medicines regularly, even when he or she is feeling good.

• Consider family therapy.

  If family therapy is available, make sure that everyone in the family attends.

• Help your loved one after an episode.

  Allow your loved one to take enough time to feel better and get back into daily activities.

• Understand hypomania.

  Hypomania can occur in people with bipolar disorder. Hypomanic episodes are less severe than manic episodes. You may notice that your loved one's mood is different than his or her usual nondepressed mood, but not manic. You may think that your loved one is just having a good day. But hypomania can still interfere with your loved one's ability to function. An episode can last for a week or more.

• Help yourself.

  If a loved one has bipolar disorder, it may be helpful for you to get counseling. This can help you deal with the disorder's impact on your own life. Manic episodes can be particularly hard. Talk with a psychiatrist, a psychologist, a social worker, or a licensed professional counselor for your own therapy.

  Counseling can also be helpful for a child who has a bipolar parent. The parent's mood swings may negatively affect the child. This can cause tearfulness, anger, depression, or rebellious behavior.

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