Bipolar Disorder

Our mission is to educate patients, their families, and the wider community about bipolar disorder. Below are frequently asked questions about this disorder and its treatment.

What is bipolar disorder?

Bipolar disorder is a treatable illness that is characterized by episodes of mania (bipolar I-BPI) or hypomania (bipolar II-BPII), that alternate with episodes of major depression1. Bipolar disorder is common, affecting up to 5.7 million Americans (or 2.6% of the population) every year. The peak age of onset of bipolar disorder is from ages 15 to 25, and it affects male and females at approximately equal rates. What are the symptoms of mania?

Patients with bipolar disorder may experience manic episodes as a period lasting several days or longer when they feel much more excited and full of energy than usual. Their minds may go too fast. They may talk a lot. They may be very restless or unable to sit still, and they may do things that are unusual for them such as driving too fast or spending too much money. They may also experience mania as a period lasting several days or longer when most of the time they are so irritable or grouchy that they start arguments, shout at people, or hit people.

During these episodes of feeling excited, full of energy, or grouchy, patients with bipolar disorder often feel more talkative, experience racing thoughts, constantly change their plans or activities, are unable to concentrate, sleep far less than usual without getting tired, act very restless (pace up and down or can’t stand still), go on buying sprees (spending so much more money than usual that it causes financial difficulties), and behave in ways they would normally think are inappropriate (talking about private topics, doing things that are impossible to do, or taking on large amounts of work).

What are the symptoms of depression?

Depression is more than just being in a bad mood. While everyone feels sad from time to time, depression lasts at least two weeks, and often much longer. Depression can involve disturbances in sleep, appetite (eating too much or too little), weight loss or gain, and markedly reduced interest in once pleasurable activities.

What is the difference between mania and hypomania?

Symptoms of mania last longer and are more intense than symptoms of hypomania. A collection of these symptoms must last at least a week and severely impair a patient’s daily functioning in order to be considered a manic episode. Patients with bipolar disorder are often hospitalized during a manic episode.

What is the difference between bipolar I and bipolar II?

A patient with bipolar I has experienced at least one manic episode in their lifetime. A patient with bipolar II experiences hypomanic episodes but does not experience manic episodes.

How do I know if I have bipolar disorder?

A psychiatrist, psychologist, or other mental health professional can help you decide if you have bipolar disorder. If you believe that you may have bipolar disorder, consult your physician.

Are patients with bipolar disorder always either manic or depressed?

No. Patients with bipolar disorder may recover from their depressed or manic episodes and have a normal mood state. However, they always run the risk of having further episodes of depression or mania, especially if they are not on mood-regulating medication.

In addition, patients may be hypomanic. That is, they may have some symptoms of mania but not for long enough or severely enough to interfere with their functioning in a marked way. This can be difficult to distinguish from feeling "average" or "normal" in mood.

What is the course of the illness?

While some people have only one episode of depression or mania without recurrence, the vast majority of patients (95%) have multiple episodes of depression and mania. At first, episodes may occur in response to stressful events, such as the break-up of a relationship, the death of a loved one, a move, or the loss of a job. Later on, episodes may come on "out of the blue," without connection to stressful events. There is evidence that the more episodes a person has, the more likely they are to have new episodes. In addition, the longer a person has the disorder, the shorter the time until the next episode. Therefore, as people have more episodes, they spend more and more time being ill.

The pattern of episodes can vary. Some people have single episodes of depression or mania with periods of normal mood in between. Others may have a manic episode immediately followed by a depressive episode, or a depressive episode immediately followed by a manic episode. Some people have both manic and depressed symptoms within a given episode. Some people have what is known as rapid cycling, where they have many episodes within a short period of time. While the frequency of mood switches can vary greatly, a person is considered to have rapid cycling if he or she has four or more episodes per year. Thus, a frequency of episodes of every 3 months is sufficient to diagnose a rapid-cycling course.

What causes bipolar disorder?

Bipolar disorder is thought to be caused by chemical imbalances in certain brain cells responsible for regulating emotions and behavior. These imbalances probably come about through an interaction of genetic factors and life experiences. It is not entirely genetic or entirely environmental. Examples of life experiences that can lead to bipolar disorder in people genetically predisposed to this illness include stressful life events, medical conditions (e.g., thyroid abnormalities), or use of medications like steroids. The disorder is clearly a medical illness, and differences in brain function can be identified in people who are depressed or manic compared with a person experiencing a normal mood state.

What are some complications of bipolar disorder?

Going through depressed, manic, or mixed episodes can be very debilitating for the affected person and his or her family. The symptoms of the illness can interfere with a person's ability to take part in relationships and to function well at work. For instance, a person who is depressed may withdraw from friends and family or feel too irritable to be with them. He or she may be unable to concentrate on work or even to get out of bed to go to work. A person who is manic may have difficulty communicating with friends or family and may be irritable and potentially aggressive. He or she may be too disorganized and distracted to function at work.

Once the person recovers from the episode, he or she may face an abundance of debilitating consequences. People may find that their behavior has lost them their jobs, strained their relationships, and caused financial hardship or even homelessness. They may feel embarrassed by the way they behaved when depressed or manic. These hardships can lead to grief and demoralization. People often need help, such as psychotherapy and support groups to cope with these complications. Suicide is another potential consequence resulting from bipolar disorder, particularly among patients who remain untreated.

Can bipolar disorder be cured?

The disorder cannot be cured, but it can be treated or controlled. In this way it is similar to chronic medical conditions like diabetes or heart disease, and just like these conditions, better treatments are being developed.

What should I do if someone I love has bipolar disorder?

Some of the most important things you can do are learn about bipolar disorder, encourage your loved one to get treatment, and simply be there for them. Understand that bipolar disorder is a serious illness, but that with appropriate treatment, your loved one can get better. It may be helpful to visit the websites of organizations like the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) so that you and your loved one can learn more about this illness and seek appropriate support. Talking to others with bipolar disorder who have experienced the same issues and benefited from treatment can be quite helpful. DBSA has support groups all over Massachusetts and the country where those with bipolar disorder and their friends with families can seek support.

For more information, visit our Resources tab.

How can you help someone with bipolar disorder who does not want treatment?

Many patients with acute mania do not realize that they are experiencing manic symptoms. Individuals should be encouraged to see a psychiatrist or other mental health professional to ask questions about mania and bipolar disorder and to respond to their doubts and concerns about being diagnosed with bipolar disorder.

Treatments for bipolar disorder

Treatments are available that control the disorder either by preventing episodes of depression and mania or by lessening the severity of these episodes.

Treatments for stopping episodes of depression or mania include medications, electroconvulsive therapy, and psychotherapy. If a person becomes so depressed or manic that he might hurt himself or others, brief hospitalization is also an option. While a person is recovering from an episode, he or she may attend a day treatment program or stay in a halfway house.

Treatments for preventing or lessening the severity of episodes of depression or mania include medications and psychotherapy.

How can medications help control bipolar disorder?

Multiple medications have been found to help control bipolar disorder. Some can be used to stop mania, and they may also help stop or lessen the severity of depression. These medications are also used to prevent or decrease the recurrence of episodes of mania or depression.

Some people have good responses to medications, alone or in combination. In many others, the symptoms do not completely go away. They do, however, get less intense and more manageable so that the quality of the person's life improves. Often, people need to take more than one medication at a time for maximal benefit. More information on specific uses and side effects of medications is available in pamphlets from your physician. How can psychotherapy help control bipolar disorder?

Cognitive-behavioral therapy, or CBT, can help enhance the effectiveness of medications in controlling bipolar disorder. It can be offered in individual or group format. CBT can help people learn to monitor and control the symptoms of bipolar disorder, to reduce obstacles to medication adherence, and to cope with stressors that may make new episodes more likely. Cognitive therapy (often included as one component of CBT) is an approach where patients learn to identify and modify the patterns of thinking that accompany mood shifts. For example, people who are depressed may see themselves, their world, and their future in an extremely negative, grim, pessimistic way. They may feel that all is doomed, that they are bad or worthless, and that nothing will ever go right. This way of looking at the world is a distortion which can exacerbate their depressed feelings.

At the opposite extreme, people who are manic or hypomanic tend to see themselves, their world, and their future in a very positive, optimistic, "rose-colored" way. They may feel that luck is on their side, that they are extremely capable or powerful, and that nothing can go wrong. This outlook is also a distortion, and it can lead to unwise or risky choices and serious problems. In cognitive therapy, people can learn to monitor their thoughts and test them out logically in order to counter the distortions that go with depressed and elevated moods.

References
  1. Association AP. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington DC, : American Psychiatric Association Press, Inc.; 1994.
  2. “Bipolar Disorder Statistics.” Depression and Bipolar Support Alliance. DBSAlliance.org. Web. 18 August 2015.