What is Bipolar Disorder?

Bipolar disorder, which was formerly known as manic depressive disorder, is a mental health condition that can be unpredictable, painful, and dangerous. Health care professionals classify bipolar disorder as a mood disorder. People with bipolar disorder alternate between elevated and depressed moods. During episodes of depression, it is common for people to experience all of the depressive symptoms typical to major depressive disorder.

 While it might seem that the elevated moods that sufferers experience would be a welcome relief from the depressive episodes, the reality is that these elevated moods are just as debilitating. For individuals with bipolar disorder, cycling back and forth between these two states of mind can make it difficult to manage energy levels, concentration, mood, and the tasks of day-to-day life.

The elevated moods that people with bipolar disorder experience are generally broken down by health professionals into two levels of severity. Manic episodes are characterized by moods and energy levels that are so abnormally elevated that the result is often psychosis. Hypomanic episodes, on the other hand, are less severe, though they can also be quite painful. Whether an individual is experiencing mania or hypomania, they are likely to experience symptoms of irritability, insomnia, and impulsivity.

Left untreated, bipolar disorder can inflict serious damage on a person’s life. Not only does the condition make it difficult to function normally, but it can make the experience of living miserable. Many sufferers find it difficult to meet work or school commitments, and as a result both academic and financial achievement can suffer. The symptoms of bipolar disorder can also make it difficult to handle interpersonal relationships. 

People who develop bipolar disorder are also at an increased risk of developing substance use disorders, anxiety disorders, and suicidal ideation. Until a person begins following a treatment plan, bipolar disorder will cause a great deal of suffering in their own life — as well as in the lives of family members and other loved ones.

Most Common Types of Bipolar Disorder

Health professionals divide bipolar disorder into three different subtype. While all types of bipolar disorder have traits in common, the three categories of bipolar disorder have varying origins, side effects, and respond differently to treatment. Some varieties of bipolar disorder are also more difficult to recognize, and laypeople might dismiss symptoms as mere “mood swings.”

For this reason, it is recommended that anyone who is suffering seek the help of a medical professional. Health professionals can diagnose bipolar disorder and help to develop a treatment plan.

The most common types of bipolar disorder include:

Bipolar I Disorder

Individuals with Bipolar I Disorder experience manic episodes that last for 7 days or longer. The manic episodes and mood swings that sufferers experience can be so severe that they can become a danger to themselves or others. Psychosis is also possible. Depressive symptoms usually last longer than the manic episodes, often lasting for 2 weeks or more. These periods of depression are sometimes characterized by mixed features, meaning that even during a depressive episode a person will experience manic symptoms.

Bipolar II Disorder

An individual with Bipolar II Disorder will rapidly cycle back and forth between hypomania and depression. The hypomanic episodes that they experience are not as severe as the manic episodes that individuals with Bipolar I Disorder experience. However, the rapid cycling between these two extreme states can be profoundly debilitating and painful.

Cyclothymic Disorder

Individuals with Cyclothymic Disorder often go undiagnosed and untreated. Like other forms of bipolar disorder, this disorder involves cycling between two extreme states. However, Cyclothymic Disorder is unique in that these states last for longer periods of time. 

Adults can experience hypomanic or depressive symptoms for periods lasting approximately 2 years, whereas in adolescents these states can last as long as 1 year. The condition often goes unrecognized because symptoms experienced in each state are not severe enough to be diagnosed as depressive episodes or even hypomanic episodes. It is also common for family members and even sufferers themselves to explain away their symptoms as mere personality defects, due to the considerable length of time symptoms are experienced.

Treating people with bipolar disorder involves a combination of medication and psychotherapy, both of which inpatient rehabilitation programs provide while also helping sufferers rebuild their lives. Most treatment plans will involve the use of a mood stabilizer or antipsychotic medication to help mitigate the more extreme symptoms of bipolar disorder. 

However, most health professionals emphasize a need for lifestyle changes to help cope with the condition and avoid exacerbating symptoms. This aspect of treatment can include developing a social support system or treating a substance use disorder.

Symptoms of Bipolar Disorder

Bipolar disorder manifests itself through a wide range of symptoms and side effects that vary in severity and length. Not all people with bipolar disorder experience immediately recognizable episodes of depression, since they may experience manic symptoms simultaneously. Manic episodes can also sometimes present mixed features.

 In the case of cyclothymic disorder, symptoms can last so long that the mood swings can be easy to dismiss as part of a person’s personality, rather than stemming from a mental health condition. With many different types of bipolar disorder and considerable individual variation, it can be difficult to make a self-diagnosis.

Health professionals can help with diagnosing bipolar disorder. They can look at your medical history for crucial risk factors. A diagnosis is generally made based on how severely mood swings have interfered with your life. It should also be noted that manic and depressed states present a number of physical symptoms.

Given that symptoms vary considerably between manic or depressed states, and between mania or hypomania, it is important to loosely categorize symptoms into two lists. However, it should be emphasized that even during a hypomanic episode, a person can experience depressed mood, and episodes of depression can feature manic symptoms.

Symptoms of Manic Episodes

• Irritability, jumpiness, touchiness
• Elation, euphoria, and a sense of being “wired”
• Considerable loss of appetite
• Decreased need for sleep, insomnia
• Racing thoughts, a feeling that ones mind won’t turn off
• Unrealistic ambitions to accomplish a lot at once
• Rapid or jumbled speech patterns
• Grandiose thinking or self-image, a belief that one is all-powerful
• Risky or impulsive behavior, lack of judgment

Symptoms of Depressive Episodes

• A sense of being slowed down
• Feeling hopeless, sad, and empty
• Sleep problems, ranging from insomnia to sleeping too much
• Weight gain or increased appetite
• Slowed speech patterns, feeling like they have nothing to say
• Forgetfulness
• Difficulty concentrating or making decisions
• Feeling incapable of accomplishing even small tasks
• Poor self-esteem, sense of personal worthlessness
• Decreased interest in activities and passions
• Decreased sex drive and libido
• An inability to experience pleasure, often known as anhedonia
• Suicidal ideation

Causes of Bipolar Disorder

Scientists are still not certain of the exact neurological mechanism that results in bipolar disorder. However, researchers have come to a better understanding in recent years of the causes that play a role in developing bipolar disorder. There is no one single cause. Rather, there are a multitude of risk factors and circumstances that can increase the likelihood that a person will develop the symptoms of bipolar disorder.

Genetics plays a major role in Bipolar I Disorder as well as Bipolar II Disorder. According to the National Institute of Mental Health, bipolar disorder runs in families. While there is no single gene that accounts for the condition, it has been statistically demonstrated that having a parent or sibling with the condition makes it more likely that one will develop it oneself. 40% of identical twins share the condition, suggesting that genetics plays a considerable part in the development of this mental illness.

However, genes do not represent the entirety of the picture. A person’s living circumstances and experiences affect the onset of bipolar disorder as well. Like depression and other mood disorders, bipolar disorder can be triggered by life events. Individuals with bipolar disorder are more likely than others to have experienced early childhood trauma. 

The presence of post-traumatic stress disorder symptoms can result in a worse prognosis for bipolar disorder as well, increasing the likelihood of suicidal ideation and dangerous behavior during manic episodes. Other lifestyle factors, such as sleep, also play a role. 

While the exact mechanism that causes a person to switch from a depressive episode to a hypomanic episode is not well-understood, research has shown that sleep deprivation can initiate a manic episode in approximately 30% of people with bipolar disorder. It is for these reasons that lifestyle interventions are often used as part of treatment plans in conjunction with medication.

Individuals with bipolar disorder are also far more likely than the general population to engage in substance abuse. For many, substance abuse begins as a form of self-medication for symptoms of mania or depression. The result, ultimately, is a worsening of symptoms. While it in unclear if substance abuse alone is sufficient to be the sole cause of bipolar disorder, it is certain to make symptoms worse and impede the management of mood swings. 

Dual diagnosis patients with bipolar disorder and a substance use disorder also often face difficulties with treatment, unless they attend a rehab specifically designed to treat comorbid conditions.

Diagnosing Bipolar Disorder

There are many factors that make it complicated to diagnose bipolar disorder. It is common for friends and family to mistake the symptoms of hypomanic or depressive episodes for mere mood swings. However, when bipolar disorder prevents a person from functioning normally or interferes in interpersonal relationships, it is often clear that mental illness needs to be addressed. 

In order to get an accurate diagnosis, it is essential to see a psychiatrist or a primary care physician. These medical professionals can not only diagnose the condition, but they can help put patients in touch with resources and treatment centers that provide relief.

Psychiatrists use a book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, to identify mental health conditions. The book, which is published by the American Psychiatric Associated and regularly updated to reflect contemporary research, presents somewhat different diagnostic criteria for Bipolar I and Bipolar II Disorders.

To be diagnosed with Bipolar I Disorder, an individual must have experienced at least one manic episode, though these episodes can be followed by depressive or hypomanic episodes as well. The DSM-5 defines a manic episode as follows:

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
• During the period of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms (4 if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective experience that thoughts are racing
  5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
  6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity)
  7. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity)
• The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
• The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

To be diagnosed with Bipolar II Disorder, a person must have experienced at least one hypomanic episode and at least one depressive episode. If they have experienced a manic episode, they are considered less likely to suffer from Bipolar II Disorder. The diagnosis also requires a person to have experienced significant impairments in their functioning as a result of their mood swings. The DSM-5 diagnoses hypomanic episodes using the following criteria:

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
• During the period of mood disturbance and increased energy and activity, 3 (or more) of the above symptoms (4 if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree.
• The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
• The disturbance in mood and the change in functioning are observable by others.
• The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
• The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment).
  Who is at Risk for Bipolar Disorder?

While anyone can suffer from bipolar disorder, certain risk factors increase the likelihood of developing the disorder. These range from genetic to environmental factors. Conditions and circumstances that put people at risk of developing symptoms of bipolar disorder include:

• Having a family member with the condition
• Suffering from another mental health condition or mood disorder, such as major depression
• Early childhood trauma, childhood abuse, and the presence of post-traumatic stress disorder (PTSD)
• Long-term stress
• Drug or alcohol abuse

Bipolar Disorder Statistics

Across the globe, approximately 1% of the world population is affected by bipolar disorder. In the United States, 2.8% of the population suffers from the vacillating states of mania and depression that characterize bipolar disorder, and 4.4% of people in the United States suffer from these mood swings at some point in their lives. 

The condition affects men and women equally. While the age of onset is generally around age 25, adolescents and even children can suffer from this condition when they develop early onset bipolar disorder. Bipolar disorder is a significant cause of disability. Among mental health disorders, it has one of the highest rates of severe impairment. 

According to the National Institute of Mental Health, 82.9% of people with bipolar disorder experience severe impairment. Bipolar disorder also affects mortality rates in the United States. Lifestyle choices and medications lead to higher rates of cardiovascular problems among people with bipolar disorder. Sufferers are also more likely to engage in dangerous and life-threatening behavior patterns, such as substance abuse, which can lead to overdose. 

Suicidal ideation is also a common symptom of both depressive and manic episodes, and 25% of people with bipolar disorder attempt suicide. Tragically, 10% of sufferers who attempt suicide succeed. Without a treatment plan in place, bipolar disorder is not only a cause of disability, but a significant risk factor for premature death.

Medications Used to Treat Bipolar Disorder

A wide variety of medications are used for treating bipolar disorder. Since the symptoms of bipolar disorder tend to change dramatically between mood swings, the pharmaceutical needs of patients generally change as well. Health professionals and psychiatrists generally make use of the following classes of medications while treating people with bipolar disorder:

Mood Stabilizers

Mood stabilizers can help people control manic and hypomanic episodes. They can reduce energy levels, impulsivity, and grandiose thinking. Mood stabilizers can often also prevent the onset of psychosis. Common mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal).

Antipsychotics

Antipsychotics are sometimes prescribed alongside mood stabilizers when symptoms of mania or depression respond poorly to treatment. Common antipsychotics include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), and asenapine (Saphris).

Antidepressants

The use of antidepressants to treat bipolar disorder can present a risk factor, since antidepressants can trigger a manic episode. However, when they are prescribed alongside a mood stabilizer and antipsychotic, they can often be used effectively to mitigate the symptoms of a depressive episode.

Anti-anxiety Medications

Benzodiazepines are sometimes prescribed to reduce the anxiety that individuals experience during manic and hypomanic episodes. However, they are generally only prescribed for short periods, since long-term use can lead to dependence and increases the risk of drug abuse.

Dual Diagnosis Treatment For Bipolar Disorder and Addiction at NuView Treatment Center

NuView Treatment Center understands that individuals who suffer from bipolar disorder alongside a substance use disorder often require more care. Bipolar disorder can lead people to turn to addictive substances, and substance abuse can in turn exacerbate the symptoms of bipolar disorder. 

Treating one condition to the exclusion of the other often leads nowhere, since a manic episode can trigger a relapse, and continued substance abuse can also worsen the symptoms of bipolar disorder. The relationship between these conditions is complex, often making both diagnosis and treatment difficult.

At our dual diagnosis treatment centers, dual diagnosis patients can receive the integrated care they need. NuView assesses each individual patient to provide them with a treatment plan that addresses their unique needs. We offer a wide range of treatment modalities to ensure that patients improve physically, mentally, and emotionally. Our dual diagnosis rehab program offers psychotherapy, group therapy, CAM therapy, and medication-assisted therapy. By entering our treatment program for bipolar disorder and addiction, individuals can get the long term relief they need.

If you are experiencing depression, mania, hypomania, suicidal thoughts, or struggle with alcohol or drug abuse, we are here to help. Recovery is possible!