Bipolar Disorder

Manic & Hypomanic Episode Symptoms

Both manic and hypomanic episodes include three or more of the below symptoms:

• Talking much more than usual 
• Racing thoughts
• Being distracted
• Feeling the need for less sleep
• Elevated Mood: Feeling abnormally upbeat, jumpy or wired
• Increased activity levels, energy or agitation
• Inflated sense of well-being and self-confidence 
• Poor decision-making and increased impulsive behavior

Major Depressive Episode Symptoms

The third symptom of bipolar disorder is depression, which can severely impact a person’s daily life. A person is experiencing a major depressive episode if they are experiencing five or more of the following symptoms:

• Severe loss of interest or feeling no pleasure in normal activities 
• Noticeable weight loss when not trying to lose weight, weight gain, or changes in appetite 
• Feeling sad, empty, hopeless, or teary all the time. In children/teens, this depressed mood can present as irritability 
• Sleeping too much or not being able to sleep, as with insomnia
• Having less energy or always feeling tired 
• Feeling worthless or overly guilty 
• Struggling to concentrate or make decisions 
• Feeling suicidal or having suicidal thoughts

Bipolar disorder often co-occurs with other conditions, ultimately making treatment and management much more difficult. Some of the following additional conditions can potentially lessen the effectiveness of treatment or worsen symptoms of bipolar.

• Bipolar depression — While bipolar disorder and depression are two separate conditions, bipolar depression can occur during depressive episodes. It often presents as feelings of guilt, unpredictable mood swings, irritability, or feelings of extreme restlessness. Sometimes speaking slowly, gaining weight, and sleeping more than normal is also experienced.
• Major depression — While bipolar disorder and depressive disorder are two separate conditions, major depression is often experienced during bipolar depressive disorders.
• Anxiety — Anxiety has various causes and can coexist with bipolar disorder.  
• Substance abuse — Substance abuse and addiction is a common comorbidity for those with bipolar disorder. In addition, when using substances, more extreme manic and depressive episodes can occur.
• Attention deficit hyperactivity disorder (ADHD) — Often bipolar disorder and ADHD occur simultaneously. Making it particularly challenging is the fact that many symptoms overlap between the two disorders. For example, impulsivity and inattention are major symptoms of both disorders.

Many people experience additional disorders that are related to bipolar disorder. Sometimes the coexistence of multiple conditions or disorders can lead to misdiagnosis or difficulty diagnosing or creating treatment plans for bipolar disorder. 

• Anxiety disorders — Anxiety disorders are common with bipolar disorder. Types of anxiety disorders that are often present in those who also have bipolar disorder include general anxiety disorder (GAD), panic disorder, and social phobias.

• Post traumatic stress disorder (PTSD) — Research shows that people who have bipolar disorder have an increased chance of developing the psychiatric disorder post traumatic stress disorder (PTSD). While they are two distinct mental health diagnoses, they share several common symptoms that can make diagnosis and treatment sometimes difficult.
• Schizophrenia — The hallucinations and/or delusions often experienced by someone with bipolar disorder can make it easy to confuse the condition with schizophrenia. That said, it is possible to have both disorders. When this occurs, it’s known as schizoaffective disorder.
• Borderline personality disorder — While borderline personality disorder (BPD) and bipolar disorder can have an overlap in symptoms — including extreme emotions and impulsive behavior — the disorders are actually quite different. BPD has a significant impact on how someone feels and thinks about themself and others in their life. For a more in-depth understanding of the two, learn more about borderline personality vs. bipolar disorder.

After seeking a diagnosis, talk therapy can become a vital part of treatment and can include several types of therapy, including:

Interpersonal and social rhythm therapy (IPSRT)

This type of therapy focuses on the idea that a consistent routine allows for better mood management. A therapist will work with an individual to stabilize daily rhythms such as sleeping, exercise, and eating.

Cognitive behavioral therapy (CBT)

The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can be a valuable way to identify what triggers bipolar episodes.

Psychoeducation

Learning about bipolar disorder can help a person and their loved ones better understand the condition and guide them in identifying issues, making a plan to prevent relapse, and sticking with treatment.

Family-focused therapy

Community support and communication can help a person stick with their treatment and better manage the warning signs of possible mood swings.

There is still more research to be done surrounding when and how intensive therapy and treatment can best have an impact on bipolar disorder. Much of the discussion pertains to whether early interventions may be able to prevent or limit full-blown episodes.

Medication is likely going to be an important component of any bipolar disorder treatment plan. When used in conjunction with therapy and other techniques, it can be possible to manage bipolar disorder with the right medication. Types of bipolar disorder medications and doses will be based on an individual’s specific symptoms. 

• Mood stabilizers — Mood stabilizers are commonly prescribed to treat bipolar disorder during manic or hypomanic episodes. These are often considered to be one of the most important medications to treat bipolar disorder. 
• Atypical antipsychotics — Used to treat both types of episodes (manic and depressive), atypical antipsychotics can be an effective form of treatment for both long- and short-term plans. Additionally, they can be used to treat psychotic symptoms like delusions, hallucinations, and mania symptoms.
• Anticonvulsants — Anticonvulsants can be prescribed either on their own or with the combination of an antipsychotic drug or lithium prescription. Many anticonvulsants are recognized as a type of mood stabilizer.
• Benzodiazepines — Though not usually a core bipolar treatment, benzodiazepines (or “benzos”) can help quickly control manic symptoms. Can be prescribed for short-term use until other mood stabilizing drugs start to take effect.

Once prescribed, the medication shouldn’t be stopped without first consulting a health care provider first. Medications for bipolar disorder are meant to be taken consistently, as prescribed, even once a person starts feeling better. If an individual stops taking a prescribed medication, it may actually lead to a worsening of bipolar symptoms. 

Depending on a person’s situation and unique needs, in addition to medications, symptoms of bipolar disorder can be managed with the following treatment options:  

• Day treatment —  Day treatment programs are able to offer the necessary support for the individual as they work to control their symptoms.
• Continuous treatment — Bipolar disorder may require lifelong treatment along with medication even when a person feels better. Skipping any kind of maintenance treatment can result in a relapse of symptoms and may result in depression or symptoms of mania. 
• Hospitalization — If a person is behaving dangerously, psychiatric treatment at a hospital can help keep the individual calm and safe while stabilizing their mood during a manic or major depressive episode.

Medication isn’t the only way to treat bipolar disorder. The most effective form of treatment is going to be a combination of the right medication (or medications) and psychotherapy (also known as talk therapy). Since bipolar disorder is a lifelong mental health condition, long-term and continuous treatment is going to be important, even in cases when people are in between episodes and aren’t experiencing major manic or depressive symptoms.

Some types of treatment, in addition to medication, to treat bipolar disorder can include:

• Talk therapy — Talk therapy (or psychotherapy) is an essential part of any bipolar treatment plan. Learn how to identify, talk about, and address thoughts and feelings that may be contributing to symptoms of bipolar disorder.  
• Electroconvulsive therapy (ECT) — ECT is a procedure that stimulates the brain and is known to help people with bipolar disorder gain significant relief from symptoms. Typically, ECT requires a series of sessions over multiple weeks, and it requires general anesthesia. When talk therapy and medication are not effective, ECT may be instrumental in relieving and treating symptoms of both manic and depressive episodes.
• Transcranial magnetic stimulation (TMS) — TMS is another approach that’s newer than ECT. It also involves brain stimulation using magnetic waves. The difference between TMS and ECT is that TMS is administered while patients are awake, eliminating the need for general anesthesia. It’ll be administered almost every day for one month. While TMS is effective for treating depression, how well it works to treat bipolar disorder is still being researched.

There are several things that in addition to medication and therapy that can help treat bipolar disorder.

• Exercise regularly — Regular exercise can help ease depression and stabilize moods. It’s also known to improve sleep habits. All of these can be beneficial in managing bipolar disorder.
• Journal and keep a life chart — Life charts are a way to track daily mood symptoms, sleep patterns, medication and other treatments, and major life events that may spark a bipolar episode.
• Keep a consistent sleep cycle — Getting enough sleep is a known mood stabilizer. It can also reduce irritability and is useful in establishing healthy routines that can help manage bipolar disorder. 
• Eat a balanced and healthy diet — Eating a healthy diet, including foods high in omega-3 fatty acids, it’s always a good thing. With bipolar disorder, it can also be important to reduce the intake of any trans and saturated fats, both of which are linked to chemical imbalances in the brain.
• Learn calming techniques — Calming techniques like yoga, acupuncture, massage therapy, and mindful meditation are all ways to reduce stress and anxiety, both of which can complicate bipolar disorder. While they can’t cure it, calming techniques are a definitive way to manage bipolar symptoms. They can be an extremely valuable part of any treatment plan.

Though living with bipolar disorder is often a challenge, there are coping techniques that can help make it easier to manage. Bipolar disorder is a lifelong condition and will always require treatment. The most important part of coping with it is finding a treatment plan that works, and then staying on it. 

Other ways to cope with bipolar disorder can include:

• Being patient
• Staying committed to therapy appointments 
• Taking medication as directed, even between episodes
• Being open and honest with a therapist or doctor about symptoms and treatment options
• Avoiding excessive alcohol and drug use or abuse
• Keeping structure to daily activities — eat, sleep, and exercise regularly and on a routine
• Learning to recognize symptoms and mood swings
• Asking for help

When left untreated, bipolar disorder can develop into a significantly more severe condition. It’s not uncommon for symptoms to increase in severity, and in the most extreme cases, they can become so severe that they lead to suicide. Both manic and depressive episodes can become not only more intense, but also more frequent when an effective treatment plan isn’t put into place. 

Other complications that can arise as a result of untreated bipolar disorder include: 

• Social issues
• Financial or legal issues
• Emotional and physical symptoms
• Damaged relationships — both personal and professional (learn more about bipolar disorder and relationships)
• Poor performance — at work or school
• Suicidal ideation or attempts