Skip to content
Table of Contents
Table of Contents
Topic » Bipolar Disorder

Bipolar Disorder

Share:
Share on facebook
Share on twitter
Share on linkedin
Share on email
Share on print
Share on whatsapp
Share on telegram
Bipolar Disorder

Bipolar disorder is a psychiatric condition that leads to extreme changes in moods, behavior, and energy levels. When left untreated, it can seriously disrupt a person’s life. But with effective treatment, many sufferers can cope with the symptoms and live a productive life.

What Is Bipolar Disorder?

Bipolar disorder (BD or BPD) is a serious mental illness where normal feelings become intensely magnified in an erratic manner. It is characterized by repeated episodes of depression and unnaturally elevated mood along with changes in levels of energy and activity. These episodes are recurrent and may last from several days to weeks. Also known as bipolar affective disorder, bipolar disease, manic-depressive illness or manic depression, BD can lead to extremely high and low moods and drastic changes in thinking, behavior, energy and sleep.

MindHelp explains that “People with bipolar disorder can rapidly go from one extreme mood to the other, swinging from confusion, fatigue and sadness to clarity, energy and euphoria. These mood swings can be so quick, excessive and devastating that the person may develop suicidal ideation and behavior.”

One 2019 study 1, found that the risk of suicide is around 10-30 times higher in people with bipolar disorder than in normal people. It also revealed that approximately 20% of sufferers commit suicide, whereas about 20-60% patient attempt suicide at least once. They may also engage in self-harm or self-injury frequently.

Moreover, comorbid conditions, like anxiety disorders and substance use disorders, are related to BD. People with this disorder can be treated effectively with psychological counseling and medications depending on whether the condition is dominated by mania or depression.

What Are The Mood Episodes In Bipolar Disorder?

According to experts, individuals suffering from bipolar disorder experience severe and extreme emotional states that can come up at specific times, identified as mood episodes. These episodes are categorized as manic, hypomanic or depressive. A person affected by this condition may feel like they can rule the world during periods of mania, while feeling like doing absolutely nothing during depressive episodes 2.

1. Manic episodes

Severe episodes of elevated mood are known as mania 3, less severe episodes are called hypomania. During manic periods, the sufferer may feel highly energetic, happy or irritable and may behave abnormally making impulsive decisions. They may also experience insomnia during mania. The sufferer may become full of energy, euphoric or abnormally irritable during mania or hypomania. They may become workaholics and start several projects, irrespective of their level of skill or experience.

During manic episodes, the sufferer may become highly talkative, be distracted and suddenly have an inflated self-esteem. A reduced need for sleep is another common feature as the patient may remain active for days without sleep. They may also engage in high-risk behavior and activities without considering the adverse consequences, such as spending heavily, gambling, risky sexual behavior, drug use, etc.

They may also behave in a hostile manner or become angry when they are interrupted or challenged. Hypomania, although similar to mania, is not as severe as mania and usually doesn’t lead to major impairment or disruption to daily functioning.

Read More About Hypomania Here

2. Depressive episodes

Depression 4 is mainly common in patients and may sustain longer than elevated mood. During episodes of depression, the person may feel extreme sadness, cry frequently and develop a negative perspective. They may also avoid making eye contact and lack interest in activities. However, not all sufferers may become depressed. Periods of depression can mean loss of interest in activities leading to truancy, poor performance and even resignation from work in extreme cases. This can further add to the depression leading to hopelessness and self-loathing from being unemployed and in debt.

The occurrence of at least one episode of depression is common in BD which may last for at least two weeks. Bipolar depression tend to be severely distressing due to serious risk of suicide. They can experience intense anxiety and feelings of emptiness, restlessness, worthlessness, guilt, indecisiveness and fatigue. Recurrent thoughts of suicide and suicidal ideation is common during such episodes.

Read More About Major Depressive Disorder ( Depression ) Here

How Common Is Bipolar Disorder?

Research 5 indicates that around 1% of the global population is affected by bipolar disorder. Studies 6 also indicate that “Bipolar disorder has a yearly prevalence of 2%.” BD has the highest percentage 7 of severe impairment amongst all mood disorders. Around 2.9% of adolescents suffer from this condition while 2.6% of them experience severe impairment.

According to a 2011 cross-sectional survey 8, the bipolar disorder statistics of 11 different nations comprised about 2.4% with a lifetime prevalence. It was also revealed that prevalence for bipolar type 1 was around 0.6% and for bipolar type 2, it was about 0.4%. Men and women tend to be affected at the same rate. One 2010 study 9 found that “it is widely perceived that the reported equal rate of illness in men and women reflects no important gender distinctions.” The general age for the onset of bipolar disorder symptoms usually appears to be 20-25 years, however, earlier onset can mean worse prognosis. BD is amongst the top 20 reasons for disability 10 globally and affects our society severely.

Understanding Bipolar Disorder

BD is characterized by polar opposite thinking, behavior, energy and mood swings. Although most of us experience low and high moods at times depending on our level of anxiety and stress, people with BD can experience overwhelming and severe mood swings that can disrupt their daily functioning and affect their education, career and personal relationships. A person with bipolar disorder is likely to have periods where they may experience:

  • Elevated moods (manic or hypomanic episodes)
  • Extremely low moods (depressive episodes)
  • Potential psychotic symptoms during mania or depression

Experts believe bipolar disorder as a spectrum of moods should be considered as a spectrum of moods. At one end of the spectrum is severe to mild depression, while mania and hypomania are at the other end. Surprisingly, a balanced and normal mood also lies in the middle of the spectrum as well. Some individuals may experience symptoms of both mania and depression at the same time – this is known as mixed bipolar state.

The mood episodes for any variant in the spectrum may last from days to weeks and may occur once or multiple times in a year. So the person can act highly dramatic for a period of time and feel intense sadness and hopelessness in another period. Drastic changes in behavior is also evident with episodes of normal mood in between mood swings. These rapid and excessive mood swings can cloud their judgment, alter their concentration and substantially affect thinking and behavior.

It is believed that around 90% of people with bipolar disorder experiencing a single episode of mania may have repeated mania or depression episodes. Individuals with bipolar disorder have trouble managing their symptoms. Bipolar disorder can begin during a person’s late teen or early adult years. However, children and adults can also suffer from bipolar disorder as well and the condition may last a lifetime. Unfortunately, the condition tends to get worse without treatment. This is why early diagnosis and treatment under a mental health professional is crucial for effective management of symptoms of bipolar disorder.

What Are The Types Of Bipolar Disorder?

Types Of Bipolar Disorder
Bipolar Disorder

Depending on the frequency, severity and presence of symptoms, a person may be diagnosed with different types of bipolar disorder. However, as bipolar disorder symptoms take place on a spectrum, the distinction between the different types of BD is not necessarily clear. Here are the major types of bipolar disorder that may be used by doctors to diagnose a patient:

1. Bipolar I disorder (manic or mixed episode)

One 2007 study 11 states “Bipolar I disorder (BPI) is among the top 10 most debilitating illnesses globally.” It is marked by at least one episode of mania. Periods of major depression or hypomania may also occur before or after the manic episode. This type of BD can often lead to dramatic mood swings and make the person feel like they are on top of the world. However, periods of normal moods are common between such episodes. It may also trigger psychosis. Studies 12 reveal that lifetime prevalence of bipolar disorder type 1 is around 1% in the general population.

Bipolar I disorder requires that the patient must experience a manic episode for at least 7 days or the episode must be severe enough to necessitate hospitalization. However, the symptoms must not be caused by any other mental conditions, like delusional disorder or schizophrenia.

2. Bipolar II disorder (hypomania and depression)

Individuals with this variant of BD experience an episode of major depression which may sustain for two weeks or more. The sufferer may also experience a period of hypomania which can last up to four days. It has been observed that bipolar II disorder is more common in female patients than males. Contrary to popular belief, this is not a milder version of bipolar I disorder; it is a distinct subtype with its own diagnosis criteria.

Individuals with bipolar II disorder usually do not experience a manic episode, but depression often dominates their mood. During a hypomanic episode, the sufferer may feel normal and function effectively, but he/she will experience depressive episodes with unstable and volatile moods. The mood shifts of bipolar II disorder are very different from mood disorders caused by other mental conditions or medications. Yet, even though the symptoms of bipolar II disorder are milder, these are often accompanied by a plethora of symptoms linked to depression, anxiety, or substance abuse. This condition generally doesn’t require hospitalization.

3. Cyclothymic disorder (hypomania and mild depression)

Cyclothymia is characterized by less intense and shorter episodes of depression and hypomania. Its symptoms are milder than bipolar I or bipolar II disorders. Sufferers with this condition experience stable moods for a period of one or two month and several episodes of hypomania and depression that last for at least two years. Nonetheless, most of the times, the symptoms of cyclothymia fail to meet the criteria established for hypomanic or depressive episodes. During this 2–year period, the mood swings sustain for at least 50% of the period, without ceasing for over 2 months.

The cyclothymic disorder causes frequent mood changes bordering on emotional highs and lows. People with this disorder experience brief episodes of normal moods which last for less than 8 weeks. Sufferers usually experience difficulties in relationships, poor decision making and impulsivity. It also affects their career and financial stability. Cyclothymia diagnosis is sometimes skipped by patients who are in denial and under the impression that their symptoms are not serious or damaging enough. However, because the condition lies on the BD spectrum, it can severely impact a person’s quality of life. Although it is a milder form of BD, if left untreated, it can lead to more severe bipolar disorder.

4. Bipolar Disorder, “other specified” and “unspecified”

Research shows that there are multiple types of “unspecified” bipolar disorders in which the sufferer does not meet the criteria for bipolar I, II or cyclothymia. But the sufferers still experience periods of clinical mood elevation and suffer from health disorders triggered by substance abuse, a psychiatric illness, or a medical condition (such as a stroke, multiple sclerosis, or Cushing’s disease. Understanding these different types of bipolar disorder can help the doctors and the patients better understand and diagnose the conditions related to BD for more effective treatment outcomes.

Patterns Of Bipolar Disorder

A person with BD experiences periods of varying degrees of depression or mania or both. He/she may also experience periods of “normal” moods between episodes of mania and depression. BD has certain patterns but these vary from one patient to another. Speaking of the more common patterns, a person with this mental condition experiences the following states:

1. Mixed state

A person in a mixed state of bipolar disorder experiences both mania and depression simultaneously or in an immediate successive sequence without any normal period or recovery between episodes. This state may include feelings of irritability, agitation, overactivity, racing thoughts, and high levels of energy. Mixed affective states often predict a more severe course of illness, treatment resistance, and poor patient outcomes.

2. Rapid cycling bipolar disorder (RCBD)

Individuals affected by bipolar disorder often experience rapid cycling 13, “a type of manic-depressive illness in which the patient experiences four or more episodes of mania and/or major depression per year.” RCBD can lead to intense feelings of loss of control and helplessness. This primarily occurs when symptoms associated with BD are not properly and timely diagnosed and treated. During this 12-month period, mood swings associated with manic or depressive episodes may occur rapidly. The patient may experience an emotional rollercoaster ride from the highs of elevated moods to the lows of major depression repeatedly in a matter of days or hours.

Bipolar Disorder In Children

Children, adolescents, and teens are often diagnosed with BD. However, as these younger age groups don’t typically show the same symptoms as adults, identifying or diagnosing the condition in them can be challenging. Moreover, their thought patterns, moods, and behaviors may not match the diagnostic criteria used by most healthcare professionals. Signs of bipolar disorder in children can also be similar to other psychiatric disorders, like attention deficit hyperactivity disorder (ADHD).

One 2015 study 14 reveals that “rates of reported lifetime mania of youths have varied from 0.1% (5) to 1.7% among adolescents and to 2.5% for bipolar I and II lifetime disorders among adolescents.” Another 2014 study 15 found that the overall occurrence of this disorder in adolescents and children is 1.8%, reaffirming that “although DSM criteria for bipolar disorder may have limitations in the context of diagnosing bipolar disorder in children, it is clear that children are receiving this diagnosis.” Doctors are increasingly becoming proficient in diagnosing children with BD and helping them get the right treatment.

Children with BD experience episodes of elevated mood and depression. They face abnormal changes in energy, moods, activity levels, and daily functioning. Most times, they seem happy and excited and then show signs of depressive behavior. Although mood changes are common in children, signs of bipolar disorder are extremely pronounced and are very different from typical mood swings. However, with effective and timely treatment, children, adolescents, and teens can overcome bipolar disorder.

Symptoms Of Bipolar Disorder

Symptoms Of Bipolar Disorder
Bipolar Disorder

BD is characterized by cognitive deficits and affective instability. Symptoms of bipolar disorder can be different for each patient as the disorder varies widely in frequency, severity, and pattern. Some may experience highs and lows in quick succession while others may experience episodes that last for months or even years.

A person with BD may also experience mood disruptions once a year or frequently. Mood episodes in bipolar disorder are cyclical and intense, wherein a person may be more susceptible to either depression or mania or both episodes equally.

Listed below are some of the most common manic and depressive symptoms of bipolar disorder:

1. Manic symptoms

Mania or hypomania are characterized by elevated moods. According to the American Psychiatric Association, manic episodes in BD usually last at least a week wherein the person is excessively irritable or extremely high spirited. He/she displays at least three of the following symptoms:

  • Intrusive, unmanageable racing thoughts and rapidly changing topics or ideas
  • Inflated self-esteem or an exaggerated sense of grandiosity
  • Reduced need for sleep
  • Getting distracted easily
  • Increased risky behavior
  • Being highly talkative or speaking rapidly and loudly
  • Engaging more activities or events at once than can be completed

Mania or hypomania also involves these additional symptoms, including:

  • Jumpy or upbeat behavior
  • Extremely high levels of energy
  • Flawed judgment and poor decision-making
  • Grand delusions
  • Hallucinations
  • Boredom
  • Aggression
  • Increased libido leading to unprotected sex
  • Euphoria
  • Incoherent speech
  • Exaggerated self-confidence and self-importance
  • Spending sprees
  • Substance abuse, like alcoholism, drug abuse, etc.

2. Depressive symptoms

According to research conducted by the American Psychiatric Association, an episode of major depression tends to last for two weeks and involves at least five of the following symptoms:

  • Extreme despair or sadness
  • Feelings of worthlessness
  • Hopelessness
  • Helplessness
  • Guilt
  • Shame
  • Loss of interest in pleasurable activities
  • Disturbed sleeping patterns, like insomnia or oversleeping
  • Agitation
  • Restlessness
  • Slurred speech
  • Restricted body movement
  • Changes in appetite
  • Chronic fatigue, exhaustion, or loss of energy
  • Poor concentration
  • Chronic forgetfulness
  • Suicidal ideation

A patient in a depressive episode of bipolar disorder also experiences the following symptoms:

  • Uncontrollable weeping
  • Weight gain or weight loss
  • Indecisiveness or difficulty in making decisions
  • Anxiety about insignificant issues
  • Irritability
  • Listlessness
  • Lack of interest in work or school leads to underperformance
  • High sensitivity to sensory stimuli

What Causes Bipolar Disorder?

Researchers are yet to identify the exact cause for the development of BD. However, it is believed that the disorder may be caused by a combination of factors related to genetics and the environment. Moreover, stressful life events and other factors may also trigger the condition in someone with financial difficulties, relationship problems, medication, substance abuse tendencies, etc. Such triggers can often lead to new episodes of BD. Brain structure and development may also play a crucial role in the onset of BD.

As further research is being conducted to understand the precise causes of bipolar disorder, listed below are some contributing factors that may play a major role in increasing a person’s risk of BD:

1. Genetics

Bipolar I disorder has the highest genetic link of all psychiatric disorders. This mental condition is more common in individuals who have a first-degree family member with BD. Behavioral genetic studies 16 show that several candidate genes and chromosomal regions are associated with BD susceptibility. Although no specific gene has yet been identified, researchers believe that the disorder is highly heritable 17 and may ‘run in families’.

According to a 2021 study 18, “the risk of bipolar disorder is 10-25% when one parent has a mood disorder” whereas twins have a 70-90% concordance rate. Around 80-90 percent of people with this disorder tend to have a relative suffering from either bipolar moods or depression. Adult relatives of patients with bipolar I and bipolar II disorders can have a ten-fold increased risk 19 for BD.

However, understanding the role of genetics in bipolar disorders, as in other disorders, is highly complex as the genetic patterns and links associated with BD tend to be non-uniform. For instance, a person with a family history of BD may never develop the condition. Research in twin studies also reveals that even when one identical twin may suffer from bipolar disorder, the other identical twin may not develop it.

2. Brain structure and functioning

Brain chemistry can also be a contributing factor in the development of manic depression. Although the significance of physical changes in the brain is still not clear, abnormalities in the structure and function, including chemical imbalances, in the human brain can substantially increase the risk. Brain-imaging has revealed that, in people with BD, many regions in the brain are characterized by decreased thickness of the cortex. Moreover, processing of sensory stimuli may also be affected during manic and depressive episodes which may lead to impairment in perception.

One 2006 study 20 claims that bipolar disorders are “characterized by dysregulation in the dopamine and serotonin systems and by pathology in the brain systems involved in regulating emotion.”

Moreover, adrenocortical hyperactivity occurs during mania episodes. People with a family history of depression or mood disorders have higher glucose metabolism in the limbic region 11 with reduced metabolism of the anterior cerebral cortex. BD is also associated with issues in the functioning of neurotransmitters or chemical messengers or hormones (such as noradrenaline, norepinephrine, serotonin, and dopamine) which influence the brain.

Manic episodes also occur when noradrenaline is present in high levels; on the other hand, depressive episodes occur when noradrenaline levels are severely low. However, it is yet to be identified whether such dysfunctions in the neurotransmitters are a cause or a result of the mental condition. These neurotransmitters may also be triggered due to environmental factors like stress, social issues, etc.

Research also shows that bipolar disorders are caused by certain neurological conditions, like:

  • Traumatic brain injury
  • Stroke
  • Multiple sclerosis
  • Porphyria
  • HIV
  • Temporal lobe epilepsy

Read More About Brain Science Here.

3. Environmental factors

Apart from genetics and brain chemistry, environmental and psychosocial factors can also play an influential role in the onset of BD. A number of external factors can often trigger the condition, such as excessive stress, anxiety, traumatic events, physical illness etc. Events that cause extreme mental stress and trauma—like the the death of a loved, an abusive relationship, physical or sexual assault, or other adverse life events—may trigger the initial episodes in a vulnerable person with genetic dispositions 21 or an abnormal brain structure.

A 2021 study 18 on bipolar disorder states that certain life stressors “can lead to neuronal changes such as neurotransmitter levels, synaptic signaling alterations, as well as neuronal loss. This is implicated in the first episode of the mood disorder, as well as the recurrence of subsequent episodes.” Some of the common factors that can externally trigger the condition include:

  • An unsuccessful intimate relationship, like a breakup, divorce, etc.
  • Abandonment or neglect
  • Financial problems
  • Physical, emotional, or sexual abuse
  • Grief from the loss of a loved one
  • Sleep disturbances
  • Serious physical illness
  • Overwhelming issues in daily life

Research 22 indicates that the “circadian rhythm desynchronization” can also be a contributing factor in bipolar disorder. In fact, insomnia and sleep deprivation are associated with more than around 30% of sufferers 23 with BD. Surveys 24 moreover reveal that approximately 30–50% of adult patients with BD report childhood abuse, a factor that related with an early onset of BD, an increased risk of suicide, and comorbid or co-occurring conditions like post-traumatic stress disorder (PTSD).

Studies 20 also show that people with dysthymia or cyclothymia are highly vulnerable to depression or bipolar I disorder, whereas individuals with personality disorders (like borderline, obsessive-compulsive, or histrionic personality disorders) are at increased risks of developing depressive disorders.

4. Substance abuse

Drug or alcohol abuse can also influence the onset of BD, although it may not directly lead to the development of the mental disorder. However, it can significantly make the symptoms worse and affect the recovery process. Using illegal drugs, alcohol, tranquilizers, or even certain medications can cause severe depression in most cases. Unfortunately, most patients tend to use alcohol or drugs during episodes of mania or depression to ease their sufferings. Such drugs include sympathomimetics (like cocaine, amphetamines, etc.), alcohol, certain antidepressants (such as tricyclics, monoamine oxidase inhibitors [MAOIs], etc.) and so forth.

However, use of such substances worsens symptomatic conditions of bipolar disorders. For instance, some antidepressants can result in hypomania or mania as a side effect, especially during withdrawal. Moreover, an incorrect diagnosis and prescription may also make the patient take the wrong medications enhancing the depressive or manic symptoms. If you are taking alcohol or illegal drugs, then make sure to inform your doctor during bipolar disorder diagnosis. A patient may need to detox first from the effects of the substances before treatment can begin as substance abuse can result in psychosis.

Comorbid Conditions

According to a 2014 study 25, “bipolar disorder is associated with high rates of medical illness.” People suffering from BD may also develop other mental and/or physical health conditions that should be accurately diagnosed and treated along with bipolar disorder. According to a 2002 study 26, around 95% of people with bipolar disorder meet the criteria for three or more lifelong psychiatric disorders. Bipolar I disorder is often related to severe medical and psychiatric comorbidity 27, serious functional disability, and early mortality. One 2006 study 22 elaborates that “comorbid psychiatric disorders in individuals with bipolar disorder are associated with poorer outcome and poorer treatment response, increased service utilization, and increased cost.”

Bipolar disorders have common and debilitating comorbidity conditions that decrease the chances of great bipolar disorder treatment outcomes. These include:

  • Attention-deficit hyperactivity disorder (ADHD)
  • Post-traumatic stress disorder (PTSD)
  • Obsessive-compulsive disorder (OCD)
  • Psychosis
  • Anxiety disorders
  • Panic disorder
  • Generalized anxiety disorder (GAD)
  • Social anxiety disorder
  • Eating disorders
  • Personality disorders
  • Impulse control disorders
  • Seasonal depression
  • Phobias
  • Substance abuse
  • Obesity
  • Metabolic syndrome
  • Diabetes
  • Other physical health conditions, like heart disease, thyroid problems, etc
  • Suicidal behavior

Read More About Obsessive-Compulsive Disorder (OCD) Here

Research 28 indicates that bipolar disorder treatment is often plagued by misdiagnosis, particularly when it comes to ‘comorbid’ symptoms of anxiety disorders, schizoaffective disorders, personality disorders, etc. This can worsen the symptoms, make the treatment process difficult and ineffective, and lead to poor prognosis of the condition.

A 2016 study 29 reveals that BD has one of the highest rates of comorbid substance abuse disorders among all axis I diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. Research 30 also shows that more than 60% of bipolar I and 48% of bipolar II patients have anxiety and drug or alcohol use disorder. Moreover, lifetime prevalence of the disorder is more than 90%. It is also found that BD is associated with violent and criminal tendencies, suicidal ideation and execution, frequent hospital admissions, and poor treatment compliance.

Bipolar Disorder Diagnosis

There is no specifically prescribed bipolar disorder test. According to a 2016 study 31, currently there are no trustworthy biomarkers for early diagnosis of this debilitating mental disorder. This is why it is crucial that the sufferer consults a mental health professional (such as a psychiatrist, psychologist or a clinical social worker) to diagnose their symptoms. Although a general practitioner or a family physician may conduct a preliminary diagnosis, only a mental health expert can diagnose BD accurately and reliably using the specific criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

For clinical purposes, the diagnosis of bipolar disorder is carried out on identification of symptoms of mania, hypomania, or self-harm. The symptoms may also be observed in severe cases of social withdrawal, functioning impairment, or hospitalization. To be diagnosed with BD, the sufferer must experience at least one episode of mania or hypomania. For mania, the elevated or irritable mood must persist for at least 7 consecutive days and be experienced almost every day. For hypomania, the mood must persist for at least 4 consecutive days and be experienced almost every day.

The patient must display noticeable behavior change owing to him/her experiencing at least three of the following symptoms during this period:

  • Inflated self-esteem
  • Grandiosity
  • Reduced sleep
  • Easy distraction
  • Restlessness
  • Extremely talkative behavior
  • Risk-taking tendencies
  • Increased psychomotor agitation

A person with BD is to be diagnosed with major depression, must at least display the following symptoms for a two–week period:

  • Depressed mood
  • Loss of interest in pleasurable activities
  • Loss of energy or fatigue
  • Changes in appetite
  • Changes in weight
  • Feelings of guilt, shame, or worthlessness
  • Purposeless movement
  • Indecisiveness
  • Lack of concentration
  • Repeated suicidal ideation or attempt

Diagnosing bipolar disorder accurately and timely can significantly help to manage the condition and improve the prognosis for the patient. One 2014 study 32 states that “a thorough diagnostic evaluation at a clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis.” However, due to the diversity of symptoms, proper bipolar disorder diagnosis can often be a challenge. Moreover, as people tend to seek treatment mostly for depressive symptoms, it is often likely that the healthcare expert may misdiagnose BD as depression or schizophrenia. This is why a doctor may conduct certain laboratory tests and a physical examination to rule out other causes. Some common bipolar disorder tests may include:

Read More About Schizophrenia Here

  • Blood tests
  • Electrolyte levels
  • CBC count
  • Protein levels
  • ESR levels
  • Fasting glucose levels
  • Thyroid hormone levels
  • Liver and lipid panel
  • Substance and alcohol screening
  • HIV testing
  • VDRL testing

MRI and/or electroencephalography may also be required for certain patients. The doctor may ask a few questions such as:

  • How many symptoms are experienced by the patient?
  • How long do depressive or manic episodes last?
  • How frequently do the episodes occur?
  • How many episodes have been experienced so far?
  • How do the symptoms affect the patient’s life and daily functioning?

This is because mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, family history, and lifetime experiences. Because of the wide array of disorders, bipolar disorder diagnosis also constitutes differential diagnosis 18 to detect the following conditions:

  • Major depressive disorder
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia
  • Generalized anxiety disorder
  • Substance-induced bipolar disorder
  • Personality disorders
  • Attention-deficit/hyperactivity disorder
  • Oppositional defiant disorder
  • Alcoholism or substance abuse disorder
  • Self-harm
  • Suicidal tendencies

Read More About Generalized Anxiety Disorder (GAD) Here

How To Treat Bipolar Disorder?

If you or a loved one is suffering from bipolar disorder, it is crucial that you seek medical attention immediately. Fortunately, a number of treatment options are available that can enable the patient to live a productive and healthy life. After an accurate diagnosis has been made, a treatment plan can be devised involving a combination of medications and psychotherapy. The objective of treatment for bipolar disorder is to help the sufferer function successfully in daily life. Some of the most common and effective treatment options for BD include:

  • Medications
  • Psychotherapy
  • Physical intervention
  • Lifestyle changes and self-care

Bipolar disorder is highly treatable by psychotherapy, medication, psychoeducation, or combination 33 therapy. However, it is a recurrent chronic disorder that requires long-term treatment and ongoing care. Even if easy treatment for bipolar disorder is available, proper diagnosis and identifying a suitable treatment plan can be a time-consuming process.

Here are some of the most helpful options of treatment for bipolar disorder:

1. Medications

There are certain medications that can help someone suffering from this disorder. Medicinal treatment for bipolar disorder is primarily aimed at stabilizing mood, managing anxiety, and sleep issues. There are different types of medication available and it should be left to medical professionals to decide which medication works best. Typically, these medications are found to be most effective when used in combination with psychotherapy.

Mood stabilizers, like lithium, are perhaps the most commonly prescribed medication for BD. Moreover, atypical antipsychotics, antiseizure drugs, antidepressants, and sleeping pills may also be prescribed.

Let’s take a look at some of the most common medications available for bipolar disorder:

A. Mood stabilizers

Lithium carbonate is the most well-known and effective mood stabilizer that can not only decrease the severity of mania symptoms but also prevent them from reoccurring. One 2013 study 34 found that “Lithium has the strongest evidence for long-term relapse prevention.” It can also notably decrease the risk of suicide.

A 2015 study 35 reveals that lithium is the gold standard for bipolar disorder treatment and it is “used primarily for long term (prophylactic) treatment of BD with the aim to prevent further manic and depressive recurrences.” According to another 2009 study 36, lithium is the cornerstone of pharmacotherapy in BD which helps to manage acute mood episodes, prophylactic treatment, and suicide prevention. However, there can be certain side effects of this mood stabilizer, such as frequent urination, diarrhea, weight gain, nausea, cognitive decline, etc. It may also affect the thyroid gland, kidneys, and heart. This is why it is crucial to consult a mental health expert and conduct a physical examination and blood tests before taking this medicine.

B. Antiseizure medications

Doctors often prescribe antiseizure drugs in place of lithium, specifically if the patient experiences a rapid mood cycle. Anti-seizure medications or anticonvulsants help to stabilize moods in BD and can be substantially helpful in treating the patient during an episode. It is also useful in preventing future episodes. Some common anti-seizure drugs for BD may include:

  • Lamotrigine
  • Oxcarbazepine
  • Carbamazepine
  • Valproate (valproic acid)
  • Gabapentin
  • Topiramate

A 2003 study 37 states that “valproate is commonly used as a first-line agent for the treatment of acute bipolar I mania.” Its effectiveness for treating acute mania “may have comparable efficacy to lithium and olanzapine.” However, anti-seizure medicines may have unwanted side effects, such as tremors, weight gain, loss of appetite, nausea, diarrhea, etc. Medical practitioners also warn that lithium and valproic acid usage during pregnancy can harm fetal development. Moreover, such medications may also slightly increase the risk of suicidal thoughts or behaviors. Hence, it is crucial that you take medications only under the supervision of a healthcare professional.

C. Antipsychotic medications

Research 38 indicates that second generation antipsychotic medications tend to be effective in managing BD symptoms. “Atypical antipsychotic drugs are recommended for use in bipolar disorder for acute treatment, maintenance treatment, and for treatment-resistant patients,” explains a 2003 study 39. However, these types of medications can also have certain side effects, including:

  • Asenapine: Dizziness, stiffness,restlessness, numbness in mouth, tremor, sleepiness, etc.
  • Quetiapine: Weight gain, dizziness, sleepiness, and dry mouth.
  • Ziprasidone: Sleepiness, restlessness, nausea, dizziness, tremor, etc.
  • Aripiprazole: Sleeplessness or sleepiness, restlessness, upset stomach, and nausea.
  • Risperidone: Nausea, restlessness, and sleepiness.
  • Olanzapine: Weight gain, dizziness, sleepiness, and dry mouth.

These medicines can also create problems in blood lipids and heighten the risk of diabetes. However, the benefits tend to outweigh the side effects in most cases.

D. Anti-anxiety medications

A doctor may also prescribe anti-anxiety medications to help a patient calm down and overcome the agitation and anxiety typically associated with an episode of mania. Some common types of anti-anxiety medications include clonazepam (Klonopin) and lorazepam (Ativan).

E. Antidepressants

Although antidepressants are not typically prescribed for independent use during the treatment for bipolar disorder, this type of medication can help sufferers overcome episodes of depression. Most doctors avoid prescribing it as it may trigger an episode of mania or lead to a pattern of rapid cycling. Perhaps, this is why most psychiatrists prefer to treat this condition using mood stabilizers after an accurate bipolar disorder diagnosis. One 2014 study 40 explains that “only when mood stabilizer or atypical antipsychotic monotherapy has failed should adjunctive treatment with an antidepressant be considered.”

However, research indicates that antidepressants can be valuable in the treatment process and help to manage low moods, especially when used in combination with antipsychotic medications or mood stabilizers. A doctor may also prescribe antidepressants when other medications have proven to be ineffective. A 2018 study 41 discovered that antidepressants, along with mood stabilizers, are important for an optimal maintenance of a treatment regime. It elaborated that “a number of recent studies have demonstrated both the safety and efficacy of antidepressant monotherapy in treating bipolar II depression.”

Another 2008 study 42 claims that there is certainly scope for the usage of antidepressants in bipolar disorder treatment. However, doctors must be cautious and analyze each patient individually. The researchers explain “Looking at specific depressive symptoms might help physicians in making the choice of whether to prescribe or not prescribe antidepressants.” Apart from these, sleep aids may also be recommended to overcome mania.

2. Psychotherapy

Psychotherapy can be an effective tool for treating bipolar disorder. Psychotherapy can involve a wide range of psychological intervention techniques, like psychoeducation and cognitive behavioral therapy (CBT), family-focused therapy, and interpersonal and social rhythm therapy (IPSRT). These can help a patient identify their difficult emotions, behaviors, and thoughts and change them. Evidence shows that psychotherapy can enable patients to identify mood symptoms early for mania and develop coping strategies for depression. It can also motivate them to follow the treatment plan closely. Family education can also improve communication among family members and help sufferers adjust easily.

Therapy and counseling can offer guidance, education, and support to the sufferer and family members and empower them to better cope with the condition. It can also help them cope with embarrassments, loss, practical challenges and painful consequences associated with manic or depressive episodes. According to a 2013 study 34, “treatment guidelines increasingly suggest that optimum management of bipolar disorder needs integration of pharmacotherapy with targeted psychotherapy.”

Read More About Psychotherapy Here

Psychosocial interventions for BD primarily aims at:

  • Enhancing the acknowledgement and acceptance of the disorder
  • Increasing the capability to recognize warning signs of recurrences and intervene early
  • Improving adherence with treatment plan and medicine regimens
  • Improving the ability to overcome environmental stressors related to symptoms
  • Decreasing alcohol or substance misuse
  • Stabilizing sleep and wake rhythms and other important daily routines
  • Improving social and familial relationships
  • Enhancing communication
  • Re-engaging in occupational, social, and familial roles

In psychotherapy, the patient can work with a mental health professional to understand the disorder, the triggers, and ways to cope with the symptoms. A 2006 study 43 suggests that “adjunctive psychological therapies reduce overall rates of relapse, but are more effective for depression than for mania.” However, another 2004 study 44 reveals that “a range of psychological approaches appear to benefit people with bipolar disorder.” The study has found that individual CBT is perhaps the most effective technique which helps to manage bipolar disorder symptoms, improve social functioning, and reduce the risk of relapse.

A. Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy is a form of talk therapy which enables the patient to recognize their thought processes and behavior patterns to help them better manage their mental conditions. A therapist will understand the thought patterns of the sufferer and help replace bad behavior and habits. CBT can also help patients develop positive coping strategies to manage stress, anxiety, and negative triggers. Cognitive behavioral therapy can enable a person with bipolar disorder to:

  • Identify stress and key triggers and better manage them
  • Recognize early warning signs and symptoms of manic or depressive episodes to better cope with them
  • Adopt habits that help to sustain a stabilized mood for longer durations
  • Involve family, friends, teachers and coworkers in making positive decisions

According to a 2017 study 45, around 90 minute sessions of CBT can significantly help to reduce mania or depression and even decrease the rate of relapse among type I BD patients.

Read More About Cognitive Behavioral Therapy Here

B. Interpersonal and social rhythm therapy (IPSRT)

IPSRT is a psychological intervention that has been specifically developed for the treatment of bipolar disorder. This type of therapy aims to stabilize disruptions in the circadian rhythm which is common in BD patients. Interpersonal and social rhythm therapy is based on the principles of interpersonal psychotherapy and emphasizes the importance of establishing and closely following daily routine or rhythm for everything. It is believed that this can help to maintain a stable mood.

By focusing on building and managing daily habits, like eating, sleeping, meditating and exercising, IPSRT 46 can help the sufferer to manage their condition. A 2015 study 47 states that “attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.”

C. Psychoeducation

It is a type of counseling and evidence-based therapeutic intervention that helps the patient and their family members understand the condition by gaining crucial information. This can help to improve communication skills among families and provide better support to the sufferer when episodes occur. Understanding and learning about bipolar disorder will help you and your loved ones to better cope with it. Evidence indicates that psychoeducation also helps to improve recovery, reduce rates of relapse and enhance family well-being.

One 2007 study 48 elaborates that “psychoeducation should be part of the integrated treatment of bipolar disorder. As a complement to pharmacotherapy, psychoeducation delivered individually or in a group setting constitutes a first-line psychological intervention.”

D. Family-focused therapy (FFT)

Also known as family therapy 49 and family counseling, FFT is a form of psychotherapy that focuses on helping families and couples in intimate relationships cope with bipolar disorder and embrace change and development. The objective is to empower family members to create a stronger and more helpful support system to help with the treatment plan and recovery process. A family therapist can also teach loved ones to identify the triggers and recognize the onset of an episode.

One study 50 has revealed that FFT is an effective adjunct to pharmacotherapy as “family approaches present an opportunity for patients to gain control over concurrent episodes while building skills that might prevent or decrease the impact of future episodes.”

3. Electroconvulsive therapy (ECT)

Also known as electroshock therapy, ECT is a psychiatric procedure used for bipolar disorder treatment when other treatment options have proved ineffective. The process involves directing small doses of electrical currents through the brain to deliberately induce a brief seizure. This is done under general anesthesia with the objective of “rebooting” the brain and altering the balance of specific brain chemicals. This can rapidly reverse bipolar symptoms. This treatment approach is usually safe and controlled with minimum side effects and risks.

ECT is specifically helpful in treating clinical depression. According to a 2019 study 51, about 80.2% of BD patients tend to show a positive response to electroconvulsive therapy, especially when it comes to treating the symptoms of bipolar depression.

However, it should be noted that relapse is common among bipolar disorder patients, even with a proper treatment plan. The patient should also clearly communicate about any substance, drugs, or unprescribed medications they are consuming to their doctor so that treatment can be effective and successful. Moreover, as BD can strain family dynamics and create stress among family members, loved ones and caregivers of the patient should also seek professional help and support for themselves, if needed.

4. Self-management strategies

Apart from closely following the treatment plan and the instructions of your doctor, there are certain changes you can make in your lifestyle to better manage your symptoms of bipolar disorder. These include:

  • Maintaining a good sleep hygiene regime and get at least 7-8 hours sleep every night
  • Taking steps to prevent sleep disturbances
  • Eating a healthy and balanced diet
  • Following a regular routine for your daily tasks, such as eating, sleeping, working, socializing, etc
  • Learning how to identify triggers and sudden mood swings
  • Seeking support from family and friends for your treatment
  • Not hesitating to seek medical help
  • Maintaining a daily journal and write down your thoughts, feelings, triggers, and symptoms
  • Learning how to manage and overcome stress
  • Pursuing hobbies and interests that make you happy
  • Avoiding consumption of excessive amounts of caffeine or nicotine
  • Staying away from alcohol and recreational drugs
  • Staying connected with friends and family and be socially active

Supplements And Natural Remedies For Bipolar Disorder

There are certain supplements and natural remedies that can help in coping with bipolar disorder. However, the patient must discuss using any supplements with their doctor first as these may adversely interact with the medications and may make the symptoms worse. A healthcare professional can provide proper guidance regarding what supplements can be used to stabilize mood and relieve BD symptoms.

Here some of the most common supplements and herbs used for coping with the symptoms of bipolar disorder:

1. Fish oil

Studies 52 reveal consumption of adequate amounts of fish and fish oil can help prevent the development of manic depression. Fish oil can be consumed by eating fish or taking over-the-counter (OTC) supplements of omega-3 fatty acids 53 from fish oil in capsule or liquid form. It is believed that these omega-3 fatty acids are associated with brain areas that regulate behavior and mood. However, there may be certain side-effects such as diarrhea, bloating, belching, stomach aches, heartburn, and nausea.

2. Rhodiola rosea

Rhodiola rosea is known to treat moderate to mild depression. Prescribed doses 54 of this supplement along with mood stabilizers can greatly help a BD patient with predominantly depressive symptoms, mood swings, and occasional hypomania.

3. S-adenosylmethionine (SAMe)

SAMe 55 is a natural substance available in all human cells and an amino acid supplement which can relieve symptoms of bipolar disorder, major depression, and other affective disorders. According to a 2017 study 56, “SAMe holds promise as a treatment for multiple neuropsychiatric conditions, but the body of evidence has limitations.” However, its usage can often induce manic episodes 57.

4. Other supplements

Some other supplements that help to combat BD include:

  • St. John’s wort
  • Choline
  • N-acetylcysteine
  • Inositol
  • Other minerals and vitamins

5. Relaxation techniques

Certain relaxation practices and calming techniques can help to relieve stress and anxiety, induce mindfulness, and regulate mood and behavior. Some effective relaxation techniques include:

  • Deep breathing
  • Meditation
  • Mindfulness
  • Yoga
  • Massage therapy
  • Acupuncture

Read More About Mindfulness Here

Although these practices cannot directly cure the disorder, these can substantially help the sufferer manage the symptoms and support the recovery process. For instance, deep breathing can reduce anxiety symptoms in bipolar disorder with zero side effects. According to a 2019 study 58, “deep breathing protocol was effective in reducing anxiety levels in patients with bipolar disorder.” Another 2017 study 59 reveals that mindfulness-based treatment, like mindfulness based cognitive therapy (MBCT), can have positive effects and relieve anxiety symptoms in patients with BD.

When To Consult A Doctor

Although they experience extreme mood swings, individuals affected by bipolar disorder often fail to realize that they are suffering from a psychiatric illness. They are unable to process the fact that their manic and depressive episodes, if untreated, can lead to chronic emotional instability. This can disrupt their daily functioning and affect the lives of their family and friends.

A person with BD may enjoy high levels of energy, the ability to be highly productive, and euphoric feelings during manic episodes, but this can lead to an emotional crash during depressive periods which always follows a manic episode. Without treatment, episodes may become increasingly frequent and last longer over time. Such conditions destroy social relationships, career, etc. and even lead to suicide.

As the symptoms of bipolar disorder do not improve naturally over time, it is best to seek professional help. This can be especially important if the symptoms become too severe or if the episodes occur too frequently. Moreover, suicidal ideation and behavior are also common among sufferers. Consulting a licensed mental health professional experienced in treating mood disorders can help the patient overcome the symptoms and recover successfully. In extreme cases, a person with bipolar disease may need to be hospitalized, even if they are reluctant about it.

Bipolar Depression And Suicide

Suicide is considered to a be a major risk factor of the depressive phase associated with bipolar disorder. According to a recent 2020 research 60 “bipolar disorder has the highest rate of suicide of all psychiatric conditions.” It is also one of the primary factors that lead to reduced life expectancy in patients with BD. Studies 61 show that around 25%–56% of bipolar patients have attempted suicide at least once, while 4%-19% of BD patients 62 have committed suicide.

It has also been observed that individuals suffering from bipolar depression have a higher risk of attempting suicide than people affected with normal depression. A 2019 study reveals that suicide rates among people with this condition is about 10-30 times higher when compared to normal normal people. Recent research shows that some of the most common risk factors for suicide in BD patients include:

  • Frequent episodes of depression or predominant depressive polarity
  • Early onset of the disorder
  • Mixed episodes
  • Being of the male gender
  • Isolation
  • Broken relationships
  • Childlessness
  • Being younger than 35 years of age
  • Being older than 75 years of age
  • Unemployment or financial hardship
  • Personal or family history of suicidal attempts or completion
  • Alcohol or substance abuse

Self-harm is also a common symptom of this condition which may or may not be related to suicidal attempts. Regardless, early identification, diagnosis and treatment for bipolar disease can help prevent suicidal behavior as suicide risk tends to be higher during the initial phase of the illness. Some common suicide warning signs for BD patients may include the following:

  • Repeatedly talking about self-harm, death or suicide
  • Severe depression
  • Feeling worthless, helpless. or hopeless
  • Changes in appetite, weight, sleeping or activities
  • Social withdrawal and isolation
  • Behaving recklessly and taking high risks unnecessarily
  • Having frequent accidents leading to injury
  • Obsessed with negative, morbid or macabre themes
  • Being tearful or uncontrollable crying or not being emotionally expressive
  • Saying goodbyes and putting affairs in order
  • Giving away valuable or treasured possessions
  • Alcohol or substance abuse
  • Seeking out ways to commit suicide, like pills or weapons

Read More About Self-Harm Here

If you are having thoughts about suicide, then make sure to:

  • Talk to a trusted loved one and seek help immediately
  • Call your doctor, mental health professional or health care provider
  • Call a suicide helpline or the emergency department of the nearest hospital

If a loved one suffering from bipolar disorder is showing signs of suicidal ideation or attempt, then:

  • Do not leave them alone
  • Call your doctor or the nearest hospital for immediate help
  • Remove weapons or other potential tools that can be used for suicide or self-harm, like medications, sharp objects, ropes, firearms etc.
  • Encourage them to focus on the positive side of life

Coping And Living With Bipolar Disorder

Living And Coping With Bipolar Disorder
Bipolar Disorder

Living with and managing bipolar disease on a daily basis can be challenging. As it is a chronic mental illness, the patient may have to live with the condition for the rest of their life. However if you have BD, with effective treatment, you can still lead a healthy and happy life. Here are a few ways that make your and your loved ones’ lives easier while coping with bipolar disorder:

1. Take treatment seriously

Medical treatment under the supervision of a psychologist or psychiatrist can help you cope with symptoms. Hence, it is crucial that you find a doctor experienced with treating BD. As treatment is usually a long-term process, make sure to be patient and persevering so that you and your doctor can find the right treatment that works for you. Stick with the treatment plan, take medicines properly, keep your therapy appointments, and communicate with your doctor frequently about any issues.

2. Seek support

Build a strong support and care team consisting of your loved ones, family, and friends. Your support can help you identify triggers, anticipate mood changes and maintain a healthy and normal life. You can also join local support groups. Community support can enable you to meet others coping with bipolar disorder, learn from them, and find new friends you can rely on. Your support team can encourage and help you when you need it the most. Seeking help is not a sign of weakness. In fact, it will strengthen your bonding with the people you trust and love.

3. Stay physically active

Make sure to exercise regularly as it can positively affect your mood, thoughts, and emotions. Cardio workouts and aerobic exercises, like running, swimming, brisk walking, dancing or bicycling may help reduce the frequency of BD episodes. As such exercises result in arm and leg movement, increased blood circulation, improved oxygen levels in the body, lower risk of heart diseases, it is also beneficial for the brain and nervous system. Regular exercise can also reduce stress, anxiety and depression, and improve sleep. Anaerobic exercises, like yoga, pilates, and weightlifting are also helpful in aiding recovery.

One 2016 study 63 shows that higher levels of cardiorespiratory fitness and regular exercise can lower the risk for premature mortality in people with BD. Research 64 shows that physical activity interventions greatly enhances the mental and physical health of patients with BD.

4. Build routines

Living an undisciplined and chaotic life can often lead to episodes of mania or depression. Establishing and maintaining a regular routine is one of the most important coping mechanisms for this disorder. Building routines for daily tasks and activities can not only help the sufferer to monitor and regulate their moods but it can also empower them to make healthy choices in life, like eating, sleeping, and exercising properly. Routines can also encourage patients to stick to the treatment plan and take medications regularly, despite how good or bad they may feel.

By doing the same things every day in a specific order, you can set up effective yet practical daily routines, resulting in reduced cycle changes. However, you should avoid making routines during a manic episode as things can go overboard and you may end up doing more things than you need to, leading to further stress.

Apart from these, you also need to learn how to monitor your mood, identify triggers and warning signs, manage stress, manage your finances, and plan ahead for an episode so that you know exactly what to do or who to call for help. If you are thinking about suicide or self-harm, then make sure to talk to someone from your support team or call your doctor immediately for help. Although dealing with bipolar disorder can seem daunting, it does not necessarily have to affect your entire life. When you learn to cope with the symptoms, you can make smart choices, relieve the symptoms and improve your well being.

Helping Someone With Bipolar Disorder

Bipolar disorder affects 45 million people 65 across the world. So if you’re living with it or caring for someone with this condition, it can be a difficult experience for you. The patient with BD may become violent, abusive, or disruptive in most cases. This can affect family dynamics, damage relationships, and drain family finances. However, it is crucial that you understand that the patient is suffering from a genuine and serious mental illness. But it is also important that you understand your own rights, establish healthy personal boundaries, and protect your interests.

If your loved one or someone you know is affected by bipolar disorder, then here are a few ways to help them recover and help yourself as well:

1. Educate yourself

Learning about the condition is one of the best things you can do to help a family member or friend cope with BD. As there are numerous informative and reliable free resources available online, you can learn about the symptoms, triggers, medical treatments, complementary treatments, and coping strategies related to bipolar disease. This will not only empower you to help and support the patient better, but it will also enable you to be better prepared during episodes.

2. Encourage them to seek treatment

If your loved one is showing symptoms of BD, then encourage them to consult a primary care physician or a mental health professional. Even if the patient is reluctant, you can make an appointment with the doctor and support the patient through the recovery process. The love, support, care and understanding of spouses/partners, family members, and friends is crucial for both bipolar disorder treatment and recovery.

3. Talk to them

If episodes of mania or depression or even psychosis are leading to severe symptoms and making the patient self-destructive or abusive at times, then make sure to communicate with them in a gentle yet open manner. Let them know how their behavior is affecting you and others and damaging their relationships. Being honest and transparent can strengthen your relationship and encourage them to seek medical attention.

4. Ask them how you can help

Instead of assuming how you may support them, ask them about their needs and wants and how you may help them, when the patient is in a stable mood. This will help you understand exactly how you can support them during their manic and depressive states and make them feel better.

5. Respond, don’t react

To help someone who is living with bipolar disorder can be seriously frustrating. Due to their extreme mood swings, you may feel extremely stressed out and drained. This can often lead to high levels of frustration and make you react negatively, criticize and condemn the patient. This is why it is important that you learn to manage your own stress and frustration so that you can effectively respond to them, instead of reacting negatively which can further worsen the symptoms. Staying positive in the long run is a crucial element of living and coping with mental disorders.

6. Help them follow the treatment plan

Work with your loved one to establish a routine which helps them stick to the treatment plan and take medications properly as instructed by the doctor. You also need to make appointments with the doctor for frequent check-ups and talk about any issues the patient or you may be facing due to BD. This may seem like a big responsibility, but this is one of the most important aspects of the recovery process.

7. Help them live better

You can encourage your loved one to make smart choices regarding their health, career, relationships, and life. Mental disorders can often damage relationships and so encourage them to stay connected with family and friends and strengthen bonds with loved ones. You can also motivate them to exercise regularly and follow a healthy sleep and diet routine by cooking healthy meals and sleeping early. If your patient shows signs of suicidal ideation or behavior then talk to a doctor or trusted loved ones immediately.

8. Practice self-care

When caring for a person with bipolar disorder, you can often forget to look after yourself. This can lead to high levels of stress and affect your own mental and physical health. This is why it is crucial that you practice self-love and self-care. Make sure to look after your own health by getting enough sleep, daily exercise and a balanced diet. Do things that help you to relax, like yoga, meditation, reading a book, getting a massage or a spa session or some alone time. You can also join a support group to meet people in similar situations. Moreover, you need to build healthy personal boundaries to protect yourself and help your loved ones in the long run.

Prognosis For Bipolar Disorder

Bipolar disorder is a serious yet common psychiatric illness that can affect a person’s mood, behavior and energy levels. Although it can severely disrupt the daily functioning of the patient when left untreated, ongoing and appropriate treatment can be significantly helpful in managing symptoms. One 2013 study 34 shows that about 58% of patients with types I and II BD recover with effective treatment. However, 49% of patients experience recurrences in a 2-year period. Moreover, 60% of people receiving treatment relapse into mania or depression within 2 years and 37% within 1 year.

Although treatment may not completely cure the disorder or eliminate mood shifts, ongoing treatment and constantly cooperating with medical professionals can help the patients better manage their symptoms, stabilize their moods, and improve the quality of their life.

Bipolar Disorder At A Glance

  1. Bipolar disorder (BD) is a condition that leads to extreme changes in mood, behavior, and energy levels.
  2. Around 1% of the global population is affected by it.
  3. People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive.
  4. A person with BD may experience periods of depression more frequently than periods of mania or vice versa.
  5. Suicide is considered to a be a major risk factor of the depressive phase associated with bipolar disorder.
  6. Bipolar disorder is a recurrent chronic disorder that requires long-term treatment and ongoing care.

Frequently Asked Questions (FAQs)

1. Is bipolar disorder genetic?

Bipolar disorders (BD) have the highest genetic link, especially when compared to other psychiatric disorders. Research shows that individuals who have a first-degree family member with BD are more likely to develop the disorder.

2. Who are some of the famous people with bipolar disorder?

Catherine Zeta-Jones, Kurt Cobain, Graham Greene, Nina Simone, Winston Churchill, and Demi Lovato are some of the famous people who are believed to have suffered from bipolar disorders.

3. Is bipolar disorder curable?

Bipolar disorder, like any other complex mood disorder, cannot be cured. It is a life-long condition with long-term consequences, but it can be easily managed with therapies, medication, etc.

👇 References:
  1. Dome, P., Rihmer, Z., & Gonda, X. (2019). Suicide Risk in Bipolar Disorder: A Brief Review. Medicina (Kaunas, Lithuania), 55(8), 403. https://doi.org/10.3390/medicina55080403 []
  2. Tondo, L., Vázquez, G. H., & Baldessarini, R. J. (2017). Depression and Mania in Bipolar Disorder. Current neuropharmacology, 15(3), 353–358. https://doi.org/10.2174/1570159X14666160606210811 []
  3. Dailey MW, Saadabadi A. Mania. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493168/ []
  4. Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1 []
  5. Bipolar disorder. (n.d.). ScienceDirect.com | Science, health and medical journals, full text articles and books. https://www.sciencedirect.com/science/article/abs/pii/S014067361500241X []
  6. Bipolar disorder | NEJM. (2020, July 1). New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMra1906193 []
  7. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 617–627. https://doi.org/10.1001/archpsyc.62.6.617 []
  8. Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., Viana, M. C., Andrade, L. H., Hu, C., Karam, E. G., Ladea, M., Medina-Mora, M. E., Ono, Y., Posada-Villa, J., Sagar, R., Wells, J. E., & Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry, 68(3), 241–251. https://doi.org/10.1001/archgenpsychiatry.2011.12 []
  9. Is sex important? Gender differences in bipolar disorder. (2010, November 3). Taylor & Francis. https://www.tandfonline.com/doi/full/10.3109/09540261.2010.514601 []
  10. Ferrari, A. J., Stockings, E., Khoo, J., Erskine, H. E., Degenhardt, L., Vos, T., & Whiteford, H. A. (2016). The prevalence and burden of bipolar disorder: Findings from the global burden of disease study 2013. Bipolar Disorders, 18(5), 440-450. https://doi.org/10.1111/bdi.12423 []
  11. Keener, M. T., & Phillips, M. L. (2007). Neuroimaging in bipolar disorder: a critical review of current findings. Current psychiatry reports, 9(6), 512–520. https://doi.org/10.1007/s11920-007-0070-2 [][]
  12. Bebbington, P., & Ramana, R. (1995). The epidemiology of bipolar affective disorder. Social psychiatry and psychiatric epidemiology, 30(6), 279–292. https://doi.org/10.1007/BF00805795 []
  13. Barrios, C., Chaudhry, T. A., & Goodnick, P. J. (2001). Rapid cycling bipolar disorder. Expert opinion on pharmacotherapy, 2(12), 1963–1973. https://doi.org/10.1517/14656566.2.12.1963 []
  14. Carlson, G. A., & Pataki, C. (2016). Bipolar Disorder Among Children and Adolescents. Focus (American Psychiatric Publishing), 14(1), 15–19. https://doi.org/10.1176/appi.focus.20150038 []
  15. Renk, K., White, R., Lauer, B. A., McSwiggan, M., Puff, J., & Lowell, A. (2014). Bipolar disorder in children. Psychiatry journal, 2014, 928685. https://doi.org/10.1155/2014/928685 []
  16. Kerner B. (2014). Genetics of bipolar disorder. The application of clinical genetics, 7, 33–42. https://doi.org/10.2147/TACG.S39297 []
  17. McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of general psychiatry, 60(5), 497–502. https://doi.org/10.1001/archpsyc.60.5.497 []
  18. Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/ [][][]
  19. Barnett, J. H., & Smoller, J. W. (2009). The genetics of bipolar disorder. Neuroscience, 164(1), 331–343. https://doi.org/10.1016/j.neuroscience.2009.03.080 []
  20. Miklowitz, D. J., & Johnson, S. L. (2006). The psychopathology and treatment of bipolar disorder. Annual review of clinical psychology, 2, 199–235. https://doi.org/10.1146/annurev.clinpsy.2.022305.095332 [][]
  21. Serretti, A., Mandelli, L. The genetics of bipolar disorder: genome ‘hot regions,’ genes, new potential candidates and future directions. Mol Psychiatry 13, 742–771 (2008). https://doi.org/10.1038/mp.2008.29 []
  22. Hilty, D. M., Leamon, M. H., Lim, R. F., Kelly, R. H., & Hales, R. E. (2006). A review of bipolar disorder in adults. Psychiatry (Edgmont (Pa. : Township), 3(9), 43–55. [][]
  23. Young, J. W., & Dulcis, D. (2015). Investigating the mechanism(s) underlying switching between states in bipolar disorder. European Journal of Pharmacology, 759, 151-162. https://doi.org/10.1016/j.ejphar.2015.03.019 []
  24. Brietzke, E., Sant’anna, M. K., Jackowski, A., Grassi-Oliveira, R., Bucker, J., Zugman, A., Mansur, R. B., & Bressan, R. A. (2012). Impact of childhood stress on psychopathology. Revista Brasileira de Psiquiatria, 34(4), 480-488. https://doi.org/10.1016/j.rbp.2012.04.009 []
  25. Forty, L., Ulanova, A., Jones, L., Jones, I., Gordon-Smith, K., Fraser, C., Farmer, A., McGuffin, P., Lewis, C. M., Hosang, G. M., Rivera, M., & Craddock, N. (2014). Comorbid medical illness in bipolar disorder. The British journal of psychiatry : the journal of mental science, 205(6), 465–472. https://doi.org/10.1192/bjp.bp.114.152249 []
  26. McElroy, S. L., Altshuler, L. L., Suppes, T., Keck, P. E., Jr, Frye, M. A., Denicoff, K. D., Nolen, W. A., Kupka, R. W., Leverich, G. S., Rochussen, J. R., Rush, A. J., & Post, R. M. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. The American journal of psychiatry, 158(3), 420–426. https://doi.org/10.1176/appi.ajp.158.3.420 []
  27. Blanco, C., Compton, W. M., Saha, T. D., Goldstein, B. I., Ruan, W. J., Huang, B., & Grant, B. F. (2017). Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions – III. Journal of psychiatric research, 84, 310–317. https://doi.org/10.1016/j.jpsychires.2016.10.003 []
  28. Keller M. B. (2006). Prevalence and impact of comorbid anxiety and bipolar disorder. The Journal of clinical psychiatry, 67 Suppl 1, 5–7. []
  29. Vieta, E., Berk, M., Birmaher, B., & Grande, I. (2016). Bipolar disorder: Defining symptoms and comorbidities – Authors’ reply. The Lancet, 388(10047), 869-870. https://doi.org/10.1016/s0140-6736(16)30966-7 []
  30. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593 []
  31. Gomez-Casati, D., Grisolía, M., & Busi, M. (2016). The significance of Metabolomics in human health. Medical and Health Genomics, 89-100. https://doi.org/10.1016/b978-0-12-420196-5.00007-1 []
  32. Culpepper L. (2014). The diagnosis and treatment of bipolar disorder: decision-making in primary care. The primary care companion for CNS disorders, 16(3), PCC.13r01609. https://doi.org/10.4088/PCC.13r01609 []
  33. Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder. JAMA Psychiatry, 78(2), 141. https://doi.org/10.1001/jamapsychiatry.2020.2993 []
  34. Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. Lancet (London, England), 381(9878), 1672–1682. https://doi.org/10.1016/S0140-6736(13)60857-0 [][][]
  35. Alda M. (2015). Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Molecular psychiatry, 20(6), 661–670. https://doi.org/10.1038/mp.2015.4 []
  36. Machado-Vieira, R., Manji, H. K., & Zarate, C. A., Jr (2009). The role of lithium in the treatment of bipolar disorder: convergent evidence for neurotrophic effects as a unifying hypothesis. Bipolar disorders, 11 Suppl 2(Suppl 2), 92–109. https://doi.org/10.1111/j.1399-5618.2009.00714.x []
  37. Keck, P. E., Jr, & McElroy, S. L. (2003). Divalproex in the treatment of bipolar disorder. Psychopharmacology bulletin, 37 Suppl 2, 67–73. []
  38. Surja, A. A., Tamas, R. L., & El-Mallakh, R. S. (2006). Antipsychotic medications in the treatment of bipolar disorder. Current drug targets, 7(9), 1217–1224. https://doi.org/10.2174/138945006778226598 []
  39. Ertugrul, A., & Meltzer, H. Y. (2003). Antipsychotic drugs in bipolar disorder. The international journal of neuropsychopharmacology, 6(3), 277–284. https://doi.org/10.1017/S1461145703003560 []
  40. McInerney, S. J., & Kennedy, S. H. (2014). Review of evidence for use of antidepressants in bipolar depression. The primary care companion for CNS disorders, 16(5), 10.4088/PCC.14r01653. https://doi.org/10.4088/PCC.14r01653 []
  41. Gitlin M. J. (2018). Antidepressants in bipolar depression: an enduring controversy. International journal of bipolar disorders, 6(1), 25. https://doi.org/10.1186/s40345-018-0133-9 []
  42. Salvi, V., Fagiolini, A., Swartz, H. A., Maina, G., & Frank, E. (2008). The use of antidepressants in bipolar disorder. The Journal of clinical psychiatry, 69(8), 1307–1318. https://doi.org/10.4088/jcp.v69n0816 []
  43. Scott J. (2006). Psychotherapy for bipolar disorders – efficacy and effectiveness. Journal of psychopharmacology (Oxford, England), 20(2 Suppl), 46–50. https://doi.org/10.1177/1359786806063078 []
  44. Jones S. (2004). Psychotherapy of bipolar disorder: a review. Journal of affective disorders, 80(2-3), 101–114. https://doi.org/10.1016/S0165-0327(03)00111-3 []
  45. Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849 []
  46. Stein, B. D., Celedonia, K. L., Kogan, J. N., Swartz, H. A., & Frank, E. (2013). Facilitators and barriers associated with implementation of evidence-based psychotherapy in community settings. Psychiatric services (Washington, D.C.), 64(12), 1263–1266. https://doi.org/10.1176/appi.ps.201200508 []
  47. Crowe, M., Beaglehole, B., & Inder, M. (2015). Social rhythm interventions for bipolar disorder: A systematic review and rationale for practice. Journal of Psychiatric and Mental Health Nursing, 23(1), 3-11. https://doi.org/10.1111/jpm.12271 []
  48. Rouget, B. W., & Aubry, J. M. (2007). Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature. Journal of affective disorders, 98(1-2), 11–27. https://doi.org/10.1016/j.jad.2006.07.016 []
  49. Miklowitz, D. J., & Chung, B. (2016). Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Family process, 55(3), 483–499. https://doi.org/10.1111/famp.12237 []
  50. Morris, C. D., Miklowitz, D. J., & Waxmonsky, J. A. (2007). Family-focused treatment for bipolar disorder in adults and youth. Journal of clinical psychology, 63(5), 433–445. https://doi.org/10.1002/jclp.20359 []
  51. Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., Nordanskog, P., & Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression – effectiveness and prognostic factors. Acta psychiatrica Scandinavica, 140(3), 196–204. https://doi.org/10.1111/acps.13075 []
  52. Qureshi, N. A., & Al-Bedah, A. M. (2013). Mood disorders and complementary and alternative medicine: a literature review. Neuropsychiatric disease and treatment, 9, 639–658. https://doi.org/10.2147/NDT.S43419 []
  53. Shakeri, J., Khanegi, M., Golshani, S., Farnia, V., Tatari, F., Alikhani, M., Nooripour, R., & Ghezelbash, M. S. (2016). Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder. International journal of preventive medicine, 7, 77. https://doi.org/10.4103/2008-7802.182734 []
  54. Mao, J. J., Li, Q. S., Soeller, I., Xie, S. X., & Amsterdam, J. D. (2014). Rhodiola rosea therapy for major depressive disorder: a study protocol for a randomized, double-blind, placebo- controlled trial. Journal of clinical trials, 4, 170. https://doi.org/10.4172/2167-0870.1000170 []
  55. Berigan T. R. (2002). A Case Report of a Manic Episode Triggered by S-Adenosylmethionine (SAMe). Primary care companion to the Journal of clinical psychiatry, 4(4), 159. https://doi.org/10.4088/pcc.v04n0408b []
  56. Sharma, A., Gerbarg, P., Bottiglieri, T., Massoumi, L., Carpenter, L. L., Lavretsky, H., Muskin, P. R., Brown, R. P., Mischoulon, D., & as Work Group of the American Psychiatric Association Council on Research (2017). S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research. The Journal of clinical psychiatry, 78(6), e656–e667. https://doi.org/10.4088/JCP.16r11113 []
  57. Abeysundera, H., & Gill, R. (2018). Possible SAMe-induced mania. BMJ case reports, 2018, bcr2018224338. https://doi.org/10.1136/bcr-2018-224338 []
  58. Serafim, S. D., da Ponte, F., Lima, F. M., Martins, D. S., Rosa, A. R., & Kunz, M. (2019). Effects of deep breathing in patients with bipolar disorder. Perspectives in psychiatric care, 55(1), 119–125. https://doi.org/10.1111/ppc.12325 []
  59. Bojic, S., & Becerra, R. (2017). Mindfulness-Based Treatment for Bipolar Disorder: A Systematic Review of the Literature. Europe’s journal of psychology, 13(3), 573–598. https://doi.org/10.5964/ejop.v13i3.1138 []
  60. Miller, J. N., & Black, D. W. (2020). Bipolar Disorder and Suicide: a Review. Current psychiatry reports, 22(2), 6. https://doi.org/10.1007/s11920-020-1130-0 []
  61. Pompili, M., Innamorati, M., Raja, M., Falcone, I., Ducci, G., Angeletti, G., Lester, D., Girardi, P., Tatarelli, R., & De Pisa, E. (2008). Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent?. Neuropsychiatric disease and treatment, 4(1), 247–255. https://doi.org/10.2147/ndt.s2192 []
  62. Novick, D. M., Swartz, H. A., & Frank, E. (2010). Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar disorders, 12(1), 1–9. https://doi.org/10.1111/j.1399-5618.2009.00786.x []
  63. Hearing, C. M., Chang, W. C., Szuhany, K. L., Deckersbach, T., Nierenberg, A. A., & Sylvia, L. G. (2016). Physical Exercise for Treatment of Mood Disorders: A Critical Review. Current behavioral neuroscience reports, 3(4), 350–359. https://doi.org/10.1007/s40473-016-0089-y []
  64. Thomson, D., Turner, A., Lauder, S., Gigler, M. E., Berk, L., Singh, A. B., Pasco, J. A., Berk, M., & Sylvia, L. (2015). A brief review of exercise, bipolar disorder, and mechanistic pathways. Frontiers in psychology, 6, 147. https://doi.org/10.3389/fpsyg.2015.00147 []
  65. Monteith, S., Glenn, T., Geddes, J., Whybrow, P. C., & Bauer, M. (2016). Big data for bipolar disorder. International journal of bipolar disorders, 4(1), 10. https://doi.org/10.1186/s40345-016-0051-7 []

Share on facebook
Share on twitter
Share on linkedin
Share on email
Share on print
Share on whatsapp
Share on telegram