Bipolar disorder is a psychiatric condition that leads to extreme changes in mood, behaviour 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?
- Bulimia Nervosa At A Glance
- Mood Episodes In Bipolar Disorder
- Prevalence Of Bipolar Disorder
- Understanding Bipolar Disorder
- Types Of Bipolar Disorder
- Patterns Of Bipolar Disorder
- Bipolar Disorder In Children
- Symptoms Of Bipolar Disorder
- Causes Of Bipolar Disorder
- Comorbid Conditions
- Diagnosis Of Bipolar Disorder
- Treatment For Bipolar Disorder
- Supplements & Natural Remedies For Bipolar Disorder
- When To Consult A Doctor?
- Bipolar Depression And Suicide
- Living & Coping With Bipolar Disorder
- Helping Someone With Bipolar Disorder
- Prognosis For Bipolar Disorder
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.
Mind Help 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 behaviour.” 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.
Bulimia Nervosa At A Glance
- Bulimia involves repeated episodes of abnormal binge-eating, immediately followed by purging.
- 1-3 women out of 100 are affected by this condition at least once in their lives.
- Bulimia usually involves uncontrollable eating which may stop if the individual is interrupted or if their stomach starts to hurt.
- Sufferers of this mental illness immediately purge the food due to guilt and shame.
- It is a treatable condition and a combination of cognitive behavioral therapy and medication works best.
Mood Episodes In Bipolar Disorder
According to the American Psychiatric Association “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.” 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.
1. Manic episodes
Severe episodes of elevated mood are known as mania, 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 workaholic 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 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. Harvard Health explains “there is some evidence that the depression phase is much more common than periods of mania in this illness. Bipolar depression can be much more distressing than mania and, because of the risk of suicide, is potentially more dangerous.” 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
Prevalence Of Bipolar Disorder
Research 2 indicates that around 1% of the global population is affected by bipolar disorder. The New England Journal of Medicine (NEJM) states “Bipolar disorder has a yearly prevalence of 2%.” According to the National Institute of Mental Health (NIMH), about 4.4% of U.S. adults suffer from this disorder once in their life. Moreover, around 82.9% of adult patients experienced severe impairment that affected their daily functioning, whereas approximately 17.1% of patients experienced moderate impairment. NIMH claims that BD has the highest percentage 3 of severe impairment amongst all mood disorders. It also showed that around 2.9% of adolescents suffer from this condition while 2.6% of them experience severe impairment.
According to a 2011 cross-sectional survey 4 of 11 different nations, overall lifetime prevalence was found to be about 2.4% for bipolar spectrum disorders. It was also revealed that prevalence for bipolar type 1 was around 0.6% and for bipolar type 2, it was about 0.4%. However, Harvard Health Publishing claims that “Depending on how they define the disorder, researchers estimate that bipolar disorder occurs in up to 4% of the population.” Men and women tend to be affected at the same rate. One 2010 study 5 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 symptoms usually appears to be 20-25 years, however, earlier onset can mean worse prognosis. BD is amongst the top 20 reasons 6 for disability 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
Anxiety and Depression Association of America (ADAA) explains “It can be helpful to think of bipolar disorder 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 people may experience symptoms of mania and depression together in what is called a mixed bipolar state,” adds ADAA. 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 behaviour 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 behaviour.
According to the United Kingdom National Health Service (NHS), “Bipolar disorder is a mental health condition that affects your moods, which can swing from one extreme to another.” 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. According to the U.S. National Library of Medicine, “Bipolar disorder often starts in a person’s late teen or early adult years. But children and adults can have bipolar disorder too. The illness usually lasts 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.
Types Of Bipolar Disorder
Depending on the frequency, severity and presence of symptoms, a person may be diagnosed with different types of bipolar disorder. However, as symptoms take place on a spectrum, the distinction between the different types of BD is not necessarily clear. Here are the major types of BD that may be used by doctors to diagnose a patient:
1. Bipolar I disorder (manic or mixed episode)
One 2007 study 7 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. According to the American Psychiatric Association, this type of BD can often lead to dramatic mood swings. It explains “During a manic episode, people with bipolar I disorder may feel high and on top of the world, or uncomfortably irritable and ‘revved up.’ During a depressive episode they may feel sad and hopeless.” However, periods of normal moods are common between such episodes. It may also trigger psychosis. Studies 8 reveal that lifetime prevalence of bipolar disorder type 1 is around 1% in the general population.
Bipolar I 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 & depression)
Individuals with this variant of BD can 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 is more common in female patients than males. Contrary to popular belief, this is not a milder version of bipolar I, but a distinct diagnosis. Individuals with bipolar II disorder usually do not experience a manic episode, and depression often dominates their mood. During a hypomanic episode, the person may feel normal and function effectively, however they will have depression with unstable and volatile moods. The mood shifts should not be caused by any other mental disorder or medications.
“People with bipolar II often first seek treatment because of depressive symptoms, which can be severe,” explains the American Psychiatric Association. It adds that patients “often have other co-occurring mental illnesses such as an anxiety disorder or substance use disorder.” The symptoms are relatively harder to recognize as these are milder. 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. The symptoms are milder than bipolar I or bipolar II disorder. Sufferers with this condition experience stable moods for a period of one or two months. The American Psychiatric Association adds “Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly.” The person may experience several episodes of hypomania and depression for at least two years, but the symptoms fail to meet the criteria established for hypomanic or depressive episodes. During this 2 year period, the mood swings must have sustained for at least 50% of the period and have not ceased for over 2 months.
The NHS, UK explains, “Cyclothymia, or cyclothymic disorder, causes mood changes – from feeling low to emotional highs.” People suffering from this type of bipolar disorder experience brief episodes of normal mood which typically does not last more than 8 weeks. Sufferers can experience difficulty in relationships, poor decision making and impulsivity. It can also affect their career and financial stability as well. The diagnosis can be difficult for the patient as they may feel their symptoms are not that serious or damaging. Hence, they may not seek treatment. However, the condition lies on the BD spectrum and may severely impact a person’s quality of life. Although it is a milder form of BD, when left untreated cyclothymia can lead to severe bipolar disorder.
4. Bipolar Disorder, “other specified” and “unspecified”
According to the National Alliance on Mental Illness (NAMI), this is another form of BD where “a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.”
Other types of BD may include related disorders triggered by alcohol or substance abuse resulting in a psychiatric illness or a medical condition, such as a stroke, multiple sclerosis or Cushing’s disease. These different types of bipolar disorder can help the doctors and the patients to better understand and diagnose the condition for more effective treatment and coping.
Patterns Of Bipolar Disorder
A person with BD may experience periods of depression more frequently than periods of mania or vice versa. They may also experience periods when they are in a “normal” mood between an episode of mania and depression. BD has certain patterns but these are not the same for every patient. Regardless, a person with this mental condition may experience the following states:
1. Mixed state
It involves both mania and depression occurring simultaneously or in an immediate successive sequence without any normal period or recovery between episodes. According to the NHS, this occurs when a sufferer “experiences symptoms of depression and mania together; for example, overactivity with a depressed mood.” This mixed state may include feelings of irritability, agitation, overactivity, racing thoughts and high levels of energy. A 2017 study 9 states “Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance.”
2. Rapid cycling
Individuals affected by bipolar disorder often experience rapid cycling. The NHS explains that rapid cycling bipolar disorder (RCBD) occurs when the sufferer “repeatedly swings from a high to a low phase quickly without having a ‘normal’ period in between.” 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. One study 10 defines rapid cycling as “a type of manic-depressive illness in which the patient experiences four or more episodes of mania and/or major depression per year.” 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 can often be diagnosed with BD. However, as children 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 also not match the diagnostic criteria used by most healthcare professionals. Symptoms of bipolar disorder in children can also be similar to a range of other psychiatric disorders, like attention deficit hyperactivity disorder (ADHD). One 2015 study 11 reveals that according to meta-analysis of studies worldwide, “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 scientific analysis 12 found that the overall occurrence of this disorder in adolescents and children is 1.8%. It adds “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 more proficient in diagnosing children with BD and helping them get the right treatment. Children may also experience episodes of elevated mood and depression. They may experience abnormal changes in energy, moods, activity levels and daily functioning. They can also seem happy and excited and then show signs of depressive behavior. Although mood changes are common in children, the symptoms of this condition are extremely pronounced and very different from typical mood swings. However, with effective treatment, children, adolescents and teens can overcome bipolar disorder.
Symptoms Of Bipolar Disorder
BD is characterized by cognitive deficits and affective instability. Symptoms for this disorder can be different for each patient as it may widely vary 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. Moreover, a person may be more susceptible to either depression or mania, whereas another patient may experience both episodes equally. A person with BD may also experience mood disruptions once a year or frequently.
According to Harvard Medical School, “Bipolar disorder is a recurring disease that goes in cycles. One part of the cycle is marked by symptoms of mania, the other by symptoms of depression. These ‘mood episodes’ are often intense.” Here 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 usually last at least a week when the person is excessively irritable or extremely high spirited. It must include at least three of the following symptoms:
- Intrusive, unmanageable racing thoughts & rapidly changing topics or ideas
- Inflated self-esteem or an exaggerated sense of grandiosity
- Reduced need for sleep
- Getting distracted easily
- Increased risky behaviour
- Being highly talkative or speaking rapidly and loudly
- Engaging more activities or events at once than can be completed
Mania or hypomania can also involve these additional symptoms as well:
- Unusually jumpy or upbeat
- Extremely high levels of energy
- Flawed judgment and poor decision-making
- Feeling capable of doing impossible tasks
- Easily bored
- Being aggressively forward or sociable
- Increased libido leading to unprotected sex
- Feeling euphoric or exhilarated
- Incoherent speech
- Exaggerated self-confidence and self-importance
- Shopping or spending sprees
- Substance or alcohol abuse
- Delusions and hallucinations (in extreme cases)
NAMI explains “Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood.”
2. Depressive symptoms
As per the American Psychiatric Association, an episode of major depression tends to last for two weeks and involves at least five of the following symptoms (including one from the first two):
- Extreme despair or sadness; feeling worthless, hopeless or helpless
- Loss of interest in pleasurable activities
- Feeling inappropriate guilt or shame
- Sleep disturbances, like insomnia or oversleeping
- Feeling agitated or restless
- Slowed movements or speech
- Changes in appetite
- Chronic fatigue, exhaustion or loss of energy
- Trouble concentrating or remembering details
- Suicidal ideation
Here are some additional symptoms of a depressive episode in someone with bipolar disorder:
- Tearful or uncontrollable crying
- Weight gain or weight loss
- Indecisiveness or difficulty making decisions
- Anxiety about insignificant issues
- Lack of interest in work or school leading to underperformance
- Highly sensitive to smells, noises, and other senses that are unimportant
Causes Of 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 different factors, such as genetics and environment. According to a research paper published in Encyclopedia of Neuroscience, 2009, “Abnormalities within the ALN and related brain regions appear to be involved in the neurophysiology of bipolar disorder. Moreover, studies indicate a high level of heritability in bipolar disorder, although the involvement of specific genes has not been definitively established.”
Apart from these, stressful life events and some other factors may also trigger the condition in someone, such as financial difficulties, relationship problems, medication, substance abuse etc. Such triggers can often lead to new episodes and periods of the condition. Brain structure and how our brains develop may also play a crucial role in the onset of BD. “Heredity plays a significant role. There is also evidence of dysregulation of serotonin, norepinephrine, and dopamine. Psychosocial factors may be involved. Stressful life events are often associated with initial development of symptoms,” explain The Merck Manuals. As further research is being conducted to understand the precise causes for the development of bipolar disorder, here are some contributing factors that may play a major role and increase a person’s risk:
This mental condition is more common in individuals who have a first-degree family member with BD. 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 can have 10-fold increased risk 13 for BD. Behavioral genetic studies 14 show that several candidate genes and chromosomal regions may be associated with BD susceptibility with each gene employing a moderate to mild effect. Although no single specific gene has yet been identified, researchers believe that the disorder may run in families. NIMH explains “Many genes are involved, and no one gene can cause the disorder.” Regardless, there is a possibility that the disorder may be passed on through families. However, genetic links tend to be more complex.
According to a recent scientific analysis 15, “The risk of bipolar disorder is 10-25% when one parent has a mood disorder. Twin studies have shown 70-90% concordance rates in monozygotic twins. Bipolar 1 disorder has the highest genetic link of all psychiatric disorders.” Another 2003 study 16 reveals that BD is highly heritable. The report states “There are substantial genetic and nonshared environmental correlations between mania and depression, but most of the genetic variance in liability to mania is specific to the manic syndrome.”
If a parent or sibling of a person has bipolar, then they have a higher risk of onset. According to the National Alliance on Mental Illness (NAMI), “The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute.” A person with a family history of BD may never develop the condition. NAMI also claims that twin studies reveal that even when one identical twin may suffer from bipolar disorder, the other identical twin may not develop it. Moreover, family members of people with bipolar disorders are also highly likely to develop certain psychotic, anxiety and mood disorders as well.
2. Brain structure & 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 functioning, structure and chemical imbalances in the human brain can substantially increase the risk. “Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder,” explains NAMI. Brain-imaging studies have revealed that many regions in the brain are characterized by a 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 17 reveals that this disorder is “characterized by dysregulation in the dopamine and serotonin systems and by pathology in the brain systems involved in regulating emotion.”
Moreover, adrenocortical hyperactivity is present during mania episodes. People with a family history of depression or a mood disorder have higher glucose metabolism in the limbic region 7 with reduced metabolism of the anterior cerebral cortex. BD is also associated with issues in the function of neurotransmitters or chemical messengers or hormones, such as noradrenaline, norepinephrine, serotonin & dopamine which influence the brain. According to the NHS, UK, “There’s some evidence that if there’s an imbalance in the levels of 1 or more neurotransmitters, a person may develop some symptoms of bipolar disorder.” Manic episodes may occur when noradrenaline is present in high levels and depressive episodes may occur when noradrenaline levels are severely low. However, it is yet to be identified whether such problems 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 and social issues. Bipolar disorder may also develop due to certain neurological conditions, like –
- Traumatic brain injury
- Multiple sclerosis
- 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, relationship abuse or physical or sexual assault and other adverse life events may trigger the initial episodes in a vulnerable person with genetic dispositions 18 or an abnormal brain structure. NAMI explains “A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.”
A recent scientific analysis 15 on bipolar disorder states 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 external factors that can trigger the condition may include:
- A breakup or divorce or interpersonal relationship issues
- Abandonment or neglect
- Financial problems
- Physical, emotional or sexual abuse
- Loss of a loved one and bereavement
- Sleep disturbances
- Serious physical illness
- Overwhelming issues in daily life
Research indicates that “circadian rhythm desynchronization” can also be a contributing factor in bipolar disorder. In fact, insomnia and sleep deprivation is associated with around 30% of sufferers 19 with BD. Surveys 20 reveal that approximately 30-50% of adult patients claim they have experienced abuse in their childhood. Abuse and trauma during childhood is also related with early onset, an increased risk of suicide and comorbid or co-occurring conditions like post-traumatic stress disorder (PTSD). Research 17 also shows that people with dysthymia or cyclothymia are highly likely to develop depression or bipolar I, whereas individuals with personality disorders, like borderline, obsessive-compulsive, or histrionic personalities are at increased risk of developing depression.
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 a severe depression at times. Unfortunately, most patients tend to use alcohol or drugs during episodes of mania or depression. According to The Merck Manuals, “Certain drugs can trigger exacerbations in some patients with bipolar disorder; these drugs include sympathomimetics (eg, cocaine, amphetamines), alcohol, certain antidepressants (eg, tricyclics, monoamine oxidase inhibitors [MAOIs]).”
In fact, 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 causing depressive or manic symptoms. If you are taking alcohol or illegal drugs, then make sure to inform your doctor during 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.
According to a 2014 study 21, “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 Psychiatric Times, around 95% of people with bipolar met the criteria for 3 or more lifetime psychiatric disorders in the National Comorbidity Survey. Another survey found that about 65% of patients met the DSM-IV criteria for at least 1 comorbid Axis I disorder. Bipolar I is often related to severe medical and psychiatric comorbidity 22, serious functional disability and early mortality. One 2006 study states “Comorbid psychiatric disorders in individuals with bipolar disorder are associated with poorer outcome and poorer treatment response, increased service utilization, and increased cost.”
Some of the most common and debilitating co-occurring disorders that can make BD treatment less effective, may include:
- Attention-deficit hyperactivity disorder (ADHD)
- Posttraumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Panic disorder
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Eating disorders
- Personality disorders
- Impulse control disorders
- Seasonal depression
- Substance abuse
- Metabolic syndrome
- Other physical health conditions, like heart disease, thyroid problems etc
- Suicidal behaviour
Research 23 indicates that anxiety disorders can often worsen the symptoms and prognosis of the condition. NAMI adds “People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia. Bipolar disorder can be also misdiagnosed as Borderline Personality Disorder (BPD).” A misdiagnosis can often make the treatment process difficult and ineffective.
One study 24 published in The Lancet 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 25 also shows that more than 60% of bipolar I and 48% of bipolar II patients have a drug or alcohol use disorder. Moreover, lifetime prevalence is more than 90%. “Anxiety and substance abuse are the most frequent lifetime comorbid disorders in BPD (bipolar disorder) and the presence of comorbid anxiety further increases the likelihood of substance abuse,” states the Psychiatric Times. The Lancet study also found that excess violent crime is related with bipolar disorder and substance abuse comorbidity as well. The condition is also associated with recurring suicide attempts, frequent hospital admissions and poor treatment compliance.
Diagnosis Of Bipolar Disorder
There is no specific test to identify bipolar disorder. According to the Medical and Health Genomics 26, 2016, 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 discuss and 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).
The Merck Manuals explain “Diagnosis of bipolar disorder is based on the identification of symptoms of mania or hypomania,” which must be “severe enough to markedly impair social or occupational functioning or to require hospitalization to prevent harm to self or others.” 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, most of the day. For hypomania, the mood must persist for at least 4 consecutive days and be experienced almost every day, most of the day. The patient must also experience at least 3 of the following symptoms during this period along with a noticeable change in behaviour:
- Inflated self-esteem or grandiosity
- Reduced need for sleep
- Easily distracted
- Racing thoughts
- Highly talkative
- Engaging in risky behaviour and activities
- Increase in psychomotor agitation
If the person is experiencing depressed mood, then at least 5 of the following symptoms must be present in a 2-week period to be diagnosed with major depression:
- Depressed mood almost every day, most of the day
- Loss of interest in pleasurable activities
- Loss of energy or fatigue
- Changes in appetite and/or weight
- Feelings of guilt, shame or worthlessness
- Purposeless movements
- Indecisiveness or inability to concentrate
- Repeated suicidal ideation or attempt
Accurate and early diagnosis can significantly help to manage the condition and improve the prognosis for the patient. One 2014 study 27 states “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 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 their condition, like depression or schizophrenia. This is why a doctor may conduct certain laboratory tests and a physical examination to rule out other causes. Some common lab tests may include:
- 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 also ask a few questions, such as:
- How many symptoms are experienced by the patient
- How long do depressive or manic episodes last
- How frequently the episodes occur
- How many episodes have been experienced so far
- How the symptoms affect the patient’s life and daily functioning
- The medical and family history of the patient
The NIMH explains “Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important.” Differential diagnosis 15 for bipolar disorder may involve the following conditions:
- Major Depressive Disorder
- Post-traumatic stress disorder (PTSD)
- Generalized Anxiety Disorder
- Substance-induced Bipolar Disorder
- Personality Disorders
- Attention-deficit/hyperactivity disorder
- Oppositional Defiant Disorder
- Alcohol or substance abuse
The doctor may also enquire if the patient has attempted suicides as it can be a warning sign for BD. “Because medications and other illnesses can cause symptoms of mania and depression, a psychiatrist and primary care physician must sometimes work together with other mental health professionals to evaluate the problem,” explains Harvard Health.
Treatment For Bipolar Disorder
If you or a loved one is suffering from the symptoms of bipolar disorder, then 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 is to help the sufferer function successfully in daily life. Some of the most common and effective treatment options for BD include:
- Physical intervention
- Lifestyle changes & self-care
Bipolar disorder is a recurrent chronic disorder that requires long-term treatment and ongoing care. Although proper diagnosis and identifying a suitable treatment plan can be a time-consuming process, bipolar disorder is highly treatable. Harvard Health explains “A combination of medication and talk therapy is most helpful.” As each patient is different, treatment must be individualized to reduce the intensity of the symptoms and to stabilize their mood. According to a recent 2020 research paper 28 published in JAMA Psychiatry, “A review of 39 randomized clinical trials by scientists from UCLA and their colleagues from other institutions has found that combining the use medication with psychoeducational therapy is more effective at preventing a recurrence of illness in people with bipolar disorder than medication alone.”
Substance or alcohol abuse can often make treatment more challenging and the doctor may also need to treat substance abuse problems as well. Irrespective of the treatment approach, ongoing adherence to the treatment plan is essential in the long run for successful recovery. Here are some of the most helpful treatment options for bipolar disorder:
There are certain medications that can help someone suffering from this disorder. As there are different types of medication available for the treatment of BD, both doctors and patients may need to try out a number of different medications before finding out which one works best for them. Mood stabilizers, like lithium, are perhaps the most commonly prescribed medication for BD. Apart from these, atypical antipsychotics, antiseizure drugs, antidepressants and sleeping pills may also be prescribed as well. Treatment is primarily aimed at stabilizing mood, managing anxiety and sleep issues. Typically, these medications are found to be most effective when used in combination with psychotherapy.
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. Being one of the oldest medicines utilized in psychiatry, there is adequate evidence supporting it’s effectiveness. According to Harvard Medical School, “Seventy percent of people with bipolar disorder who take lithium experience fewer and less-intense manic episodes. In about 20% of people with bipolar disorder, lithium completely relieves symptoms.” One 2013 study 29 found that “Lithium has the strongest evidence for long-term relapse prevention.” It can also notably decrease the risk of suicide.
A 2015 study 30 reveals that lithium is considered as the gold standard for BD treatment and remains the first-line treatment. It states “Lithium 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 31 Lithium is the cornerstone of pharmacotherapy in BD which helps to manage acute mood episodes, prophylactic treatment & 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 may often prescribe antiseizure drugs in place of lithium, specifically if the patient experiences a rapid mood cycle. Antiseizure medications or anticonvulsants can also help to stabilize mood and can be substantially helpful in treating the patient during an episode. It can also be useful in preventing future episodes as well. Some common antiseizure drugs for BD may include:
- Valproate (valproic acid)
A 2003 study 32 states that “Valproate is commonly used as a first-line agent for the treatment of acute bipolar I mania.” It’s effectiveness for treating acute mania “may have comparable efficacy to lithium and olanzapine,” based on randomized, controlled trials. However, antiseizure medicines may also have unwanted side effects, such as tremors, weight gain, loss of appetite, nausea, diarrhea etc. Harvard Health warns “Lithium and valproic acid should be avoided during the first three months of pregnancy, because they are known to cause birth defects.” 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 33 indicates that second generation antipsychotic medications tend to be effective in managing BD symptoms. The researchers explain “Antipsychotic medications play a very important role in the treatment of bipolar illness. This has become especially true since the introduction of second generation agents. There is a wealth of data documenting the use of these agents in bipolar mania.” However, these types of medications can also have certain side effects which must be balanced with their healing effects. Some common side effects may include:
- Asenapine: Dizziness, stiffness, restlessness, numbness in the mouth, tremor, sleepiness etc.
- Quetiapine: Weight gain, dizziness, sleepiness and dry mouth.
- Ziprasidone: Sleepiness, restlessness, nausea, dizziness, tremor etc.
- Aripiprazole: Sleeplessness or sleepiness, restlessness, stomach upset and nausea.
- Risperidone: Nausea, restlessness and sleepiness.
- Olanzapine: Weight gain, dizziness, sleepiness and dry mouth.
These medicines can also result in issues with blood lipids and heighten the risk of diabetes. However, the benefits tend to outweigh the side effects in most cases. “Atypical antipsychotic drugs are recommended for use in bipolar disorder for acute treatment, maintenance treatment, and for treatment-resistant patients,” explains a 2003 study 34.
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).
Although antidepressants are not typically prescribed for independent use during the treatment of bipolar disorder, this type of medication can help sufferers overcome episodes of depression. The Harvard Medical School adds “The use of antidepressants in bipolar disorder is controversial.” Most doctors tend to 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 diagnosis. One 2014 study 35 explains “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 prove ineffective. A 2018 study discovered that antidepressants, along with mood stabilizers, are important for an optimal maintenance treatment regimen. It adds “a number of recent studies have demonstrated both the safety and efficacy of antidepressant monotherapy in treating bipolar II depression.” Another 2008 study 36 claims that there is certainly scope for the usage of antidepressants in BD 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.
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 to 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 counselling 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, losses, practical challenges and painful consequences associated with manic or depressive episodes. According to a 2013 study 29, “Treatment guidelines increasingly suggest that optimum management of bipolar disorder needs integration of pharmacotherapy with targeted psychotherapy. A recent randomised trial in Denmark has shown clinical benefits from this approach.”
Psychosocial interventions for BD primarily aims at:
- Enhancing acceptance of the disorder
- Increase capability to recognize warning signs of recurrences and intervene early
- Improve adherence with a treatment plan and medicine regimens
- Improve ability to overcome environmental stressors related to symptoms
- Decrease alcohol or substance misuse
- Stabilize sleep and wake rhythms & other important daily routines
- Improve social and family relationships and enhance communication
- Re-engage 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 systematic review suggests that “adjunctive psychological therapies reduce overall rates of relapse, but are more effective for depression than for mania.” However, another study 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 the symptoms, improve social functioning and reduce the risk of relapse.
A. Cognitive behavioral therapy (CBT)
Cognitive-behavioural therapy is a form of talk therapy which enables the patient to recognize their thought and behaviour patterns and better manage their mental condition. A therapist will understand the thinking patterns of the sufferer and help them replace bad behaviour & habits. CBT can also help patients develop positive coping strategies to manage stress, anxiety and negative triggers. Cognitive behavioural 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 37, around 90-minute sessions of CBT can significantly help to reduce mania or depression & even decrease the rate of relapse among type I BD patients. It states “CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning, with a mild-to-moderate effect size.”
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 can help the sufferer to manage their condition. A 2015 study 38 on social rhythm interventions for bipolar disorder states “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.”
It is a type of counseling and evidence-based therapeutic intervention that helps the patient and their family members to 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 cope with it a lot better. Evidence indicates that psychoeducation also helps to improve recovery, reduce rates of relapse and enhance family well-being. One 2007 39 study states “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 40 and family counseling, FFT is a form of psychotherapy that focuses on helping families and couples in romantic relationships to cope with bipolar disorder and embrace change & 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 triggers and recognize the onset of an episode. One study 41 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.”
E. Electroconvulsive therapy (ECT)
Also known as electroshock therapy, ECT is a psychiatric procedure used to treat BD when other treatment options have proved ineffective or unsuccessful. 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. Harvard Health explains that it “can be an effective treatment for severe manic or depressive episodes, especially among individuals having serious suicidal or psychotic symptoms, or when medical therapy is not working.” According to a 2019 scientific analysis 42 about 80.2% patients tend to show a positive response to electroconvulsive therapy and has been found to be highly effective for people with severe depression. ECT “for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive‐compulsive disorder or personality disorder, and less prior pharmacologic treatment,” state the researchers.
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.
3. 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:
- Maintain good sleep hygiene and get at least 7-8 hours sleep every night
- Take steps to prevent sleep disturbances
- Eat a healthy and balanced diet
- Follow a regular routine for your daily tasks, such as eating, sleeping, working, socializing etc
- Learn how to identify triggers and sudden mood swings
- Seek support from family and friends for your treatment
- Do not hesitate to seek medical help
- Maintain a daily journal and write down your thoughts, feelings, triggers and symptoms
- Learn how to manage and overcome stress
- Pursue hobbies and interests that make you happy
- Avoid consuming excessive amounts of caffeine or nicotine
- Stay away from alcohol and recreational drugs
- Stay connected with friends and family and be socially active
Supplements & 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 43 reveal consumption of adequate amounts of fish & 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 44 from fish oil in capsule or liquid form. It is believed that omega-3 fatty acids from fish oil are associated with brain areas that regulate behaviour and mood. However, there may be certain side-effects such as diarrhoea, bloating, belching, stomach aches, heartburn and nausea.
2. Rhodiola rosea
Rhodiola rosea is known to treat moderate to mild depression. Prescribed doses of this supplement along with mood stabilizers can greatly help a BD patient with predominantly depressive symptoms, mood swings and occasional hypomania. One 2014 study 45 states “few controlled clinical trials have examined the safety and efficacy of R. rosea for the treatment of major depressive disorder (MDD).”
3. S-adenosylmethionine (SAMe)
SAMe 46 is a natural substance available in all human cells and an amino acid supplement which can relieve symptoms of BD, major depression and other affective disorders. According to a 2017 study 47, “SAMe holds promise as a treatment for multiple neuropsychiatric conditions, but the body of evidence has limitations.” However, this can often induce manic episodes 48.
Some other helpful supplements may include:
- St. John’s wort
- Other minerals and vitamins
4. Relaxation techniques
Apart from these, certain relaxation practices and calming techniques can help to relieve stress and anxiety and regulate mood and behavior. Some effective relaxation techniques include:
- Deep breathing
- Massage therapy
Although these practices cannot directly cure the disorder, these can substantially help the sufferer manage the symptoms and support the recovery process. Deep breathing can reduce anxiety symptoms in bipolar disorder and has no side effects, according to a 2019 study 49. The study authors state “deep breathing protocol was effective in reducing anxiety levels in patients with bipolar disorder.” Another 2017 study 50 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 realize that their manic and depressive episodes can lead to chronic emotional instability which can disrupt their daily functioning and affect the lives of the family & friends, when left untreated. A person with BD may enjoy the high levels of energy, ability to be highly productive and the feelings of euphoria that occur during manic episodes. But this can lead to an emotional crash during depressive periods which always follows a manic episode. Such emotional instability can result in legal and financial issues and strain personal and social relationships. If left untreated, episodes may become increasingly frequent and last longer over time. The U.S. National Library of Medicine explains “If not treated, bipolar disorder can lead to damaged relationships, poor job or school performance, and even suicide. However, there are effective treatments to control symptoms.”
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 behaviour are also common among sufferers. Consulting a licensed mental health professional experienced in treating mood disorders can help the patient to overcome the symptoms and recover successfully. In extreme cases, a person with the bipolar disease may need to be hospitalized, even if they are reluctant about it. “Many patients are grateful later when they learn that they avoided a loss or embarrassment and were pushed to get the treatment they needed,” adds Harvard Health Publishing.
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 51 “Bipolar disorder has the highest rate of suicide of all psychiatric conditions.” Suicide is one of the primary factors leading to reduced life expectancy of patients with BD. Studies 52 also show that around 25%–56% of all bipolar patient attempt suicide at least once, while 4%-19% BD patients 53 complete suicide. According to the Arizona Department of Health Services (ADHS), approximately 1 out of 5 people with BD complete suicidal attempts and the condition has an average 9.2 years reduction in expected life span.
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 1 reveals that suicide rates among people with this condition are about 10-30 times higher when compared to normal people. It states “Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20-60% of them attempt suicide at least once in their lifetime.”
Recent research shows that some of the most common risk factors for suicide in BD patients include the following:
- Frequent episodes of depression or predominant depressive polarity
- Early onset of the disorder
- Mixed episodes
- Being male
- Isolation or living alone
- Divorced or separated
- Having no children
- 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 of bipolar disease can help to 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
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, like medications, sharp objects, ropes, firearms etc.
- Encourage them to focus on the positive side of life
Living & Coping With Bipolar Disorder
Living with and managing the 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, then you can still lead a healthy and happy life. Here are a few ways that make your and your loved one’s 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 talk to 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 people you trust.
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 & leg movement, increased blood circulation, improved oxygen levels in the body, lower risk of heart diseases and is also beneficial for the brain and nervous system. Regular exercise can also reduce stress, anxiety & depression and improve sleep. Anaerobic exercises, like yoga, pilates and weightlifting can also be helpful.
One 2016 study 54 shows that higher levels of cardiorespiratory fitness and regular exercise can lower the risk for premature mortality in people with BD. The researchers state “Results from open trials of exercise as an adjunctive intervention for bipolar disorder show that it may benefit the physical and mental health of individuals with bipolar disorder.” Another 2015 scientific review 55 concludes that “There are promising data that exercise may be a viable and effective strategy to deal with the depressive phase of bipolar disorder.”
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, according to research. 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 & 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 across the world. So if you’re living with or caring for someone with this condition, then it can be a difficult experience for you as the patient may become violent or abusive in some 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 treatment.
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 speak with them in a gentle yet open manner. Let them know how their behavior is affecting you and others and damaging your relationship. 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
Living with and helping someone 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. As mental disorders can often damage relationships, 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 to help your loved one in the long run.
Prognosis For Bipolar Disorder
Bipolar disorder is a serious yet common psychiatric illness that can affect a person’s mood, behaviour 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 29 shows that about 58% of patients with types I and II BD recover with effective treatment. However, 49% patient 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 working with the doctor can help the patients to better manage their symptoms, stabilize their moods and improve the quality of their life. “Treatment can be very effective; many of the symptoms can be diminished and in some cases eliminated. As a result, many people with bipolar disorder are able to function completely normally and have highly successful lives,” concludes Harvard Health Publications.
Take This Free Bipolar Disorder Test
[netsposts include_blog=”5″ post_type=”sfwd-quiz” taxonomy_type=”sfwd-quiz” include_post=”1570″ thumbnail=”true” size=’large’ title_color=’#197591′ show_title=’true’ excerpt_length=’10’ auto_excerpt=’true’ list=’1′ random=’true’ title_length=’40’ hide_excerpt=’false’ meta_info=’false’ wrap_text_start=” include_link_title=’true’ wrap_title_start=”” wrap_start=’
- 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
- Iria Grande, Michael Berk, Boris Birmaher, Eduard Vieta, Bipolar disorder, The Lancet, Volume 387, Issue 10027, 2016, Pages 1561-1572, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(15)00241-X
- Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. doi: 10.1001/archpsyc.62.6.617. Erratum in: Arch Gen Psychiatry. 2005 Jul;62(7):709. Merikangas, Kathleen R [added]. PMID: 15939839; PMCID: PMC2847357.
- Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011 Mar;68(3):241-51. doi: 10.1001/archgenpsychiatry.2011.12. PMID: 21383262; PMCID: PMC3486639.
- Arianna Diflorio & Ian Jones (2010) Is sex important? Gender differences in bipolar disorder, International Review of Psychiatry, 22:5, 437-452, DOI: 10.3109/09540261.2010.514601
- Ferrari AJ, Stockings E, Khoo JP, et al. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disorders. 2016 Aug;18(5):440-450. DOI: 10.1111/bdi.12423.
- Keener MT, Phillips ML. Neuroimaging in bipolar disorder: a critical review of current findings. Curr Psychiatry Rep. 2007 Dec;9(6):512-20. doi: 10.1007/s11920-007-0070-2. PMID: 18221633; PMCID: PMC2686113.
- Bebbington P, Ramana R. The epidemiology of bipolar affective disorder. Soc Psychiatry Psychiatr Epidemiol. 1995 Nov;30(6):279-92. doi: 10.1007/BF00805795. PMID: 8560330.
- Muneer A. (2017). Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment. Chonnam medical journal, 53(1), 1–13. https://doi.org/10.4068/cmj.2017.53.1.1
- Barrios C, Chaudhry TA, Goodnick PJ. Rapid cycling bipolar disorder. Expert Opin Pharmacother. 2001 Dec;2(12):1963-73. doi: 10.1517/14656518.104.22.1683. PMID: 11825328.
- 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
- 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
- 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
- Kerner B. (2014). Genetics of bipolar disorder. The application of clinical genetics, 7, 33–42. https://doi.org/10.2147/TACG.S39297
- Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2020 Oct 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/
- McGuffin P, Rijsdijk F, Andrew M, Sham P, Katz R, Cardno A. The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Arch Gen Psychiatry. 2003 May;60(5):497-502. doi: 10.1001/archpsyc.60.5.497. PMID: 12742871.
- Miklowitz DJ, Johnson SL. The psychopathology and treatment of bipolar disorder. Annu Rev Clin Psychol. 2006;2:199-235. doi: 10.1146/annurev.clinpsy.2.022305.095332. PMID: 17716069; PMCID: PMC2813703.
- 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
- Young, J., & Dulcis, D. (2015). Investigating the mechanism(s) underlying switching between states in bipolar disorder. UC San Diego. http://dx.doi.org/10.1016/j.ejphar.2015.03.019 Retrieved from https://escholarship.org/uc/item/05z312jn
- Elisa Brietzke, Márcia Kauer Sant’anna, Andréa Jackowski, Rodrigo Grassi-Oliveira, Joanna Bucker, André Zugman, Rodrigo Barbachan Mansur, Rodrigo Affonseca Bressan, Impact of Childhood Stress on Psychopathology, Revista Brasileira de Psiquiatria, Volume 34, Issue 4, 2012, Pages 480-488, ISSN 1516-4446, https://doi.org/10.1016/j.rbp.2012.04.009.
- 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
- Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions – III. J Psychiatr Res. 2017 Jan;84:310-317. doi: 10.1016/j.jpsychires.2016.10.003. Epub 2016 Oct 7. PMID: 27814503; PMCID: PMC7416534.
- Keller MB. Prevalence and impact of comorbid anxiety and bipolar disorder. J Clin Psychiatry. 2006;67 Suppl 1:5-7. PMID: 16426110.
- Farren CK, Hill KP, Weiss RD. Bipolar disorder and alcohol use disorder: a review. Curr Psychiatry Rep. 2012 Dec;14(6):659-66. doi: 10.1007/s11920-012-0320-9. PMID: 22983943; PMCID: PMC3730445.
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. doi: 10.1001/archpsyc.62.6.593. Erratum in: Arch Gen Psychiatry. 2005 Jul;62(7):768. Merikangas, Kathleen R [added]. PMID: 15939837.
- D.F. Gomez-Casati, M. Grisolía, M.V. Busi, Chapter 7 – The Significance of Metabolomics in Human Health, Editor(s): Dhavendra Kumar, Stylianos Antonarakis, Medical and Health Genomics, Academic Press, 2016, Pages 89-100, ISBN 9780124201965, https://doi.org/10.1016/B978-0-12-420196-5.00007-1.
- 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
- University of California – Los Angeles Health Sciences. (2020, October 14). Therapy plus medication better than medication alone in bipolar disorder. ScienceDaily. Retrieved December 18, 2020 from www.sciencedaily.com/releases/2020/10/201014140938.htm
- 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
- 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
- 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
- Keck PE Jr, McElroy SL. Divalproex in the treatment of bipolar disorder. Psychopharmacol Bull. 2003;37 Suppl 2:67-73. PMID: 15021862.
- Surja AA, Tamas RL, El-Mallakh RS. Antipsychotic medications in the treatment of bipolar disorder. Curr Drug Targets. 2006 Sep;7(9):1217-24. doi: 10.2174/138945006778226598. PMID: 17017897.
- Ertugrul A, Meltzer HY. Antipsychotic drugs in bipolar disorder. Int J Neuropsychopharmacol. 2003 Sep;6(3):277-84. doi: 10.1017/S1461145703003560. PMID: 12974994.
- 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
- Salvi V, Fagiolini A, Swartz HA, Maina G, Frank E. The use of antidepressants in bipolar disorder. J Clin Psychiatry. 2008 Aug;69(8):1307-18. doi: 10.4088/jcp.v69n0816. PMID: 18681751.
- 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
- Crowe M, Beaglehole B, Inder M. Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice. J Psychiatr Ment Health Nurs. 2016 Feb;23(1):3-11. doi: 10.1111/jpm.12271. Epub 2015 Oct 12. PMID: 26459928.
- Rouget BW, Aubry JM. Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature. J Affect Disord. 2007 Feb;98(1-2):11-27. doi: 10.1016/j.jad.2006.07.016. Epub 2006 Sep 1. PMID: 16950516.
- Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Fam Process. 2016 Sep;55(3):483-99. doi: 10.1111/famp.12237. Epub 2016 Jul 29. PMID: 27471058; PMCID: PMC5922774.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Abeysundera, H., & Gill, R. (2018). Possible SAMe-induced mania. BMJ case reports, 2018, bcr2018224338. https://doi.org/10.1136/bcr-2018-224338
- Serafim SD, da Ponte FDR, Lima FM, Martins DS, Rosa AR, Kunz M. Effects of deep breathing in patients with bipolar disorder. Perspect Psychiatr Care. 2019 Jan;55(1):119-125. doi: 10.1111/ppc.12325. Epub 2018 Sep 6. PMID: 30189115.
- 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
- Miller JN, Black DW. Bipolar Disorder and Suicide: a Review. Curr Psychiatry Rep. 2020 Jan 18;22(2):6. doi: 10.1007/s11920-020-1130-0. PMID: 31955273.
- 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
- 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
- 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
- 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