Bipolar Disorder

Bipolar disorder (also known as manic depression) causes serious shifts in a person’s mood, energy, thinking, and behavior – from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with your ability to function.

During a manic episode, a person might impulsively quit a job, charge up huge amounts on credit cards, or feel rested after sleeping two hours.

During a depressive episode, the same person might be too tired to get out of bed and full of self-loathing and hopelessness over being unemployed and in debt.

Bipolar disorder causes and triggers

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder. Yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some research points to neurotransmitter imbalances, abnormal thyroid function, and high levels of the stress hormone cortisol.  External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

  • Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes – either good or bad – such as getting married, going away to college, losing a loved one, getting fired, or moving.

  • Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

  • Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

  • Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.

  • Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

Signs and symptoms of bipolar disorder

The symptoms of bipolar disorder vary widely from person to person, with unpredictable differences in their pattern, severity, and frequency.

Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.

The four types of mood episodes (Mania, Hypomania, Depression, Mixed episode) each has a unique set of symptoms.

Signs and symptoms of mania

In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. They may also feel like they’re all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. People often behave recklessly during a manic episode: gambling away savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. They may also become angry, irritable, and aggressive – picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior. Some people even become delusional or start hearing voices.

Hypomania symptoms

Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but they are able to carry on with their day-to-day lives and they never lose touch with reality. To others, it may seem as if people with hypomania are merely in an unusually good mood. However, hypomania can result in bad decisions that harm relationships, careers, and reputations. In addition, hypomania often escalates to full-blown mania or is followed by a major depressive episode.

Common signs and symptoms of mania include:

  • Feeling unusually “high” and optimistic or extremely irritable

  • Unrealistic, grandiose beliefs about one’s abilities or powers

  • Sleeping very little, but feeling extremely energetic

  • Talking so rapidly that others can’t keep up

  • Racing thoughts; jumping quickly from one idea to the next

  • Highly distractible, unable to concentrate

  • Impaired judgment and impulsiveness

  • Acting recklessly without thinking about the consequences

  • Delusions and hallucinations (in severe cases)

Signs and symptoms of bipolar depression

In the past, bipolar depression was lumped in with regular depression. But a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse – triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and speak slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depression – a condition in which they’ve lost contact with reality – and to experience major disability in work and social functioning.

Common symptoms of bipolar depression include:

  • Feeling hopeless, sad, or empty.

  • Irritability

  • Inability to experience pleasure

  • Fatigue or loss of energy

  • Physical and mental sluggishness

  • Appetite or weight changes

  • Sleep problems

  • Concentration and memory problems

  • Feelings of worthlessness or guilt

  • Thoughts of death or suicide

Signs and symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Treatment for bipolar disorder

  • Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it’s important to continue treatment even when you’re feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

  • There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.

  • It’s best to work with an experienced psychiatrist & therapist. Bipolar disorder is a complex condition. Diagnosis can be tricky, medication should be closely monitored by a psychiatrist and treatment should include combination of medicine and psychotherapy.

Links and Resources

Bipolar Disorders Support Groups

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