Bipolar disorder is a complex condition in which people suffer from dramatic shifts in their activity levels, mood, and energy that are so severe that they affect the person’s ability to carry out everyday tasks.
Everyone experiences some ups and downs in attitude during their daily lives. For people with bipolar disorder, these swings are more intense. They may occur frequently and can totally disrupt everyday life for the person living with bipolar and for the people who love them.
Previously referred to as manic-depressive illness, the disorder is characterized by feelings of either extreme depression, at times with suicidal thoughts, or alternately of mania and euphoria, in which the person cannot stop working, talking, or engaging in highly repetitive behaviors. These shifts led to the initial labeling of the condition as ‘manic depression.’ Still, more current research and understanding demonstrates that the condition is more complex, and the terms bipolar I and bipolar II are more appropriate names.
Bipolar I Disorder is a mental health condition that causes extreme mood swings. These mood swings include “highs,” called manic episodes, and “lows,” known as depressive episodes.
- During a manic episode, a person might feel very excited, have lots of energy, talk quickly, and take risks they normally wouldn’t. Sometimes, their behavior can be so extreme that they need medical care.
- In a depressive episode, they may feel very sad, tired, hopeless, and have trouble enjoying things or even getting out of bed.
Bipolar I disorder is diagnosed based on the presence of at least one manic episode lasting at least a week (or shorter if it requires hospitalization).
During this time, a person may feel abnormally elevated, energetic, or irritable. They might engage in risky behaviors, such as spending sprees or dangerous driving, and have racing thoughts or trouble sleeping. In severe cases, they might experience psychosis, losing touch with reality. A depressive episode is not required for diagnosis, though many people with Bipolar I also experience periods of extreme depression.
The key feature of Bipolar I is the intensity of manic episodes, which can severely disrupt daily life. These highs often require medical intervention to stabilize mood. Depressive episodes, when they occur, bring overwhelming feelings of sadness, fatigue, and difficulty concentrating, which can make normal activities feel impossible. Treatment typically includes mood stabilizers, therapy, and support to help manage the condition over time.
Bipolar II disorder is diagnosed when someone experiences at least one hypomanic episode and one major depressive episode. Hypomania is similar to mania but less severe. During a hypomanic episode, a person might feel energized, confident, and productive, but their behavior doesn’t usually cause major problems or require hospitalization. However, the depressive episodes in Bipolar II are often longer and more severe than those in Bipolar I.
The defining feature of Bipolar II is the combination of severe depression with milder hypomanic highs. This can make the condition harder to recognize, as hypomania might appear as a period of high energy or enthusiasm. However, the deep lows of depression can significantly impair a person’s ability to function. Treatment often focuses on managing depression and preventing mood swings with therapy and medication.
Between two and three percent of the U.S. population suffers from either form of bipolar disorder, amounting to nearly six million people.
The disorder is highly heritable, with 70 to 80 percent of people with the disorder having at least one relative with either bipolar disorder or clinical depression. In the United States, the mean age of onset is in the early 20s.
Both Bipolar I and II are serious, lifelong conditions, but with proper care, people can manage their symptoms and live fulfilling lives.
Treating bipolar disorder
For many years, bipolar disorder was often undiagnosed. This was either because patients didn’t report their symptoms to a doctor or because the condition was misunderstood as a disorder requiring only psychotherapy or psychoanalysis. It wasn’t until the 1970s, when lithium began being used to treat patients with depression, that medications specifically for bipolar disorder started gaining attention in the pharmaceutical industry.
Lithium is widely recognized as one of the most effective treatments in psychiatry, particularly for mood stabilization in bipolar disorder. Its side effects are manageable, and many patients stay on low-dose lithium for decades. Its benefits, in terms of the relief of mania and the prophylaxis of depression, are incalculable.
Today, the main treatments fall into seven categories:
Mood stabilizers – based on lithium Carbolith (Eskalith, Lithobid): highly effective at controlling mood swings, particularly highs. Lithium can take up to a month to work fully, which makes it better for long-term treatment rather than for acute manic episodes. Laboratory tests of blood levels of lithium must be conducted periodically to avoid side effects.
Another mood stabilizer prescribed in place of lithium is Lamictal (active ingredient: lamotrigine): This drug helps to delay episodes of depression, mania, and mixed episodes, being especially helpful in preventing depression.
Anticonvulsive drugs like Depakote (active ingredient: sodium valproate) and Trileptal (active ingredient: oxcarbazepine) also work to level out mood swings. They work by calming hyperactivity in the brain. They are most often prescribed for people who have four or more episodes of mania and depression in a single year. They have more rapid action than lithium but may produce unwanted side effects like feeling excessively tired or sleepy, headaches, and weight gain.
Antipsychotics can be prescribed in some circumstances to control psychotic symptoms such as hallucinations or delusions, although hypomanic episodes do not really classify as psychotic episodes. Drugs such as Abilify (active ingredient: aripiprazole), Vraylar (active ingredient: cariprazine), Seroquel (active ingredient: quetiapine fumarate), Zyprexa (active ingredient: olanzapine), Risperdal (active ingredient: risperidone), and Geodon (active ingredient: ziprasidone) are sometimes used in patients undergoing a bout of hypomania.
Benzodiazepines are minor tranquilizers used for short-term control of acute bouts of hypomania such as insomnia or agitation.
Tricyclic Antidepressants like Seroquel (active ingredient: quetiapine fumarate) are used specifically for bipolar II depression. They work by increasing activity levels of serotonin and norepinephrine in the brain. Scientists believe these play a role in regulating mood. However, they can increase the risk of mania.
Antidepressants using selective serotonin reuptake inhibitors (SSRI), such as Prozac (active ingredient: fluoxetine), Paxil (active ingredient: paroxetine), and Zoloft (active ingredient: sertraline) may also be used in bipolar II depression, but are thought to be likely to cause or worsen hypomania in bipolar I disorder.
Psychotherapy, such as cognitive-behavioral or “talk” therapy, may also help.
Electroconvulsive Therapy (ECT) is a treatment for severe manic or depressive episodes where immediate intervention may be needed.
Because bipolar disorder may involve recurrent episodes, ongoing treatment with medication is often recommended to prevent relapse.
