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Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorders are mental health conditions characterized by periodic, intense emotional states affecting a person’s mood, energy, and ability to function. These periods, lasting from days to weeks, are called mood episodes. Mood episodes are categorized as manic/hypomanic episodes when the predominant mood is intensely happy or irritable, or depressive episodes, when there is an intensely sad mood or the ability to experience joy or pleasure disappears. People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.

While people without bipolar disorder may also experience mood fluctuations, mood changes that are part of commonly lived experience typically last hours rather than days and are not accompanied by extreme changes in behaviour or changes in functioning, such as difficulties with daily routines and social interactions. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.

Types of Bipolar Disorder

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

  • Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
  • Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
  • Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and Symptoms of Bipolar Disorder?

People with bipolar disorder experience periods of unusually intense emotion and changes in sleep patterns and activity levels, and engage in behaviours that are out of character for them—often without recognizing their likely harmful or undesirable effects. These distinct periods are called mood episodes. Mood episodes are very different from the person’s usual moods and behaviours. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

Symptoms of a Manic Episode

  • Feeling very up, high, elated, or extremely irritable or touchy
  • Feeling jumpy or wired, more active than usual
  • Having a decreased need for sleep
  • Talking fast about a lot of different things (“flight of ideas”)
  • Racing thoughts
  • Feeling able to do many things at once without getting tired
  • Having excessive appetite for food, drinking, sex, or other pleasurable activities
  • Feeling unusually important, talented, or powerful

Symptoms of a Depressive Episode

  • Feeling very down or sad, or anxious
  • Feeling slowed down or restless
  • Having trouble falling asleep, waking up too early, or sleeping too much
  • Talking very slowly, feeling unable to find anything to say, or forgetting a lot
  • Having trouble concentrating or making decisions
  • Feeling unable to do even simple things
  • Having a lack of interest in almost all activities
  • Feeling hopeless or worthless, or thinking about death or suicide

Sometimes people have both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. During an episode with mixed features, people may feel very sad, empty, or hopeless while at the same time feeling extremely energized.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar II disorder experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Treatment Options for Bipolar Disorder

The two main types of treatment for bipolar disorder are medication and talking therapies. The exact combination of treatments offered will depend on whether you’re managing a current mood episode, or managing your mental health in the longer term.

During depressive episodes:

  • Your doctor is likely to offer you medication. This might be new medication or a change to your current bipolar medication.
  • Your doctor might offer you a structured psychological treatment that’s used to treat depression, such as cognitive behavioural therapy (CBT).

During manic or hypomanic episodes:

  • Your doctor is likely to offer you medication. This might be new medication or a change to your current bipolar medication.
  • Your doctor is unlikely to offer a talking treatment if you’re currently experiencing a manic or hypomanic episode.

Talking therapies for bipolar disorder

Your doctor might offer one of several talking therapies to help you manage bipolar disorder in the longer term. These could include:

  • Cognitive behavioural therapy (CBT): Looks at how your feelings, thoughts and behaviour influence each other and how you can change these patterns.
  • Interpersonal therapy: Focuses on your relationships with other people. Looks at how your relationships affect your thoughts, feelings and behaviour – and how they affect your relationships.
  • Behavioural couples therapy: Focuses on recognising and trying to resolve emotional problems between partners.
  • Individual psychoeducation: Involves a brief intervention helping you to identify triggers, spot warning signs and develop coping strategies.
  • Group psychoeducation: Involves working in a group of people with shared experiences. Aims to build knowledge about bipolar disorder and self-management. It is led by a trained therapist.
  • Family-focused therapy: Involves working as a family to look at behavioural traits, identify risks and build communication and problem-solving skills.
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