Bipolar Disorder: Key Q&A

Reviewed By:
Steven A. King, M.D.

What is bipolar disorder?
Bipolar disorder is a cycling mood disorder characterized by alternating periods of depression and mania. A mood disorder is a mental illness characterized primarily by mood swings or an abnormally high or low mood. Manic episodes are periods of abnormal highs in mood. Depressive episodes are periods of abnormal lows in mood. Some types of bipolar disorder can be diagnosed when only a manic episode has occurred. Bipolar depression may also be called manic depression.

 

How common is bipolar disorder?
According to the National Institute of Mental Health, about 5.7 million adult Americans are diagnosed with bipolar disorder. The condition occurs across all races and ethnic backgrounds. In general, men and women are affected equally. However, men are more likely to experience a manic episode before a depressive episode. Women, on the other hand, are more likely to have a major depressive episode before a manic episode and are more likely to have more depressive episodes than manic episodes. Women are also more likely to experience rapid cycling. Rapid cycling occurs when a person has four or more episodes per year.

 

At what age is bipolar disorder most likely to develop?
The onset of bipolar disorder usually occurs in late adolescence or early adulthood, and the average age at onset is 20. However, the disorder can occur at any age, including over 50. Bipolar disorder was once thought to be very rare in children under the age of 12, but recent studies show it may be more common than was previously believed.

 

How dangerous is bipolar disorder?
People with bipolar disorder can have delusions of invulnerability may lead to dangerous, reckless behavior. Furthermore, according to Mental Health America, untreated bipolar disorder can lead to suicide in up to 15 percent of cases. In some cases, alcohol abuse and other substance abuse problems occur in patients with bipolar disorder and may worsen their condition. Bipolar disorder also significantly impacts the economy, resulting in functional impairment, disability or loss of productivity for those affected. According to the National Association of Mental Illness, bipolar disorder is among the top 10 causes of disability worldwide.

 

Are there different types of bipolar disorder?
Yes. Bipolar disorder is divided into four categories. Bipolar I disorder is the most common type of bipolar disorder. This diagnosis requires at least one manic or mixed episode, and episodes of major depression have usually occurred, but are not required for diagnosis. Bipolar II disorder is diagnosed when at least one episode of hypomania and one episode of major depression have occurred. For this diagnosis, you must have never had a manic or mixed episode. Cyclothymia is a cycling between hypomania and lows in mood that do not meet the criteria for major depressive episodes. These milder episodes may be less severe or shorter in duration. They are, however, chronic, and they last for at least two years with no lapse in symptoms for more than two months at a time. Nonspecified bipolar disorder is diagnosed if your bipolar disorder has features that do not match those noted above. This may be more common in early onset bipolar disorder.

 

What are the symptoms of manic episodes?
Symptoms of manic episodes include euphoria, elevated mood, irritability and elevated self-esteem. You may also have a decreased need for sleep, increased goal-directed activity and feel as though your thoughts are racing. Other symptoms include rapid talking, intrusive or aggressive behavior, denial that anything is wrong and seeking pleasure without regard to consequences.

Hypomanic episodes are similar to manic episodes but are less severe or shorter in duration.

 

What are the symptoms of depressive episodes?
The symptoms of major depressive episodes are altered mood and loss of interest in activities you formerly found pleasurable. Other symptoms include significant change in appetite or weight, changes in sleep patterns and changes in physical or verbal activity. Fatigue and loss of energy, feeling of worthlessness, reduced concentration and thoughts of death may also occur.

Sometimes symptoms of depression may occur during a manic episode, resulting in a mixed episode. Psychotic features such as hallucinations and delusions may be present in manic, mixed or depressive episodes. Obsessions and compulsions may also occur.

 

What medications are used to treat bipolar disorder?
Medications are generally the first line of treatment for bipolar disorder. They are used to quickly control and eliminate dangerous or disabling symptoms and prevent further episodes. Mood-stabilizing drugs are the primary medications for bipolar disorder. Lithium is the most common mood stabilizer, and it's generally the first medication used to treat bipolar disorder. Anticonvulsant mood-stabilizing drugs may be used for difficult and complex types of bipolar disorder, such as rapid cycling.

 

What types of therapy are used to treat bipolar disorder?
Psychotherapy is typically used only when the most severe symptoms are under control. It can be effective if your symptoms have been stabilized with medication. Psychotherapy encourages you to take medication properly, assists you and your family in establishing and maintaining appropriate behavioral boundaries and provides counseling and support.

Electroconvulsive therapy is generally considered only in severe cases or in cases where medications are not effective. However, it may be an alternative to medications for pregnant or breastfeeding women. Modern techniques are much improved, and past problems, such as long-lasting memory loss, have been greatly reduced.