What Is Bipolar Disorder? Symptoms, Causes And Treatment

Bipolar disorder is a serious mental health condition characterized by severe mood swings that are significant enough to impair daily life. The disorder affects an estimated 5.7 million U.S. adults^[1]Bipolar Disorder Statistics. Depression and Bipolar Support Alliance. Accessed 1/16/2023. .

Once referred to as manic depression or manic depressive disorder, bipolar disorder causes episodes of mania (periods of elevated or irritable mood), hypomania and sometimes, depression. There are two types of bipolar disorder, bipolar 1 and bipolar 2, says Jasmine Kaur, M.D., a psychiatrist with Mindpath Health in San Jose, California. Here’s a look at how the two types differ:

Bipolar 1: Individuals with bipolar 1 disorder have experienced at least one manic episode in their lifetime (that is not due to the effects of medication, substances or medical issues). Dr. Kaur defines a manic episode as a period of “either euphoric or highly irritable mood” that persists for at least seven days. During this time, an individual may also experience symptoms such as racing thoughts, decreased sleep needs and exhibiting high-risk behaviors, like sexual promiscuity and unrestrained spending, adds Dr. Kaur.

Sometimes, individuals with bipolar 1 experience manic episodes that involve paranoid or delusional thinking. While people with bipolar 1 disorder may also experience depressive episodes, the experience of depressive episodes is not required for diagnosis.

Bipolar 2: Individuals with bipolar 2 disorder have experienced at least one depressive episode and one hypomanic episode in their lifetime. Hypomanic episodes are similar to manic episodes, says Dr. Kaur, though they are less severe, have less impact on daily life and do not require hospitalization like manic episodes might, she notes.

Hypomanic symptoms have to last for four days to be diagnosed, and can also include irritable or expansive mood, but usually does not involve paranoid or delusional thinking. The depressive component of bipolar 2 is defined as a depressed mood for at least two weeks, and may include symptoms such as persistent sadness, loss of interest in activities they used to enjoy, changes in appetite and sleep, insomnia and thoughts of suicide.

While there is no known singular cause of bipolar disorder, certain physical and environmental factors may play a role in people developing the condition.

Genetics: There is a genetic component to bipolar disorder. If an individual has one first-degree relative with bipolar disorder, studies suggest a 15% to 30% lifetime risk of developing bipolar affective disorder, a percentage that increases to 75% for those with two first-degree relatives with the disorder^[2]Fusar-Poli P, Howes O, Bechdolf A, Borgwardt S. Mapping vulnerability to bipolar disorder: a systematic review and meta-analysis of neuroimaging studies. J Psychiatry Neurosci. 2012;37(3):170-184. . However, more research is needed into the role genetics plays in developing this condition.

Trauma: Experiencing severe stress or traumatic events in childhood may increase the chances of an individual developing bipolar disorder later in life. These events might include losing a parent or caregiver or experiencing abuse or neglect.

Brain formation: Research suggests that people with bipolar disorder may have slight, though key, differences in how their brains are structured. These changes may increase their risk for the condition.

“Symptoms of bipolar disorder can overlap with other disorders,” says Lienna Wilson, Ph.D., a psychologist in Princeton, New Jersey. “For example, bipolar 1 can include psychotic features, which can also occur during schizophrenia or other psychotic disorders.” Dr. Wilson emphasizes that seeing a trained mental health professional is critical to receiving the correct diagnosis.

To diagnose bipolar disorder 1, clinicians conduct a full medical exam, complete a medical history, rule out underlying physical illnesses and look for symptoms of a mood episode as part of a mental health evaluation. These symptoms may include:

• Manic or hypomanic episodes, which includes some or all of the following symptoms to varying degrees of severity:
  • Inflated self esteem
  • Feelings of euphoria
  • Feeling restless or unusually active
  • Irritability
  • Racing thoughts and fast talking
  • Distractibility
  • Increase in goal directed activity
  • Decreased need for sleep
  • Feelings of grandiosity
  • Engaging in high-risk, reckless behaviors

• Depressive episodes, defined by:
  • Feelings of sadness and hopelessness
  • Feelings of isolation
  • Trouble focusing or forgetfulness
  • Increased need for sleep
  • Changes in appetite
  • Losing interest in usual activities
  • Low energy
  • Thoughts of suicide

“Treatment of bipolar disorder is multifactorial and geared towards a person’s presenting symptoms and future goals,” says Dr. Kaur. “A complete plan for treatment will include not only immediate symptoms, but also maintenance of symptoms over the long-term.”

While treatment plans vary from person to person, they typically include medications—such as mood stabilizers, antipsychotics and antidepressants—and psychotherapy. Additionally, if a person is at risk of harming themselves, they may require hospitalization to help them stabilize, adds Dr. Kaur. To treat mild and moderate symptoms of bipolar disorder, patients may be seen in an outpatient facility or doctor’s office, she adds.

“If left untreated, bipolar disorder can be progressive with significant loss of functionality over time. However, with treatment, the prognosis of this condition is quite good, with many patients achieving a reduction in symptoms and even remission,” says Dr. Kaur.

If you’re experiencing symptoms of bipolar disorder like intense mood swings or manic episodes, reach out to your health care provider. While only a qualified mental health professional can make a diagnosis, your general practitioner can offer you a referral for the services you need—and rule out underlying conditions that may be causing your symptoms, adds Dr. Kaur.

Treating bipolar disorder is a lifelong process, she adds. But it is not without hope. “With regular treatment, the outlook for bipolar disorder is optimistic in that many patients are able to lead healthy, productive and fulfilling lives,” she says.