Bipolar Disorder: What It Is, Symptoms & Treatments

TUESDAY, May 16, 2023 (HealthDay News) -- More than 10 million people in the United States are living with bipolar disorder, according to the National Alliance on Mental Illness (NAMI).

It's characterized by severe, dramatic shifts in mood that can catch people off guard. The name captures the dramatic swing from elation to despair. With treatment, many people with bipolar disorder lead stable, satisfying lives.

What is bipolar disorder?

Bipolar disorder is a mental health condition marked by extreme swings between mania (elevated mood) and depression. On average, it starts around age 25, according to NAMI, although it may begin in adolescence.

"These are not just your normal run-of-the-day mood swings," said James Maddux, a senior scholar at George Mason University’s Center for the Advancement of Well-Being, in Fairfax, Va. He explained that the condition “involves a manic episode that could be for several weeks or several months, followed by a crash into a major depression — which also can last several weeks to several months."

Bipolar disorder symptoms

The main symptoms of bipolar disorder are mania or hypomania and depression. These periods may occur separately, one right after the other or at the same time, according to NAMI and the American Psychological Association.

Mania is marked by:

• Elevated mood
• Psychotic symptoms, such as hallucinations and delusional thinking
• Impulsive behavior
• Risk-taking
• Poor decision-making
• Irritability, agitation and restlessness
• Overconfidence
• Suicidal thoughts

Hypomania is similar but milder. The person can generally still function fine at work, school and socially.

The depression phase of bipolar disorder is marked by:

• Low mood that makes it difficult to function
• Unusual sleep patterns
• Feelings of guilt, hopelessness or failure
• Suicidal thoughts
• Irritability
• Lack of focus

What causes bipolar disorder?

According to NAMI, scientists have not yet found a single cause of bipolar disorder. They suspect several factors may contribute, including:

• Having a family member with bipolar disorder, especially a sibling or parent
• Stressful events such as a divorce, death in the family or money problems that trigger states of mania, hypomania or depression
• Brain function and structure

Is bipolar disorder genetic?

“There's a lot of good research that … a good portion of the vulnerability to bipolar disorder is genetic and is inherited,” Maddux said.

A study published in the journal Nature Genetics found that a gene called AKAP11 has a significant effect on a person’s risk for bipolar disorder. The study involved about 28,000 participants.

People with bipolar disorder were more likely to carry variants of that gene.

“This work is exciting because it’s the first time we’ve had a gene with large-effect mutations for bipolar disorder,” said Dr. Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard in Cambridge, Mass., which led the study.

Types of bipolar disorder

NAMI lists the types of bipolar disorder as:

• Bipolar I Disorder: A person has experienced at least one manic episode and may often alternate between mania and depression.
• Bipolar II Disorder: A person shifts between depression and hypomania but doesn’t experience full-blown mania.
• Cyclothymia: A person has shifted between depression and hypomania for at least two years and had normal moods for less than eight weeks at a time.
• "Other Specified" Bipolar Disorder: While unusually elevated moods are present, a person doesn’t meet the criteria for the three other types of bipolar disorder.

Bipolar disorder treatments

There are several treatment options, including:

• Bipolar disorder medications, including the mood stabilizer lithium
• Cognitive behavioral therapy (CBT) to help reshape thinking and behavior patterns
• Psychotherapy focused on self-care and self-regulation strategies

“Cognitive behavioral therapy can be used in helping the person, first of all, identify the life stressor that may be triggering a manic phase, for example, and can help the person learn to better manage stress,” Maddux said. “Psychotherapy can be effective in helping the person manage the symptoms, as well as manage the consequences.”

Maddux also stressed the importance of speaking with a psychiatrist, who can prescribe medications such as lithium to help manage the symptoms of bipolar disorder.

Borderline personality disorder versus bipolar: What’s the difference?

Bipolar disorder is more rooted in the biology of the nervous system and more responsive to medication, according to NewYork-Presbyterian Hospital.

While mood swings are characteristic of both conditions, people with bipolar disorder tend to be emotionally stable in between manic and depressive episodes. The same is not true for those with borderline personality disorder.

“Borderline personality disorder … [is] characterized largely by emotional instability. The mood swings can be extreme, but usually a very quick, very, very short duration,” Maddux said. “A person, for example, in a conversation, may feel offended and lash out and scream and yell at the person in the conversation with them, and then 30 seconds later be perfectly calm and normal.”

NAMI offers several helpful infographics and videos for teens and adults who are interested in learning more about bipolar disorder.