Bipolar Disorder 101
"I wasn’t suicidal, but I wasn’t sure I’d jump out of the path of an oncoming bus."
The depression caught Beth* off guard. After days of racing thoughts and frenetic activity, the 23-year-old law student was suddenly smothering beneath a black mood. She was scared. Her moods had been swinging from high to low for months, but this time the bottom fell out.
"My mind was racing, my speech was rapid and I’d been up three nights straight—I had incredible energy," Beth recalls. "Then depression hit me hard and fast. I slept away entire days at a time," she says. "I almost dropped out of school."
Her boyfriend left her. She didn’t care about her appearance or much of anything else. Hopelessness set in. "I wound up hospitalized for a week before eventually being diagnosed with Bipolar Disorder Type II."
Bipolar Disorder—the term has become trivialized, working its way into our vernacular, much like the misnomer "schizoid" did in decades past. Simply changing one’s mind can prompt the ill–informed to respond with an eye-roll, "You’re so bipolar."
Bipolar Disorder causes swings between two extremes of mood—a high (manic) state, and a low (depressed) state—the opposite ends, or poles, of our mood range. Although the term gets tossed around casually, there is nothing casual about the disease or the numbers of people suffering with it. According to the National Institute of Mental Health, Bipolar Disorder affects 5.7 million adults and an estimated 1.1 million children in the United States.
As Kay Redfield Jamison wrote in An Unquiet Mind: A Memoir of Moods and Madness (Vintage, 1997), "[m]anic-depression [Bipolar Disorder] distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it, an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."
"Bipolar Disorder is a very common brain disease," says Jair Soares, MD, chair of the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston (UTHealth) and co-director of the UT Center of Excellence on Mood Disorders (CEMD). "It causes shifts in a person’s mood, energy and ability to function. Bipolar Disorder symptoms are severe. They are different from the normal ups and downs we all experience in daily life," Soares says, often leading to unsatisfactory job performance, bad grades, ruined relationships and even suicide.
Like Beth, most sufferers develop symptoms of Bipolar Disorder in their late teens or early adult years—at least half before age 25. The other half of patients develop symptoms at all ages. Researchers are not sure what causes Bipolar Disorder. Small changes in the area of the brain that modulates emotions seem to play a key role, but it remains unclear why or how these changes happen.
What is clear to researchers is that Bipolar Disorder has a genetic component. "Bipolar Disorder runs in families," says Soares. "When we are trying to diagnose a child or an adult, we look carefully at family history. It is rare to find a child with Bipolar Disorder who has no one else in the family with it."
Ups and downs
People with Bipolar Disorder experience atypically strong emotional states that occur in discrete periods called "mood episodes." An overly elated or overexcited state is called a manic episode, and an extremely sad, empty or hopeless state is called a depressive episode.
A person in a manic state can experience feelings that range from excitement to irritability to a feeling of invincibility. Mania also produces feelings of hyperactivity, little or no need for sleep or food, agitation, high energy, racing thoughts, delusions of grandeur, lack of temper control, impulsivity and reckless behavior. Someone having a manic episode may exhibit just one or any number of these behaviors.
Hypomania is a subdued version of mania that can in some ways be more dangerous to the person experiencing it because they do not recognize that there is a problem. People who are hypomanic often describe it as feeling very good. For some people, like Beth, it is a time of tremendous productivity. In general, hypomania has the same range of symptoms as mania, but to a lesser degree.
A depressive episode looks quite different than either mania or hypomania. It has its own dangers that stem from persistent feelings of sadness, loss of hope, too much or too little sleep, a loss of appetite, a feeling of worthlessness, and suicidal thoughts or actions.
Types of Bipolar Disorder
"Bipolar Disorder is a general term referring to a spectrum of disorders, each having slight differences," says Soares.
- Bipolar Disorder Type I is what most people think of when they hear the term bipolar or manic depression. Someone with Bipolar I experiences high (manic) and low (depressive) moods and will have mood swings between manic and depressive episodes. These moods often occur back-to-back, but it is possible to have periods of stability between them.
- Bipolar Disorder Type II might be thought of as "bipolar light" because persons with it do not experience the truest form of mania. Rather, they have periods of hypomania. (Think of mania as grandiose and invincible; hypomania as extremely confident and energetic.)
- Someone diagnosed with cyclothymia has moods that swing back and forth between hypomanic highs and mild depressive lows.
- Bipolar Disorder Not Otherwise Specified (NOS) is used for those whose symptoms do not present in ways that fit the other categories. A person who experiences manic and depressive features at the same time is often diagnosed with this category.
Diagnosis and treatment
Bipolar Disorder can be difficult to diagnose—taking a number of months or even years. "In adults, we have reliable ways to diagnose Bipolar Disorder," says Soares. "But often there are co-occurring illnesses or conditions such as alcohol or drug abuse that make it harder to diagnose." Children can be difficult to diagnose properly because they may not be able to articulate the feelings they’re experiencing.
The symptoms often seem related to different problems, rather than parts of one disorder. Most psychiatrists make the diagnosis only after they have treated the patient over time, after identifying his or her changing mood patterns. This type of diagnosis allows for effective design and implementation of proper treatment plans.
Not all Bipolar Disorders are created equal. What may work for one patient with Bipolar I may be ineffective for another with Bipolar I. Often, trial and error—over time—is the only way to find the proper medication or combination of medications. Talk therapy is often an effective adjunct to the drug regimen.
Ultimately, all the effort to find the correct diagnosis is worth it, as the patient who gets the proper treatment will experience more sustained periods of stability. In Beth’s case, she eventually found the appropriate medication regimen that stabilized her and along with talk therapy, has allowed her to live a full and productive life. "Though I occasionally need fine-tuning with my meds and experience some highs and lows, I am aware of it, know when to see my doctor and know that I will cycle through it," she says.
Soares says, "People with Bipolar Disorder who are receiving the proper care can lead full and productive lives."
*name changed in the interest of privacy.