I have written about every mental illness symptom I have experienced—mania, depression, psychosis, intrusive thoughts and postpartum psychosis, but I have never written a post devoted strictly to bipolar disorder.
I have a confession to make. In the twenty-three years I have been managing bipolar disorder, I have done very little research on the subject. I thought having bipolar disorder meant—well, I thought it meant I had bipolar disorder. For years, I didn’t know bipolar disorder had different classifications.
When I heard a famous actress had bipolar II disorder, I had to look it up to find out what that meant. It was only then I discovered I have a textbook case of bipolar I disorder.
Ignorance is Bliss
I don’t know why I never immersed myself in knowledge about bipolar disorder. It is not something I ever gave any thought to. Chalk it up to sometimes too much information is too much information. Living in my need-to-know bubble served me well.
I think my limited knowledge made it easier for me to follow my psychiatrist’s orders. I have a tendency to overthink everything, so knowing too much in those early years could have impeded my ability to follow my doctor’s directions to the letter.
But now I feel like an elder stateswoman of bipolar disorder. The poster child. If I am going to write about bipolar disorder extensively, now is the perfect time to expand my understanding of my diagnosis.
I will not only educate myself in all things bipolar, I will educate you too. My goal is to share everything you need to know about bipolar disorder and provide the tools to navigate your diagnosis or the diagnosis of someone you love.
Sifting Through Resources
There is a plethora of information on bipolar disorder on the internet. I could get lost for days digesting all the resources available. For this discussion, I narrowed my research to two credible sources. I gathered all the facts you will read in this post from the National Alliance on Mental Illness and the Mayo Clinic.
According to the National Alliance on Mental Illness (NAMI), “Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar disorder experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience.”
Bipolar disorder affects 2.8% of American adults, and it affects men and woman equally. Although the median age of onset is 25, bipolar disorder can start in early childhood or later in life. It affects all ages, races, and social classes.
Four Types of Bipolar Disorder
According to the National Alliance on Mental Illness (NAMI) there are four types of bipolar disorder:
1. Bipolar I Disorder
For a bipolar I disorder diagnosis, the patient must experience at least one episode of mania. Most patients with bipolar I disorder have both manic and depressive episodes, but a depressive episode is not necessary for diagnosis. For diagnostic purposes, the manic episode must last at least a week or require hospitalization.
2. Bipolar II Disorder
For a bipolar II disorder diagnosis, the patient must experience shifting episodes of depression and hypomania (a milder form a mania without psychotic features) without ever having a full-blown manic episode. It is NOT a milder form of bipolar I disorder.
3. Cyclothymic Disorder or Cyclothymia
For a cyclothymic disorder diagnosis, the patient must exhibit a chronic unstable mood with hypomania and mild depression for at least two years. For children and teenagers, the length of the instability must be one year. The patient may experience periods of stability, but it lasts less than eight weeks.
4. Bipolar Disorder, “Other Specified” and “Unspecified”
For this diagnosis, the patient must not meet the diagnostic requirements for any of the other three classifications, but they must still experience significant abnormal elevated moods over time. This classification may also cover episodes triggered by drugs, alcohol or a medical condition.
Mania and Hypomania
A manic and hypomanic episode must include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Poor decision-making (shopping sprees, taking sexual risks, foolish investments)
- Psychotic features like hallucinations and/or delusions
A major depressive episode must include five or more of these symptoms and noticeably impair the patient’s day-to-day life:
- Depressed mood, such as feeling sad, empty, hopeless or tearful
- In children, a depressed mood may present as irritability
- Marked loss of interest or feeling no pleasure in all—or almost all—activities
- Significant weight loss when not dieting, weight gain or appetite changes
- In children, failure to gain weight as expected can be a sign of depression
- Insomnia or sleeping too much
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate or indecisiveness
- Thinking about, planning or attempting suicide
Scientists have not yet pinpointed the exact cause of bipolar disorder, but several factors contribute to an individual developing the condition.
- Genetics. A person with a first-degree relative such as a parent or sibling is more likely to develop bipolar disorder. Having a genetic predisposition does not make the diagnosis inevitable. Studies have shown that in identical twins, one may develop bipolar disorder while the other does not. Scientists are trying to determine which genes cause the development of bipolar disorder.
- Brain Structure and Function. Research has shown differences in the brains of people with bipolar disorder.
- Stress. A traumatic life event can trigger mania or depression. The way a person handles stress may also play a role in a person’s development of bipolar disorder.
A multifaceted treatment plan tailored to the patient’s specific needs is necessary to manage bipolar disorder.
Common interventions include:
- Medication including lithium, mood stabilizers, second-generation antipsychotics and antidepressants.
- Psychotherapy including cognitive behavior therapy, family-focused therapy and stress regulation.
- Electroconvulsive Therapy (ECT) involves a brief electrical stimulation of the brain while the patient is under anesthesia.
Psychotherapy and proper medication are the standard of care in most cases. It usually takes a combination of medications to keep a patient stabilized. Electroconvulsive therapy (ECT) is an option if a patient with severe mania or depression does not respond to other treatments.
In addition, solid self-care habits, a set routine and a support system are crucial. It is also critical to have the self-awareness to recognize symptoms at their onset. Educate your family members and support system, so they know what to expect too.
If I have learned anything in my 23 years of managing bipolar disorder, it is that it is not one size fits all. Sufferers may have similarities in symptoms and treatment protocols, but ultimately, bipolar disorder is a nuanced condition that will present uniquely to a particular person’s hardwiring.
In my experience, having the right psychiatrist is an essential element in any treatment plan. The patient must trust the doctor’s judgment and have confidence they have their best interests at heart.
Do your homework so you can be your own advocate and pick a psychiatrist you trust. Then you can work together to construct a treatment plan that fits your needs.