Condition Center: Bipolar Disorder

Photo Illustration by Keila Gonzalez
Photo Illustration by Keila Gonzalez

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Mood changes are a part of life. But when ups and downs are extreme and last for weeks instead of hours, the cause could be something more serious — like bipolar disorder, a mental health condition characterized by intense, fluctuating emotional states. Because bipolar disorder includes elements of other mental health issues, it can take six or more years to get a correct diagnosis. "People with bipolar disorder often see a doctor when they're depressed, but it's important for medical professionals to ask about bipolar symptoms, like racing thoughts and insomnia, because bipolar requires different treatment than depression," says Kathleen Cairns, PsyD, a clinical psychologist in private practice in West Hartford, CT.

What Is Bipolar Disorder?

About 4.5 percent of people in the US experience bipolar disorder at some point in their lives. It affects equal numbers of men and women, and the average age it appears is 25.

There are several types of bipolar disorder, including bipolar I, which has the most dramatic mood symptoms; bipolar II, which has depressive episodes paired with milder manic episodes; and cyclothymic disorder, a combination of slightly low mood and slightly elevated mood, with symptoms that persist for at least two years.

With bipolar disorder, these alternating high and low moods are also known as mania and depression. In the elevated mood state, people might have a decreased need for sleep, risky or unpredictable behavior, racing thoughts, restlessness, hallucinations, delusions, and a sense of grandiosity (i.e., an exaggerated sense of their own self-importance). Depressive episodes can include symptoms like intense sadness, feelings of worthlessness or guilt, weight gain or loss, decreased interest in enjoyable activities, difficulty functioning, and frequent suicidal thoughts.

While the ups and downs of bipolar disorder typically come in episodes that last a week or more, the two mood states can cycle back and forth far more quickly, or even occur simultaneously, and some people have long stretches — even years — with no symptoms. In most people with bipolar I, however, the disorder causes serious impairment, more than any other mood disorder, according to the National Institute of Mental Health.

Causes of Bipolar Disorder

The definitive cause of bipolar disorder is unknown, but there are several factors that may be involved.

  • Genes. The condition tends to run in families, and a number of genes have been linked to the disorder. "There's a more pronounced genetic component with bipolar than other mental health conditions," says Ken Abrams, PhD, a professor of psychology at Carleton University in Ottawa, Canada. That said, none play a defining role in its development.
  • Environmental factors, including prenatal exposure to infections, maternal stress, and substance abuse, are thought to increase the risk of developing bipolar disorder, though more research is needed to determine how strongly, and which factors, according to a study in the Journal of Affective Disorders. Stressful events (like an illness, divorce, financial problems, or the death of a loved one) may also increase the risk or act as a trigger for an episode, reports the Mayo Clinic.
  • Brain structure and function appear to contribute. In 2017, an international consortium of researchers conducted an MRI study to look at the brains of more than 6,500 people with and without bipolar disorder. Their findings, published in Molecular Psychiatry, showed that those with the condition had thinning gray matter in brain regions that control inhibition and motivation.

The Most Effective Treatments For Bipolar Disorder

There are a variety of medications to treat bipolar disorder, but one of the oldest — a mood stabilizer known as lithium — is still one of the most commonly prescribed, Dr. Abrams says. Anticonvulsive or antipsychotic drugs are often prescribed, too. Once they find a medication that works, most people with bipolar disorder need to stay on it permanently to prevent a relapse.

Psychotherapy is an important part of treatment, as well. Several approaches have been shown to be helpful, including family-focused therapy, which enlists the help of family members, since loved ones can encourage people with bipolar disorder to stick to their treatment plan and can recognize warning signs of a flare-up. Another helpful option is interpersonal and social rhythm therapy, which focuses on stabilizing daily activities, such as sleeping, waking, eating, and exercise, because a consistent, healthy routine can help people with bipolar manage their mood.

If you or someone you know is struggling with bipolar disorder, the National Alliance on Mental Illness has resources available including a helpline at 1-800-950-NAMI (6424). You can also dial 988, the nation's new mental health crisis hotline.