By Amanda Marker, LMHC

What is Bipolar Disorder?

Bipolar disorder is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels and concentration. Formerly, bipolar disorder was known as manic-depressive illness or manic depression. These shifts often drastically affect social and professional functioning. An individual will shift from an elevated manic episode to a depressive episode. The rate and intensity of the mood shifts will determine a more specific diagnostic category of bipolar disorder. Experiencing four or more episodes of mania or depression within one year is called “rapid cycling.”

Bipolar disorder is often diagnosed during late teen years or early adulthood. Sometimes, but more rarely, bipolar symptoms can appear in children or as late as in your 40s or 50s.

There are three typical presentations of bipolar that can be classified as: bipolar I, bipolar II and cyclothymia (sy-kloe-THIE-me-uh).

  • Bipolar I is often experiencing manic episodes that last for at least seven days (nearly every day for most of the day) or having manic symptoms that are so severe that an individual needs immediate medical care to ensure the safety of themselves and potentially others.
  • Bipolar II is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
  • Cyclothymia is when an individual has an expression of bipolar that does not quite fit in the descriptions above with clinical certainty, it may be classified as ‘other specified and unspecified bipolar and related disorders.’

What Does a ‘Manic Episode’ of Bipolar Look Like?

Characteristics of mania include increased talkativeness, rapid speech, a decreased need for sleep, racing thoughts, distractibility, increase in goal-directed activity, elevated or expansive mood, mood swings, impulsivity and irritability.

“Goal-directed activities” can look like impulsively spending excessive money, gambling excessive amounts, starting businesses unprepared, traveling, reckless driving, engaging in high-risk behaviors or promiscuity. Some individuals may engage in property damage or even harm themselves or others through verbal or physical assaults. They may also become highly aggressive, agitated or irritable.

Individuals often act with disregard during a manic episode which results in ruining reputations and careers. It is important to note, an individual amid a manic episode may not recognize they are behaving out of the norm; however, it becomes apparent to family or friends that this behavior may be due to mental illness.

Manic episodes may or may not be accompanied by psychotic symptoms that include delusions or hallucinations. A common delusion can be an individual believing they are spies, government officials, owners of major companies or that they are knowledgeable professional (even when they have no such background). Conversely, delusions of paranoia may be present, in which individuals believe people are stalking, targeting or surveilling them. Auditory or visual hallucinations may also be present, however, only when the individual is in manic phases.

What Does a ‘Depressive Episode’ of Bipolar Look Like?

Often, depressive episodes are lasting at least two weeks. Individuals experience a low mood and/or loss of interest in most activities, tiredness, changes in appetite, feelings of worthlessness and hopelessness, feeling very sad or worried. Children and adolescents with depression may be irritable rather than sad.

Individuals may not enjoy things that used to bring joy, be easily irritated or frustrated, have trouble sleeping (insomnia) or sleeping too much (hypersomnia), have a difficulty concentrating and making decisions or remembering things, experience physical issues like headache, stomachache or sexual dysfunction and may have thoughts of self-harm or suicide.

If you’re experiencing suicidal ideation (thoughts of suicide), it’s important to seek immediate care. Call 911 or the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24 hours a day, seven days a week.

What is a “Bipolar Episode with Mixed Features”?

Sometimes individuals may experience both manic and depressive symptoms in the same episode, and this is called an “episode with mixed features.” During an episode with mixed features, individuals may feel very sad, empty or hopeless while at the same time feeling extremely energized. It should be noted, this is a very risky time for an individual in the event they are feeling suicidal as they may also have excessive energy to act on an impulse related to their suicidal thoughts.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar II disorder experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

What Are the Risk Factors for Bipolar Disorder?

There is a great deal of research going into identifying the cause of bipolar disorders. There are several generally agreed upon risk factors that may be a contributing factor. These include:

  • Brain structure and functioning: Some research is identifying differences in the brains of people with bipolar and individuals without. However, currently, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.
  • Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene causes the disorder. There is a great deal to still learn about how genes play a role.
  • Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.

How is Bipolar Disorder Treated?

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. However, with treatment individuals with even the most severe presentation of bipolar disorder can have successful quality life while managing their symptoms. Common treatment for bipolar disorder is a combination of medication and psychotherapy.

Cognitive behavioral therapy (CBT) is an important treatment for depression, and CBT adapted for the treatment of insomnia can be especially helpful as part of treatment for bipolar depression.

Newer therapies that have been designed specifically for the treatment of bipolar disorder, such as interpersonal and social rhythm therapy (IPSRT) and family-focused therapy may also be included in the treatment plans.

Additionally, other treatments, like ECT may be helpful in managing bipolar symptoms. Electroconvulsive therapy (ECT) is a brain stimulation procedure that can help relieve severe symptoms of bipolar disorder. Healthcare providers and patients may discuss and consider ECT when an individual’s illness has not improved after other treatments.

What can help manage bipolar disorder symptoms?

There are several things someone can do to help manage symptoms of bipolar disorder.

  • Work with a health care provider: Treatment is the best way to start feeling better. Many people with bipolar disorder also have other mental disorders or conditions such as anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), misuse of drugs or alcohol or eating disorders. It is important to work with a trained medical professional who can help identify the root cause of an individual’s distress.
  • Follow the treatment plan as directed: Consistency is key. Sometimes individuals will stop a medication or therapy when they are feeling better, however this is not a good idea and can cause significant setbacks in one’s treatment journey. If an individual feels a change is needed in the treatment plant, work with a health care provider to adjust the plan as needed. Ask trusted friends and family members for help in keeping up with your treatment plan.
  • Quit drinking alcohol and/or using recreational drugs and tobacco: It’s essential to quit drinking and using drugs, including tobacco, since they can interfere with medications you may take. They can also worsen bipolar disorder and trigger a mood episode. Please note, it may be unsafe to abruptly stop drinking alcohol or taking certain illicit drugs. Please consult a medical professional for a safe plan of action. Our blog What to Expect During Detox may be a helpful as well.
  • Keep a daily mood chart: Keeping track of your daily thoughts, feelings and behaviors can help you be aware of how well your treatment is working and/or help you identify potential triggers of manic or depressive episodes. This is useful data for your medical team as well as the patterns that emerge can help clarify a diagnosis.
  • Keep a healthy sleep schedule: Bipolar disorder can greatly affect your sleep patterns. Prioritize a routine sleeping schedule, including going to sleep and getting up at the same times every day. Learn more about good sleep hygiene on our Sleep Hygiene
  • Exercise: Exercise has been proven to improve mood and mental health. Weight gain is a common side effect of some bipolar disorder medications and exercise may also help with weight management.
  • Meditation: Meditation has been shown to be effective in improving the depression that’s part of bipolar disorder.
  • Manage stress and maintain healthy relationships: Stress and anxiety can worsen mood symptoms in many people with bipolar disorder. It’s important to manage your stress in a healthy way and to try to eliminate stressors when you can. A big part of this is maintaining healthy relationships with friends and family who support you, and letting go of toxic relationships with people who add stress to your life.
  • Be patient: Improvement takes time. Staying connected with sources of social support can help. Join a support group and connect with others going through this as well. Remember you are not alone, and you do not have to go through this alone.

Bipolar Resources

If you want to learn more about bipolar disorder, check out these informational videos created by the National Institute of Mental Health:

If you or a loved one needs treatment for bipolar disorder, call our admission line 24/7 for a no-cost assessment and to learn more about our treatment options. We can help. 727-322-7222.

In life-threatening situations, call 911 or go to the nearest emergency room.

If you are suicidal or in emotional distress, consider using the 988 Suicide & Crisis Lifeline.

Call or text 988 or chat online to connect with a trained crisis counselor. The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. You can reach a specialized LGBTQI+ affirming counselor by texting “Q” to 988 or by calling 988 and pressing “3.”

If you are a veteran, consider using the Veterans Crisis Line.

Call 988, then press “1.” You can also text 838255 or chat online. The Veterans Crisis Line is a 24-hour, confidential resource that connects veterans with a trained responder. The service is available to all veterans and those who support them, even if they are not registered with the VA or enrolled in VA healthcare.