Bipolar disorder was formerly called manic-depressive disorder. It’s a brain disorder that causes extreme highs and lows in mood. These swings can affect your ability to perform everyday tasks.
Bipolar disorder is a long-term condition usually diagnosed in late adolescence or early adulthood. More than 10 million American adults and children will experience bipolar disorder at some point in their lives. Experts aren’t sure exactly what causes bipolar disorder. Family history can increase your risk.
It’s important to see a doctor if you suspect you may be showing symptoms of bipolar disorder. Doing so will help you get an accurate diagnosis and the appropriate treatment.
Read on to see how doctors and mental healthcare professionals diagnose this disorder.
Current bipolar screening tests don’t perform well. The most common report is the Mood Disorder Questionnaire. However, this tests fails to identify 33 percent of people with bipolar and gives a false positive rate of about 20 percent.
You can try some online screening tests if you suspect you have bipolar disorder. These screening tests will ask you a variety of questions to determine the symptoms of your manic and depressive episodes.
Symptoms for manic and depressive episodes include:
|Mania, or hypomania (less severe)||Depression|
|experiencing mild to extreme emotional highs||decreased interest in most activities|
|having high self-esteem||change in weight or appetite|
|reduced need for sleep||change in sleep habits|
|thinking fast or talking more than usual||fatigue|
|low attention span||difficulty focusing or concentrating|
|being goal-oriented||feeling guilty or worthless|
|engaging in pleasurable activities that may have negative consequences||having suicidal thoughts|
|high irritability||high irritability most of the day|
These tests should not replace a professional diagnosis. People taking the screening test are more likely to be experiencing symptoms of depression than mania. As a result, bipolar disorder is often overlooked for depression.
Seek emergency attention right away if you or a loved one is engaging in dangerously reckless behavior or having thoughts of suicide.
Sample questions from a bipolar screening test
Some screening questions will include asking if you’ve had episodes of mania and depression and how they affected your day to day:
- Within the last two weeks were you so depressed that
you were unable to work or work only with difficulty and felt at least four of
- loss of interest in most activities
- change in appetite or weight
- trouble sleeping
- hopelessness and helplessness
- trouble focusing
- thoughts of suicide
- Do you have mood swings that cycle between periods of high and low?
- During your high episodes, do you feel more energetic or hyper than you would during moments of normality?
A healthcare professional can provide the best evaluation. They’ll also look at a timeline of your symptoms, any medications you’re taking, other illnesses, and family history to make a diagnosis.
When diagnosing for bipolar disorder, the usual method is to first rule out other medical conditions or disorders. Your doctor will:
- conduct a physical exam
- test your blood and urine
- ask about your moods and behaviors for a psychological evaluation.
If your doctor doesn’t find a medical cause, they may refer you to a mental healthcare provider, such as a psychiatrist, for possible medication to treat the condition. You may also be referred to a psychologist to help you cope with the symptoms of the disorder.
The criteria for bipolar disorder are in the new edition of the Diagnostic and Statistical Manual of Mental Disorders. Getting a diagnosis may take time — even multiple sessions. The symptoms of bipolar disorder tend to overlap with those of other mental health disorders.
The timing of bipolar mood shifts isn’t always predictable. In the case of rapid cycling, moods may shift from mania to depression four or more times a year. Someone may also be experiencing a “mixed episode,” where the symptoms of mania and depression are present at the same time.
When your mood shifts to mania, you may experience a sudden abatement of depressive symptoms or suddenly feel incredibly good and energetic. But there will be clear changes in mood, energy, and activity levels.
Even in the case of rapid cycling or mixed episodes, a bipolar diagnosis requires someone to experience:
- a week for mania (less if hospitalized)
- four days for an episode of hypomania
- a distinct intervening episode of depression that lasts for two weeks
Your mental healthcare may also send you home with a journal and ask you to write about your moods so they can look for patterns.
There are four types of bipolar disorder and the criteria for each is slightly different. Your psychiatrist, therapist, or psychologist will help you identify which type you have based on their exams.
|Type||Manic episodes||Depressive episodes|
|Bipolar I||last for at least seven days at a time or are so severe you need immediate medical attention||last at least two weeks and may be interrupted by mania|
|Bipolar II||are less extreme than bipolar I disorder (hypomania)||are often severe and alternate with hypomania|
|Cyclothymic||happen often and fit under hypomanic, alternating with depressive periods||alternate with periods of hypomania for at least two years in adults and one year in children and teenagers|
Other specified and unspecified bipolar and related disorders is another type of bipolar disorder. You can have this type if your symptoms don’t meet the three types listed above.
The best way to manage bipolar disorder and its symptoms is long-term treatment. Doctors usually prescribe a mixture of medication, psychotherapy, and at-home therapies.
Some medications can help with stabilizing moods. It’s important to report back often to your doctors if you experience any side effects or don’t see any stabilization in your moods. Some commonly prescribed medications include:
- mood stabilizers such as lithium (Lithobid), valproic acid (Depakene), or lamaotrigine (Lamictal)
- antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and aripiprazole (Abilify)
- antidepressants (Valium, Paxil)
- antidepressant-antipsychotics such as Symbyax, a combination of fluoxetine and olanzapine
- anti-anxiety medications such as benzodiazepines
Other medical interventions
When medication doesn’t work, your mental healthcare professional may recommend:
- electroconvulsive therapy (ECT): electrical currents are passed through the brain to help relieve depression
- transcranial magnetic stimulation (TMS): regulates mood for people who aren’t responding to antidepressants
Psychotherapy is also a key part of treating bipolar disorder. This can be in an individual, family, or group setting. Some psychotherapies that may be helpful include:
- cognitive behavior therapy to help identify triggers of your bipolar disorder, replace negative thoughts and behaviors with positive ones, learn how to cope, and better manage stress
- psychoeducation to learn more about bipolar disorder so you can make better decisions about your care and treatment
- interpersonal and social rhythm therapy (IPSRT) to help you create a consistent daily routine for sleep, diet, and exercise
- talk therapy to express your feelings and discuss your issues face to face
Some lifestyle changes can lessen the intensity of moods and frequency of cycling.
- abstaining from alcohol and illegal drugs
- avoiding unhealthy relationships
- getting at least 30 minutes of exercise a day
- getting at least seven to nine hours of sleep per night
- eating a healthy, balanced diet rich in fruits and vegetables
Talk to your doctor if your medication and therapies don’t relieve your symptoms. In some cases, antidepressants can make your bipolar symptoms worse. There are always alternative medications and therapies to help manage your condition.