Everyone experiences mood changes at some point in their lives. Often these are in response to changes in your life. Hearing bad news can make you sad or angry. A fun vacation brings about feelings of happiness.
For most people, such emotional highs and lows are temporary and are appropriate to the situation. For people with bipolar disorder, however, dramatic shifts in mood can last for long periods and can emerge at any time.
What Are Bipolar Disorder Episodes?
Bipolar disorder symptoms can occur as manic, hypomanic, or depressive episodes.
A manic episode is a period of extreme happiness, overly outgoing behavior, or extreme irritability combined with increased energy. These episodes last for one or more weeks and may result in hospitalization. Someone in a manic episode may also:
- talk very quickly, loudly, or interrupt others
- be frequently distracted and unable to focus on one task or thought at a time
- require less sleep than they usually do
- go on spending sprees or engage in risky sexual behavior
- have an unusually high self-esteem
Moods can shift rapidly from happiness to anger, sadness, or irritability during a manic episode. The symptoms are severe enough to cause problems at work or in one’s personal life. A person experiencing a manic episode may not know they are ill and may not want to seek treatment.
A hypomanic episode has similar symptoms to a manic episode, but lasts only four days or less. It does not cause as severe problems in one's work or personal life.
A major depressive episode includes multiple features of depression that interfere with work or relationships. It lasts for at least two weeks. A person in a depressive episode may feel sad or hopeless. They may withdraw from social situations. They may also lose interest in people and activities they usually enjoy. Features of a depressive episode include:
- trouble concentrating
- feelings of fatigue
- changes in eating or sleeping patterns
- thoughts of death and suicide
Some episodes can include symptoms of manic and depressive episodes. This phenomenon is called a mixed state, or a mood episode with mixed features.
Episodes may be sporadic. You may not experience any symptoms between episodes. For some people with bipolar disorder, manic and depressive episodes may be frequent and interfere with work and relationships. Without treatment, bipolar disorder symptoms often worsen over time.
Bipolar disorder is a lifetime condition. It can be managed with a combination of medications, therapy, and a healthy lifestyle.
How Is Bipolar Disorder Diagnosed?
Your mood changes and behaviors need to be significantly different than your typical moods and behaviors to receive a diagnosis of bipolar disorder. Not all episodes, like a hypomanic episode, will cause problems in your social or work life.
There are six types of bipolar disorder. They differ based on the type and intensity of the mood episodes.
- Bipolar I disorder: Manic episodes with mixed features that last at least a week or, if shorter, are so serious that you need to be hospitalized for your safety and the safety of those around you. Bipolar I disorder may also include depressive episodes of at least two weeks in duration.
- Bipolar II disorder: At least one hypomanic episode and one major depressive episode with no serious manic or mixed episodes.
- Bipolar disorder not otherwise specified: Manic and depressive symptoms are present, but are not too much beyond a person’s usual range of emotions and behaviors. People that have some, but not all, features of bipolar disorder and are given a diagnosis of bipolar disorder not otherwise specified.
- Cyclothymic disorder: Numerous episodes of mild hypomania and mild depression that appear for at least two years. In cyclothymic disorder, symptoms don’t rise to the level of full-blown hypomania or major depression.
- Bipolar disorder due to a substance or medication: Symptoms of bipolar disorder that occur after exposure to a substance or medication. For example, exposure to recreational drugs like cocaine or phencyclidine (PCP), or to medications such as prednisone, can cause symptoms of a manic episode.
- Bipolar disorder due to a medical condition: Symptoms of bipolar disorder that occur due to a medical condition.
There’s also a very serious version of bipolar disorder called rapid-cycling bipolar disorder. It’s defined as having at least four episodes of mania, hypomania, or major depression within 12 months. Women may be more likely to have rapid-cycling bipolar disorder. It’s also more common among people whose first episode occurred when they were young.
Another serious version of bipolar disorder is bipolar disorder with psychotic features. During a mood episode, a person can experience hallucinations or have delusional beliefs. An example of a hallucination is hearing someone talk to you that isn't there. An example of a delusional belief is thinking you have special powers.
Bipolar disorder can present in many different ways. The severity of the symptoms can also vary greatly. Some people have very mild symptoms. For these people, treatment can significantly limit the impact bipolar disorder has on their lives. Other people have more severe symptoms. Even with treatment, bipolar disorder can have a significant impact on these people’s lives.
Tips for Prevention
One of the most important steps in dealing with bipolar disorder is to become educated on the condition. To learn more about bipolar disorder:
- read articles about it
- keep up with the latest in medications and treatments
- talk with experts
- get regular psychotherapy
- join a support group
It’s also important to learn as much as you can about your specific type of bipolar disorder. The more knowledgeable you are, the more confident you’ll feel about living with bipolar disorder and not letting it control your life.
Pay attention to the things that trigger episodes. Identifying signs that an episode is coming on can also help. Include the people close to you in this process. They can offer support and alert you to possible triggers or behavior changes that indicate an episode is starting. When you can recognize that an episode is developing, you can aggressively intervene with strategies learned in therapy sessions.
You should also try to follow a healthy lifestyle that includes:
- sufficient sleep (at least seven hours a night)
- daily exercise
- balanced diet
- no alcohol or drugs
- stress-relief activities such as yoga, meditation, and tai chi
Even brief periods of meditation may sometimes help prevent a manic or depressive episode from getting more severe.
You’ll be able to better handle bipolar disorder if you’re actively engaged in your treatment. Treatment usually involves psychotherapy, medication, and self-management. Self-management means you actively try to avoid triggers and control the behaviors that are within your ability to manage.
Several types of psychotherapies can help symptoms, prevent new mood episodes, and improve functioning. These include:
- family-focused therapy
- cognitive behavioral therapy (CBT)
- interpersonal and social rhythm therapy
Cognitive Behavioral Therapy (CBT)
Doctors are increasingly turning to CBT for the treatment of bipolar disorder. CBT helps people identify the causes of negative thoughts and feelings. After identifying these causes, a person is given tools to change how they think and react to those negative or stressful situations. CBT may help prevent bipolar depressive episodes, though it has shown less success in the prevention of manic episodes.
There are also several types of medications your doctor may prescribe. These may include:
- mood stabilizers
- antipsychotic medications
- antidepressant medications
The use of antidepressants for the treatment of bipolar disorder is controversial. That’s because antidepressants can sometimes trigger manic episodes.
Not everyone reacts the same to medication. A medication that works for someone you know may not work for you. It may also cause unwanted side effects. Be prepared to try a few different medications to find the safest and most effective ones for you.
Even with treatment and support, episodes can sometimes become quite serious and require hospitalization. If you feel you’re losing control, or you’re concerned about someone who has bipolar disorder, don’t hesitate to call 911 and get emergency assistance.
Bipolar disorder may be difficult to identify at first. You may not even be aware that your behavior is noticeably different when an episode occurs. If you feel that you’re not as in control of your emotions or behaviors as you should be, seek out a mental health professional and explain your symptoms and concerns. Talk with your friends and relatives. Listen to their observations and concerns with an open mind.
Bipolar disorder can worsen without treatment. It’s better to intervene as soon as you become aware of your symptoms. Even if you have a mild form of bipolar disorder, you can learn how to control symptoms so they don’t interfere with your quality of life.