Bipolar Disorder: What It Is, Causes, Symptoms, and Treatment Methods

Bipolar disorder, formerly known as manic-depressive disorder, is a bipolar psychiatric disorder characterized by emotional highs and lows that lead to exaggerated mood swings.

Bipolar disorder, formerly known as manic-depressive disorder, is a bipolar psychiatric disorder characterized by emotional highs and lows that lead to exaggerated mood swings. Emotional episodes manifest as mania or hypomania, while the lows are experienced as depression. During the depressive phase associated with bipolar disorder, a person may feel unhappy, downcast, and hopeless, often losing interest in activities they once enjoyed. When they enter a phase of mania or hypomania (less extreme than mania), they may feel euphoric, energized, or abnormally irritable. These sharp mood swings can negatively affect the person's sleep, energy, activity, judgment, behavior, and ability to think clearly. Mood changes can occur several times a year or may appear less frequently. In most patients, some emotional symptoms continue during periods between episodes, while in others, there may be no symptoms at all. Bipolar disorder is a chronic condition that persists throughout life. However, it is possible to manage mood swings and other symptoms by adhering to a treatment plan prescribed by a doctor. Bipolar disorder is often treated with medications and psychotherapy.

What Is Bipolar Disorder?

Bipolar disorder is a mental health issue that alters a person's emotional state, concentration, ability to perform daily tasks, and energy levels. There are three defined subtypes of bipolar disorder. All three types involve unusual and significant changes in mood, energy, and activity levels. These mood changes consist of manic periods, characterized by excessively cheerful, irritable, or energetic behavior, and depressive periods, marked by feelings of sadness, apathy, or hopelessness. Milder emotional elevations are referred to as hypomanic periods. The subtypes of bipolar disorder can be listed as follows:

• Bipolar I Disorder: Bipolar I disorder is characterized by manic episodes lasting at least 7 days (most of the day, nearly every day) or severe manic symptoms that require emergency hospitalization. Typically, depressive periods lasting at least 2 weeks also occur in relation to the disorder. It is also possible to experience mixed depressive periods where depressive and manic symptoms occur simultaneously. Experiencing four or more episodes of mania or depression within a year is termed rapid cycling bipolar disorder.
• Bipolar II Disorder: Bipolar II disorder is defined by a pattern of one depressive and one hypomanic episode. The episodes are less severe than the manic episodes in Bipolar I disorder.
• Cyclothymic Disorder: Also known as cyclothymia, this subtype is characterized by recurrent hypomanic and depressive symptoms that are not intense enough to qualify as a hypomanic or depressive episode and do not last long enough.
• Other Specified and Unspecified Bipolar and Related Disorders: Sometimes, a person may experience symptoms of bipolar disorder that do not fit into the three categories listed above. In this case, the disorder is referred to as "Other Specified and Unspecified Bipolar and Related Disorders."

The diagnosis of bipolar disorder is often made in late adolescence or early adulthood. Bipolar symptoms can also occasionally be observed in children. Although the symptoms may change over time, either increasing or decreasing, they generally require lifelong treatment. Following the treatment plan prescribed by a doctor helps patients manage their symptoms and improve their quality of life.

What Causes Bipolar Disorder?

The exact cause of the disorder is not yet fully understood. However, there is a strong belief that hereditary transmission may play a significant role. Bipolar disorder is considered one of the psychiatric conditions with the strongest hereditary transmission, as more than two-thirds of individuals with bipolar disorder have at least one close biological relative with the same diagnosis. Even if a biological relative has bipolar disorder, it does not necessarily mean that you will also develop the same condition. According to research, some other factors that may contribute to the onset of the disorder include:

• Structural Changes in the Brain: Researchers have identified small differences in the size or chemical properties of certain brain structures in individuals with bipolar disorder. However, these differences cannot be observed using imaging methods such as MRI or CT scans.
• Environmental Factors Such as Stress or Trauma: Stressful life events, such as the loss of a loved one, contracting a serious illness, divorce, or financial difficulties, can trigger manic or depressive episodes. Therefore, stress and trauma may play a role in the emergence of bipolar disorder.

How Is Bipolar Disorder Diagnosed?

If your family doctor suspects the presence of bipolar disorder, they will typically refer you to a psychiatrist, a doctor trained in mental health and nervous disorders. The psychiatrist will listen to your complaints and ask detailed questions about your symptoms. With your permission, they may also speak with a close relative to gather detailed information about your symptoms. Your doctor will then conduct a physical examination and may order some tests to identify any underlying conditions that could be causing the symptoms.

Symptoms Associated with Bipolar Disorder

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Both conditions are characterized by excitement, impulsivity, and high energy; however, hypomania is associated with less severe symptoms than mania. While manic symptoms can significantly impact daily life at work or home, hypomanic symptoms typically do not cause much disruption in daily life, although they can still be bothersome. Some individuals may also experience major depressive symptoms. The symptoms vary depending on the type of disorder. The symptoms that can be seen during manic and depressive episodes of bipolar disorder are detailed below.

Symptoms of Manic or Hypomanic Episodes:

• Emotional elevation, feeling very happy, or extremely irritable or touchy
• Feeling tense and more active than usual
• Decreased need for sleep
• Rapid speech on many different topics, experiencing racing thoughts
• Feeling as though one can do many things simultaneously without tiring
• Excessive appetite for food, drink, sex, or other pleasurable activities
• Feeling unusually important, talented, or powerful

Symptoms of Depressive Episodes:

• Feeling very sad, pessimistic, or anxious
• Feeling restless and sluggish
• Problems with falling asleep or staying asleep, waking up too early, or oversleeping
• Speaking very slowly, struggling to find words, or forgetting many things
• Feeling unable to do even the simplest tasks
• A lack of interest in almost all activities
• Feeling hopeless and worthless or contemplating death or suicide

Treatment for Bipolar Disorder

There is currently no treatment option that provides complete recovery for bipolar disorder. The treatments that are available aim to control the symptoms of the disorder. The primary treatments for bipolar disorder include medication to manage symptoms and psychological counseling (psychotherapy). Participation in education and support groups can also contribute positively to treatment. Treatment is determined based on the patient’s needs and may include the following:

• Medications: Medication therapy is often initiated to prevent exaggerated mood swings in the patient. Medication is continued not only during episodes but also during asymptomatic periods. Treatment often continues for a lifetime.
• Substance Abuse Prevention: To control bipolar disorder, any issues related to alcohol and substance use in the patient must also be addressed.
• Hospitalization: Patients exhibiting dangerous behaviors, who are suicidal, or who have psychotic symptoms that disconnect them from reality may require hospitalization for treatment.
• Psychotherapy: Psychotherapy, or talk therapy, is an essential component of bipolar disorder treatment. It can be applied individually or in family or group settings.
• ECT (Electroconvulsive Therapy): Also known as electroshock therapy, ECT can be applied, particularly when symptoms are severe, there is a risk of suicide, psychotic symptoms are present, or medications appear ineffective. ECT is a short-term treatment that can be effective in about 75% of patients during severe manic or depressive episodes.

If you observe symptoms similar to bipolar disorder in yourself, you can consult a healthcare institution for a psychiatric evaluation.