Everything You Need to Know About Bipolar Disorder | Neurology

Bipolar disorder

What is bipolar disorder (manic depression)?

Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. It is also known as bipolar disease or manic depression.

People with this disease may have trouble managing everyday life tasks at school or work, or maintaining relationships. There’s no cure, but there are many treatment options available that can help to manage the symptoms.

Facts about bipolar disorder

Bipolar disorder isn’t a rare brain disorder. In fact, 2.8 per cent of U.S. adults or about 5 million people have been diagnosed with it. The average age when people with the bipolar disorder begin to show symptoms is 25 years old.

Depression caused by bipolar disorder lasts at least two weeks. A high (manic) episode can last for several days or weeks. Some people will experience episodes of mood changes several times a year, while others may experience them only rarely.

Symptoms of bipolar disorder

Three main symptoms can occur with bipolar disorder: mania, hypomania, and depression.

While experiencing mania, a person with bipolar disorder may feel an emotional high. They can feel excited, impulsive, euphoric, and full of energy. During manic episodes, they may also engage in behaviour such as:

  • Spending sprees
  • Unprotected sex
  • Drug use

Hypomania is generally associated with bipolar II disorder. It’s similar to mania, but it’s not as severe. Unlike mania, hypomania may not result in any trouble at work, school, or in social relationships. However, people with hypomania still notice changes in their mood.

During an episode of depression you may experience:

  • Deep sadness
  • Hopelessness
  • Loss of energy
  • Lack of interest in activities they once enjoyed
  • Periods of too little or too much sleep
  • Suicidal thoughts

Although it’s not a rare condition, bipolar disorder can be hard to diagnose because of its varied symptoms.

Symptoms of bipolar disorder in women

An equal number of men and women suffer from bipolar disorder. However, the main symptoms of the disorder vary between the two sexes. In many cases, a woman with bipolar disorder may:

  • She will be diagnosed in her 20s or 30s, later in life.
  • There are mild episodes of mania.
  • You will experience more depressing episodes than manic episodes.
  • Four or more episodes a year involve mania and depression, known as fast cycles.
  • You may experience other conditions simultaneously such as thyroid disease, oesophagus, anxiety disorders, and migraines.
  • Alcohol use increases the lifelong risk of the disorder

Women with bipolar disorder may also relapse more often. This is believed to be caused by hormonal changes related to menstruation, pregnancy, or menopause. If you’re a woman and think you may have bipolar disorder, you need to get the facts.

Symptoms of bipolar disorder in men

Men and women both experience common symptoms of bipolar disorder. However, men may experience symptoms differently than women. Men with bipolar disorder may:

  • Be diagnosed earlier in life
  • Experience more severe episodes, especially manic episodes
  • Have substance abuse issues
  • Act out during manic episodes

Men with bipolar disorder are less likely than women to seek medical care on their own. They’re also more likely to die by suicide.

Types of bipolar disorder

There are 3 main types: bipolar I, bipolar II, and cyclothymia.

Bipolar I

It is defined by the appearance of at least one manic episode. You may experience major depression or hypomanic episodes before and after the manic episode. This type of bipolar affects men and women equally.

Bipolar II

People with this type of disorder experience a major depressive episode lasting at least two weeks. They also have a hypomanic episode that lasts at least four days. It is more common in women.


People with cyclothymia have episodes of hypomania and depression. These symptoms are shorter and less severe than the mania and depression caused by bipolar I or bipolar II disorder. Most people with this condition only experience a month or two at a time where their moods are stable.

When discussing your diagnosis, your doctor will be able to tell you what kind of bipolar disorder you have.

Bipolar disorder in children

Diagnosing bipolar disorder in children is controversial. This is large because children don’t always display the same bipolar disorder symptoms as adults. Their moods and behaviours may also not follow the standards doctors use to diagnose the disorder in adults.

Many bipolar disorder symptoms that occur in children also overlap with symptoms from a range of other disorders that can occur in children, such as attention deficit hyperactivity disorder (ADHD).

However, in the last few decades, doctors and mental health professionals have come to recognize the condition in children. A diagnosis can help children get treatment, but reaching a diagnosis may take many weeks or months. Your child may need to seek special care from a professional trained to treat children with mental health issues.

Like adults, children with bipolar disorder experience episodes of elevated mood. They can appear very happy and show signs of excitable behaviour. These periods are then followed by depression. While all children experience mood changes, changes caused by bipolar disorder are very pronounced. They’re also usually more extreme than a child’s typical change in mood.

Manic symptoms in children

Symptoms of a child’s manic episode caused by bipolar disorder can include:

  • Acting very silly and feeling overly happy
  • Talking fast and rapidly changing subjects
  • Having trouble focusing or concentrating
  • Doing risky things or experimenting with risky behaviours
  • Having a very short temper that leads quickly to outbursts of anger
  • Having trouble sleeping and not feeling tired after sleep loss

Other possible diagnoses

Some of the behaviour issues you may witness in your child could be the result of another condition. ADHD and other behaviour disorders can occur in children with bipolar disorder. Work with your child’s doctor to document your child’s unusual behaviours, which will help lead to a diagnosis.

Finding the correct diagnosis can help your child’s doctor determine treatments that can help your child live a healthy life.

Bipolar disorder and depression

Bipolar disorder can have two extremes: up and down. To be diagnosed with bipolar, you must experience a period of mania or hypomania. People generally feel “up” in this phase of the disorder. When you’re experiencing an “up” change in mood, you may feel highly energized and be easily excitable.

Some people with bipolar disorder will also experience a major depressive episode or a “down” mood. When you’re experiencing a “down” change in mood, you may feel lethargic, unmotivated, and sad. However, not all people with bipolar disorder who have this symptom feel “down” enough to be labeled depressed. For instance, for some people, once their mania is treated, a normal mood may feel like depression because they enjoyed the “high” caused by the manic episode.

While bipolar disorder can cause you to feel depressed, it’s not the same as the condition called depression. It can cause highs and lows, but depression causes moods and emotions that are always “down.”


Bipolar disorder is a common mental health disorder, but it’s a bit of a mystery to doctors and researchers. It’s not yet clear what causes some people to develop the condition and not others.

Possible causes may include:


If your parent or sibling has this disease, you’re more likely than other people to develop the condition (see below). However, it’s important to keep in mind that most people who have bipolar disorder in their family history don’t develop it.

Your brain

The structure of your brain affects your risk of disease. Abnormalities in the structure or function of your brain increase your risk.

Environmental factors

Not only is it present in your body, but it can also cause the disorder. External factors also contribute. These factors include:

  • Severe stress
  • Traumatic experiences
  • Physical illness

These factors can affect who develops which bipolar disorder. However, a combination of factors contributes to the development of the disease.

Is bipolar disorder hereditary?

This can be passed from parent to child. Research has identified a strong genetic link in people with the disorder. If you have a relative with the disorder, your chances of also developing it are four to six times higher than people without a family history of the condition.

However, this doesn’t mean that everyone with relatives who have the disorder will develop it. Also, not everyone with bipolar disorder has a family history of the disease.

Still, genetics seem to play a considerable role in the incidence of manic depression.

Diagnosis of bipolar disorder

A diagnosis of bipolar disorder I involve either one or more manic episodes, or mixed (manic and depressive) episodes. It may also include a major depressive episode, but it may not. A diagnosis of bipolar II involves one or more major depressive episodes and at least one episode of hypomania.

To be diagnosed with a manic episode, you must experience symptoms that last for at least one week or that cause you to be hospitalized. You must experience symptoms almost all day every day during this time. Major depressive episodes, on the other hand, must last for at least two weeks.

This can be difficult to diagnose because mood swings can vary. It’s even harder to diagnose in children and adolescents. This age group often has greater changes in mood, behaviour, and energy levels.

It often gets worse if it’s left untreated. Episodes may happen more often or become more extreme. But if you receive treatment for your disease, you can lead a healthy and productive life. Therefore, diagnosis is very important.

Bipolar disorder symptoms test

One test result doesn’t make a bipolar disorder diagnosis. Instead, your doctor will use several tests and exams. These may include:

  • Physical exam. Your doctor will do a full physical exam. They may also order blood or urine tests to rule out other possible causes of your symptoms.
  • Mental health evaluation. Your doctor may refer you to a mental health professional such as a psychologist or psychiatrist. These doctors diagnose and treat mental health conditions. During the visit, they will evaluate your mental health and look for signs of bipolar disorder.
  • Mood journal. If your doctor suspects your behaviour changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. The easiest way to do this is to keep a journal of how you’re feeling and how long these feelings last. Your doctor may also suggest that you record your sleeping and eating patterns.
  • Diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an outline of symptoms for various mental health disorders. Doctors can follow this list to confirm a bipolar diagnosis.


There are several treatments available that can help you manage your disorder. These include medications, counselling, and lifestyle changes. Some natural remedies can also help.


Recommended medications may include:

  • Mood stabilizers, such as lithium (Lithobid)
  • Antipsychotics, such as olanzapine (Zyprexa)
  • Antidepressant-antipsychotics, such as fluoxetine-olanzapine (symbyax)
  • Benzodiazepines, a type of anti-anxiety medication such as alprazolam (Xanax) that may be used for short-term treatment


Recommended psychotherapy treatments may include:

Cognitive behaviour therapy

Cognitive-behavioural therapy is a form of psychotherapy. You and the therapist will talk about ways to manage your disorder. They help you understand your way of thinking. They can help you come up with positive coping strategies.


Psychoeducation is a form of counselling that helps you and your loved ones understand the disorder.

Interpersonal and social rhythm therapy

Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics can help you manage your disorder.

Other treatment options

Other treatment options may include:

  • Electroconvulsive therapy
  • Sleep medications
  • Supplements
  • Acupuncture

Changes in lifestyle

  • Maintain a routine for eating and sleeping
  • Learn to spot mood swings
  • Ask a friend or family member to support your treatment plans.
  • Talk to a doctor or licensed healthcare provider

Other lifestyle changes can also help eliminate depressive symptoms.

Natural remedies for bipolar disorder

Some natural remedies may be helpful. However, it’s important not to use these remedies without first talking with your doctor. These treatments could interfere with medications you’re taking.

The following herbs and supplements may help stabilize your mood and relieve the symptoms:

  • Fish oil. A 2013 study shows that people who consume a lot of fish and fish oil are less likely to develop bipolar disease. You can eat more fish to get the oil naturally, or you can take an over-the-counter (OTC) supplement.
  • Rhodiola Rosea. This research also shows that this plant may be a helpful treatment for moderate depression. It may help treat depressive symptoms.
  • S-adenosylmethionine (SAMe). SAMe is an amino acid supplement. The research shows it can ease symptoms of major depression and other mood disorders.

Several other minerals and vitamins may also reduce symptoms.

Bipolar disorder and relationships

When it comes to managing a relationship while you live with this disease, honesty is the best policy. This can have an impact on any relationship in your life, perhaps especially in a romantic relationship. So, it’s important to be open about your condition.

There’s no right or wrong time to tell someone you have bipolar disorder. Be open and honest as soon as you’re ready. Consider sharing these facts to help your partner better understand the condition:

  • When you were diagnosed
  • What to expect during your depressive phases
  • What to expect during your manic phases
  • How you typically treat your moods
  • How they can be helpful to you

One of the best ways to support and make a relationship successful is to stick with your treatment. Treatment helps you reduce symptoms and scale back the severity of your mood changes. With these aspects of the disorder under control, you can focus more on your relationship.

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