Treatment can be lifesaving for this complicated mental illness.
Bipolar disorder is more than just, say, intense mood swings; this mental health disorder can take a dramatic toll on patients’ lives, affecting their ability to succeed at work, maintain healthy relationships, and take care of responsibilities like managing finances. It may also be more common than you think: Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population, according to the National Institute of Mental Health.
Unfortunately, bipolar disorder is often poorly understood and surrounded by misconceptions about what symptoms actually look like or why it’s critical to receive a proper diagnosis and treatment. Here, mental health experts shed light on key facts about bipolar disorder that all patients (and those who love or help care for them) should know.
Bipolar disorder has two main types.
Bipolar I consists of depression alternating with true manic episodes, which include psychotic symptoms. Psychosis is a break from reality when you see, hear, or believe things that aren’t really there.
Bipolar II involves depression alternating with hypomania, which is a milder form of mania that does not include psychosis. Hypomania consists of an elevated mood, which can present as either euphoric or irritable.
Occasionally, patients with bipolar disorder may experience a mixed state, which is depression and hypomania at the same time. Another lesser-known state is cyclothymia, according to Gail Saltz, MD, a psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. This is an up-and-down fluctuation between mild depression and mild hypomania, without ever becoming severely manic or depressed.
Most people are familiar with depression symptoms, but mania might be a little harder to recognize. Mania isn’t just a prolonged good mood or burst of energy. When someone with bipolar disorder is experiencing mania, the following symptoms may occur, according to Ben Michaelis, PhD, a psychologist in New York City.
Decreased need for sleep
Experiencing racing thoughts
Being more talkative than usual
Engaging in risky activities, which can range from substance abuse to excess spending
Many people with bipolar disorder experience mania seldomly. Many patients may look and feel depressed most of the time and may not seem bipolar. In fact, you only need to have experienced one manic episode in your life to be diagnosed with bipolar disorder, says Susan Samuels, MD, a psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
Depression symptoms include:
Feeling sad most of the day, every day
Feeling hopeless or worthless
Inability to concentrate
Loss of enjoyment in things you used to like
Treatment for Bipolar Disorder
Typically, doctors treat bipolar disorder using mood stabilizers, according to Dr. Samuels. These neutralize and stabilize the high and low moods. Additional medication may also help treat specific symptoms of bipolar disorder.
In addition to taking medication, patients with bipolar disorder also benefit from psychotherapy. “Bipolar disorder—untreated—is dangerous,” says Dr. Saltz. “It really can wreak havoc with your life, marriages split up, jobs are lost.” Together, medication and psychotherapy can help patients avoid the consequences of risky behaviors and poor decision making.
Seeking and following treatment for bipolar disorder is crucial. Ignoring a mental health issue can make symptoms more severe or harder to manage. Getting the right diagnosis is also key, as bipolar disorder can be mistaken (and mistreated) for other mental health issues like depression. Suicide rates are high among patients with bipolar disorder (as many as one in five patients with bipolar disorder completes suicide), so getting treatment could even save your life.
“This is a deadly illness if left untreated,” says Dr. Saltz. “This is an illness that must be treated.”
Dr. Saltz is a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medicine and a psychoanalyst with the New York Psychoanalytic Institute.Ben Michaelis
Dr. Michaelis is a clinical and media psychologist in New York City.Susan Samuels
Dr. Samuels is an assistant professor of clinical psychiatry and clinical pediatrics at Weill Cornell Medicine and an assistant attending psychiatrist at NewYork-Presbyterian Hospital.
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Bipolar disorder fits in
the class of mood disorders.
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It means that you have
episodes of depression, but
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I'm talking about real depression,
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And you alternate those with episodes
of either hypomania or mania,
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which means an elevated state of mood.
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So the main types really are bipolar I and
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Bipolar I means you have
true manic episodes.
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So you have, when you have mania,
you have these psychotic symptoms.
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I'm talking to God.
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The Martians are in the television.
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Something that is really a delusion.
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A break with reality where you hear
things, or see things, that is psychosis.
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Bipolar II means you have the depression
alternating with hypomania.
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You never become an actual maniac,
you never have psychotic symptoms.
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There's also a state in bipolar disorder
called mixed state, which is rarer,
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but you actually have sort of
a combination of depression and hypomania.
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So you may be extremely sad,
but at the same time,
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highly expansive and irritable.
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And there's even something called
cyclothymia, which is a state where
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you have mild depression,
alternating with mild hypomania.
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So your moods are very up and
down for periods of time.
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But you never become
severely either manic or
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A manic episode is an experience
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lasting at least one week, where a person
feels really great about themselves.
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They tend to need less sleep,
they experience racing thoughts.
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They're more talkative than usual.
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And they tend to engage in more
activities involving drugs or alcohol or
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spending or sex.
Symptoms of depression
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include being sad for most of the day,
every day, for more than two weeks.
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Feelings of hopelessness,
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Loss of concentration, anhedonia, which is
the inability to take pleasure in things
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that you formally took pleasure in.
The manic episodes did not happen
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I was way more depressed.
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It was a feeling of hopelessness and
dread and lethargy.
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And then I would have these little bleeps
where I would be really productive, and
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everything was perfect.
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And I had tons of energy.
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And I didn't sleep very well.
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like most mental health disorders,
does have a genetic component.
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But there is also clearly
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people who develop bipolar disorder
who don't have any genetic background.
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there seems to be some enviromental or
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to bipolar disorder.
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A lot of trauma, use of substances,
these kinds of things are all considered,
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but the reality is we don't know.
To qualify for the diagnosis,
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you only need to have ever had one
manic episode in your entire life.
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So it can be kind of confusing if you're
meeting somebody that presents with only
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depression in front of you.
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But they actually may have a bipolar
disorder cuz they experienced a manic
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episode 5, 10, or 15 years prior.
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Bipolar disorder is generally
treated with mood stabilizers.
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These are medications that help
work with both the highs and
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the lows of bipolar disorder,
so the mood is more neutral and
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the other important factor in treating
bipolar disorder is treating episodes.
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Hopefully, the mood stabilizer
keeps you from having episodes.
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But if you do break through and have one,
then in addition to the mood stabilizer,
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you would be on a medication to
treat that particular symptom.
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In addition, psychotherapy is often
helpful for people with bipolar disorder.
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Bipolar disorder, untreated, is dangerous.
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It really can wreak havoc with your life.
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Marriages split up.
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Jobs are lost.
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In major depression, there is
a 15% mortality rate from suicide.
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There is also a high mortality rate
from suicide in a mixed state and
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in a manic state.
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So this is a deadly
illness if left untreated.
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This is an illness that must be treated.
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If you ever feel like you might want
to harm yourself or somebody else,
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please call 911 immediately or
proceed to your nearest emergency room.
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It's also good to have on hand
the National Suicide Prevention Lifeline
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which is 1-800-273-8255.
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