Bipolar Disorder

Symptoms

The manic phase may last from days to months. It may include these symptoms:

• Easily distracted
• Excess involvement in activities
• Little need for sleep
• Poor judgment
• Poor temper control
• Reckless behavior and lack of self-control, such as drinking, drug use, sex with many partners, gambling and spending sprees
• Very irritable mood, racing thoughts, talking a lot, and false beliefs about self or abilities

The depressive episode may include these symptoms:

• Daily low mood or sadness
• Problems concentrating, remembering, or making decisions
• Eating problems such as loss of appetite and weight loss, or overeating and weight gain
• Fatigue or lack of energy
• Feelings of worthlessness, hopelessness, or guilt
• Loss of pleasure in activities once enjoyed
• Loss of self-esteem
• Thoughts of death or suicide
• Trouble getting to sleep or sleeping too much
• Pulling away from friends or activities that were once enjoyed

People with bipolar disorder are at high risk of suicide. They may use alcohol or other substances. This can make the symptoms and suicide risk worse.

Episodes of depression are more common than episodes of mania. The pattern is not the same in all people with bipolar disorder:

• Depression and mania symptoms may occur together. This is called a mixed state.
• Symptoms may also occur right after each other. This is called rapid cycling.

Exams and Tests

To diagnose bipolar disorder, the provider may do some or all of the following:

• Ask whether other family members have bipolar disorder
• Ask about your recent mood swings and for how long you have had them
• Perform a thorough exam and order lab tests to look for other illnesses that may be causing symptoms that resemble bipolar disorder
• Talk to family members about your symptoms and overall health
• Ask about any health problems you have and any medicines you take
• Watch your behavior and mood

Treatment

The main goal of treatment is to:

• Make the episodes less frequent and severe
• Help you function well and enjoy your life at home and at work
• Prevent self-injury and suicide

MEDICINES

Medicines are a key part of treating bipolar disorder. Most often, the first medicines used are called mood stabilizers. They help you avoid mood swings and extreme changes in activity and energy levels.

With medicines, you may begin to feel better. For some, symptoms of mania may feel good. Or side effects from the medicines may occur. As a result, you may be tempted to stop taking your medicine or change the way you are taking them. But stopping your medicines or taking them in the wrong way can cause symptoms to come back or become much worse. DO NOT stop taking or change the dosages of your medicines. Talk with your provider first, if you have questions about your medicines.

Ask family members or friends to help you take medicines the right way. This means taking the right dose at the right time. They can also help make sure that episodes of mania and depression are treated as soon as possible.

If mood stabilizers do not help, your provider may suggest other medicines, such as antipsychotics or antidepressants.

You will need regular visits with a psychiatrist to talk about your medicines and their possible side effects. Blood tests are often needed too.

OTHER TREATMENTS

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase if it does not respond to medicine.

People who are in the middle of a severe manic or depressive episode may need to stay in a hospital until they are stable and their behavior is under control.

SUPPORT PROGRAMS AND TALK THERAPY

Joining a support group may help you and your loved ones. Involving family members and caregivers in your treatment may help reduce the chance of symptoms returning.

Important skills you may learn at such programs include how to:

• Cope with symptoms that continue even while you are taking medicines
• Get enough sleep and stay away from recreational drugs
• Take medicines correctly and manage side effects
• Watch for the return of symptoms, and know what to do when they return
• Find out what triggers the episodes and avoid these triggers

Talk therapy with a mental health provider may be helpful for people with bipolar disorder.

Outlook (Prognosis)

Periods of depression or mania return in most people, even with treatment. People may also have issues with alcohol or drug use. They may also have problems with relationships, school, work, and finances.

Suicide is a very real risk during both mania and depression. People with bipolar disorder who think or talk about suicide need emergency attention right away.

When to Contact a Medical Professional

Seek help right way if you:

• Have symptoms of mania
• Feel the urge to hurt yourself or others
• Feel hopeless, scared, or overwhelmed
• See things that are not really there
• Feel you cannot leave the house
• Are not able to care for yourself

Call the treating provider if:

• Symptoms are getting worse
• You have side effects from medicines
• You are not taking medicine the right way

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Ketter TA, Miller S, Goldberg JF. Acute and maintenance treatment of bipolar and related disorders. In: Gabbard GO, ed. Gabbard's Treatments of Psychiatric Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2014:chap 13.

Perlis RH, Ostacher MJ. Bipolar disorder. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2016:chap 30.