Bipolar disorder is a brain-based mood disorder characterized by periods of high mood states, or mania, and low or depressed mood states. The differences in how the illness presents within an individual and across individuals can make it difficult to diagnose and at times treat. In fact, many people have symptoms that begin in adolescence but are not accurately diagnosed until later in life. This is unfortunate, as early identification and proper treatment are key to preventing the mood fluctuations that lead to dysfunction in all aspects of life, such as work, education and relationships. A bipolar disorder diagnosis means you’ve had at least one manic episode in your life. The three main types of moderate bipolar disorders are diagnosed based on the severity of manic symptoms during the worst episode over an individuals’ lifespan. The three main types are:
- Bipolar Type 1: defined as having severe manic symptoms that last at least one week or requires hospitalization.
- Bipolar Type 2: defined as having mild to moderate manic symptoms (hypomania) that last at least three days but are associated with mild to moderate problems in daily functioning.
- Cyclothymia: defined as having mild hypomanic symptoms for at least one (children and adolescents) or two (adults) years and mild depressive symptoms, neither of which meets full criteria for mild hypomania or major depression.
So, what are manic symptoms? Mania is a mood state associated with:
- A persistently elevated “high” or irritable mood
- Increased goal-directed activity, agitation or high energy levels
- Inflated self-esteem or grandiosity
- Decreased need for sleep and feeling rested the next day
- Very talkative and hard to interrupt
- Racing thoughts that jump from topic to topic and hard to follow
- Highly distractible and poor concentration
- Increase in risky behaviors such as alcohol and drugs use, spending a lot of money, and hypersexuality
In order to meet criteria for mania, one needs to have at least three of the above symptoms (four if irritable mood) during the same period of time. Hypomanic symptoms are similar to manic symptoms but are less severe and don’t cause major functional impairments in life. Individuals often have severe depressive episodes as well, but this is not required to make a diagnosis of bipolar disorder. The depressive episodes in those individuals with bipolar disorder tend to be long and severe and very debilitating and are usually the reason why someone will seek out mental health treatment. In addition, it is also possible for individuals to have both mania and depression at the same time and this is called a mixed episode of bipolar disorder.
Other key information that helps in the diagnosis of bipolar illness is family history. Having a member of the family having been diagnosed puts an individual at increased risk of also having the disorder. Because there are several drugs (prescribed and illicit) and medical issues that can cause manic-like symptoms, an examination of lifetime history of mood episodes in combination with a thorough medical and drug and alcohol assessment is performed prior to diagnosing bipolar disorder.
Bipolar disorder is a brain-based biological illness, thus biological therapies such as medications are the main treatment strategies. Mood stabilizers are the medications of choice and help keep the moods from fluctuating into a depression or mania. Outside of treating bipolar disorder with medications, I also ensure individuals focus on sleep, exercise and stress management. In particular, sleep is often the first sign of impending mood issues and I monitor this closely. I have found that a consistent and good night sleep helps reduce the occurrence of future mood episodes. Furthermore, exercise helps to ensure a good night sleep, relieve stress and rids the body of any excess anxiety, energy or agitation that may potentially trigger other mood episodes.
Bipolar disorder is a major mood disorder that can have significant lifelong impairments. Early evaluation and aggressive treatments that include mind-body approaches to treating the whole person can reduce and possibly eliminate future mood episodes. If you or a family member have any of the listed symptoms of bipolar then please reach out to a mental health professional for a thorough evaluation. Have questions? Please reach out to me as help really IS a phone call away.
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