Bipolar disorder is characterized by extreme emotional highs (mania) and lows (depression). Manic episodes are “up” times, marked by high energy, little sleep and exuberant self-confidence and euphoria. Depressive episodes are marked by low energy, trouble concentrating, anxiety and often hopelessness.
We may not understand how much havoc bipolar disorder causes in the lives of affected individuals, who struggle to manage their extreme changes in mood, energy and sleep patterns. Mania can cause people to be unintentionally disruptive at work, leading to job losses and frequent job changes. High energy and overconfidence can lead to risk taking with money and relationships, resulting in financial problems and broken ties. Depressive episodes make simple day-to-day functioning difficult.
Bipolar affects equal numbers of men and women, nearly 3% of the population in the US. A third of those diagnosed with bipolar attempt suicide; untreated bipolar disorder can result in greater risk of suicide. Treating bipolar disorder presents unique challenges, but it’s worth it—appropriate treatment can save lives and improve quality of life.
Diagnosing Bipolar Disorder
Any treatment of bipolar disorder must begin with proper diagnosis, which is often difficult. Along with the symptoms above, manic episodes can manifest in irritability or agitation, talkativeness and fast speech, impulsivity and unsafe sex, and sometimes psychosis. Depressive episodes can lead to slow speech, trouble concentrating, forgetfulness, indecisiveness, sleeping or eating too much or too little, anxiety and thoughts of suicide.
An initial assessment will help rule out thyroid disease, which can mimic the moods of bipolar disorder. An inventory of medications—both prescribed and other substances—will uncover side effects to identify symptoms that may, or may not be, due to bipolar.
Overlapping symptoms with other disorders—such as depression, anxiety and OCD—can result in misdiagnosis. ADHD has symptoms in common with bipolar, which also shares symptoms with borderline personality disorder. In one study, 40% of people with borderline personality disorder were misdiagnosed with bipolar disorder. Bipolar individuals with psychosis are sometimes misdiagnosed with schizophrenia.
Bipolar disorder may also look different in children. Mania may present as extreme irritability or rage. In children, outbursts and destructiveness are more likely than the wild excitement of adults. Depression in children can show up in tummy aches, headaches, fatigue, school absences, crying, oversensitivity, and talk about running away from home (if not actually running away). Children with bipolar disorder are often diagnosed, accurately or not, with ADHD.
At least one episode of depression and one of mania must occur to confirm a diagnosis of bipolar disorder. However, practitioners must rely on patients to report all their symptoms. Hypomania—which is not as severe as mania—may not be reported because patients might view it as desirable and pleasurable.
For all these reasons, it may take years to diagnose bipolar disorder.
Treating Bipolar Disorder
Treatment for bipolar disorder involves a combination of medication and psychotherapy. Because of the nature of bipolar disorder and possible co-occurring conditions, treatment must be individualized to each person.
It takes time to find the right combination of medications to treat symptoms, which vary from person to person. All medications have side effects; some are more easily tolerated. Medications also take time to become effective. Wait-and-assess periods are part of the treatment process as medications are adjusted or changed. The goal is to relieve symptoms and limit detrimental side effects. As symptoms change, medications may need to be adjusted. The high-and-low nature of bipolar disorder and co-occurring conditions makes medication management a delicate balancing act—for example, antidepressants can trigger mania, as can the stimulants used to treat ADHD.
Psychotherapy is an essential part of treating bipolar. Children may receive only psychotherapy before providers consider medication. Therapies like cognitive behavioral therapy and family therapy help teach bipolar individuals about their disorder, how to recognize dangerous thought patterns, and coping skills like stress management.
Up to 75% of people with bipolar disorder have co-occurring conditions like anxiety and impulse control. Children often have co-occurring conditions like ADHD, learning disabilities or PTSD. Co-occurring conditions require another layer of individualization to treat all the issues involved. Up to 50% of bipolar individuals will develop a substance use disorder at some point in their lives. Substance use is particularly dangerous for those with bipolar disorder. Untreated, it makes the disorder harder to manage.
Bipolar disorder has a high rate of relapse—over 70%. Environmental stressors can trigger relapse and aggravate symptoms of mania and depression. Stressful transitions or events like trauma, hospitalization, death of a loved one, or disruptions to sleep can be danger zones for bipolar individuals.
The Need for Ongoing Treatment
Treatment for bipolar disorder must be individualized to each person. To remain effective, treatment should be monitored and adjusted to respond to changes in symptoms or needs. Patience—for both bipolar individuals and providers—is key.
Bipolar is a chronic, lifelong disorder. Untreated, it usually gets worse, which can result in more frequent hospitalizations and risk to life. The earlier bipolar disorder is identified and treated, the better. Family involvement and self-education, along with developing a healthy lifestyle, can complement medications and therapy.
At Best Day, our counselors are trained to diagnose and treat bipolar disorder. Please reach out if you think you or a loved one needs help. We will work with you to determine appropriate treatment to manage bipolar disorder and help enable a full, satisfying life.
How We Can Help You?
Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:
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