Bipolar disorder is a spectrum mood disorder, meaning that the intensity of the disorder varies from person to person. It is a biological illness with strong genetic components (it runs in families), and is worsened by changes in hormone levels, trauma to the nervous system (i.e., emotional shocks) and the consumption of street drugs. Psychological stress or distress can trigger a bipolar episode. Bipolar means having two opposite poles, in this case, depression on one end and mania on the other. Depending on of the severity of symptoms, a large number of sufferers receive the diagnosis of bipolar I or bipolar II. There are variations in the sequence depressive and manic symptoms manifest. Some sufferers experience mania and depression simultaneously. Others experience depression first for months, and then, suddenly, mania. That is why each person with bipolar is unique and requires treatment tailored to their presentation and situation. Someone will not be diagnosed as having bipolar disorder until manic behaviors are identified.
Common symptoms of depression include:
- Difficulty with concentration and memory
- Difficulty making decisions
- Frequent thoughts about dying
- Dwelling on past failures
- Feelings of worthlessness
- Feeling helpless and overwhelmed
- Pessimism about the future
- Loss of sex drive
- Restlessness or pacing
- Sleeping too much or insomnia
- Keeping away from people
- Frequent crying
- Trouble starting or finishing projects
Again, the intensity and duration of those symptoms vary from person to person.
Manic symptoms are of two general types: High (euphoria/excitement/elation) and agitation (anxiety/restlessness/anger/acerbic mood)
Signs of euphoria include:
- Abnormally high "Esteem" or arrogance and entitlement
- Decreased need for sleep which can lead to temporary psychosis
- Racing thoughts
- High risk behaviors
Signs of agitation include:
- Volatile behavior
- Looking anxious and unhappy
- Ill treatment of others
- Irrational thinking
With both euphoria and agitation, the person's brain no longer functions normally. There is a strong scientific evidence that part of the frontal lobe that is responsible for demonstrating a notion of right and wrong, empathy for others, and capable of insight, foresight and hindsight is greatly compromised not only during mania but also several weeks following a manic episode. The consequences of that impairment are far reaching. During mania, whether euphoric or agitated, people literally lose their minds. People act as if they had taken amphetamines: they think faster, feel hyper logical (cold logic), become very goal-oriented, have a decrease need for sleep, can no longer evaluate the consequences of their behavior, and no longer listen to feedback.
Treatment and Self-Help
Many people with bipolar disorder require pharmacological treatment to function. Today, there are excellent choices of psychotropic medications. Knowledgeable and experienced in mental health medical professionals, including psychiatrists, can prescribe appropriate medications and follow- up with patients.
Several initiatives bipolar sufferers can take to reach a balance include maintaining good sleep hygiene and life routines, reducing stress, learning to recognize triggers, learning from past episodes and keeping friends. If needed, there are workbooks available that guide sufferers through a series of topics from identifying mania triggers to coping with anxiety and depression, with the purpose of learning to live well with bipolar symptoms. Each person being different, such workbooks cover both general principles and specific skill building tips depending on personal situations (see section More Information and Resources).
Sometimes the guidance of a professional therapist is recommended to help individuals prevent or manage episodes. Typical therapies are cognitive-behavioral Therapy, family therapy and/or support group therapy.
Where to go for help
Psychiatrists have received specialized training to medically treat bipolar and bipolar related disorders. However, other medical professionals such as NP and PA with a solid background in mental health can also treat.
Visits to psychologists or other types of psychotherapists can be useful for learning how to manage bipolar and other unwanted symptoms, and thriving in life in spite of the disorder.
The National Alliance for the Mentally Ill (NAMI) and their local chapters offer extensive and up-to-date information on the disorder. In addition, NAMI offers support groups for sufferers and their families.
How to help others
Friends or family members of bipolar individuals may recognize the onset of bipolar symptoms more readily than the individual themselves. Whether it be pressured speech or skipping sleep, it will be important to point out to those behaviors to the sufferer, communicate concern, and bring the person to taking positive action, hopefully. Sometimes, bipolar I patients in full-blown mania may get angrier when challenged. It will be futile and perhaps even dangerous to confront them, so opt for listening instead which will make them feel understood so they calm down.
Depression in bipolar I can be very deep and lead to suicidal behavior. A friend should not hesitate to use local and national emergency numbers, such as hotlines, emergency rooms and even 911, if the threat of suicide is present. (BYU-Idaho after crisis number is 208 496 HELP or 4357).
More information and resources
Overcoming Bipolar Disorder – Mark Bauer (workbook)
Bipolar,The Handbook of Bipolar Disorder, A Practical Guide – Jay Carter
Open.Osmosis.org. for a quick summary of the disorder and treatment.
National Institute of Mental Health
National Alliance for Mental Health
(Find your local chapter on the same page.)
Medscape Psychiatry& Mental Health https://www.medscape.com/resource/bipolardisorder