Bipolar Disorder Diagnosis and Treatment

Bipolar disorder (also referred to as manic depression) is a brain disorder characterized by unusual shifts in mood, energy, and activity levels, ranging from extremely “up” to extremely “down.” Some people who have bipolar disorder may experience depression primarily or almost exclusively, whereas others are more prone to mania, and some alternate between mania and depression. These shifts in mood and energy are beyond those considered normal and are typically episodic—occurring occasionally, at irregular intervals, and lasting for more than just a few hours or days.

Mood episodes required for a diagnosis of bipolar disorder must meet the following diagnostic criteria:

  • Major depressive episode: Five or more of the following symptoms must be present for at least two weeks straight:
    • Depressed mood
    • Significantly diminished interest in activities considered pleasurable
    • Notable increase or decrease in appetite or weight (five percent or more) in a span of 30 days that isn’t attributable to planned changes in diet or exercise
    • Sleeping too much or too little nearly every day
    • Daily fatigue
    • Feelings of worthlessness or excessive guilt nearly every day
    • Obvious and uncharacteristic inability to think clearly, concentrate, or make decisions
    • Recurrent thoughts of death or suicide
  • Manic episode: Three or more of the following symptoms must be present and last for at least one week to qualify as a manic episode. In addition, symptoms must be severe enough to impair the person’s ability to work or socialize; require hospitalization; or cause psychosis (paranoia, hallucinations, or delusions):
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • Pressured speech (need to talk continuously)
    • Flight of ideas (racing thoughts)
    • Inability to concentrate or being easily distracted
    • Significant increase in goal-directed or aimless activity
    • Excessive involvement in risky or potentially self-destructive activity
  • Hypomanic episode: A hypomanic episode requires the same symptoms as a manic episode with the following differences:
    • The episode may last as little as four consecutive days
    • The episode doesn’t cause severe impairment or require hospitalization
    • The episode doesn’t include psychosis

Types of Bipolar Disorder

There are several bipolar disorder subtypes, which vary based on the symptoms and triggers. The two primary categories are bipolar disorder I and II:

  • Bipolar disorder I requires at least one manic episode over the course of one’s life. It typically includes alternating episodes of mania, hypomania, and depression, but some people who have bipolar disorder I report experiencing very little, if any, depression.
  • Bipolar disorder II requires one or more major depressive episodes with at least one hypomanic episode over the course of one’s life. If a person with bipolar disorder II experiences a manic episode, the diagnosis changes to bipolar disorder I.

Other forms of bipolar disorder include the following:

  • Cyclothymic disorder: Multiple episodes of hypomania and depressive symptoms that do not rise to the level of a major depressive or manic episode and that last for at least two years without a period of more than two months of stable mood.
  • Substance/medication-induced bipolar disorder: Manic or major depressive episodes that occur only in the context of medication or drug use (or withdrawal) and that do not occur when the medication or other substance is no longer in use.
  • Bipolar and related disorder due to another medical condition: If the depression, hypomania, or mania can be attributed to another medical condition, such as a thyroid condition, this diagnosis may be most appropriate.
  • Other specified bipolar and related disorder: This diagnosis may be appropriate if a person’s symptoms do not quite fulfill the diagnostic criteria for bipolar disorder but still cause significant clinical distress and functional impairment.

Bipolar Disorder Treatment

Many people who have bipolar disorder respond well to treatment and live very successful and enjoyable lives. Effective treatment typically requires a combination of medication, psychotherapy, and self-help:

  • Medication: Several medications may be helpful in controlling bipolar symptoms or preventing mood episodes:
    • Lithium: Lithium is the gold standard in treating bipolar disorder because it is often effective at controlling both “poles”—mania and depression.
    • Anti-seizure medications: These include carbamazepine, divalproex sodium (Depakote), and lamotrigine (Lamictal). Anti-seizure medications are often useful in treating mania but are usually ineffective at preventing depression.
    • Atypical antipsychotics: Antipsychotics are often useful in treating acute manic episodes and depression that does not respond well to antidepressants.
    • Antidepressants: Various classes of antidepressants are useful for combatting depression. Unfortunately, many of them carry the risk of triggering mania in people with bipolar disorder, so they are commonly used in tandem with lithium, an anti-seizure medication, or an antipsychotic.
    • Sleep aids: Because bipolar disorder is often accompanied by and exacerbated by sleep problems, medications are often used to help a patient fall asleep or sleep through the night.
  • Psychotherapy: Certain types of psychotherapy (talk therapy) can be very helpful in preventing episodes of mania, hypomania, and depression, including the following:
    • Behavioral therapy: Changing behaviors to reduce stress.
    • Cognitive therapy: Identifying and modifying the patterns of thinking that give rise to shifts in mood.
    • Interpersonal therapy: Working on relationships to reduce the burden that bipolar disorder places on them and to reduce the emotional stressors and triggers that may be present in unhealthy relationships.
    • Social rhythm therapy: Developing and maintaining healthy, predictable routines, especially in terms of maintaining a normal sleep schedule.
  • Self-help: Self-help strategies and techniques for managing bipolar disorder include the following:
    • Monitoring mood: Keeping a journal or calendar to track mood and sleep patterns can provide early warning signs of an impending episode and enable early intervention to short-circuit a mood shift.
    • Diet and exercise: Healthy diet and physical activity can do wonders to regulate mood.
    • Identifying and avoiding stressors and triggers: Positive or negative “stress” can both trigger mood episodes, so identifying and avoiding one’s stressors or triggers can help to prevent serious shifts in mood. Stressors and triggers include situations, people, and substances (such as alcohol).
    • Forming and maintaining healthy relationships: Healthy, supportive relationships are crucial for maintaining mood stability.
    • Engaging in mindfulness or other centering activities: Centering activities include mindfulness, yoga, tai chi, meditation, and controlled breathing—any activity that calms the mind and body.
    • Participating in support groups: Support groups, such as those sponsored by the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) provide the means to find support and exchange information among peers.