Bipolar Disorder

Bipolar Disorder

Bipolar, formerly known as manic depression, is characterized by mood dysregulation resulting in one or more episodes of abnormally increased energy level, mood, and cognition, that alternate with one or more depressive episodes.

Bipolar affects approximately 2.6% of the adult population in the United States. Although bipolar symptoms can emerge at any time, the typical age of onset is between 18 and 25. Bipolar affects men and women equally. There are some factors that increase the risk of bipolar including:

Genetic factors: A family history of bipolar is one of the strongest risk factors. Most available research states that bipolar is not caused by a single gene, but rather multiple genes that act in combination with environmental factors.

Environmental factors: Bipolar is more common in high-income countries. Additionally, stress can trigger a bipolar episode. Clinically, elevated moods are defined as mania, and in milder cases, hypomania. People experiencing manic or hypomanic episodes also commonly experience depressive episodes, or mixed episodes, where aspects of both mania and depression occur at the same time. Episodes may be separated by periods of “normal” mood but, in some individuals, mania and depression may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as hallucinations and delusions and may require hospitalization to prevent harm to oneself or others.

The manic phase may last one week or more and is characterized by increased energy and an elevated or irritable mood that is present for most of the day. Diagnosis requires the presence of three or more of these symptoms:

  • Inflated ego and/or self-esteem (false beliefs in special abilities, delusions of grandeur)
  • Increase in goal-directed activity
  • Racing thoughts/flight of ideas
  • Decreased need for sleep
  • Pressured, rapid speech
  • Reckless behavior(s) such as sexual promiscuity and excessive spending
  • Increased distractibility

Symptoms of hypomanic episodes are similar, but tend to be shorter in duration, lasting four days or more. Psychotic symptoms are not present during hypomanic episodes, and the symptoms are not so severe as to require hospitalization. Hypomanic symptoms are common among all the bipolar diagnoses, but manic episodes are symptomatic solely of bipolar I.

The depressive phase of bipolar includes at least five symptoms of major depression that last for at least two weeks, including:

  • Depressed/sad mood that is present for most of the day
  • Diminished interest or pleasure in activities
  • Changes in weight and/or appetite
  • Changes in sleep (insomnia or hypersomnia)
  • Fatigue/loss of energy
  • Psychomotor agitation (restlessness or other increased motion) or depression (slowing down of movement)
  • Difficulty remembering, making decisions, and/or concentrating
  • Feelings of worthlessness or guilt
  • Recurrent thoughts of death/suicidal thoughts

While bipolar cannot be cured, it can be managed effectively. Psychotherapy can help people with bipolar by teaching them how to recognize triggers so they can understand or possibly avoid them, decrease negatively expressed emotions, and practice healthy coping skills. Finding a therapist or counselor with whom you can establish a healthy therapeutic relationship may help develop some of the following skills for managing bipolar:

  • Sleep hygiene
  • Mood journaling
  • Building positive, supportive relationships
  • Managing stress effectively
  • Relaxation techniques
  • Developing a healthy daily routine
  • Creating an emergency plan to deal with relapse

Some types of psychotherapy such as family-focused and dialectable therapies are effective in preventing relapses. Although the research clearly demonstrates that bipolar often has an organic ideology, psychotherapy has been proven to be an effective treatment. Medication is also commonly used in the treatment of bipolar.

Another myth about bipolar is that it is only caused by a chemical imbalance in the brain. While there is an organic component to it, bipolar is typically influenced by a variety of factors including environment and experience. Finally, it is a myth that people with bipolar cannot lead a normal life. Bipolar can be effectively managed with treatment, and many people with bipolar experience long periods of remission.

If you or someone you know suffers from bipolar symptoms, please contact me at 415-454-8931 or