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Bipolar Disorder

What is Bipolar Disorder?

Once called manic-depression, it is characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression). They can result in damaged relationships, poor job or school performance, and even suicide.


About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. Bipolar disorder is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. It is a long-term illness that requires careful management throughout the person's life.​

Signs and symptoms of manic episode:


  • Increased energy, activity, and restlessness

  • Excessively high, overly good, euphoric mood

  • Extreme irritability

  • Racing thoughts and talking fast, jumping from one idea to another

  • Distractibility or lack of concentration

  • Little sleep needed

  • Unrealistic beliefs in one's abilities and powers

  • Spending sprees

  • A lasting period of behavior that is different from usual

  • Increased sexual drive

  • Abuse of drugs—cocaine, alcohol, and sleep medications

  • Provocative, intrusive, or aggressive behavior

  • Denial that anything is wrong


A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer.​

Signs and symptoms of depressive episode:


  • Lasting sad, anxious, or empty mood

  • Feelings of hopelessness or pessimism

  • Feelings of guilt, worthlessness, or helplessness

  • Loss of interest or pleasure in activities once enjoyed, including sex

  • Decreased energy, a feeling of fatigue or of being "slowed down"

  • Difficulty concentrating, remembering, making decisions

  • Restlessness or irritability

  • Sleeping too much, or inability to sleep

  • Change in appetite and, or, unintended weight loss or gain

  • Chronic pain or other persistent physical symptoms not caused by physical illness or injury

  • Thoughts of death or suicide, or suicide attempts


A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer.


A strategy that combines medication and psychotherapy treatment is optimal for managing the disorder over time.


Most people with bipolar disorder, even those with the most severe forms, can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. Mood swings from manic to depressive are often gradual, although occasionally they can occur abruptly.


In most cases, bipolar disorder is much better controlled if treatment is continuous rather than on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.


As an addition to medication, psychotherapy is helpful in providing support, education, and guidance to patients and their families. Studies have shown that psychotherapeutic interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.


Psychotherapy interventions commonly used for bipolar disorder are cognitive behavioral therapy (CBT), psycho- education, family therapy, and a newer technique—interpersonal and social rhythm therapy.


Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.


Psycho-education involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown episode occurs.


Psycho-education may also be helpful for family members.


Family therapy uses strategies to reduce the level of family distress that may either contribute to or result from the ill person's symptoms.


Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regulate daily routines. Daily routines and sleep schedules may help protect against manic episodes.


As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

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