Updated on October 21, 2024
Are you or a loved one living with bipolar disorder? If so, you may know that the condition can cause major shifts in mood, energy, and activity levels, and other disruptive symptoms. These, in turn, may significantly impact job performance, relationships, and daily living. If not properly managed, symptoms can worsen.
Fortunately, people with bipolar disorder can lead healthy lives when they receive effective treatment. Discover the options and how to choose what works best for you in managing the condition.
Types of bipolar disorder
Symptoms of bipolar disorder can be divided into two emotional states: the highs of mania and the lows of depression.
When experiencing manic symptoms, people may be very energized. They may feel agitated, restless, and have racing thoughts. They might behave in reckless ways, like gambling or spending large amounts of money, and they might experience symptoms of psychosis, or loss of contact with reality. Some people may experience hypomania, which involves milder manic periods.
The depressive stage typically shows up as lack of energy, feelings of hopelessness, tiredness, and losing interest in doing most activities. And in between depression and mania, a person may experience a healthy mood, known as euthymia.
A bipolar diagnosis is determined by the frequency and severity of the symptoms experienced, which can vary dramatically between individuals.
A diagnosis may also specify one of several types of bipolar, including:
Bipolar I disorder involves having at least one episode of mania that lasts at least a week, and that disrupts the person’s life or causes them to require hospital care. Some people with this type also experience major depressive episodes.
Bipolar II disorder is characterized by at least one major episode each of hypomania and depression, but no episodes of mania.
Cyclothymic disorder (or cyclothymia) is a less severe type of bipolar. People will have milder symptoms of both depression and hypomania lasting for at least two years.
Substance/medication-induced bipolar and related disorder involves a major mood disturbance with unusually high energy and activity that seems to have developed after being exposed to—or going through withdrawal from—a medication that’s known to cause these symptoms.
Bipolar and related disorder due to another medical issue involves intensely elevated energy and activity levels that are found to be caused by another medical condition.
Other specified bipolar and related disorder refers to symptoms that are typical of a bipolar disorder but that don’t quite meet the full criteria for any of the other bipolar disorder types. The word “specified” means the healthcare provider (HCP) has included a reason why the symptoms don’t meet the criteria for another bipolar type.
Unspecified bipolar and related disorder is similar to other specified bipolar and related disorders except the HCP making the diagnosis isn’t sure about how or whether the symptoms meet the criteria for another bipolar type. This might be a common diagnosis in an emergency room setting, where there isn’t the chance to observe the person over a longer period of time to gather more information.
HCPs may also use the diagnosis unspecified mood disorder if they aren’t sure if the symptoms meet bipolar diagnostic criteria or another mood disorder.
While not considered types of bipolar disorder, some people also experience these features of the condition:
Rapid cycling can occur with any type of bipolar disorder. It is diagnosed when someone has at least four episodes of depression, mania, or hypomania within a 12-month period.
An episode with mixed features (also known as a mixed episode) involves symptoms of mania and depression happening at the same time.
Symptoms to understand
Manic symptoms may include:
- Exaggerated optimism and self-confidence
- Fast talking and racing thoughts
- Grandiose ideas about oneself
- Impulsive and reckless behavior (such as wild shopping sprees, irresponsible driving choices, engaging in risky sexual activity, or abusing drugs)
- Extreme agitation and irritability
- Restlessness and getting little to no sleep
- Psychotic behaviors (such as delusions or hallucinations)
Depressive symptoms may include:
- Hopelessness and sadness
- Fatigue and exhaustion
- Nervousness
- Irritability
- Loss of interest in daily matters
- Suicidal thoughts or actions
Main treatment options for bipolar disorder
Effective treatment for bipolar disorder often involves several approaches. These may include:
Medication for bipolar disorder
While there is no cure for bipolar disorder, medication prescribed by an HCP can go a long way toward helping to regulate symptoms. Some of the most common choices include the following:
Mood stabilizers help control moods and are usually the go-to medication for treating bipolar disorder. Lithium is a popular mood stabilizer.
Anticonvulsants like valproic acid and lamotrigine can also act as mood stabilizers and are used to treat mania and to delay episodes in some people.
Atypical antipsychotic medications (also known as second-generation antipsychotics) often help control acute mania, mixed episodes, and acute bipolar depression. They are often paired with other bipolar medications.
Antidepressants can sometimes be effective in treating the depressive signs of the condition. Taking antidepressants alone, however, may sometimes lead to increased mania or hypomania, which is why HCPs tend to prescribe antidepressants with mood-stabilizing medication as well.
Therapy for bipolar disorder
While taking medication is key to treatment, having counseling sessions with a psychiatrist or psychologist who is knowledgeable about treating bipolar disorder can also help. Psychotherapy, also known as talk therapy, can offer guidance and support to people with bipolar disorder and their families. The following are common forms of psychotherapy:
- Cognitive behavioral therapy (CBT) teaches about hot wo change negative or destructive thoughts, patterns, and behaviors.
- Family-focused therapy includes family members and enhances family coping strategies.
- Interpersonal and social rhythm therapy helps with improving daily routines, relationships, and interactions.
- Psychoeducation is typically done in a group setting. This type of therapy provides a more in-depth look into the condition and treatments, as well as how to recognize and manage symptoms before they get worse.
Electroconvulsive therapy (ECT)
When symptoms are severe, and when medication and psychotherapy don’t appropriately ease symptoms, electroconvulsive therapy, formerly called “electroshock therapy,” may be recommended. While this form of therapy has received criticism in previous years, the way it’s administered has improved. In its current form, it can offer relief for people with severe bipolar symptoms or those who don’t respond to medications.
Transcranial magnetic stimulation (TMS)
Another treatment used when medication and therapy aren’t effective is transcranial magnetic stimulation (TMS). This therapy involves applying magnetic pulses to overactive or underactive areas of the cerebral cortex in the brain. This newer technique is noninvasive and while more research needs to be done, brain stimulation techniques like TMS may reduce depressive symptoms in people with bipolar disorder.
Lifestyle habits
In addition to consulting regularly with an HCP and following the treatment plan you develop together, certain lifestyle habits can help manage symptoms.
Exercise. Getting regular physical activity can help people with bipolar disorder fend off symptoms of depression and raise their quality of life. It may also improve sleep and help curb weight gain, which is one possible side effect of bipolar medication.
Diet and nutrition. A 2022 review published in the journal Nutritional Neuroscience looked at 60 studies and found promising evidence that diet may improve bipolar symptoms. Although much more research needs to be done, a few nutrients stand out. In addition to a healthy diet of vegetables, fruits, lean protein like chicken and fish, and whole grains, research has shown that omega-3 fatty acids, folic acid, zinc, and some probiotics may offer some symptom relief.
Journaling. Writing or journaling can also be a constructive outlet and a helpful way to manage a broad range of mental health symptoms. People with bipolar disorder may find it helpful to write down racing thoughts and the many feelings, questions, and ideas that may come up in both manic and depressive episodes.
Avoid alcohol and drugs. It’s also important to refrain from drinking or using illegal drugs. Substance abuse is common among people with bipolar disorder because it may feel like substances can offer symptom relief. The reality is that drugs and alcohol cause serious issues, including making it more difficult to diagnose and treat bipolar disorder, causing more severe symptoms, and raising the risk of suicide.
Getting the right treatment
Take medications as prescribed and tell your HCP about any side effects or symptoms you experience. Keeping track of your moods, treatment progress, and sleep patterns can help your HCP see if medication is working properly. Your HCP may switch or add medications if your symptoms worsen or become unbearable.
Try to be patient with your treatment plan. Medications don't all work the same for everyone. You may need to try several prescriptions (sometimes more than one at a time) before you and your HCP determine what works. Continue to communicate with your provider for an overall treatment plan that is best for you.
