What is Bipolar Disorder?

Bipolar disorder is a type of mood disorder characterized by extreme swings in mood, energy, and ability to function. These changes are more dramatic than normal ups and downs; they can hurt relationships and cause poor job or school performance.

The two mood extremes of bipolar disorder are mania and depression. In mania, one of the defining symptoms is increased energy and a decreased need for sleep. The mood may be overly happy or irritable. In depression, a down mood with fatigue takes over, often accompanied by irritability. The depressive side of bipolar disorder is nearly identical to major depressive disorder, which is another type of mood disorder.

There are two forms of bipolar disorder:

  • Bipolar I disorder involves episodes of mania (and at other times episodes of depression)
  • Bipolar II disorder involves milder episodes of mania (called hypomania) alternating with episodes of depression

Symptoms of Bipolar Disorder

While exact bipolar symptoms can differ from person to person, the condition is characterized by the following traits:

  • Dramatic mood swings that can range from hopeless despondency to elated excitability
  • Periods of normal mood in between intense ups and downs
  • Extreme changes in energy and behavior

Signs and symptoms of mania include:

  • Persistent and inexplicable elevation in mood
  • Increased energy and effort toward goal-directed activities
  • Restlessness and agitation
  • Racing thoughts, jumps from one idea to another
  • Rapid speech or pressure to keep talking
  • Difficulty concentrating
  • Decreased need for sleep
  • Overconfidence or inflated self-esteem
  • Poor judgment, often involving spending sprees and sexual indiscretions

Signs and symptoms of depression include:

  • Prolonged sad, hopeless, or empty mood
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy or fatigue
  • Trouble concentrating, remembering, and/or making decisions
  • Restlessness or diminished movements
  • Agitation
  • Sleeping too much or too little
  • Unintended weight loss or gain
  • Thoughts of death or suicide with or without suicide attempts

Severe episodes of mania or depression may sometimes be associated with psychotic symptoms such as:

  • Hallucinations
  • Delusions
  • Disorders of thought

Causes of Bipolar Disorder

The cause of bipolar disorder is not known. Specific genes may play a role, and a family history of the disorder increases your chance of developing it (tell your doctor if you have a family member with bipolar disorder).

Diagnosis for Bipolar Disorder

Correct diagnosis of bipolar disorder (which can be mistaken for depression due to the symptoms they share) is crucial to putting a patient on the correct treatment path. Your doctor will ask about your symptoms and medical history, and may conduct a physical exam. In some cases, lab tests are ordered to help rule out other causes of mood and behavior symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on:

  • Presence of certain symptoms over time
  • Absence of other causes, such as certain medications and illicit drugs (including corticosteroids, cocaine, and methamphetamines) and certain conditions (including thyroid disease and multiple sclerosis)
  • Family history of bipolar disorder

Mania is diagnosed if:

  • Mood is elevated and there are three or more manic symptoms (listed above). If the mood is irritable, not elevated, four symptoms must be present for a diagnosis of mania
  • Symptoms last most of the day, nearly every day, for one week or longer

A depressive episode is diagnosed if:

  • There are five or more of the depressive symptoms (listed above)
  • Symptoms last most of the day, nearly every day, for a period of two weeks or longer