Bipolar disorder guide

Bipolar disorder, formerly known as manic depression, is a mental health condition marked by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

These shifts in mood, energy, and activity levels can be intense and disruptive to daily life, relationships, and functioning.

Symptoms of bipolar depression

1. Manic episode (or hypomanic, in a milder form)

• • Mood
    
    

Elevated, overly happy, or irritable.

• • Energy

Unusually high, with less need for sleep.

• • Behavior

Fast talking, impulsivity, risk-taking (spending sprees, substance use, risky sex), inflated self-esteem, or grandiosity.

• • Cognitive signs

Racing thoughts or easily distracted.

• • • Mania lasts at least 7 days (or requires hospitalization).

• • • Hypomania continues for at least 4 days but is less severe and typically doesn’t require hospitalization.

2. Depressive episode

• • Mood
    
    

Deep sadness, emptiness, hopelessness.

• • Energy

Fatigue and slowed behavior.

• • Behavior

Loss of interest in things once enjoyed, withdrawal from others.

• • Cognitive signs

Trouble concentrating, thoughts of death or suicide.

These episodes typically endure for at least 2 weeks.

Types of bipolar disorder

Type	Description
Bipolar I	At least one full manic period. May also have depressive episodes, but it is not required for diagnosis. Often more severe.
Bipolar II	At least one hypomanic episode and one major depressive episode. No full mania. Often misdiagnosed as depression.
Cyclothymia	Chronic, milder fluctuations of hypomanic and depressive symptoms for 2+ years (1+ year in children/teens), but not full episodes.
Other/unspecified	Symptoms don’t exactly match the above types, but still cause major distress.

What causes bipolar disorder?

There’s no single cause, but it likely stems from a mix of biological, psychological, and environmental factors:

• Genetics

If a parent or sibling has bipolar disorder, your risk increases.

• Brain structure/function

Differences in neurotransmitters and brain circuits regulating emotion and impulse control.

• Stress/trauma

Major life stressors, childhood trauma, or substance abuse can trigger episodes.

A large twin study estimates the heritability to be as high as 60–85% for bipolar disorder.

How is it diagnosed?

Sadly, there’s no blood test or brain scan to diagnose it.

That’s why a mental health professional will use tools like:

• Clinical interviews.

• DSM-5 criteria.

• Mood tracking over time.

• Input from family/friends.

Misdiagnosis is common, notably confusing Bipolar II with major depression.

Treatment options

Bipolar disorder is highly treatable, but not curable.

Dealing with it effectively concentrates on managing mood swings and preventing relapses:

1. Medications
   
   

• • Mood stabilizers

Lithium (the gold standard).

• • Antipsychotics

E.g., quetiapine, olanzapine (helpful in mania or bipolar depression).

• • Antidepressants

Used cautiously, often with mood stabilizers.

• • Anticonvulsants

Like valproate or lamotrigine.

2. Psychotherapy

• • Cognitive behavioral therapy (CBT).

• • Psychoeducation (learning about your condition).

• • Interpersonal and social rhythm therapy (IPSRT): Stabilizing routines and sleep patterns.

• • Family therapy if support is needed at home.

3. Lifestyle management
   
   

• • Regular sleep schedule.

• • Tracking moods (apps or journals).

• • Avoiding alcohol/drugs.

• • Stress reduction strategies (like mindfulness or exercise).

Without treatment, bipolar disorder can:

• • Lead to job/relationship problems.

• • Increase risk of suicide (particularly during depressive episodes).

• • Be mistaken for other conditions like ADHD, depression, or BPD.

Roughly 1 in 5 people with bipolar disorder die by suicide, which is why early diagnosis and ongoing care are crucial.

How common is bipolar depression?

• Global prevalence

About 1–2.4% of people will experience bipolar disorder in their lifetime.

• U.S. prevalence

In the U.S., the lifetime prevalence is around 2.8%.

Depression is more common than mania

• People with bipolar type I typically spend three times more time being depressed than manic.

• Those with bipolar II spend even more time in depression, with numbers up to 35–50% of their lives, according to some studies.

Although mania or hypomania defines bipolar disorder, depression is often the most frequent and impairing phase.

What are the risk factors for bipolar depression?

Bipolar depression doesn’t just appear out of nowhere since it’s influenced by a mix of biological, psychological, and environmental risk factors such as:

1. Genetics (family history)

• • Genetics is the strongest known risk factor.

• • Your risk increases substantially if a first-degree relative (parent or sibling) has bipolar disorder.

• • Twin studies indicate 60–85% heritability.

That means if one identical twin has bipolar disorder, the other has a 40–70% chance of developing it too.

2. Brain chemistry and biology
   
   

• • Neurotransmitter imbalances involving dopamine, serotonin, and norepinephrine are implicated.

• • Structural and functional brain changes are seen in areas that regulate mood, such as the prefrontal cortex and amygdala.

• • Circadian rhythm disturbances (like irregular sleep/wake cycles) are also correlated to increased risk and relapse.

3. Psychological factors

• • Temperament/personality traits such as:

• • • High emotional reactivity.

• • • Impulsivity.

• • • Mood lability.

• • Cognitive styles that include:

• • • Negative self-thinking.

• • • Rumination.

• • • Unrealistically high self-expectations during elevated moods.

4. Childhood trauma or abuse
   
   

• • Childhood adversity, including:

• • • Emotional, physical, or sexual abuse.

• • • Neglect.

• • • Loss of a parent or instability in the home.

These experiences are linked to earlier onset, more severe depressive episodes, and higher risk of suicidality in bipolar individuals.

A 2016 meta-analysis discovered that people with bipolar disorder who experienced childhood trauma had 2.63 times higher odds of experiencing more severe clinical symptoms.

5. Substance use

• • Substance abuse (especially cannabis, alcohol, and cocaine) can:

• • • Start mood episodes.

• • • Worsen depressive phases.

• • • Increase cycling between mania and depression.

• • Some people use substances to self-medicate depressive symptoms, which can create a vicious cycle.

6. Sleep disruption
   
   

• • Bipolar depression is closely related to disrupted sleep patterns.

• • Lack of sleep or irregular circadian rhythms can:

• • • Precede depressive episodes.

• • • Trigger alterations into mania/hypomania.

• • Even minor disruptions in sleep routines can destabilize mood in sensitive individuals.

7. Life stress and major changes

• • Highly stressful life events can trigger the onset of bipolar symptoms, predominantly depression:

• • • Job loss.

• • • Relationship breakdowns.

• • • Death of a loved one.

• • Chronic stress and lack of coping resources also raise relapse risk.

8. Medical conditions and medications
   
   

• • Certain physical illnesses, like thyroid disorders or neurological conditions, such as MS and epilepsy, can mimic or add to mood symptoms.

• • Medications such as corticosteroids and antidepressants (when not combined with a mood stabilizer) can cause or deteriorate bipolar depression.

9. Age of onset

• • Early onset (typically in teens or early 20s) is associated with a more severe course of illness:

• • • More frequent depressive episodes.

• • • Higher danger of suicidal behavior.

• • • More rapid cycling.

10. Misdiagnosis or delayed diagnosis

• • Misdiagnosing bipolar depression as major depressive disorder often leads to:

• • • Inappropriate treatment (e.g., antidepressant monotherapy).

• • • Symptoms or mood instability getting worse.

• • • Delayed access to mood-stabilizing treatment.

Bottom line

Bipolar disorder isn’t just “moodiness.” It’s a serious mental illness with extreme ups and downs that affect thoughts, energy, and behavior.

It arises from a complex mix of vulnerability and triggers, not just one cause.

Luckily, most people with bipolar disorder can lead stable, fulfilling lives with the right treatment and support.

Join our forum and Facebook

Please consider joining our forum and Facebook if you enjoyed reading this and would like to chat with like-minded peers about anything depression related.

It would certainly go a long way toward making my dream of creating a thriving, supportive community a reality!