Bipolar

Bipolar disorder is often misunderstood and frequently mislabeled in people who simply have labile personalities or dramatic mood shifts. However, it is very different from everyday mood reactivity. Bipolar disorder involves distinct mood episodes — specifically periods of mania (or hypomania) and depression — that follow a recognizable pattern.

An accurate diagnosis requires careful assessment of mood elevation, duration and frequency of symptoms, functional impairment, and the exclusion of other possible causes. Bipolar disorder is an umbrella term that includes subtypes such as Bipolar I, Bipolar II, and cyclothymia.

The correct diagnosis can be complicated since substances, certain medical conditions and common differential disorders such as depression, untreated ADHD and personality disorders can resemble bipolar disorder.  

You may have bipolar disorder if you have a history of:

  • Grandiosity

  • Elevated and Irritable Mood

  • Decreased Need for Sleep

  • Extreme Impulsivity and Risk Taking

  • Increased Goal Directed Activity

  • Episodes of Depression with No Relief from Traditionally SSRI Treatment

  • Noticeable Fluctuations in Mood Around Seasonal Changes

What is Mania?

Mania is most commonly associated with Bipolar I Disorder and is characterized by a distinct period of elevated, expansive, or irritable mood accompanied by significantly increased energy and activity, lasting days to weeks. These episodes often lead to marked impairment in functioning and may require hospitalization.

Hypomania, which is associated with Bipolar II Disorder, is a less severe form of mania. Symptoms are similar but lower in intensity and typically do not cause significant functional impairment or require hospitalization. Many individuals with Bipolar II report feeling highly productive or at their “best” during hypomanic episodes and may be hesitant to pursue treatment.

However, Bipolar II Disorder is often marked by more frequent and severe depressive episodes. This pattern contributes to a higher risk of suicidal thoughts compared to Bipolar I Disorder or major depressive disorder.

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Sensitive Markers for Mania

Increased goal-directed activity is a highly sensitive marker to determine if someone may be experiencing mania. This presents as having an increased “busyness” which involves working towards some kind of reward or outcome. When this activity is blocked the individual may become very irritable, yelling or lashing out at whomever or whatever is getting in their way. Additionally, these individuals may experience heightened levels of pleasure and excessive impulsivity such as excessive shopping, drug use, gambling and sex.  

The Treatment Part…

Treatment begins with first determining the correct diagnosis since each presentation is treated differently. Untreated, mania can last 3-6 months and bipolar depression up to a year. Medications are used to treat most presentations of bipolar disorder and fall into a few different categories: Mood Stabilizers, Anticonvulsants and Antipsychotics. Determining the right medication is dependent on each individual’s preferences, presenting symptoms and history.

Additionally, complimentary psychotherapy has shown to reduce relapse rates, mood fluctuations, hospital admissions and potentially need for medications. These interventions are aimed at education around creating an optimal routine and lifestyle to reduce future episodes of mania and depression.