- How to spot the symptoms of bipolar disorder
- Treatment and management
- What is the treatment for mania, hypomania and depression?
- What are the long-term treatments for bipolar disorder?
- What can I do to manage my symptoms?
- Support groups
- End The Loneliness and Hurt… Watch This Video Today
- Does Your Teenager Have Bipolar Disorder?
- A New Understanding of Risk for Bipolar Disorder
- Signs and Symptoms of Bipolar Disorder
- What Causes Bipolar and How is it Diagnosed?
- What are the Treatment Options?
How to spot the symptoms of bipolar disorder
Share on PinterestSymptoms of mania include euphoria.
Bipolar disorder is a condition with mood swings that can range from euphoria to depression.
However, for a diagnosis of bipolar I disorder, a person only needs to have a manic episode.
In fact, a person with bipolar I disorder may never experience a major depressive disorder, despite the name bipolar.
Signs of mania
When someone has mania, they do not just feel very happy. They feel euphoric.
A person with mania may:
- have a lot of energy
- feel able to do and achieve anything
- have difficulty sleeping
- use rapid speech that jumps between topics and ideas
- feel agitated, jumpy, or “wired”
- engage in risky behaviors, such as reckless sex, spending a lot of money, dangerous driving, or unwise consumption of alcohol and other substances
- believe that they are more important than others or have important connections
- show anger or aggression if others challenge their views or behavior
Severe mania can involve psychosis, with hallucinations or delusions. Hallucinations can cause a person to see, hear, or feel things that are not there.
People may have delusions and distorted thinking that cause them to believe that certain things are true when they are not.
They may believe, for example, that they have important friends (such as the president of the United States) or that they descend from royalty.
A person in a manic state may not realize that their behavior is unusual, but others may notice a change in behavior. Some may see the person’s outlook as sociable and fun-loving, while others may find it unusual or bizarre.
The individual may not realize that they are acting inappropriately or be aware of the potential consequences of their behavior.
They may need help in getting help and staying safe.
Not everyone will have a severe manic episode. Less severe mania is known as hypomania. Symptoms are similar to those of mania, but the behaviors are less extreme, and people can often function well in their daily life.
If a person does not address the signs of hypomania, it can progress into a more severe form of the condition at a later time.
Share on PinterestDuring a low phase, a person may feel depressed and unable to do anything.
Signs of a depressive episode are the same as the symptoms of a major depressive episode.
They may include:
- feeling down or sad
- having very little energy
- having trouble sleeping or sleeping a lot more than usual
- thinking of death or suicide
- forgetting things
- feeling tired
- losing enjoyment in daily activities
- having a “flatness” of emotion that may show in the person’s facial expression
In severe cases, a person may experience psychosis or a catatonic depression, in which they are unable to move, talk, or take any action.
Although rare, bipolar disorder could occur in young children and teenagers.
Bipolar disorder is a lifelong condition. It can be present in young children, although it often does not emerge later, often in the late teens or early adulthood.
This may happen when a trigger causes clear signs of mania or depression, but often there is no clear trigger.
It can be hard to detect bipolar disorder in toddlers or young children, as children of this age often display uncontrolled behavior until they learn new ways of behaving. This has led to controversy over the diagnosis of bipolar disorder in young children.
Children with bipolar disorder may have severe temper tantrums that can last for hours, possibly with signs of aggression. These may not improve with age, as bipolar disorder makes it harder than others to learn alternative behaviors.
Parents may also notice periods of extreme happiness and silly moods in their child.
At this age, the signs of bipolar disorder may resemble those of another condition, such as attention deficit hyperactivity disorder (ADHD).
Teenagers may show some of the more common signs of bipolar disorder, especially an increase in risky behaviors, such as:
- reckless sexual activity, drug or alcohol use
- poor performance in school
- thinking more about death or suicide
It is important that any young person showing these symptoms sees a mental health professional.
Learn more here about how bipolar disorder can affect teens.
Doctors do not know exactly what causes bipolar disorder, but the following appear to play a role:
Genetic factors: A person with bipolar disorder may have a parent with the condition. However, having a parent or even a twin with bipolar disorder does not mean a person will have it.
Stress: Someone who has a genetic predisposition may experience their first episode of depression or mania during or after a time of severe stress, for example, the loss of a job or a loved one.
Treatment and management
What is the treatment for mania, hypomania and depression?
You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence (NICE) website. NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at www.nice.org.uk.
The NHS does not have to follow these recommendations. But they should have a good reason for not following them.
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms. For the purposes of this page mood stabilisers are:
• Certain antipsychotic medication
• Certain anticonvulsive medication
• Certain benzodiazepine medication
Mania and hypomania
You should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as ‘antimanic’ medication.
If you are taking an antidepressant your doctor may think about stopping this medication.
You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
If the first antipsychotic you are given doesn’t work then you should be offered a different antipsychotic medication from the list above.
If a different antipsychotic doesn’t work then you may be offered lithium to take alongside it. If the lithium doesn’t work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication. Sodium Valproate shouldn’t be given to girls or young women who might want to get pregnant.
Your doctor should think about giving you benzodiazepine medication short term.
Your doctor will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.
Your doctor should offer you medication to treat depressive symptoms. You may be offered the following medication:
• Fluoxetine with Olanzapine
• Olanzapine or
Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant medication.
Your doctor can prescribe the above medication alongside:
• Lithium, and
• Sodium valproate.
Doctors will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.
If you have an episode of depression you should be offered a high intensity talking therapy, such as cognitive behavioural therapy (CBT) or interpersonal therapy as well as medication.
What is CBT?
CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.
What is interpersonal therapy?
Interpersonal therapy is a talking therapy that focuses on you and your relationships with other people.
What are the long-term treatments for bipolar disorder?
Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition.
Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium.
Lithium usually works better than other types of medication for long-term treatment. Your doctor should give you information about how to take lithium safely. If lithium doesn’t work well enough or causes you problems, you may be offered:
• Olanzapine, or
Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:
• measuring your weight,
• blood and urine tests,
• checking your liver and heart, and
• checking your pulse and blood pressure.
You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.
The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse.’ Your therapy should help you to:
• understand your condition,
• think about the effect that your thoughts and behaviour have on your mood,
• monitor your mood, thoughts and behaviour,
• think about risk and distress,
• make plans to stay well,
• make plans to follow if you start to become unwell,
• be aware of how you communicate, and
• manage difficulties you may have in day to day life.
If you live with your family or are in close contact with them you should also be offered ‘family intervention.’
Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with. The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.
Your mental health team should give you advice about exercise and healthy eating. If you want to return to work you should be offered support to help with training or returning to work. You should get this support if your care is managed by your GP or by you community mental health team.
If you can’t work, or haven’t been able to find work at the moment, your healthcare professionals should think about other activities that could help you back to employment in the future.
Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again. And ways of coping. Your plan should also have people to call if you become very distressed.
You should be encouraged to make an ‘advance statement.’ This is an instruction to health professionals about what you would like to happen with your care if you ever lack mental capacity to make your own decisions.
Care Programme Approach
You may be assessed under the Care Programme Approach (CPA) if you have complex needs or you are vulnerable. CPA is a package of care that is used by secondary mental health services. You will have a care plan and someone to coordinate your care. All care plans must include a crisis plan.
CPA aims to support your mental health recovery by helping you to understand your:
• support needs, and
CPA should be available if you have a wide range of needs from different services or you are thought to be a high risk. Both you and your GP should be given a copy of your care plan. Your carers can be involved in your care plan and given a copy if you give your consent for this to happen.
What can I do to manage my symptoms?
You can learn to manage your symptoms by looking after yourself. Self-care is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.
Making small lifestyle changes can improve your wellbeing and can help your recovery. Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week. Your healthcare professionals should give you advice about exercise and diet and sleep.
You could join a support group. A support group is where people come together to share information, experiences and give each other support.
You might be able to find a local group by searching online. The charity Bi-polar UK have an online support group. They also have face to face support groups in some areas of the country.
Rethink Mental Illness have support groups in some areas. You can find out what is available in your area by clicking here.
Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. But the college may inform your care team.
Unfortunately, recovery colleges are not available in all areas. To see if there is a recovery college in your area you can use a search engine such as Google. Or contact Rethink Mental Illness Advice Service on 0300 5000 927.
Make a Wellness Recovery Action Plan (WRAP)
Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them. There are guides that can help with this. You can ask your healthcare professional to make one with you or ask them for a template of one.
In the world of mental health, amateur diagnosis runs rampant. We often use terms unwittingly to describe emotional ups and downs, even if they are supposed to be reserved for very real mental health issues – and in doing so, we blur the lines between relatively “normal” difficulties and real, diagnosable mental illnesses.
On the other side of this same coin, our overuse of the terms can also minimize how seriously we take true mental illness when it is professionally diagnosed. And similarly, can cause many, many people to go undiagnosed altogether.
Now – it was extremely important to get that clarification out of the way, to establish the (sometimes murky) distinction between the terms we commonly use and the mental health problems that bear the same names.
Above all, you should seek professional diagnosis if you worry that you or your spouse is suffering from some form of mental illness.
Today, we’re looking at one of the most commonly overused terms – that’s also one of the mostly commonly undiagnosed issues: Bipolar Disorder.
If you’re concerned that your spouse may be bipolar, examining these symptoms can help you decide if you need to seek further help. Again, the expertise of a professional is always paramount here. This is not meant to determine whether or not your spouse has a mental health condition, but rather to help you understand if you need to explore it further.
Here are 10 symptoms you can be on the lookout for:
1. Incomplete Tasks
People with Bipolar Disorder struggle between bouts of high energy and bouts of low energy, and this is manifested in incomplete projects at home, at work, or otherwise. These projects are begun with enthusiasm during a manic state, and abandoned as worthless or too difficult during a depressive state.
2. Speed Talking
In a manic state, it can feel like the mind is running totally amok. In attempts to vocalize these feelings, bipolar people can end up tripping over their words, trying to speak as quickly as the thoughts are racing in, and end up almost incomprehensible to the listener.
Do you think your spouse is bipolar?
3. Alcohol/Drug Abuse
Nearly 50% of diagnosed sufferers of Bipolar Disorder also struggle with substance abuse of some kind. It is often linked to escapist behavior, as a bipolar person may seek drugs or alcohol to help calm spells of mania or to escape bouts of depression. In most cases, it’s an attempt at self-medicating.
This “up” side of Bipolar Disorder can actually be enjoyable for many people, because it generally involves feelings of excitement and euphoria without the distress of other manic symptoms. It’s only when you see other, drastically unhappier states that you can recognize hypomania as an indicator of a problem.
The opposite end of hypomania, depression in Bipolar Disorder is like “regular” depression – lack of appetite, lethargy, sadness without a specific cause, etc. – and can have the same devastating effects on work, relationships, and even physical health.
Somewhere between a manic state and a depressed state, people suffering from Bipolar Disorder can be extremely irritable. It’s like the sensations of depression, but with the energy of mania. This makes them extremely edgy with little room for relief.
7. Problems at Work
The drastic emotional ups and downs cause difficulty in all aspects of life, including the workplace. Since most jobs don’t really have the flexibility to change expectations with an employee’s mental or emotional state, Bipolar Disorder may lead to unmet deadlines, unfinished projects, even issues with customers or coworkers – especially if other employees/supervisors are unaware of the condition.
8. Sleeping Issues
Both sides of Bipolar Disorder can cause problems with sleep. Manic states can make sleep extremely difficult, and depressive states can lead to wanting to sleep all the time. Neither is healthy.
9. Erratic Behavior
Manic phases can lead to a distorted sense of consequence, making people behave erratically without considering the outcome. Similarly, deep depression can make things feel meaningless – which may also lead to destructive behavior.
10. “Flight of Ideas”
Because of the rapid thoughts that come with states of mania, Bipolar Disorder can also cause people to feel like they can’t even grasp the ideas that are forming – simply because there are too many, moving much to quickly. It feels like they can’t think straight, and the resulting anxiety only makes the problem worse.
If these symptoms sound familiar – if they seem to describe problems your spouse struggles with – it might be time to talk to your doctor or pursue other professional help. Bipolar Disorder can be extremely difficult to live with, but proper diagnosis, medication, and some lifestyle management, it doesn’t have to create a rift in your marriage or be a tremendous burden on your spouse’s life.
Millions of people across the world have been diagnosed, and are now finding a happier, more stable life through various forms of treatment.
If Bipolar Disorder may be affecting your marriage – seek help today!
For more advice on how to strengthen your marriage, check out the StrongMarriageNow System today!
End The Loneliness and Hurt… Watch This Video Today
Dr. Dana Fillmore and Amy Barnhart, co-Founders, StrongMarriageNow.com
Does Your Teenager Have Bipolar Disorder?
Bipolar disorder commonly begins to show itself in the late teens. Bipolar disorder in the teenage years is serious; it’s often more severe than in adults. Adolescents with bipolar disorder are at high risk for suicide.
Unfortunately, bipolar disorder in teens frequently goes undiagnosed and untreated. Partly, this is because while symptoms may begin in adolescence, they often don’t meet the full diagnostic criteria for bipolar disorder. Some experts think that bipolar disorder also can be over diagnosed in children or younger adolescents, especially when symptoms involve just mood swings or disruptive behaviors rather than changes in energy or sleep patterns. Partly for that reason, the diagnosis of “disruptive mood dysregulation disorder” has come into use to describe teens who mainly have persistent irritability and severe temper outbursts or mood swings.
Symptoms of bipolar disorder in teens may be unusual — not a straightforward “manic depression.” ADHD, anxiety disorders, and substance abuse are often also present, confusing the picture.
Some symptoms that suggest a teenager might have bipolar disorder are:
- Uncharacteristic periods of anger and aggression
- Grandiosity and overconfidence
- Easy tearfulness, frequent sadness
- Needing little sleep to feel rested
- Uncharacteristic impulsive behavior
- Confusion and inattention
Other potential symptoms that may indicate the presence of a psychiatric disorder requiring evaluation may include feeling trapped, overeating, excessive worry, and anxiety. Other possible diagnoses in addition to bipolar disorder that should be considered in the setting of symptoms such as these include unipolar (major) depression, anxiety disorders, substance use disorders, adjustment disorders, attention deficit hyperactivity disorder, and personality disorders such as borderline personality disorder.
It’s important to remember that sometimes some of these symptoms can occur in many healthy teens and adults. The time for concern is when they form a pattern over time, interfering with daily life. Children with symptoms that suggest bipolar disorder should be seen and evaluated by a psychiatrist or psychologist with expertise in mood disorder.
A New Understanding of Risk for Bipolar Disorder
Monday, September 17, 2018
Bipolar disorder (BD) can be a difficult condition to diagnose because its signature symptoms–episodes of abnormal, often persistent, highs and lows–are related to one another in different ways in different people. We often think of highs and lows as mutually exclusive opposites. Yet in BD they are not opposites but are sometimes “mixed” in varying degrees of intensity.
One can be depressed, for instance, and yet for brief intervals– say, a couple of days–display certain features of mania, or a less severe form of mania called hypomania (for example, elation, increased energy, decreased need for sleep, rapid speech, irritability, a tendency toward risky behavior). It’s also possible to experience milder or “subthreshold” symptoms that aren’t classified as either manic or depressive. In some patients, depression may be the dominant mood; in others, there will be distinct periods of mania and depression of varying duration, and in others very rapid changes in mood. A fairly new term, bipolar spectrum disorder (BPSD), covers the full range–on the one hand, full-blown BD featuring depression plus at least one period of mania or hypomania, but also subthreshold depressive and/or manic mood symptoms. BPSD is an umbrella term that emphasizes that the manifestations of BD exist in a continuum.
Identifying patterns–in moods, behaviors, brain activity, gene activation, even the body’s metabolism–can distinguish different sub-groups of patients, and is a major objective of research being conducted by many of the Foundation’s grantees. Describing these patterns and determining their prevalence in a growing range of illnesses from psychosis and schizophrenia to depression and suicidality–is now leading to the development of the first tools to predict risk, as well as the course a disorder will take in specific individuals, a major achievement that is decades in the making.
At the University of Pittsburgh’s School of Medicine and Western Psychiatric Clinic, Boris Birmaher, M.D., Endowed Chair in Early Bipolar Disorder and 2013 recipient of the Colvin Prize for Mood Disorders Research, has for the past 17 years led a highly impactful study that exemplifies how the analysis of a single, large patient cohort over an extended period of time can generate the kind of knowledge needed to improve patient care.
Dr. Birmaher heads The Pittsburgh Bipolar Offspring Study, or BIOS, which is looking at the mental health of children born to a parent with a diagnosis of bipolar disorder. By the early 2000s, when BIOS got underway, it was already clear that there was no more powerful factor affecting a child’s risk of developing BD. By age 21, about 3.4 percent of the general population will be diagnosed with BD, a rate that Dr. Birmaher’s group and many others assumed was far higher in children with at least one parent with the diagnosis. But how much higher? No one knew for sure.
There were lots of other unknowns. Was there a way to predict which high-risk children would “convert” to the illness, and if so, which form of it and at what point in their development? Just as important, was there a biological or behavioral pattern –a “signature”–for high-risk children who probably would not develop BD? What was the risk that children of affected parents would develop other psychiatric or behavioral issues?
Joining Dr. Birmaher in this work from its inception have been 2001 Distinguished Investigator and 2006 Ruane Prize for Child and Adolescent Psychiatric Research recipient David A. Brent, M.D. at the University of Pittsburgh and David Axelson, M.D., currently the Director of Child Psychiatry at the Nationswide Children’s Hospital in Columbus, Ohio.
First BIOS Results
In 2009, the BIOS study generated its first headlines. Six years after contacting over 1,600 people living within 200 miles of Pittsburgh, they assembled an initial study cohort of 388 children of 233 parents with BD, plus 251 children of 143 demographically matched control parents.
Before BIOS, various experts estimated that children of BD parents aged six to 17 would have anywhere from two to seven times the risk of developing BD symptoms as compared with children of parents without BD. BIOS showed the risk to be 14 times higher.
It also revealed a two- to three-fold greater incidence in these high-risk children of developing any mood or anxiety disorder. Families in which both parents had BD generally had more offspring with BD spectrum disorders than families with one affected parent. And a very important finding from the study revealed that in children of affected parents who developed BD, episodes began during childhood, usually before age 12, most often manifesting with sub-threshold manic symptoms, and to a lesser degree, depression. Fully 85 percent of the children who developed BD had comorbid conditions–usually anxiety disorders, disruptive behavior and/or ADHD–that typically preceded the onset of BD.
The study made clear that children of parents with bipolar illness were indeed at very high risk of developing the disorder themselves. But there was a ray of light in the first analysis of data from the study. “Because nearly half the children of parents with BD have not yet manifested any diagnosable psychiatric illness, there is a great need and opportunity for primary prevention in this high-risk population,” Dr. Birmaher and colleagues concluded.
Two years later, in February 2010, the BIOS team announced more newsworthy results. While the first results had analyzed children of school age, this time the focus was on children of preschool age. In a group of 121 preschoolers, aged two to five, of 83 parents with bipolar disorder, the risk of developing ADHD was calculated to be eight times that of a matched control sample consisting of 102 children of 65 parents. Children of parents with BD also had six times the risk of having two or more other psychiatric disorders.
Again, there was a ray of hope generated by these worrying results. At the time of the report, only three of the 121 preschool children of bipolar-diagnosed parents had developed mild depressions, and none had developed BD. The remainder, particularly those with ADHD, were much more likely than children of control parents to have subclinical manic and depressive symptoms. “We believe there is a window of opportunity for prevention in the high-risk group of kids,” Dr. Birmaher said at the time of the study’s release.
Another report from the BIOS team appeared in 2016. In the pages of the American Journal of Psychiatry, Drs. Hafeman and Birmaher and the BIOS team now were able to measure the risk that children of bipolar parents would show warning signs, sometimes called a “prodrome” period by doctors. Children of BD parents with symptoms of depression, anxiety, unstable mood, and subclinical manic symptoms were at high risk to develop BD. The risk of developing BD increased to almost 50 percent in children with these symptoms whose parents had developed BD before age 21.
A Calculator to Measure Risk
This result highlighted a familiar problem. A major depressive episode is known to be a warning sign of risk for conversion to bipolar disorder. But only a minority of depressed young people will ever experience mania or hypomania and therefore receive a BD diagnosis and treatments specific to BD, as opposed to depression. Among other things, antidepressants may not help a young person whose depression is just the prelude to mania and BD. Those with the diagnosis are usually treated with mood stabilizers including lithium, anti-seizure and antipsychotic medications.
The BIOS team’s 2016 paper that identified prodromal symptoms before the onset of mania drew from results across the study cohort as a whole, but did not identify the individual risk for specific children. To address this issue, a paper published by the BIOS team in August 2017 in JAMA Psychiatry brought hopeful news.
Based on a study cohort that now numbered 412 children of parents with BD–of whom 54 had themselves developed BD during the follow-up period of the study–the team was now able to construct a risk calculator. Based on established criteria for assessing risk for BD–mood and anxiety symptoms, general psychosocial functioning, and age of one’s parent when she or he began to suffer from a mood disorder–the risk calculator was tested in the BIOS study population, where the researchers had observed some of the high-risk young people initially enrolled actually develop the illness over the course of the study.
Estimating the preliminary or prodrome period for BD at anywhere from two to 10 years, depending on the individual, the team noted that all of the early warning signs were not in themselves specific to BD. One could be anxious or habitually defy authority or be irritable or have sleep disturbances or be depressed–and not go on to develop mania and BD.
Yet such symptoms as factored into the risk calculator tested by the team succeeded with a 70 percent accuracy of “predicting” which of the high-risk young people in the BIOS study did go on to receive a BD diagnosis within five years of their “check-in” assessment. The accuracy was by no means perfect, but it was almost exactly equal to that used in risk assessments for heart disease and colorectal cancer that are widely adopted in medicine.
Dr. Birmaher and colleagues caution that the risk calculator is not yet ready for clinical use because it needs to be tested in sample populations not involved in the BIOS study. Yet the tool does give a sense, finally, of what doctors should look for in trying to assess whether a specific young patient is at high risk of developing BD within the next five years.
Preventive interventions can be undertaken in those whose risk is found to be high. The tool is equally valuable for researchers, who now can pay particularly close attention to those thought to be likely to develop the illness but who have not yet done so. These are ideal candidates for state-of-the-art brain imaging and other monitoring tools, which have a good chance of discovering telltale biomarkers that will make predicting who will get sick ever more accurate in the years to come.
— Written By Peter Tarr, Ph.D.
As the world becomes more familiar with bipolar disorder—recognizing it as a mental illness that impacts a large number of lives—I’ve noticed an interesting duality. On one level, society increasingly accepts the illness, formerly known as manic depression, and seems to understand it is a condition that requires treatment in order for the person struggling with it to live a normal life. But in my work treating men in an urban setting, the stigma still appears to exist for men.
How can this be? Here’s the way I see it. In patriarchal societies such as the US, masculinity remains very much defined by self-control and emotional regulation. Gender stereotypes result in the skewed perception of symptoms. Sadly, people living with mental health conditions, such as bipolar disorder, are often marginalized by society.
Several studies have examined the relationship between quality of life and bipolar and have concluded that quality of life is distinctly impaired in people who live with bipolar. This results in stigmatization and discrimination that can interfere with recovery and social integration. One of the most successful strategies to battle stigma and discrimination is encouraging a person with bipolar to share their story and discuss their journey.
The unfortunate result of this is that men are at greater risk of being misdiagnosed and—even worse—that they are less likely to recognize the disorder in themselves. For this reason, it’s important to be aware that the symptoms of bipolar disorder in men are different than in women.
Can Bipolar Affect Men?
Mental health disorders do not discriminate by gender. According to the National Institute of Mental Health, bipolar disorder, which is characterized by significant shifts in mood and energy level such that they impact the ability to perform daily tasks, affects 2.8% of the adult population in the US. Of that group, when broken down by gender, slightly more men (2.9%) are affected than women (2.8%). Men are as vulnerable to bipolar disorder as women, in both adolescence and adulthood.
People with bipolar disorders (there are three types: bipolar I, bipolar II and cyclothymic disorder) experience intense emotional states—manic, hypomanic or depressive. They also have periods where their mood is stable.
Gender seems to play a role in how the disorder exists in the individual because the illness so strongly impacts emotional and psychological states.
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Bipolar Onset: Is Age Relevant?
The median age of onset for bipolar disorder is 25 although it can start earlier and occur later—during middle age. The same gender ratio holds true for bipolar in adolescents—there are no appreciable differences in terms of population. As to symptom differences between age groups, however, adolescent bipolar disorder often varies from the adult in terms of intensity.
When the disorder is first developing, behavioral patterns can be more erratic. The bipolar adolescent, for example, will “cycle” from a state of excitement to depression more rapidly than the adult, who maintains the specific state for longer than a day (Pipich 16-17). Age, then, is relevant only in terms of the disorder’s progression and not regarding gender or disparity in affliction.
What Does Mania Feel Like?
Mania symptoms exist in an equally wide range of forms for both men and women. It is important to understand that “mania” by no means translates to extreme behavior or physical aggression. It may, but symptoms are usually more internalized. Manic thinking and feeling sometimes veer on delusion, as in grandiose ideas of the self as having some special purpose to fulfill. During the stage of mania, the observation of the self “ego” struggles with behaviors, judgments, emotions, and actions in real time as they are manifesting and self-monitoring. Hallucinations also occur in extreme cases, wherein the individual is unable to distinguish the real from the unreal.
Manic states are often marked by sleeplessness; the person does not have insomnia, but rather is so obsessed that they believe they require less sleep or choose to remain awake as long as possible. More commonly, however, mania “feels” like a stage of prolonged excitement. This may result in a negative or positive response; the person may be agitated and anxious for hours or days, for no cause they can name, or they may be euphoric for the same extended period. Mania is essentially a heightened state of perception, feeling, and behavior, and the bipolar person cannot contain the mania. Manic states overwhelm the personality and cognitive processes, regardless of feeling abundantly happy or sad.
Bipolar Symptoms in Men
Unfortunately, many people refuse to acknowledge the reality of the disorder in themselves or those close to them (Pipich 40). Denial is common. In my experience, men may be more inclined to deny the problem, since it deals with emotional extremes and men are taught not to show emotion.
Gender norms additionally affect identification and treatment of the disorder. Women diagnosed as bipolar, for example, are far more likely to be prescribed anti-depressant medications and other forms of treatment. This raises the possibility that women are simply more willing to express their states of depression (Karanti et al. 305). There are, of course, other ways of identifying bipolar in men and women, but it is important to recognize this indication of gender before focusing on male symptoms, or symptoms more commonly seen with men.
While the illness and the symptoms are virtually identical in both genders, gender stereotypes sometimes incorrectly justify symptoms that would otherwise indicate the illness. For example, the manic state of euphoria translates to an ongoing and exaggerated feeling of well-being in men and women. Often for no apparent cause, the person just “feels great.” This can result in a type of extreme overconfidence, which might be harder to detect in men, as confidence is encouraged in men especially in American culture where confidence is synonymous with masculinity. As a result, it can become more difficult to see atypical behavior in a man.
Poor decision-making and risk-taking or reckless behaviors are also symptoms associated with mania in a person with bipolar. Again, American men are generally expected to act cautiously, so any recklessness might stand out more in men than in women. Risk-taking, sleeplessness, hyperactivity, and inexplicable euphoria—are all symptoms to watch out for in men with bipolar disorder.
Bipolar in Men During a Depressive State
In both genders, bipolar depression manifests itself through six behaviors: excessive sleeping, changes in eating, being withdrawn and sullen, irritability, inability to concentrate, and lack of interest in virtually anything typically enjoyed. Extremes, not surprisingly, include suicidal impulses and attempts as well as reclusive behaviors.
Bipolar disorder carries a high risk of suicide. Suicide in men is a significant social, behavioral health and medical problem. Men have a much larger rate of attempts and completed suicide rates in comparison with women. Early identification of bipolar disorder and risk factors is essential to intervene, treat, and prevent any risk-taking behavior.
Again, it can be argued that women more easily reveal their emotion and more willing to seek help. Extensive evidence supports that men are typically unwilling to admit to depression. In fact, they often take extreme measures to avoid being identified as depressed—clinically or otherwise—because depression and the symptoms that come with it defy male norms of independence and emotional control.
Clinicians increasingly report that depression and bipolar disorder are vastly underrepresented in male populations due to the pervasive association of these conditions with character weakness. What emerges when the 10 manic and depressive symptoms are noted, then, is that gender norms create greater difficulty diagnosing the illness in men. This is an illness centered on deep emotional and psychological conflicts, generated genetically and environmentally. All symptoms are behavioral, as opposed to illnesses that manifest in physical symptoms, food poisoning, for example.
Sadly, men suffering from bipolar are less easy to identify and less likely to seek assistance and treatment.
How to Help a Man Who May be Struggling
Both men and women resist seeing themselves as suffering from a clinical disorder but men tend to be even more sensitive to the suggestion that they are mentally ill. An adolescent boy may be less antagonistic to the suggestion that they may be struggling with a mood disorder as teens are less rigidly circumscribed by gender roles. But teens must be handled with care as adolescents can be volatile and if they sense any attempt to be controlled by an adult, will likely reject an adult’s input.
If you’re concerned about a male loved one, here are some tips to help you start a conversation:
- Seek out a private or confidential setting for your discussion. This shows respect and consideration for their privacy and will help him to feel comfortable confiding in you.
- Start by emphasizing your care and concern for him.
- Try to avoid becoming emotional yourself.
- Don’t list erratic behaviors or questionable actions as that may antagonize him.
- Point out that something beyond their control may be responsible for the concerning behaviors.
- Explain that many mental health conditions can be treated effectively and you will assist in getting him the help he needs.
Bipolar disorder is typically a lifelong, chronic illness. In most cases, long-term help may be needed to stay well this includes sticking with treatment and developing a plan for when symptoms return, even if you have been feeling well for a long time. Setbacks can happen. But with proper support and treatment, it’s possible to return a level of quality to your life and learn to live well with bipolar disorder.
If you are in crisis, call the toll-free National Suicide Prevention Lifeline at: 1-800-273-TALK (8255). Help is available 24 hours a day, seven days a week. All calls are confidential.
Article Sources Last Updated: Jun 4, 2019
You just failed a big test and are pretty bummed about it. Or, you’re going through a bad breakup and feeling pretty down. We’ve all been there. In day-to-day life, everyone experiences ups and downs every now and then. Eventually, time passes on and our mood becomes better and we become “ourselves” again. Unlike the normal population, individuals living with bipolar disorder cycle through extreme mood swings that cause disruption to daily life.
Bipolar Disorder. Manic Depression. Bipolar Affective Disorder. All three terms are synonymous with each other and the name of a mental health disorder affecting approximately 3% of the American population.1
The classic symptoms of bipolar disorder are the periodic changes in mood, alternating between periods of elevated mood (mania or hypomania) and periods of depression. If you are living with bipolar disorder, you may feel energetic, abnormally happy, and make reckless or impulsive decisions during manic states. During depressive states, you may feel the overwhelming urge to cry, experience feelings of hopelessness, and have a negative outlook on life. Hypomania is a less severe form of mania, where you generally feel pretty good–with a better sense of well-being and productivity.
With bipolar disorder, you don’t just feel “down in the dumps;” your depressive state may lead to suicidal thoughts that change over to feelings of euphoria and endless energy. These extreme mood swings can occur more frequently — such as every week. Or, show up more sporadically — maybe just twice a year. There is also no defined pattern to the mood swings. One does not always occur before the other — and the length of time you are in one state or the other varies as well. The good news is that there are a number of treatments that can keep your moods in check and allow you to live a productive life.
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Rates of bipolar disorder in men and women are about equal and the typical onset of symptoms occur around 25 years of age.2 There are many types of bipolar disorder; three of the most common include Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder. Bipolar I Disorder is characterized by the occurrence of at least one manic episode, preceded or followed by a hypomanic or major depressive episode. Manic episodes may be so severe they significantly disrupt your daily functioning or may trigger a break from reality (psychosis). If you are suffering from Bipolar I Disorder, you may require hospitalization.
If you are living with Bipolar II Disorder, you experience at least one major depressive episode lasting two weeks or more and at least one hypomanic episode lasting at least four days. But, you will not have experienced a manic episode. Cyclothymic disorder is characterized by at least two years of multiple occurrences of hypomania symptoms and depressive symptoms – these symptoms are less severe than hypomanic episodes and major depressive episodes. During this time, symptoms present themselves at least half of the time and are constant for at least two months.
Signs and Symptoms of Bipolar Disorder
Because there are many different stages of bipolar disorder, the signs and symptoms vary from person to person and from type to type. Presented below are the most common signs and symptoms of bipolar disorder, categorized by emotional state.
According to the DSM-5, a manic episode is characterized by a distinct and abnormal state of elevated, expansive, or irritable mood occurring for at least one week. The manic episode is persistently driven by goal-directed behavior or energy. A hypomanic episode is a distinct and abnormal state of elevated, expansive, or irritable mood that lasts for at least four consecutive days.
If you have been diagnosed as suffering from bipolar disorder, you may experience any of the signs and symptoms during a manic period:
- A long period of feeling “high” — an overly elated, happy, and outgoing mood
- Feeling extremely irritable
- Being easily distracted
- Having racing thoughts
- Talking very fast
- Jumping from one thought to another when talking
- Taking on a lot of new projects
- Boundless energy
- Sleeping very little
- Not feeling tired
- Unrealistically believing you can do something
- Engaging in impulsive, pleasurable, and high-risk behaviors (i.e. poor financial investments, sexual indiscretions, shopping sprees)
- Inflated self-esteem
- Feelings of grandiosity
- Increased agitation
- Increased goal-directed activity
- High sex drive
- Making grand and unattainable plans
- Detachment from reality — psychosis that may include delusions or hallucinations
Manic behaviors interfere with functioning at school or work, in social situations, and in relationships. These behaviors occur on their own — they do not occur due to alcohol or drug use, a medical illness, or a side effect of a medication.
The depressive side of bipolar disorder is characterized by a major depressive episode resulting in a depressed mood or loss of interest or pleasure in life. If you are living with bipolar disorder, during depressive states, you may experience some of the following signs and symptoms:
- Feeling sad, tearful, hopeless, or empty for the majority of the day on a daily basis
- No pleasure or interest in day to day activities
- Weight fluctuations — including significant weight loss or weight gain
- Sleep disturbances — sleeping too much or other sleep problems, such as insomnia
- Restlessness or slowed behaviors
- Suicidal thoughts, planning, or attempts
- Feelings of guilt and worthlessness
- Inability to concentrate
- Loss of energy
- Feelings of fatigue
- Psychosis — being detached from reality; delusions or hallucinations
- Loss of interest in activities you once enjoyed
- Uncontrollable crying
Depressive behaviors can interfere with school or work, family or personal relationships, and social functioning. If you are suffering from bipolar disorder and undergoing a depressive episode, it is not the result of substance abuse, medications, an underlying medical condition, or stressful situation – such as grieving the loss of a loved one.
What Causes Bipolar and How is it Diagnosed?
If you are suffering from bipolar depression, you may be wondering what it is that caused this condition. What are the risk factors? Like most mental illnesses, there is not one single cause that scientists can pinpoint to tell you why you are suffering from bipolar disorder. But, it appears genetics are likely to account for around 60-80% of the risk for developing bipolar disorder – indicating the key role heredity plays in this condition. Your risk of developing bipolar disorder is also increased significantly if you have a first-degree relative suffering from this mental state.
Environmental factors also have shown a connection to bipolar disorder – and they likely interact with genetic predispositions to catapult the onset of the disorder. What this means is that if you are living with bipolar disorder, it was probably a mixture of genes and a life event that triggered the disorder to present itself in your everyday life. You may have suffered from some type of traumatic event or abuse or a troubling and/or stressful interpersonal relationship of some type.
If you believe you are experiencing signs and symptoms of mania or depression, go see your doctor. Oftentimes, it is your family or co-workers who are first to recognize signs and symptoms of bipolar disorder. If you are suffering from this condition, you may be reluctant to seek help at first – mostly because you are not able to notice how disruptive the disorder is to your life. And, you may enjoy feeling euphoric.
However, it is important to treat this condition so you can manage your emotional states and live a productive, full life. Bipolar disorder will not go away on its own and you are likely to live with this condition for the rest of your life. However, with the right treatment plan, you can live a good life.
Your doctor or mental health provider will assess you physically to rule out any underlying medical conditions that may be causing your manic or depressive states. If no underlying medical conditions present themselves, you are likely to be referred to a mental health provider for further diagnosis.
Your mental health provider will perform a series of psychological assessments to gather additional information about your condition. These assessments will aid your mental health provider in diagnosing the presence of this condition in your life and also determine which type of bipolar disorder you may be suffering from.
What are the Treatment Options?
Medications and psychotherapy are the most commonly prescribed treatment plans for people suffering from bipolar disorder. And the success rate of these treatment plans is great if followed correctly and consistently.
If you are living with bipolar disorder, you have likely been prescribed a number of different medications. The most common medications used to treat bipolar include mood stabilizers, antidepressants, and atypical antipsychotics. Often, the first course of drug therapy is the prescription of mood stabilizers. Lithium is one of the most well-known and effective mood stabilizers for individuals affected with bipolar disorder.
You may also be prescribed an anticonvulsant for use as a mood stabilizer. Atypical antipsychotics are often combined with antidepressants to treat bipolar disorder. Because the use of antidepressants can trigger hypomanic or manic states, you will likely take an antidepressant with a mood stabilizer to even out emotions.
Psychotherapy has also been an effective tool for people living with bipolar disorder. Cognitive behavioral therapy will help you learn how to change negative or harmful thoughts or behaviors. Family-focused therapies involve your family members and focus on teaching coping strategies, communication counseling, and problem-solving techniques.
Psychoeducation has also been a powerful therapy tool to teach individuals living with bipolar disorder about their condition and how to treat it. This education allows you to notice trigger points and impending mood swings so you can seek treatment before a full-blown episode occurs. Interpersonal and social rhythm therapy (IPSRT) is used often in treating bipolar disorder as well – as this form of psychotherapy focuses on the stabilization of daily rhythms — sleep, wake, mealtimes — to introduce consistent routines to better manage moods.
Due to challenging side effects including insomnia, tremors, and weight gain, many people living with bipolar disorder aren’t helped by the current medication options. The good news is researchers continue to investigate new treatment modalities including the potential of drugs used for Lou Gehrig’s disease as well as drug used for breast cancer to treat bipolar. Transcranial magnetic stimulation is also being studied.
To learn more about ongoing research and for information about participating in a study, visit the Depression and Bipolar Support Alliance.3
In severe cases, you may need to be hospitalized for your own safety and well-being. This may result from severe states of mania or depression leading to psychosis, risky behaviors, or thoughts of suicide.
If you are living with bipolar depression, it is important to follow your treatment plan. Pay attention to warning signs or triggers — this can help you seek additional treatment, talk with your counselor or mental health provider, and prevent the onset of a full attack. Avoid drugs and alcohol, and take your medication as prescribed — even on days you feel fine. Following your treatment plan, educating yourself about your disorder, and engaging in prevention techniques will positively contribute to your overall well-being and life satisfaction.
Article Sources Last Updated: Oct 21, 2019
Bipolar disorder (BPD) is a serious mental illness and is considered to be a mood disorder. A thorough assessment and early treatment of BPD gives individuals the best outcomes.
If you have bipolar you will have extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).
Episodes of mania and depression often last for several weeks or months.
During a period of depression, your symptoms may include:
- feeling sad, hopeless or irritable most of the time
- lacking energy
- difficulty concentrating and remembering things
- loss of interest in everyday activities
- feelings of emptiness or worthlessness
- feelings of guilt and despair
- feeling pessimistic about everything
- being delusional, having hallucinations and disturbed or illogical thinking
- lack of appetite
- difficulty sleeping
- waking up early
- suicidal thoughts
The manic phase may include:
- feeling very happy, elated or overjoyed
- talking very quickly
- feeling full of energy
- feeling self-important
- feeling full of great new ideas and having important plans
- being easily distracted
- being easily irritated or agitated
- being delusional, having hallucinations and disturbed or illogical thinking
- not feeling like sleeping
- not eating
- saying things that are out of character, often risky or harmful
During a manic phase, extreme positive feelings about yourself or your life could lead to risky actions or unwise decisions. These could have negative consequences on your finances, work or relationships.
Patterns of depression and mania
You may have episodes of depression more often than episodes of mania, or vice versa.
Between episodes, you may sometimes have periods where you have a “normal” mood.
The patterns aren’t always the same and some people may experience:
- rapid cycling – quick and repeated swings from a high to low without having a “normal” period in between
- mixed state – symptoms of depression and mania together – over activity with a depressed mood
If your mood swings last a long time but aren’t severe, you may have cyclothymia. This is a mild form of bipolar disorder.
If you’re experiencing an elevated mood, or marked irritability, without changes in thinking or sleep, this could be hypomania.
Bipolar disorder can be a condition of extremes. You may be unaware of changes in your mood and behaviour during phases of mania or hypomania.
After the episode is over, you may be upset by your out-of-character behaviour. But at the time, you may believe other people are being negative or unhelpful.
Some people with bipolar disorder have more frequent and severe episodes than others. The extreme nature of the condition means staying in a job may be difficult. Relationships may also become strained. There’s also an increased risk of suicide.
During episodes of mania and depression, you may experience strange sensations. For example, hearing or smelling things that aren’t there (hallucinations). These experiences are related to changed perceptions of normal senses. They respond well to treatment.
People with bipolar disorder may also believe things that seem irrational to other people (delusions). These are symptoms of psychosis or a psychotic episode.