Bipolar Disorder: Symptoms, Test, Causes and Treatment

Bipolar disorder (previously called manic depression or manic-depressive disorder) is periods of alternating high and low mood and energy. The mood and energy swings must be severe enough to have a negative impact on your life.

Bipolar disorder is a spectrum. Most cases of bipolar disorder are not the extreme. The typical case is someone who has a job and a family, who thinks they suffer from depression, but who occasionally has unexplained highs and energetic moods. Approximately 4.4 percent of adults will develop bipolar disorder in their lifetime.[1]

Table of Contents

Symptoms of Bipolar Disorder
Definition and Diagnosis of Bipolar Disorder
Causes of Bipolar Disorder
Treatment of Bipolar Disorder

Six Symptoms of Bipolar Disorder

  • Sense of great happiness or well-being
  • Very optimistic or high self-esteem
  • Little need for sleep
  • More talkative or sociable than usual
  • Take on more projects and activities
  • More risk-taking behavior

Mania versus Hypomania

The periods of high mood and energy are called mania or hypomania. Mania is the extreme form of bipolar disorder. It can result in severe negative consequences, for example an individual may lose touch with reality (psychosis). They may think they will change the world or that they are a messenger from God.

Hypomania is the more common and less severe form. It does not cause an individual to lose touch with reality.

Bipolar I Disorder versus Bipolar II Disorder

Bipolar I Disorder: This is classic manic-depression, associated with at least one manic episode with psychosis or with severe consequences.

Bipolar II Disorder: This is the most common form associated with at least one episode of hypomania and no psychosis.

Definition and Diagnosis of Bipolar II Disorder (DSM-F31.81)

Bipolar I disorder is usually easy to recognize, but bipolar II disorder can be subtle. These are the diagnostic criteria of bipolar II disorder based on the DSM-5.[2]

  • Have you had a period of unusually elevated mood or irritability lasting for at least 4 days?
  • During this period, have you had at least 3 of the following criteria?
    • More self-confident: Did you feel on top of the world, or like you had all the answers? Did you have unwarranted optimism, and maybe started multiple new projects?
    • Decreased need for sleep: Were you able to get by on just a few hours of sleep and still be full of energy the next day?
    • More talkative: Did you talk faster or louder than normal? Did people comment on your talkativeness?
    • More social: Were you more friendly to friends or strangers? Were you more flamboyant, maybe overly familiar, or flirtatious?
    • More goal-oriented: Did you take on big projects, or clean your house more than usual, or have long exercise sessions?
    • Distractible: Did you jump from one idea to another, or have difficulty concentrating? Did your conversation change rapidly from one topic to another? Did people say it was exhausting to keep up with you?
    • Reckless behavior: Did you engage in reckless spending, driving, or relationships? Did you buy things you didn't need, or that you regretted later? Did you engage in risky sexual talk or behavior?
    • Did your symptoms have a significant negative impact on your life (relationships, work, social life, or emotional life).
    • In order to be bipolar II disorder, you did not require hospitalization, nor did you lose touch with reality (which would meet the criteria of bipolar I disorder).
    • Your symptoms were not due to medication, substance abuse, or any other medical condition (e.g., hyperthyroidism).
    • Your symptoms were not due to another mental health condition such as borderline personality disorder.
    • You have also had at least one episode of depression.

    Related Conditions

    Cyclothymic disorder is a low grade, long-term version of bipolar II disorder. The symptoms must last for at least two years, and the symptoms must occur for at least half that time.

    Borderline personality disorder is mood instability, along with instability in relationships and self-image associated with poor impulse control. In bipolar disorder you have distinct episodes of elevated mood and the other related symptoms, whereas in borderline personality disorder there are no distinct episodes and the instability can be quite fluid over a day.

    Tests

    Medical Tests

    There is no simple blood test for bipolar disorder. The diagnosis is based on history. Your health care provider can determine if your bipolar disorder is caused by an underlying medical condition, such as heart disease or thyroid problems. This may require blood tests and an electrocardiogram (ECG). A complete assessment should also include questions about your alcohol consumption and any substance use, which can contribute to bipolar disorder.

    Standardized Screening Test for Bipolar Disorder

    The Mood Disorder Questionnaire (MDQ) is a brief and effective screening tool for identifying bipolar I disorder. But because the symptoms of hypomania can be subtle, none of the available screening tools are considered reliable for the detection of bipolar II disorder.[3]

    Here is an online Bipolar II Disorder Test based on the DSM criteria (pdf).

    Bipolar Disorder is often Misdiagnosed as Depression

    Bipolar disorder is often misdiagnosed as depression because patients rarely mention elevated moods and only focus on depressed moods. A hypomanic state usually feels euphoric, therefore there is little reason to complain or to mention it when interviewed.

    Because people rarely complain about hypomanic moods, the average time between the onset of bipolar symptoms and a formal diagnosis is almost eight years.[4]

    The danger of treating bipolar disorder as depression is that antidepressants can bring on a hypomanic phase. The antidepressant will treat the depression symptoms. But then the antidepressant will continue to push your mood higher and you can become hypomanic. This is why it's important to correctly diagnose bipolar disorder.

    Causes of Bipolar Disorder

    Family History

    Genetics explain approximately 70 percent of bipolar disorder.[5] The genetic component in bipolar disorder is one of the strongest among mental health conditions. If one parent has bipolar disorder, a child is approximately 10 times more likely to develop bipolar disorder.[6]

    Substance Abuse

    Almost all drugs of abuse can produce hypomanic symptoms. Even depressant drugs can trigger hypomania.

    Marijuana can almost triple the chance of developing psychotic symptoms and bipolar disorder.[7] Marijuana which is normally considered a depressant can cause manic symptoms. A 3-year study followed over 4,000 psychosis-free people. It came to the conclusion that marijuana smokers are three times more likely to develop psychotic symptoms (including manic-depression) than non-smokers.

    Medical Causes of Bipolar Disorder

    As mentioned above, antidepressants are probably the most common medical cause of bipolar symptoms. Some non-psychiatric medications have been known to trigger a hypomanic episode, especially in people who are predisposed. Thyroid medications and corticosteroids such as prednisone are the most common. A hyperactive thyroid condition can also potentially trigger a hypomanic episode.

    Treatment of Bipolar Disorder

    Medication is usually the first line of treatment for bipolar disorder because of its strong biochemical nature. Drugs include the following:

    • Lithium
    • Anticonvulsants (carbamazepine, lamotrigine, valproate)
    • Second-generation antipsychotics (aripiprazole, clozapine, lurasidone, olanzapine, quetiapine, risperidone, ziprasidone)

    All these medications can be helpful, but they require close monitoring by your physician.

    Find Help

    Bipolar disorder is treatable. Visit www.IWantToChangeMyLife.org/findhelp for a list of resources, including crisis phonelines, counselors, therapists, psychologists, psychiatrists, and support groups. You can change your life.

    References

    1. National Comorbidity Survey Lifetime Prevalence Estimates. 2007.  DOI: http://www.hcp.med.harvard.edu/ncs/.
    2. American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association.
    3. Miller, C. J., Johnson, S. L., & Eisner, L., Assessment Tools for Adult Bipolar Disorder. Clin Psychol (New York), 2009. 16(2): p. 188-201. PMC2847794.
    4. Mantere, O., Suominen, K., Leppamaki, S., Valtonen, H., et al., The clinical characteristics of DSM-IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS). Bipolar Disord, 2004. 6(5): p. 395-405.
    5. Edvardsen, J., Torgersen, S., Roysamb, E., Lygren, S., et al., Heritability of bipolar spectrum disorders. Unity or heterogeneity? J Affect Disord, 2008. 106(3): p. 229-40.
    6. Craddock, N., & Jones, I., Genetics of bipolar disorder. J Med Genet, 1999. 36(8): p. 585-94. PMC1762980.
    7. van Os, J., Bak, M., Hanssen, M., Bijl, R. V., et al., Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol, 2002. 156(4): p. 319-27.

     

    Last Modified: September 10, 2018