The mental health condition known as manic depression or bipolar disorder is a two-pronged illness that causes vast and unusual shifts in mood and energy levels, which then lead to behavioral changes. Patients with manic depression experience sustained periods of “mood episodes” called mania and depression. Mania and depression have distinctly different symptoms, and the alternating appearance of both will frequently signify the presence of one form or another of bipolar disorder. Bipolar disorder is lifelong, but treatment often reduces the frequency and severity of episodes and can also allow patients to be free of symptoms when they are between episodes.
Mania is experienced as an extremely joyful, excited, or energetic state, or sometimes as extreme irritability. Patients experiencing a manic episode feel a sustained “high” or are overly happy and even outgoing. Common behavioral changes include racing thoughts, fast speech, distractibility, having an exaggerated sense of ability, being restless and sleeping very little, increasing activities, and impulsive behavior. Hypomania is a milder form of the manic state and it involves good feelings and productivity, but still is more energetic than the person’s normal state. People experiencing hypomania may not even be able to tell a difference in their mood or behavior, but often family and friends can sense the change.
Depressive episodes in bipolar disorder exhibit many of the same characteristics as major depressive disorder, with a pervading sense of extreme sadness or hopelessness. Depression is also characterized by a loss of interest or enjoyment in activities that were previously enjoyable. Behavioral changes that accompany a depressive state include feelings of sluggishness or fatigue, difficulty concentrating or remembering, feeling restless, and/or thoughts of suicide. Changes in eating or sleeping patterns are also frequently present in a depression.
It is possible to have “mixed states,” in which elements of both depression and mania are present. Mixed states can include symptoms such as trouble sleeping, feelings of agitation, feelings of sadness or hopelessness, thoughts of suicide, changes in appetite, and also heightened energy.
There are four main types of bipolar depression. Bipolar I has manic or mixed episodes lasting at least a week and (typically but not always) depressive episodes lasting 2 weeks or more. Bipolar II shows a pattern of depressive episodes with hypomanic periods, but no truly manic or mixed episodes. Bipolar Disorder Not Otherwise Specified (or NOS) involves characteristics of bipolar without meeting the qualifications of Bipolar I or II. And Cyclothymia, or cyclothymic disorder, is a mild form of bipolar that includes episodes of hypomania and mild depression occurring over the course of at least two years.
Treatment for bipolar depression is lifelong because there is no cure. Treatment can be very effective, however, in allowing people to exert control over their lives and be fulfilled and productive. Treatment plans are most effective when the patient and doctor(s) work together and talk openly about options and progress. Typically treatment involves both medication and psychotherapy. Often the first type of medication prescribed is a mood stabilizer. Atypical antipsychotics can be prescribed as well, and they are often taken along with other medications. Antidepressants can be taken to address depressive episodes, but they must be taken in conjunction with other medications to prevent manic episodes from occurring and to keep the disorder from descending into rapid cycling, which involves four or more episodes per year.
Psychotherapy is an important part of treatment for bipolar disorder. Therapy allows people with the disorder to find support, education, and guidance as they navigate life. Couples and families can also benefit from psychotherapy by learning coping techniques and strategies for helping their loved one recognize and manage their mood shifts. Cognitive Behavioral Therapy (CBT) is one psychotherapeutic approach that equips patients with the ability to change harmful or destructive thought and behavior patterns that crop up during an episode. CBT can also be helpful for families.
Electroconvulsive therapy (ECT) may be used as a treatment option in cases that are not improved by medications or psychotherapy, or in patients who are unable to take medications as a result of other medical conditions, such as pregnancy. It is typically not considered as the first treatment option, however.
Maintenance treatment is critical for keeping the disorder from reoccurring. Keeping an open, honest dialogue with the entire medical team, including counselors, psychiatrists, and physicians, is a significant part of any maintenance effort. It is also important to keep taking medications and seeking psychotherapy for bipolar disorder even when remission has been long maintained, as failure to stay medicated and in therapy may lead to the onset of another episode.