Definition

Bipolar disorder is a mental health condition that causes extreme mood changes. These changes can include episodes of mania or hypomania, which are times when a person's mood is elevated, and depression, which is a low mood. Mania is a more severe form of elevated mood than hypomania.

This unpredictable mood can affect sleep, energy, behavior, and decision-making ability, making daily life difficult for people with bipolar disorder.

Bipolar disorder can manifest at any age, but it is commonly diagnosed during adolescence, early adulthood, pregnancy, or the postpartum period.

Causes

The exact cause of bipolar disorder is unknown, although various factors play a role in its development, including: 

• Biological factors, where there are changes in the brain of people with bipolar disorder.
• Genetic factors where bipolar disorder occurs more often in people who have close family members with bipolar disorder, for example, parents or siblings.

Risk factor

Some factors that can increase the likelihood of developing bipolar disorder or triggering it are: 

• Close family history of bipolar disorder.
• History of severe stress, such as the loss of someone close to you or other traumatic events.
• Drug or alcohol abuse.

Symptoms

There are two poles of bipolar disorder - mania/hypomania and depression - with episodes occurring multiple times a year.

Mania and hypomania are two different episodes but have the same symptoms. The only difference is that mania's symptoms are more severe than hypomania and cause more serious problems in work, school, social interactions, and relationships. Symptoms can vary from person to person.

An episode of mania or hypomania consists of three or more of the symptoms below:

• Feeling very happy
• Feeling very energized
• High self-confidence
• Reduced need for sleep
• More talkative than usual
• Ideas abound
• Easily distracted
• Lack of concentration
• Making bad decisions, for example, during a manic episode, investing all your money without thinking twice or engaging in sexual activity without thinking about the consequences
• Nervous

A major depressive episode consists of symptoms severe enough to cause difficulty in daily activities such as work, school, and social interactions. An episode is characterized by at least 5 of the symptoms below:

• Feeling or Mood down, feeling sad, empty
• Feeling helpless
• Crying for no apparent reason
• Loss of interest or pleasure in things you usually like
• Don't want to do activities
• Decreased or increased appetite
• Unintentional weight loss or gain
• Difficulty sleeping or sleeping too much
• Fatigue
• Feeling low on energy
• Feelings of worthlessness and guilt for unknown reasons
• Decreased ability to think, concentrate and make decisions
• Thinking, planning, or attempting suicide

Recognizing bipolar disorder symptoms in children and adolescents is a difficult task. Though there are some signs, it's challenging to distinguish them from normal mood changes, stress-related symptoms, or other medical conditions. However, one of the primary symptoms of bipolar disorder in children is abrupt mood changes that are unusual and distinct from regular mood shifts.

Diagnosis

To diagnose bipolar disorder, a doctor will conduct physical and psychiatric exams. The diagnosis is based on the type of bipolar disorder. There are several types of bipolar and related disorders, including:

• Type I bipolar disorder: consists of at least one manic episode that lasts at least 7 days and can be preceded or followed by a hypomanic or major depressive episode. Manic symptoms are usually so severe that they require hospital treatment. In some cases, mania can trigger psychosis (loss of ability to assess reality), which requires hospital treatment.
• Bipolar disorder type II: consists of at least one major depressive episode and at least one hypomanic episode, with no manic episodes. This type is not more severe than type I, but it is a different diagnosis.
• Cyclothymic disorder: multiple periods of hypomania and depression that are not severe and have lasted at least two years (or one year in children and adolescents).
• Other types: bipolar induced by drugs, alcohol, or medical conditions such as Cushing's disease, multiple sclerosis, and stroke.

The doctor will also examine for other conditions that frequently coexist with bipolar disorder and exacerbate bipolar symptoms. These conditions can be treated to enhance the control of bipolar disorder. They include anxiety disorders, eating disorders, ADHD, drug and alcohol abuse, as well as medical conditions such as heart disease, thyroid disease, obesity, and so forth. 

Management

Although bipolar disorder is a lifelong condition, its symptoms can be controlled with therapy. The main therapy is with drugs and psychotherapy. The appropriate choice of therapy will be determined by a specialist doctor.

• Medication: Medications are often necessary for mood control and stabilization to prevent episodes. The type and dosage of medication will be determined based on your symptoms.
• Psychotherapy: Therapy is an essential part of treating bipolar disorder and can be conducted individually, with families or in groups.

Apart from medication, lifestyle changes are necessary to manage bipolar disorder, including: 

• Stop drinking alcohol and using illegal drugs.
• Surround yourself with people who have a positive influence.
• Create a healthy routine such as a regular sleep, eating and exercise schedule to stabilize your mood. However, you must consult a doctor before starting a particular physical exercise program. You can also tell your doctor if you are having trouble sleeping.
• Consult a doctor before taking other drugs from other doctors because some drugs can trigger episodes of mania or depression.
• Keep a mood diary to record daily mood, medication consumption, sleep time, activities, and feelings to help find the trigger for the episode and appropriate therapy.

Complications

If left untreated, bipolar disorder can significantly impact all areas of life, including: 

• Drug and alcohol use problems
• Suicidal attempts or thoughts
• Financial problems
• Law problems
• Have problems with other people
• Poor ability to work or study

Prevention

Bipolar disorder cannot be prevented, but it's possible to prevent its progression or other mental disorders by seeking therapy as early as possible. Additionally, it's possible to prevent minor symptoms from turning into serious episodes. This can be achieved by taking appropriate measures such as:

• Recognize the signs of an episode and its triggers. Once you notice these signs, consult with a doctor immediately. It's also good to ask someone close to you for help monitoring these signs.
• Avoid drugs that are not prescribed by a doctor and alcohol.
• It is important to take bipolar medication as prescribed by your doctor and not to stop taking it even if you feel better. Stopping the medication can cause a return or worsening of symptoms.

When to see a doctor?

If you experience symptoms of depression or mania, it is crucial to seek help from a psychiatrist, as this condition cannot be treated without therapy. During a manic episode, you may feel happy, experience feelings of euphoria, and be more productive due to increased energy and a reduced need for sleep. You may also have a constant flow of ideas. However, after the episode ends, you may experience a decline in mood, which can make you feel depressed and tired and even lead to financial, legal, or relationship problems with people around you.

You need to call the emergency number or go to the emergency room immediately if you are having thoughts or have tried to end your life.