Bipolar disorder is one of the most misunderstood mental health conditions out there. If your perception of the illness is mainly shaped by pop culture depictions like Carrie’s counter-terrorist exploits on Homeland, then spoiler alert: The reality of bipolar disorder is much more nuanced than it may seem. Keep reading to learn 14 key facts about bipolar disorder that everyone should know.
1. Bipolar disorder is a mental illness characterized by dramatic shifts in mood and behavior.
These shifts are referred to as “mood episodes,” according to the National Institute of Mental Health (NIMH). There are two main types of episodes: manic episodes and depressive episodes. (Hence why bipolar disorder used to be referred to as manic depression.)
In between these episodes, a person with bipolar disorder may have periods without symptoms of either mania or depression.
2. Bipolar depressive episodes tend to look a lot like classic depression.
Without knowing somebody’s medical history, it’s virtually impossible to determine whether their depression is the result of bipolar disorder or something like major depressive disorder, Dolores Malaspina, M.D., director of the Psychosis Program in the department of psychiatry at the Icahn School of Medicine at Mount Sinai, tells SELF.
But in general, the NIMH highlights these as the signs and symptoms of a bipolar depressive episode:
- Unusually low energy
- Decreased activity levels
- Feelings of hopelessness and despair
- Loss of enjoyment in activities
- Sleeping too little or too much
- Feeling worried or empty
- Eating too little or too much
- Trouble concentrating or remembering things
- Suicidal thoughts
Severe episodes of depression can also involve psychosis involving delusions or hallucinations, the NIMH notes.
3. Manic episodes are more complicated than simply being “up.”
Experiencing mania doesn’t necessarily mean a person is running around feeling invincible and happy, says Dr. Malaspina.
As the NIMH explains, there are many different signs and symptoms of mania:
- Unusually high energy
- Increased activity levels
- Feeling wired or jumpy
- Feelings of elation
- Feelings of agitation or irritability
- Feelings of overconfidence
- Trouble sleeping
- Talking unusually quickly
- Trying to take on too many things at once
- Engaging in risky behavior, such as taking sexual or financial risks you wouldn’t otherwise
4. Hypomania can involve many of the same symptoms of mania but on a less severe scale.
“There are very different severities of the mood elevation,” Wendy Marsh, M.D., director of the Bipolar Disorders Specialty Clinic and an associate professor in the department of psychiatry at the University of Massachusetts Medical School, tells SELF. At the lower end of the spectrum is hypomania, which is when a person doesn’t experience a full-blown manic episode, but only some of the symptoms on a milder scale. “It can seem like useful, goal-oriented energy,” Dr. Malaspina says.
Some people only ever experience hypomania, but it’s also possible to experience full mania, which can eventually become dangerous. “You can have too much belief in yourself … [and] very poor judgment,” says Dr. Malaspina. This can contribute to behavior like having unprotected sex or investing all your money in a business venture, she says. This grandiose thinking can also escalate into delusion. “When someone has mania, they really need to be under a doctor’s care,” Dr. Malaspina says.
5. People can experience symptoms of mania and depression at the same time.
These “mixed episodes” involve the high energy and activity of mania and the hopelessness and despair of depression. “That’s a really high-risk situation because people are miserable and they have all this extra energy,” says Dr. Marsh. These episodes are just as or more dangerous and life-threatening than severe mania, Dr. Marsh says, and require immediate care.
6. There are several types of bipolar disorder.
The symptoms of bipolar disorder can present at different severities and in various combinations in different people, so there are actually four different conditions related to the disorder.
Bipolar I consists of manic episodes lasting seven days or more—or manic symptoms that last any amount of time but are severe enough to warrant immediate hospitalization, according to the NIMH. Bipolar I typically also comes along with depressive symptoms lasting at least two weeks, or it can cause those mixed episodes that include signs of depression and mania.
With bipolar II, people experience depressive episodes along with episodes of hypomania, but not the full mania involved in bipolar I.
Then there’s a condition called cyclothymia, which resembles a less severe form of bipolar disorder. People with cyclothymia experience symptoms of hypomania and symptoms of mild depression for at least two years, interspersed with symptom-free periods, but the symptoms aren’t severe enough to qualify as actual hypomanic or depressive episodes. “Cyclothymia has both pieces—a little bit too high and a little bit too low—but never so much that they really appear dysfunctional,” Dr. Malaspina explains. People with untreated cyclothymia are at an increased risk of eventually developing bipolar disorder, though.
Finally, someone with symptoms of bipolar disorder that don’t fit neatly into the above buckets can have what is termed Other Specified and Unspecified Bipolar and Related Disorders, the NIMH explains.
7. The length of these mood episodes can vary from person to person.
Two weeks is the set minimum for a depressive episode, according to the NIMH but they often stretch out for months, Dr. Marsh says. Mania typically lasts for at least a week. However, “There’s not really a fixed range,” says Dr. Malaspina.
8. There is no known single cause of bipolar disorder.
Scientists are still investigating the roots of the disorder, but they have identified three risk factors that contribute to your likelihood of developing the condition, according to the NIMH: genetics, brain structure and functioning, and family history.
Experts have yet to pinpoint which genes may be involved here and to what extent. Same goes for brain structure and functioning; there’s a lot that’s still to be determined. What’s clearer is that bipolar disorder does tend to run in families, according to the NIMH. While most people with a family history of the condition will not develop it, having a parent or sibling with bipolar disorder does increase your odds.
9. It can take a while to receive a proper diagnosis of bipolar disorder, which is often misdiagnosed as depression.
People who have bipolar disorder are typically more likely to reach out for help during a depressive episode than a manic or hypomanic one, according to the NIMH. (Remember, mania can sometimes feel productive instead of like a problem that needs treatment.) Diagnosing bipolar disorder requires establishing a history of both mania and depression, so if all the doctor sees during the first evaluation are signs of depression, a misdiagnosis is not unlikely, Dr. Malaspina says.
Even if the person first presents with only symptoms of depression, a good clinician that sees them regularly should be able to recognize the mania over time and reassess their original diagnosis, Dr. Malaspina says.
10. Children and teenagers can have bipolar disorder, too.
Most people who have the condition develop it in their late teenage or early adult years, according to the NIMH. However, younger teenagers and children can develop it, too.
Diagnosis can be even more difficult in children and teenagers because their symptoms may not fully fit the diagnostic criteria, according to the Mayo Clinic. Children and adolescents with bipolar disorder also often have co-occurring mental or behavioral health conditions, like ADHD, that make teasing out a bipolar diagnosis trickier. Finally, it can be hard to determine when mood swings and changes in activity level are simply part of growing up or something more. Specialized child psychiatrists can be helpful in these cases.
11. Treatment almost always involves medication, but effective drugs and dosages vary widely by individual.
The main goal of medication is to stabilize a person’s mood over time in order to minimize the number of manic and depressive episodes they experience, says Dr. Malaspina.
There are several kinds of medication that have been shown to be effective for bipolar disorder in various ways. Mood stabilizers work by decreasing the amount of abnormal activity in the brain, according to the NIMH. Lithium is a common one. Anticonvulsant or antiseizure medications, first developed to treat disorders like epilepsy, are also sometimes used as mood stabilizers.
Another class of medications prescribed for bipolar disorder is antipsychotics to treat mania (during which psychotic episodes can occur), according to the NIMH.
Some people will also benefit from antidepressants to manage the lower moods associated with bipolar disorder. However, antidepressants have the potential to trigger manic episodes, Dr. Malaspina says. They are typically paired with a mood stabilizer or antipsychotic or administered as a drug that works as both an antidepressant and an antipsychotic, according to the Mayo Clinic. Some people benefit from short-term use of anti-anxiety medications as well.
Some of these medications are better at treating depressive or manic episodes, so combinations are often most effective, Dr. Malaspina says. Figuring out the best mix can be challenging at first, but people who work closely with their doctors will almost always find the right balance, Dr. Malaspina says, though the medicines may need to be adjusted over time.
12. Bipolar disorder medications can affect pregnancy and birth control.
People with bipolar disorder who plan on becoming pregnant (or who already are pregnant) should to talk to their doctors. Medications can pass through the placenta and enter breast milk, and various drugs used to treat bipolar disorder have been linked to an increased risk of birth defects, according to the Mayo Clinic.
Additionally, certain bipolar disorder medications such as antiepilepsy drugs may lessen the efficacy of birth control pills. Talk to your doctor if you’re taking medications for bipolar disorder and trying to avoid an unintended pregnancy.
13. Therapy can help people cope with bipolar disorder in a few different ways.
Therapy can help people come to terms with the disparate ways they behaved during mood episodes, especially when someone first receives a diagnosis, Dr. Malaspina explains. “So many people have been suffering for years before they get the bipolar diagnosis, and some people will have made decisions based on a [manic or depressive] mood.” With the proper diagnosis and an understanding of their disorder, therapy can help someone reframe their experiences and self-understanding.
Seeing a mental health professional can also help people manage the stressors in their lives that may aggravate their condition, Dr. Malaspina says, and allow them to “catch” a mood episode before it gets more severe.
14. People with bipolar disorder can and do lead happy, healthy lives.
There is no doubt that living with bipolar disorder presents its challenges. But it’s equally true that with proper treatment, people can achieve stability and happiness. “It’s something you get help for as if you had diabetes,” Dr. Malaspina says. “With care and time, people can do much, much better.”