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What is Bipolar Disorder?

We all experience vacillating moods. But the most extreme form of Bipolar Disorder (Bipolar 1) is much more severe than common moodiness. People with Bipolar 1 can experience manic “highs” which may involve breaks with reality. During a manic episode, for example, they may not be able to sleep. They might make grandiose gestures and commitments (such as maxing out their credit cards, promising to do things for people, engaging in inappropriate sexual activity, or making extreme claims about their abilities).

Likewise, during depressive episodes, someone suffering from Bipolar 1 could again break with reality – this time certain that the world is conspiring against them, that they are worthless, that suicide is the only way out. For Bipolar 1, these extreme episodes can last days, weeks or months. The episodes can be so debilitating that hospitalization is required.

A common misconception about Bipolar Disorder is that people who have it are “manic” all the time. In reality, it is more common for someone with Bipolar Disorder to experience depressive symptoms. States of mania and hypomania (less severe mania) are comparatively rare. In fact, because depressive episodes are more frequent, it is common for Bipolar Disorder to be mis-diagnosed as depression.

Another misconception about Bipolar Disorder is that mania is enjoyable, productive or fun. When people are experiencing mania, they often feel very good, have lots of energy, and can go without sleep for long periods of time. While this might sound great, mania can also be a very uncomfortable and unpleasant experience characterized by irritability, restlessness and feeling out of control.

During a manic episode, people can sometimes take big risks or do things that they would not ordinarily do which might have damaging effects on their career, finances, reputation or relationships. Sometimes mania can be accompanied by psychotic symptoms, which can be very frightening and distressing.

About 20 percent of those diagnosed with Bipolar Disorder fall into less severe categories such as Bipolar 2 and Cyclothymic Disorder. These are characterized by shorter periods of hypomania and shorter, less severe episodes of depression.

Before diving further into the specifics of Bipolar I and Bipolar II, it’s important to understand the broader context of bipolar disorder. This condition affects about 2.8% of the U.S. adult population in any given year, according to the National Institute of Mental Health. It’s characterized by periods of mood episodes, which vary in severity, duration, and frequency.

Bipolar Disorder? You are not alone . . .

Bipolar Disorder affects approximately 2.5% (or 6 million) Americans. Bipolar Disorder was formerly labeled manic-depressive illness. Famous people who have spoken about their struggles with Bipolar Disorder include Carrie Fisher, Frank Sinatra, Catherine Zeta-Jones, Demi Lovato, Francis Ford Coppola, Jean-Claude Van Damme, Jimi Hendrix, Mariah Carey, Rene Russo, Richard Dreyfuss, Russell Brand, Sting, Ted Tuner, and Winston Churchill. Frank Sinatra sold more than 150 million records, was a headliner in Las Vegas and won an Oscar for Best Supporting Actor in From Here to Eternity. Nonetheless, he is quoted as saying: “Being an 18-karat manic-depressive and having a lived a life of violent emotional contradictions, I have an over-acute capacity for sadness as well as elation.”

Living with Bipolar Disorder

Managing bipolar disorder requires ongoing treatment and support. Individuals with either type can lead fulfilling lives with proper management. It’s essential for those affected and their loved ones to educate themselves about the disorder and to seek support from healthcare providers, support groups, and mental health organizations.

Bipolar I Disorder: The Extremes of Mania

Bipolar I is distinguished primarily by manic episodes. These are periods of abnormally elevated mood and high energy, lasting at least a week and often severe enough to require hospitalization. During a manic episode, individuals may exhibit:

  • Excessive euphoria or irritability
  • Unusually increased activity, energy, or agitation
  • Decreased need for sleep
  • Grandiose beliefs or inflated self-esteem
  • Impulsiveness and risk-taking behaviors

A person with Bipolar I may also experience depressive episodes, but a manic episode is what defines this type of bipolar disorder.

Bipolar II Disorder: The Subtlety of Hypomania

In contrast, Bipolar II is characterized by a pattern of depressive episodes interspersed with hypomanic episodes. Hypomania is a milder form of mania and can be harder to recognize because it doesn’t usually disrupt daily life as dramatically. Symptoms of hypomania include:

  • Increased energy, activity, and productivity
  • Elevated or irritable mood
  • Increased creativity and confidence
  • Decreased need for sleep without feeling tired
  • Increased talkativeness

The depressive episodes in Bipolar II are similar to those in Bipolar I and can be quite severe.

Key Differences

The primary difference between Bipolar I and Bipolar II lies in the intensity of the manic episodes. Bipolar I involves full-blown manic episodes, while Bipolar II involves hypomanic episodes, which are less intense. It’s also noteworthy that while depressive episodes are common in both types, they are a defining feature of Bipolar II but not necessary for the diagnosis of Bipolar I.

Psychotherapy for Bipolar Disorder

Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with Bipolar Disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. It can provide support, education, and guidance to people with Bipolar Disorder and their families. Treatment may include therapies such as cognitive-behavioral therapy (CBT) and psychoeducation, which are used to treat a variety of conditions.

Treatment may also include newer therapies designed specifically for the treatment of Bipolar Disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy. Determining whether intensive psychotherapeutic intervention at the earliest stages of Bipolar Disorder can prevent or limit its full-blown onset is an important area of ongoing research.

Medications for Bipolar Disorder

Although there is no cure for Bipolar Disorder, it is a highly treatable disease. According to the National Advisory Mental Health Council, the treatment success rate for Bipolar Disorder is a remarkable 80 percent. It is important to diagnose and treat Bipolar Disorder as early as possible to help people avoid or reduce relapses and rehospitalizations. Several promising, large-scale studies suggest early intervention may forestall the worst long-term outcomes of this devastating brain disorder.

Individuals experiencing mania often lack self-awareness and do not recognize that they are ill, a clinical symptom called anosognosia. They may require treatment in the hospital to prevent self-destructive, impulsive, or aggressive behavior. Hospital stays can be as brief as two weeks and as long as six months. The most important types of medication used to control the symptoms of Bipolar Disorder are mood stabilizers and antidepressants. Mood stabilizers, the mainstay of long-term preventive treatment for both mania and depression, are used to improve symptoms during acute manic, hypomanic, and mixed episodes; they also may reduce symptoms of depression. The most widely used mood stabilizers include lithium (Eskalith, Lithobid, Lithonate, and other brands), valproate (used as divalproex or Depakote), and carbamazepine (Tegretol).

About one in three people will be completely free of symptoms by taking mood-stabilizing medications for life. In conjunction with the mood stabilizers, antianxiety medications such as lorazepam (Ativan) and clonazepam (Klonopin) and antipsychotic drugs such as haloperidol (Haldol) and perphenazine (Trilafon) are used for insomnia, agitation, or other symptoms, during a manic phase. Antidepressants are given together with mood stabilizers to prevent an “overshoot” from occurring in the patient, for if used on their own in the treatment of Bipolar Disorder, antidepressants can push moods up too high causing hypomania, mania, or rapid cycling.

Most experts consider the following two types of antidepressants to be the most effective for bipolar patients: bupropion (Wellbutrin) or selective serotonin reuptake inhibitors such as fluoxetine (Prozac); fluvoxamine (Luvox); paroxetine (Paxil), and sertraline (Zoloft).

There are many other choices if these do not work, or if they cause unpleasant side effects, including: mirtazapine (Remeron), monoamine oxidase inhibitors such as phenelzine (Nardil) and tranylcypromine (Parnate); nefazodone (Serzone); tricyclic antidepressants such as amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor); and venlafaxine (Effexor).