Mental illness is much more complicated than physical illness; after all, when the disorder is in your brain, there aren't any physical symptoms or blood tests you can run to reach a proper diagnosis. And while the conversation surrounding mental illness is growing, slowly etching away the negative stigma, mental disorders are still widely misunderstood — chief among them being bipolar disorder.
Because the prefix "bi" means two, many people wrongly associated bipolar disorder with split personality disorder, or Dissociative Identity Disorder. In reality, bipolar disorder, previously called manic depression, is defined as a mix of depressed and manic moods.
"Bipolar disorders are conditions of significant, persistent, and pervasive mood fluctuation," Pierre Azzam, MD, assistant professor of Psychiatry at the University of Pittsburgh Medical Center, told POPSUGAR. There are several bipolar disorders, and he says bipolar disorder can be viewed as an umbrella term for several different diagnoses. "Each mood episode can occur on a spectrum of severity, duration, and clinical features."
The types of bipolar disorder, according to the National Institute of Mental Health, include: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified and unspecified bipolar and related disorders.
How Bipolar Disorder Is Diagnosed
To be diagnosed with bipolar disorder, a patient must meet the criteria for mania or hypomania, plus the intermittent experience of major depression, Dr. Azzam said. Mania and hypomania are characterized by an elevated mood plus three of the following, or persistently irritable mood plus four of the following:
- Distractibility, difficulty paying attention
- Agitation or irritable behaviours
- Grandiose ideas or elevated self-esteem
- Racing thoughts
- Activities that are indiscriminate (spending sprees, risky sex, etc.)
- Decreased need for sleep, hyperproductivity
- Excessive speech
Mania typically lasts seven or more days, impairs someone's ability to function properly at work and home, or is severe enough to cause hospitalization. Hypomania, which is a less severe form of mania, lasts for four or more days, but isn't severe enough to interfere with the ability to function at home and at work; people with hypomania may seem overly productive, giddy, and need to sleep less, but they are still getting on OK with their jobs, school, or relationships.
It only takes one episode of full-blown mania to be diagnosed with bipolar I disorder. People may be diagnosed with major depressive disorder and think they only have depression until they experience an episode of mania, in which case they are diagnosed as bipolar. Patients with bipolar II, on the other hand, may just experience hypomania and may never have a full-blown manic episode.
Cyclothymia is a unique condition where someone experiences fluctuations in mood between low-grade depression and hypomania. But the symptoms for depression may not meet the diagnostic requirements for a depressive episode, and the symptoms of hypomania may not meet the specific diagnostic requirements of hypomania.
There are also other specified and unspecified bipolar and related disorders that are characterized by bipolar symptoms, but do not match the criteria of the other bipolar disorder diagnoses.
How Bipolar Disorder Is Treated
While depression is typically treated with antidepressants, these medications can trigger mania in patients with bipolar disorder, despite the symptoms of depressive episodes. Instead, bipolar disorder is typically treated with mood stabilizers, Dr. Azzam says. There are a number of these medications from different classes, including second-generation antipsychotics, some anticonvulsants, and lithium. Treatment for bipolar I and II is similar, and it may take some trial and error with medication and dosage to figure out what the best course of treatment is.
In addition to medication, the disorder can be treated with psychotherapy, which is focused on self-care and stress regulation, or cognitive behavioural therapy (CBT), which helps change the negative thinking and behaviour associated with the disorder, according to the National Alliance on Mental Illness.
Although each person with bipolar disorder is different and responds to treatment differently, supplementing medication and therapy with lifestyle changes can also help treat the illness. Making sure you get plenty of sleep (seven to eight hours) a night, exercising regularly, and eating whole, unprocessed foods can all contribute to an effective treatment plan.