Bipolar Disorder is a diagnosis consisting of episodes of mood highs and lows, referred to as "mania” and “depression,” respectively. “Bipolar” is a term that too often gets used synonymously with “mood swings.” However, these are two very different things in most cases, and the distinction is extremely important for reasons I will explain below. With bipolar disorder, the episodes of mood disturbance are expected to last for at least a week for mania, and two weeks for depression. During the manic episodes, people will get little to no sleep. However, unlike with with depression and anxiety problems, these individuals aren’t just tossing and turning at night; they are up all night doing projects or activities, driven by excess energy. Despite not sleeping, they still feel highly energized the following day. This will occur for several days in a row. Also during these episodes, people will talk louder and faster than their baseline. Often, people in their lives tell them that they have a hard time following their train of thought, which tends to jump around a lot. While manic, people often have grandiose thoughts about themselves, such as they are invincible, they are famous, they have special powers, or that they are being sent on special missions by god. They are often much more pleasure-seeking and impulsive. I’ve had patients drive 100 miles per hour in traffic, have unprotected sex with multiple partners, use drugs or alcohol, pack up and move their family across the country, attempt to swim to Catalina Island, and attempt to add an annex to their house without any help. While having any of these symptoms by themselves doesn’t mean someone is manic, having several of them together during the same distinct period of time is a strong indicator that the person likely has bipolar disorder.
Most often when people come to a psychiatrist and describe “mood swings,” what they are actually referring to is irritability. In other words, the person gets angry easily, and when they do get angry, it can be explosive. This often includes yelling, cursing, breaking things, or getting into fights. Irritability is a common symptom with a number of diagnoses, including Major Depressive Disorder, Generalized Anxiety Disorder, PTSD, ADHD, OCD, and Borderline Personality Disorder. Irritability can certainly be a component of Bipolar Disorder, too. However, the key to clarifying the diagnosis is whether or not the person has any of the other symptoms described above, and whether all of these symptoms occur primarily at the same time during distinct episodes that last for a week or more. When the irritability is a much more chronic issue, then it’s more likely attributable to one of the other diagnoses I mentioned.
The reason why it’s so important to get the diagnosis correct is that bipolar disorder has a much worse long term prognosis and requires completely different medications to treat it. For many people, depression and anxiety issues can be entirely resolved without relapse in the future. Unfortunately, Bipolar Disorder is a lifelong condition with no known cure, but with several good options to minimize symptoms. The primary treatment for depressive, anxiety, and trauma-related disorders is therapy +/- an antidepressant. With Bipolar Disorder, the treatment of choice is mood stabilizers like Valproic Acid (Depakote) and Lithium, as well as neuroleptics (aka antipsychotics) like Olanzapine (Zyprexa), Quetiapine (Seroquel), and Aripiprazole (Abilify). In fact, using antidepressants in people with Bipolar Disorder has been shown to cause them to have more manic and depressive episodes. Unfortunately, the medications used to treat Bipolar Disorder generally have more severe side effects than the antidepressants. This includes increased risk of weight gain, diabetes, and high cholesterol, as well as permanent involuntary movements called “tardive dyskinesia.” Other than the weight gain, it’s rare for people to experience these side effects in the early months of being on these medications. However, the risk goes up the longer the person takes them. For these reasons, I generally have a high threshold for giving patients a diagnosis of Bipolar Disorder or for utilizing neuroleptics until other options have been tried. Furthermore, statistically, PTSD, depressive disorders, and anxiety disorders are much more common than Bipolar Disorder.
There is much more about Bipolar Disorder that I may write about in future posts. But I believe these are the most relevant points for those who have been diagnosed with Bipolar Disorder or believe they may have this disorder but have never been formally given the diagnosis. If you have any specific questions, feel free to comment below.