Bipolar Disorder

Summary

• Involves both depression and mania
• Disrupts normal life
• Mood swings can be severe
• Is often misdiagnosed as depression

Mood changes are a part of life. Everyone goes through periods of ups and downs. A person with bipolar disorder has mood swings that disrupt their normal life. These mood shifts can cause problems at home, with relationships, at school, or at work. They can be mild. Other times, they can be quite extreme.

The low stages are much like classic depression. But people with it also have high periods called mania.

Symptoms of mania

Some of the signs include:

• Boosts of high energy and activity
• Hasty or aggressive behavior
• Rapid thoughts and speech
• Exaggerated ego
• Raised irritability
• Decrease in sleep
• Restlessness
• Being overly optimistic
• Hasty and reckless actions
• Overuse of drugs or alcohol
• Distractibility
• More talkative or pressure to keep talking

Mania may result in the abuse of drugs, alcohol, and sex. It may also cause a person to overspend money. Severe cases can include hallucinations or delusions. During the mania phase, a person is highly stimulated. He may enjoy this feeling for a while and not wish to seek treatment. He often does not know how it disturbs his life, or how it affects others. To qualify as a true manic episode, a phase needs to last at least seven days or result in a hospital stay.

Symptoms of depression

Some of the signs include:

• Lack of energy and interest
• Increased sadness
• Eating too much or too little
• Sleeping too much or too little
• Low self-esteem
• Trouble paying attention and making choices
• Anger and worry
• Withdrawal
• Thoughts of suicide
• Feelings of worthlessness or guilt
• Being agitated or slowed down

Unhappy people often lose the ability to enjoy things that used to please them. This may include a lack of interest in hobbies, social involvement, and sex. They may also have increased thoughts of death and suicide. Sometimes people with depression do not complain of low spirits but have the other symptoms. At times, it is easier to say they are irritable than depressed.

Bipolar disorder differs from major depressive disorder because it also includes periods of mania. The mania states are most often shorter. These manic episodes may happen after many episodes of low mood. This is one reason why bipolar disorder is often mistreated as depression.

Mixed state

This includes a variety of symptoms that are depressive or manic or both. All are uncomfortable. The symptoms can be hard to deal with as people feel both depressed and anxious, and are unable to rest, relax, or enjoy anything.

Types of bipolar disorder

• Bipolar I disorder is currently understood to be not just two polar opposites of mood, but a spectrum of abnormal mood, behaviors, activity, and thinking. On one end of the spectrum is mania and the other end is depression. There are mixtures of symptoms with some features of depression and some of mania. These mixed states are very uncomfortable. People can feel depressed but irritable, restless, and unable to relax or stop worrying. They may have trouble sleeping but unlike a pure manic state, they feel fatigued and drained. These mixed states can result in people making bad decisions, alienating loved ones, losing jobs, and in general feeling terrible.
• Bipolar II disorder includes periods of depression along with a milder form of energized mood, known as hypomania.
• Unspecified bipolar and related disorder cannot be classified as type I or II, but is still not considered normal behavior.
• Cyclothymic disorder is a milder type. The mood elevations and changes are much less severe and most often do not affect daily functioning.
• Rapid-cycling is when a person has four or more episodes of mania, depression, or mixed symptoms within one year.

Proper diagnosis

Besides depression, there are other illnesses that make the detection of bipolar disorder hard. Attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are among them. Severe cases are sometimes misdiagnosed as schizophrenia. Other social phobias and anxiety disorders often co-exist with it. Drug and alcohol use disorders can further complicate the diagnosis. Some medical illnesses such as thyroid disorders can mimic bipolar disorder.

A physical exam and lab tests are needed to rule out other possible illnesses. Next, an in-depth mental evaluation may be needed. Your doctor might send you to a psychiatrist. It’s important to give them a full list of symptoms and any family history of mental illness. It is a good idea to bring a loved one with you who can also give key information. Keeping a life chart of daily moods, sleep patterns, and life events can be helpful to keep track of symptoms. Your chart is key in helping you and your doctor correctly diagnose symptoms and provide the right treatment.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org/

Mood Disorder Questionnaire
www.dbsalliance.org/MDQ

National Institute of Mental Health/Bipolar Disorder
www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; Depression and Bipolar Support Alliance, www.dbsalliance.org/site/PageServer?pagename=home; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

• Involves both depression and mania
• Is sometimes hereditary
• Disrupts normal life
• Is treatable

Bipolar disorder is a mental condition marked by great changes in mood, activity level, energy, and thinking. It is more of a spectrum than a well-defined set of symptoms. There is overlap, ranging from mania to deep depression. There are combinations of symptoms which are called mixed state.

A person with bipolar may have changes in what they feel with each episode. All people feel sadness, anger, fearfulness, joy, and optimism at times. A person with bipolar has these feelings to the extreme. Energy, focus, activity, sleep, and hunger may also change.

Mania

Mania can cause big problems at home, work, or school. During an episode, the person is overactive, easily stimulated, and often irritable. The person may:

• Have a very high regard for themselves
• Believe they can do things they can’t likely do
• Engage in risky sex
• Start risky businesses
• Go on spending sprees without having enough money
• Feel rested after three hours of sleep or go for days without sleep
• Have thoughts that race and jump from topic to topic
• Lash out if someone tries to limit their actions 

The person within a manic episode may not realize she is doing anything wrong. It is easy to see how mania can result in great losses for those who go through it, as well as those who love them.

Depression

All people feel sadness, disappointment, and self-doubt at some point in their lives. Anyone who has lost a loved one or pet can have grief. A person with ongoing depression may:

• Lose interest in grooming, social events, or future planning 
• Think they are not worth anything 
• Want to stay away from people 
• Have trouble thinking 
• Find most acts to be an effort
• Not be able to sleep, or sleep too much
• Eat too much or not enough 
• Have thoughts of guilt (undeserved) 
• Think about killing themselves  

Those with bipolar often have depression before mania. Because of this, they can be misdiagnosed. Treatment is very different for bipolar manic, manic/mixed, mixed, and depressed/mixed episodes than it is for depression. A person who has depression should know the symptoms of a mixed state. 

Mixed state

This involves having some of the symptoms of mania and depression at the same time. Any group of symptoms can happen together. For example, a person may be:

• Depressed
• Restless and irritable
• Not able to sleep but tired
• Not able to stop racing thoughts

This person might not have the manic feeling of being able to do all things, and be smarter, better, and more attractive than others. It is a very painful mental state in which a person simply feels bad. Persons in a mixed state may think about taking their own life.

Types of bipolar disorder

These are the main types:

• Bipolar I disorder involves severe depression, in which the symptoms occur daily for two weeks, and one or more periods of mania, in which the symptoms occur daily for one week or less if a hospital stay occurred.
• Bipolar II disorder includes periods of change in mood, energy, and activity which is different from the person’s usual behavior and that lasts for four days. It is not severe enough to cause a great change in functioning but is clear to others.
• Unspecified bipolar and related disorder cannot be classified as type I or II, but is still not considered normal behavior.
• Cyclothymic disorder involves mood swings for at least two years which do not greatly disturb daily functioning and do not meet the level of depression, mania, or hypomania. Persons with this disorder do not have more than a two-month period in which they are free of symptoms.
• Rapid-cycling is diagnosed when there are four episodes of mania, depression, or mixed state within a 12-month period.

Possible causes

Bipolar disorder often runs in families. Other conditions that may lead to bipolar disorder are chemical imbalances, brain development problems, and environmental factors. It usually starts in the late teens, but can happen at any age. Many other disorders can look like bipolar. These include:

• Medical diseases, such as thyroid disorders
• Genetic diseases
• Post-traumatic stress disorder
• Attention-deficit/hyperactivity disorder
• Anxiety disorders
• Substance use disorder 

It is very important to get an evaluation so a diagnosis can be made. Early treatment of bipolar disorder has been shown to be related to fewer episodes and better functioning.

Treatment

Bipolar disorder is usually a lifelong illness, but treatment can be effective. Like any chronic illness such as diabetes or asthma, it is still necessary to continue treatment in between episodes. It is very important for a person with bipolar disorder to keep a daily life chart tracking moods, sleep patterns, and life events. The chart will be a record of triggers as well as activities that relieve the symptoms. 

Many people are helped by medications combined with talk therapy. In some cases, electroconvulsive therapy—in which an electric impulse is sent to the brain—is a helpful treatment. Support groups, a healthy lifestyle, and identifying and reducing stress can go a long way toward better results.

When to seek help

Mood swings are a part of life. Everyone has periods of ups and downs. If these mood swings are severe, not like your usual behavior, upset your normal life, or last more than one or two weeks, you should seek care.

If you are having thoughts of killing yourself, seek help right away. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org/

National Institute of Mental Health/Bipolar Disorder
www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Cynthia Scott, MD, Physician Advisor, Beacon Health Options and Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; Depression and Bipolar Support Alliance, www.dbsalliance.org/site/PageServer?pagename=home; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition edited by the American Psychiatric Association, 2013.

Summary

• Cyclothymic disorder is a mild form of bipolar disorder.
• The highs of cyclothymic disorder are called hypomania.
• Hypomania is a milder form of the mania seen in bipolar disorder.

Cyclothymic disorder is a relatively uncommon mood disorder. It is also called cyclothymia. It is a mild form of bipolar disorder. It is marked by swings between emotional highs and lows. Cyclothymic disorder, bipolar I disorder, and bipolar II disorder are all forms of what used to be known as manic depressive illness. They are marked by mood swings spanning months to years.

In cyclothymia the high is called hypomania. It often involves high activity or energy. It may also be marked by feelings of great joy for no reason and strong self-confidence. Hypomania is not as bad as the mania in bipolar I disorder. Mania in bipolar I disorder is so strong that it can lead to unsafe actions. It may even call for hospital care.

The lows of cyclothymic disorder look and feel like depression: low mood, activity, and energy. Some people may not be bothered enough by the lows to get help. The same is true for the highs. What’s more, people may feel fine between the highs and the lows.

The key is to note the symptoms that do cause distress and work with a doctor to find the best care. Remember, recovery is possible!

Who gets cyclothymic disorder?

It often starts in the teen or early adult years. It can appear in kids, though. It is estimated that about 0.4 percent to 1 percent of people in the U.S. are affected by it. It is equally common in men and women. People who have a parent or sibling with bipolar I disorder are at higher risk. Among those who have it, major depressive disorder and bipolar II disorder are seen in their parents and siblings more often than those who are not affected.

What causes cyclothymia?

Experts do not know what causes this disorder. It may be that major depressive disorder, bipolar disorder, and cyclothymic disorder have like causes since they often occur together in families. It is known that some people at first diagnosed with cyclothymic disorder go on to develop or are later diagnosed with bipolar I disorder or bipolar II disorder. But it is not clear what the root cause may be.

Symptoms

Getting a diagnosis can be tricky. It may not seem that there is a clear cut problem because symptoms can seem mild. Others may see people with the disorder as just moody. Yet there are guidelines that help doctors to determine if you have the disorder. People who have it may have any of these symptoms:

• Periods of hypomania and depressive symptoms for at least two years (one or more years in kids and teens)
• Mood swings that are not as harsh as those seen in major depressive and bipolar disorders
• Hypomanic and depressive symptoms lasting for half the time, with no more than two symptom-free months in a row

Doctors will decide if you have cyclothymic disorder based on your mood history. Your doctor may also order blood and urine tests to rule out other health problems that can cause mood symptoms.

Getting help

If you are having mood swings, take note of how you feel and keep track of changes. If a loved one is having mood swings, encourage him to do the same. Be sure to track moods in kids if you notice swings. Then talk with a doctor about signs, symptoms, and trends. There are treatments, both in the form of medication and talk therapy.

Even if the mood swings feel manageable, it is vital to talk with your doctor. Treatment can help even out moods and improve functioning.

Support for you and loved ones is also available from talk therapy and support groups.

Don’t wait to talk with your doctor—it can help you improve your quality of life.

Resources

Mental Health America

National Alliance on Mental Illness

Depression and Bipolar Support Alliance

By Sarah Stone

©2016-2019 Carelon Behavioral Health

Source: American Psychiatric Association. (2015) Understanding Mental Disorders: Your Guide to DSM-5; U.S. National Library of Medicine, Cyclothymic Disorder, www.nlm.nih.gov/medlineplus; National Alliance on Mental Illness, www.nami.org/Find-Support/Family-Members-and-Caregivers; Mayo Clinic, www.mayoclinic.org/diseases-conditions/cyclothymia/basics/definition/con-20028763; National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder

Reviewed by Gary R. Proctor, M.D., Associate CMO, Operations, Beacon Health Options

Summary

• People who have cyclothymic disorder may seem moody and find their own symptoms mild.
• It is important to remind people with cyclothymic disorder to stick to healthy habits to improve symptoms.

Cyclothymic disorder is a relatively rare mood disorder. It is sometimes called cyclothymia. Cyclothymic disorder is a mild form of bipolar disorder. It is marked by mood swings between emotional highs and lows. These mood swings can span years. Some people initially diagnosed with cyclothymic disorder go on to develop or are later diagnosed with bipolar I disorder or bipolar II disorder.

With this disorder, people may feel fine between the highs and the lows. The high, called hypomania, may even feel good. This phase involves high activity or energy. It may also involve feelings of great happiness for no reason and strong self-confidence.

Even though the highs may not seem severe, they can still cause distress:

• At work and school
• In relationships
• At home
• Socially

If you are caring for someone who has a bipolar disorder, you may find it hard. People who have it may not feel at their best or seem in control. But this type of condition is treatable. And the right mix of treatment options can greatly improve quality of life.

Coping as a caregiver

If you love or care for someone who has this type of disorder or another mental health condition, you are not alone. Tens of millions of people in the U.S. have a mental health condition. Countless more play a role in giving care. Even with good treatments, caregivers are a huge part of the support system. In turn, the people who provide care need support.

Sometimes, the best support is in the form of couples or family therapy. This type of therapy can help solve problems caused by the mood disorder. Support groups can also be very helpful.

Other times, rapid help is needed. The National Alliance on Mental Illness provides helpful information and resources for grave issues such as arrest or a missing person. Even if symptoms are mild, it can help to know where to turn just in case.

Communication tips

Caregivers should know that people with this disorder may start and stop treatment based on symptoms. If the highs or lows feel mild, someone may choose to stop. Or they may avoid medicine altogether. At times, talk therapy alone will be the best choice. Other times, it will take a mix of therapy, medication, and lifestyle changes to find relief. The important thing is that the treatment is guided by a doctor.

As a friend, loved one, or caregiver, there are some helpful tips you can offer:

• Stay in touch with the doctor. Remind your loved one to keep working with a doctor to find the right treatment. If you notice changes in mood swings or the person finds that symptoms do not ease up, talk about setting up an appointment.
• Keep healthy habits in mind. Talk about the importance of getting good sleep, exercising, and eating well. All of these steps can help someone feel better.
• Set up a routine. Check in to see if your loved one needs help establishing and keeping a regular daily routine. Remind him that a regular routine can help keep mood stable.
• Avoid using drugs or alcohol. Encourage your loved one to skip caffeine, alcohol, and drugs.

Resources

Mental Health America

National Alliance on Mental Illness

Depression and Bipolar Support Alliance

By Sarah Stone

©2016-2019 Carelon Behavioral Health

Source: American Psychiatric Association. (2015) Understanding Mental Disorders: Your Guide to DSM-5; U.S. National Library of Medicine, Cyclothymic Disorder, www.nlm.nih.gov/medlineplus/ency/article/001550.htm; National Alliance on Mental Illness, www.nami.org/Find-Support/Family-Members-and-Caregivers; Mayo Clinic, www.mayoclinic.org/diseases-conditions/cyclothymia/basics/definition/con-20028763

Reviewed by Gary R. Proctor, M.D., Associate CMO, Operations, Beacon Health Options

Summary

• Individuals must stay on medication.
• Be patient and stay positive.
• Learn all you can about bipolar disorder.

Bipolar disorder is an illness with far reaching effects. Those with the disorder often have trouble completing school work or keeping a job. Their extreme high and low periods can make day-to-day living difficult. It can also put a great strain on relationships. People with bipolar disorder need an extra measure of grace from friends, family, and themselves.

Helping yourself

If you have bipolar disorder, you know the toll it can take. Feeling guilty about it will only add to your hardship. Try to stay positive about your situation. Realize that with proper treatment, in time, you will get better.

Here are some ways to promote your own recovery:

• Stick to the treatment plan agreed on by you and your doctor.
• Have a routine for taking your medication.
• Have a routine for getting enough sleep and eating properly.
• Avoid unhealthy habits such as alcohol and tobacco use.
• Avoid negative people and situations; surround yourself with positive influences.
• Learn as much as you can about bipolar disorder.
• Learn how to recognize when your moods are shifting.
• Remain on your medication. Do this even if you don’t think it is working or if you start to feel better. If you feel something needs to be changed, discuss alternatives with your doctor in a timely fashion.
• Keep a mood diary and routinely chart your moods, sleep patterns and life events.
• Create a psychiatric advanced directive (PAD) to assure appropriate support, treatment, and even medication, when needed.

Helping others

Sometimes, the best way to help someone with bipolar disorder is just to be there. This allows your friend or loved one to open up about their struggles. You don’t need to have all the answers. You just need to provide encouragement and support. Listen to her, and let her know she is not alone in the fight.

Here are other ways to help friends or loved ones recover:

• Go with him to doctor appointments.
• Learn as much as you can about the disease.
• Help her establish daily routines for sleeping, eating, and taking medication.
• Praise his successes and don’t dwell on his failures.
• Be patient with her. 
• Encourage him by staying positive.
• Attend support group meetings.
• Invite her to partake in healthy activities.
• Encourage him to stay on his medication.
• Agree with your loved one to help monitor appropriate use of medication and notify health care provider if medications are discontinued or symptoms re-occur.
• Remove firearms or weapons from home to avoid impulsive acts.
• Don’t ignore suicidal thoughts. Call the person’s doctor or 911. Do not leave a person who is considering suicide alone.

Help for caregivers

There is a great deal of stress involved in caring for someone with bipolar disorder. Caregivers also need to take care of themselves. Just like their loved ones, caregivers need to get proper rest and nutrition. Caregivers should ask for extra help from family members or friends when it is needed. A healthy caregiver will make for a healthier person with the diagnosis. Many places have support groups for family members and friends of persons diagnosed with bipolar disorder. Make it a point to do this for yourself.

Medication congruency

Bipolar disorder is a lifelong disease which requires long-term treatment. This involves both therapy and medication. Medication must be taken exactly as prescribed. Serious problems can result from stopping it or taking it incorrectly. A person with the illness will have periods of depression and periods of mania. There will also be times of “normal” moods. Sometimes the illness will disappear for long periods of time. For some people as they get older, the illness severity improves. It is important that individuals continue taking their medication at all times to control symptoms and to prevent relapse. Precise, consistent treatment is the most effective.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

National Institute of Mental Health/Bipolar Disorder
www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: Depression and Bipolar Support Alliance, www.dbsalliance.org/site/PageServer?pagename=home; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

• Cyclothymic disorder is a mild form of bipolar disorder.
• Mood swings from high to low may seem mild to some, or distressing to others.
• More extreme highs and lows may mean you have bipolar I or II.

Cyclothymic disorder is a mild form of bipolar disorder. It is also called cyclothymia. It consists of emotional highs and lows. It shifts how people feel and act.

The mood states of bipolar disorders are called episodes. These are not just routine ups and downs. The symptoms can cause problems with relationships, work, and school.

It is estimated that more than 10 million people in the U.S. have a bipolar condition.

Bipolar disorders include:

• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder

The symptoms of cyclothymia are not as harsh as those in bipolar I disorder or bipolar II disorder. In fact, others may see it as just moodiness. The stronger symptoms of bipolar I disorder and bipolar II disorder can hurt relationships, jobs, and cause trouble with the law. Some of the symptoms are shared or the same. The difference in intensity is key to matching the right care.

Cyclothymia

Cyclothymia involves mood swings between highs and lows. The high is called hypomania. The highs can involve greater activity, excitement, and energy. There may be feelings of great joy for no reason and strong self-confidence.

The lows can feel like depression, leading to low mood and energy levels. Even though symptoms can be mild, they can still cause distress in all parts of life for some. For others, the symptoms may seem too mild to treat.

The disorder is fairly rare. Some studies say that between 15 percent and 50 percent of people first diagnosed with cyclothymic disorder go on to have or are later diagnosed with bipolar I disorder or bipolar II disorder. In some, it becomes life-long or in others it goes away with time and treatment. People who have it may also have other health issues. Taking action to get well and to get support gives hope that recovery can happen.

Bipolar I disorder

Bipolar I disorder brings very strong mood swings. The highs, called mania, can cause someone to feel full of energy. There are often grandiose feelings. For instance, someone may think that she is better than others. Or that he deserves special care. Or, someone may believe she has a special talent that does not exist.

Mania can also lead to unsafe actions, sometimes needing a hospital stay. The lows lead to feeling sad and hopeless. In between there can be normal moods or hypomania, which is milder than mania. The mood swings of bipolar I disorder can be so strong that upset daily life is upset. Other people will notice mood changes in someone with bipolar I disorder.

The average age at which bipolar I disorder starts is 18. Yet older and younger people do get it. Men and women are equally affected. It is not uncommon for people with bipolar I disorder to also have other mental health issues. The suicide risk among those with bipolar I disorder is much higher than in those who do not have it. This is why treatment, recovery supports, and actively taking part in wellness plans are key.

Bipolar II disorder

Bipolar disorders often start with major depressive-like symptoms. The main difference between bipolar I disorder and bipolar II disorder is that there is no mania in bipolar II disorder.

Bipolar II disorder often starts in the teen years, but it can start later in life. It is more common to see later onset in bipolar II disorder than in bipolar I disorder. It is not uncommon for people with bipolar II disorder to also have other mental health issues. Suicide risk is much higher for this group than in those who do not have it. Again, this makes care and other recovery supports vital.

Overview of each type of bipolar disorder

Finding hope

If you sense changes in your mood, talk to your doctor. She can tell if you have a mood disorder, and if so, which one. She will also make sure your symptoms are not caused by other health issues.

Treatments can help care for symptoms. Relief is possible with a blend of medicine, talk therapy, and healthy habits.

There is hope. Recovery help can include support services by those with lived experience in mental health recovery.

Resources

Mental Health America

National Alliance on Mental Illness

Depression and Bipolar Support Alliance

By Sarah Stone

©2016-2019 Carelon Behavioral Health

Source: American Psychiatric Association. (2015) Understanding Mental Disorders: Your Guide to DSM-5; U.S. National Library of Medicine, Cyclothymic Disorder, www.nlm.nih.gov/medlineplus/ency/article/001550.htm; National Alliance on Mental Illness, www.nami.org/Find-Support/Family-Members-and-Caregivers; Mayo Clinic, www.mayoclinic.org/diseases-conditions/cyclothymia/basics/definition/con-20028763

Reviewed by Gary R. Proctor, M.D., Associate CMO, Operations, Beacon Health Options

Summary

• Both disrupt normal life.
• Bipolar disorder is depression plus mania.
• Bipolar disorder is often mistreated as depression.

Everyone feels down now and then. We all have our good days and our bad days. A hard day at work or at school can leave you feeling low. A bad relationship, or ending a good one, can also make you feel down. If these low periods last more than two weeks and are causing problems in your life, you may have clinical depression.

Symptoms of depression

Some of the signs include:

• Lack of energy and interest
• Increased sadness
• Losing interest in cleanliness
• Anger and worry
• Eating too much or too little
• Sleeping too much or too little
• Low self-esteem
• Trouble paying attention and making choices
• Withdrawal
• Thoughts of killing oneself
• Unable to enjoy things that brought happiness before
• Feelings of worthlessness or guilt
• Being agitated or slowed down

Clinical depression is also known as unipolar depression or major depressive disorder. This means a person only has periods of low moods. Someone who has both low (depressed) moods and high (manic) moods or a combination of both is said to have bipolar disorder. While in a low period, this person will have signs of depression. At other times, he will show signs of mania. If both happen at the same time, it is called a mixed state. A milder form of mood elevation, hypomania, can be linked to depressive episodes. This is called bipolar type II.

Symptoms of mania

Some of the signs include:

• Boosts of high energy and activity
• Hasty or aggressive behavior
• Rapid thoughts and speech
• Exaggerated ego
• Being overly hopeful
• Increased irritability
• Restlessness
• Less need for sleep
• Impulsive or reckless behavior
• Overuse of drugs or alcohol
• Spending money, buying things they cannot afford
• Distractibility
• More talkative than usual or pressure to keep talking

These periods of mania do not always happen right away. Sometimes it is years before a person with bipolar disorder feels these “highs.” Once a person does have manic episodes, she doesn’t always see it as a problem. She may initially like how she feels during these times and may only seek help when feeling unhappy. It is often the people who know the person well who first suspect something is wrong.  The person with bipolar mania or hypomania may be angry and disagree with the family or friend who calls the mania to their attention.

All of this makes it hard to diagnose and sometimes years can pass until the proper diagnosis is made. Sometimes many bouts of low spirits can happen before the first manic episode. Many people with bipolar disorder are treated as having unipolar depression only. They may show only partial response to treatment. If they do not respond well to antidepressant treatment or experience anxiety, irritability, or other symptoms of mania, they should notify their doctor right away. Medications will most likely need to be discontinued and others prescribed. This is one reason why a daily chart keeping track of mood, energy, and other factors such as sleep is important. It gives a good map for the person and doctor to understand what is happening and to work together for effective treatment.

Getting a proper diagnosis

Besides depression, there are other illnesses that make the detection of bipolar disorder hard. Attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are among them. Other social phobias and anxiety disorders often co-exist with it. Drug and alcohol use disorders can further complicate the diagnosis.

A physical exam and lab tests are needed to rule out other illnesses. Next, a full mental evaluation may be needed. Your doctor might send to you to a psychiatrist. It’s key to give them a full list of symptoms and any family history of mental illness. It is a good idea to bring a loved one with you who can also give key information. Keeping a life chart to track daily moods, sleep patterns, and life events can be helpful for watching the symptoms and for informing treatment possibilities.

Getting the right treatment

Bipolar disorder is usually a lifelong illness. Like high blood pressure or diabetes, it does not go away on its own. There may be time between episodes, but they will most likely return throughout one’s lifetime. Failure to treat bipolar disorder tends to make it worse. Treatment during quiet periods of the illness is important to avoid further episodes. Mood stabilizers and talk therapy are most often used. Sometimes, electroconvulsive therapy (ECT), where an electric impulse to the brain is given under anesthesia, is very helpful.  

Prescribed antidepressants may cause mania symptoms to re-occur. Antidepressants and mood stabilizers may also add to suicidal thoughts in people with bipolar disorder. Close monitoring is needed, and these symptoms should be reported right away to your health care provider. A daily chart helps.

People respond differently to medicines. Sometimes changes are needed if the drugs are not working or stopped working. Be patient and work with your doctor to find out what is best for you. When properly diagnosed and treated, bipolar disorder can be controlled. Once you begin feeling better, make sure you keep on taking the medicine as prescribed. This will help avoid relapses and let you live a healthy and productive life.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org/

Mood Disorder Questionnaire
www.dbsalliance.org/MDQ

National Institute of Mental Health/Bipolar Disorder
www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: Depression and Bipolar Support Alliance, www.dbsalliance.org/site/PageServer?pagename=home; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

• Mood stabilizers are most often prescribed.
• Sometimes antipsychotics or antidepressants are used.
• Medication must be taken exactly as prescribed.

Bipolar disorder is a lifelong disease which calls for long-term treatment. This involves both therapy and medication. A person with the illness will have periods of depression and mania. There will also be times of “normal” moods. It is important to keep taking the meds at all times to control symptoms and to avoid relapse. It is typically given by a psychiatrist. Most often, treatment begins with the use of mood stabilizers. At times antipsychotics and antidepressants are also used.

Mood stabilizers

Lithium is the most common drug prescribed for a person with a bipolar diagnosis. It is useful for treating mania and depression. It may cause thyroid and kidney problems. People who are prescribed this medication should have their doctor monitor their conditions for negative side effects.

Depakote® (valproate) is sometimes used in place of lithium, and can be just as useful. It is an anticonvulsant that is also used for treating seizures. However, it might be linked to an increased risk of polycystic ovarian syndrome and congenital defects in fetuses, which may make it unsuitable for young women. 

Tegretol® (carbamazepine) is an anticonvulsive used in treatment of bipolar diagnosis. It helps moderate withdrawal symptoms. Other anticonvulsants, including Lamictal®, may be used. It appears to work better for bipolar depression.

With any of these three mood stabilizers (lithium, valproate, and carbamazepine), your doctor can check blood levels of the medication and should do so periodically.

Mood stabilizing antipsychotics

Severe cases of a bipolar diagnosis sometimes call for antipsychotics. They are mostly helpful in controlling acute manic or mixed episodes.

Zyprexa® is useful for treating severe mania. It can be injected to give fast relief of symptoms. Side effects include weight gain and may increase the chance of heart disease and diabetes.

Abilify® and Seroquel® are alternatives to Zyprexa®, and are less likely to give the same such side effects. Latuda® has shown efficacy in bipolar depression. Saphris® has also shown results in bipolar disorder. They are both useful in treating mild or severe cases of acute mania. Other antipsychotics sometimes taken include Risperdal® and Geodon®.

Antidepressants

Antidepressants are used to treat the depressive episodes that a person with this condition might experience, but they may not be right for everyone. They should not be taken alone, as they can increase the chance of mania or rapid cycling. They also may make low moods worse and increase the risk of suicidal behavior. This seems to be especially true for teens and young adults. For these reasons, mood stabilizers are also most often given for people with this illness. Lithium also has some antidepressant properties.

Some common antidepressants include Paxil®, Prozac®, Wellbutrin®, and Zoloft®. Recent research is changing the use of antidepressants in bipolar disorder, so talk about their use with your prescribing doctor. Bring your daily chart with you so your doctor can determine what medication or combination of medications is right for you. The FDA has also approved a pill that combines Prozac® and Zyprexa® called Symbyax® for bipolar depression.

Warnings

All drugs used in treating this condition will have some side effects. Talk to your doctor about the risks. Many of them are not severe and go away quickly. Severe side effects, including thoughts of killing oneself or physical changes, should be reported right away. Do not take any other medicine without first talking with your doctor. That includes many herbal remedies which may interact with your medication. Special attention should be given to teens and young adults, or anyone who is pregnant or nursing. Tell your doctor if you are actively trying to become pregnant.

Medication compliance

The medicine must be taken exactly as prescribed. This will help you get the best results. Do not stop taking it without talking with your doctor. Serious problems can result from stopping it or taking it incorrectly. If you feel the treatment is not working, talk to your doctor about it. He can change the dosage or switch medicine if needed. You and your doctor may need to try many types of drugs until you find the right one for you. Even if you start feeling better, you must keep on taking the medicine. Steady treatment will be the most helpful. Many of these drugs need ongoing lab monitoring to prevent side effects and monitor how well it works.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

National Institute of Mental Health Medications Booklet
www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

U.S. Food and Drug Administration
www.fda.gov/

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

Symptoms of bipolar disorder include:

• Severe mood swings from mania to depression
• Believing they can do things they can’t
• Doing too many things in too little time

Severe mood swings

Bipolar disorder can cause wide mood swings. The mood swings can range from mania (excited, high, or frantic) to depression (sad, hopeless). There are periods of normal moods as well. It can affect people of all ages, sexes, and races. It can affects people at all income levels. It is most often first diagnosed in adults. Once in a while, it is diagnosed in teens. In rare cases, it has been diagnosed in children as young as 5.

In adults, these moods can last weeks or months. In children or teens, the mood swings happen much more often. In fact, in many children, the mood swings cycle many times within a day. The symptoms can be similar to those of disruptive mood dysregulation disorder (DMDD). DMDD is characterized by dark moods and temper tantrums that are not age appropriate.

A child with bipolar disorder may also have other mental health issues, such as attention-deficit/hyperactivity disorder (ADHD). They may also have obsessive-compulsive disorder (OCD). Some may have drug or alcohol problems or oppositional disorders.

Mania

Everyone has mood swings. But, a person with bipolar disorder has extreme mood swings. The moods vary from mania to depression. The person’s feelings may become so intense that they lose touch with the real world. A person who has mania might have these symptoms:

• Feel on top of the world
• Think they can do things they never learned how to do such as play the piano
• Do too many things in too little time
• Sleep very little without feeling tired
• Get bothered or annoyed by small things
• Have poor judgment that leads to risky behavior and to do things they normally wouldn’t do

Depression

In a child with bipolar disorder, the depressive symptoms are like those an adult with depression. Each person with bipolar disorder is different. Some people may get very depressed for a long time, while others have only mild depression. People also have periods of normal moods in between the highs and lows.

Tips for parents

• Don’t forget your parenting jobs. When your child acts out or misbehaves, she should have consequences, even if you think your child’s behavior was caused by her mood changes.
• Don’t blame yourself. Poor parenting, divorce, or lack of discipline does not cause bipolar disorder. Scientists now believe that it is caused by genetic factors and biology.
• Medicine is one of the most useful treatments for bipolar disorder. If the doctor prescribed meds, make sure your child is taking them. It may take a while to find the right mix of medicines, in the right amount. So, be patient.
• Learn all you can about bipolar disorder. Help your child learn all he can about the disorder. Get facts from your doctor, trusted sites on the internet and from parent support groups.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

• Talk and non-talk therapies can be used.
• Alternative treatments need more research.
• Do not stop taking medications.

Talk therapies

Psychotherapy, also called talk therapy, is often used along with medicine to treat bipolar disorder. Talk therapy consists of many different forms.

Individual therapy, or counseling, gives help on a one-on-one basis. The person with this condition is taught proper coping skills to deal with her illness. This may include learning things like healthy eating habits and regular sleep routines. The therapist will also help the individual to work through her depressive thoughts.

Family support is vital to a person’s recovery. Therefore, it is recommended that family members also take part in counseling. This begins with learning about the disease. The family learns how to look for signs of oncoming bipolar episodes, in order to help their loved one get help more quickly. Families are also taught how best to care for and support the individual, as well as themselves.

Group therapy brings individuals with this condition together to talk about their lived experiences. Members support each other through their success stories. They can also comfort each other by sharing their failures. Just hearing that someone else struggles with the same things can be very helpful. Group therapy lets you know that you are not alone in the fight.

Cognitive-behavioral therapy (CBT)

CBT is a type of talk therapy that can be helpful in treating bipolar disorder. It mixes cognitive and behavioral therapy. Cognitive therapy deals with changing thoughts to change actions and mood. Behavior therapy deals with changing actions to change behavior. CBT helps the person to point out mood swings and avoid relapse.

Interpersonal and social rhythm therapy (IPSRT)

IPSRT treats the condition by focusing on healthy routines and relationships. Individuals are taught to form regular patterns for sleeping and for taking their medicine. They also learn problem-solving and people skills.

Non-talk therapies

Electroconvulsive therapy (ECT) is used when drugs and talk therapy do not reach desired results. This is typically for severe cases of bipolar disorder. It involves sending an electrical impulse to the brain. This procedure calls for the use of anesthesia. Short-term side effects, such as memory loss and confusion, may happen. These most often subside soon after treatment. ECT can be used to treat both mania and depression. Advantages are that it’s 70-80 percent effective.

Alternative treatments

Not enough research has been done on alternative treatments for people with this illness. Omega-3 fatty acids may give some benefit for minor depression. But, these and other natural and herbal remedies may not be helpful and could even be harmful. Some may not react well with other drugs that are prescribed. In some cases, they may set off a mania episode. Those diagnosed with this condition should not take any supplements without first consulting their doctor.

Medication congruency

Non-drug therapies are not meant to treat bipolar disorder alone. Drugs and talk therapy are most often the first course of action.

Pills must be taken exactly as prescribed and can be preventative for further episodes. This will help you get the best results. Do not stop taking medicine without consulting your doctor. Serious problems can result from stopping your medicine or taking it incorrectly.

Resources

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

National Institute of Mental Health/Bipolar Disorder
www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Suicide Prevention Lifeline
Call the toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) to talk with a trained counselor.

By Kevin Rizzo

©2012-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/psychotherapies/index.shtml, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Library of Medicine National Institute of Health, www.nlm.nih.gov/medlineplus/ency/article/000926.htm; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

• Cyclothymic disorder is a mild form of bipolar disorder.
• Some people may find symptoms mild enough not to treat.
• The best treatment plan includes medicine, psychotherapy, and healthy lifestyle habits.

Cyclothymic disorder is a mild form of bipolar disorder. It is marked by swings between high and low moods. The high is called hypomania. It involves a period of high activity or energy. It may also be marked by feelings of great happiness for no reason and strong self-confidence. Hypomania is not as harsh as the mania seen in bipolar I disorder.

The lows of this disorder look and feel like depression. It involves low mood, activity, and energy. Some people may not be bothered enough by the lows to seek help. The same is true for the highs. What’s more, people may feel fine between the highs and the lows. The key is to note the symptoms that do cause distress and work with a doctor to find the best treatment plan.

Treatment

Treatments include:

• Medicine
• Talk therapy
• Healthy lifestyle habits
• Recovery supports

People often do best when all four of the above are used at the same time. But the best approach depends on the person, her symptoms, and how each treatment works for her.

Some people with this disorder may find their symptoms mild. They may not feel the need to seek treatment. Or they may feel more productive during the hypomania phase. This can make people pleased rather than upset. Some people may find talk therapy alone is enough during the lows. Or they may find that healthy lifestyle habits are the key.

Medications

Some of the same medicines that are used to treat bipolar I disorder can be given for this disorder. Some people may not respond as well to these medications as people with bipolar I disorder. But mostly these medicines can help.

Although there are no formal U.S. Food and Drug Administration-approved medications indicated to treat cyclothymic disorder, doctors sometimes use lithium to treat symptoms. It may take a few weeks and a few dose adjustments for people to feel the full positive effects. In some cases, it may take as long as a few months coupled with a few dose adjustments for people to see the best results. Some of the other medicines that are sometimes prescribed for this condition include:

• Valproate (such as Depakote®)
• Carbamazepine (such as Tegretol®)
• Lamotrigine (such as Lamictal®)
• Lithium

In general, antidepressants should be used with caution. Sometimes they can cause someone who has cyclothymic disorder to become hypomanic or even manic.

People may choose to stop taking medicines after some time. If you choose to stop, it is important to work with a doctor to do it safely. The doctor will watch you to make sure you are managing well without it.

Talk therapy

An ideal treatment plan for cyclothymic disorder includes talk therapy. Talk therapy can help someone:

• Cope with mood swings
• Learn about the illness
• Solve problems
• Repair relationships

Some types of therapy can address more exact needs for living with a mood disorder. For instance, there is therapy to help make life goals, handle stress, and change behavior. These types of therapies educate people. They also help them set up healthy sleep patterns and daily routines. Couples and family therapy can also help solve problems due to mood swings.

Healthy lifestyle habits

There are daily habits that can improve symptoms for people with cyclothymic disorder:

• Keep regular daily routines
• Get regular sleep
• Exercise daily
• Eat healthy foods
• Avoid drugs and alcohol

Recovery supports

These are provided by peers who have had mental health struggles:

• Wellness Recovery Action Plan (WRAP®)
• Peer support
• Recovery education

Finding hope

Even though cyclothymic disorder may be a lifelong condition, it is treatable. Symptoms can change, though—in fact, people often start and stop treatment at different points in their lives. But it is important to work with a doctor to find the best treatment for you.

Resources

Depression and Bipolar Support Alliance

National Alliance on Mental Illness

By Sarah Stone

©2016-2019 Carelon Behavioral Health

Source: American Psychiatric Association. (2015) Understanding Mental Disorders: Your Guide to DSM-5; Stratford, HJ et al. (2015) ﾓPsychological Therapy for Anxiety in Bipolar Spectrum Disorders: A Systematic Review.ﾔ Clinical Psychology Review, Volume 35;19-34; U.S. National Library of Medicine, Cyclothymic Disorder, www.nlm.nih.gov/medlineplus/ency/article/001550.htm; Mayo Clinic, www.mayoclinic.org/diseases-conditions/cyclothymia/basics/definition/con-20028763

Reviewed by Gary R. Proctor, M.D., Associate CMO, Operations, Beacon Health Options