Bipolar Disorder: Symptoms, Treatments, and Everything You Need to Know

Bipolar disorder is a mental disorder, better known by its former name – manic depression. Both names express the essence of the disorder: extreme mood swings in both directions – sometimes, episodes of mania – an extremely energetic, vital, and cheerful mood, and sometimes, episodes of depression.

Diagnosis of bipolar disorder is performed by a psychiatrist. It is important to know that diagnosis is very important because the accuracy of the diagnosis is crucial. As part of the diagnosis, physiological tests are also conducted to rule out other physical conditions that may cause similar phenomena – for example, thyroid dysfunction. The psychological symptoms are also examined in depth, as bipolar disorder often occurs in combination with another mental disorder, so it is very important to diagnose the situation accurately.

Between 1 and 3% of the population suffers from bipolar disorder. Men and women are likely to suffer from it equally, but men more often experience episodes of mania, while women more often experience episodes of depression.

It is important to know that a diagnosis of bipolar disorder is made when the first episode that occurs is mania. If the first episode is depression, the patient will be diagnosed as suffering from depression, and the diagnosis of bipolar disorder will only come after experiencing a manic episode as well.

Bipolar Disorder: The Symptoms

Of course, not every very good mood or slightly depressing day constitutes a sign of bipolar disorder. However, the symptoms can be identified when they appear together, in an extreme manner that interferes with the normal functioning of the person, and over a certain period.

Common symptoms of mania include excessively elevated mood, particularly high self-esteem to the point of feeling superior, a sense of spiritual empowerment (even in situations where such empowerment is not required or is not done correctly), restlessness, high activity level, excessive energy, and minimal need for sleep, impatience or irritability towards others, and even aggressive behavior. There may also be very fast thinking, which creates very rapid speech – to the point of incoherent and disorganized talk; a tendency to take risks without restraint (quitting a job, sudden decision on divorce or marriage, etc.); uncontrolled spending, and also a tendency to use alcohol and drugs.

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Depressive episodes often come after a period of mania, like a mirror image of mania. Common symptoms of depressive periods include sadness and low mood, feelings of hopelessness, despair, and lack of enjoyment, sometimes to the point of suicidal thoughts and attempts, lack of energy, fatigue, difficulty getting out of bed and going to work, and on the other hand – sleep disturbances and waking up in the early hours, concentration difficulties, anxiety, guilt, loss of appetite – or conversely, an increase in appetite, both of which can affect body weight, general self-neglect, and more.

There are several types of bipolar disorder. In some, the symptoms appear in a relatively mild form, called "hypomania" and "dysthymia." In other cases, the disorder appears in an especially extreme manner and may be accompanied by hallucinations and delusions – a psychotic state.

Manic and depressive episodes require immediate medical treatment because, at both ends of the disorder, there is a danger that the person may harm themselves. Often, the person themselves cannot recognize their condition, and people around them need to be vigilant and intervene, to refer them for immediate medical treatment.

Bipolar disorder that is not well managed can also cause complications such as addiction to alcohol or drugs, social and economic problems due to money waste and unnecessary risks, sometimes leading to legal entanglements. As mentioned, suicide can also be one of the dangers associated with the disorder.

How Is Bipolar Disorder Treated?

The treatment of bipolar disorder is divided into two main parts: treatment during a manic or depressive attack, and "maintenance" treatment during routine times. The main goal of the treatment is to prevent, as much as possible, the episodes, and if they occur – to prevent the patient from harming themselves or others, and to reduce the intensity of the episodes.

For permanent treatment, lithium is usually given, which stabilizes the mood. When taking lithium, it is very important to take it continuously, because there is a risk that if stopped, and an episode of mania or depression occurs, the lithium will not affect when it is restarted. Other prescribed medications are anticonvulsants (such as Tegretol), which also serve as mood stabilizers. There are several antipsychotic medications, which are used not only for treatment during a psychotic attack but also help stabilize the mood and mitigate episodes as part of regular "maintenance" treatment. These medications include Risperdal, Haldol, Zyprexa, and more.

In cases of manic attacks, sedatives based on benzodiazepines (like Klonopin, for example, or Lorivan) are usually given. These medications can be addictive and therefore are not used regularly, only in cases of an attack. In cases of depressive attacks, antidepressants such as Cipralex and Prozac can be used. However, treatment with these medications is done very carefully (and sometimes the doctor will decide there is no need for them at all) – because they may cause a reversal of the condition, and instead of stabilizing only the depression – move the patient from a state of depression to a state of mania.

Often, those suffering from bipolar disorder need to take several medications simultaneously. The determination of suitable medications and the appropriate dosage is done by a specialist psychiatrist, according to the severity of the symptoms and other characteristics of the patient and the disorder.

Patients who do not respond to drug treatment are sometimes candidates for electroconvulsive therapy. This is a series of treatments (8-10 treatments) done once every two weeks under full anesthesia, and includes the application of a small electric current to the central nervous system. The treatment can affect mood, appetite, and general sensation, and helps balance the bipolar disorder.

In cases of extreme episodes that may endanger the patient or their surroundings, sometimes hospitalization is necessary until balance is achieved.

In addition to drug treatment, there is a need for psychotherapy, and sometimes also family therapy and support groups, which are meant to alleviate the accompanying aspects of the disorder – such as social stigma, social and economic difficulties, and so on.