Could I Have Bipolar Disorder?

Think of the different moods you might feel in a day, or even in a week. For example, there’s everything from happiness and sadness to frustration and feeling so energized you could tackle a whole mountain of work. Typically, moods are manageable and we are able to work through them on our own. However, among those with bipolar disorder, those same mood swings and shifts may be difficult to control.

Bipolar disorder is characterized by difficulty regulating mood, says Alison Gilbert, PhD, a clinical psychologist at Northwell Health. So, how can someone tell if the shifts in their moods are normal, and when they may be a sign of a condition like bipolar disorder?

Bipolar disorder is typically diagnosed in early adulthood. It Is less commonly diagnosed in teens and young children. Approximately 4% of adults in the United States experience bipolar disorder at some point in their lives, with men and women being affected equally.

Gilbert explains that people with bipolar disorder experience distinct periods of intense ups and downs, called mania and depression. These extreme mood changes interfere with an individual’s daily functioning and behavior.

Signs of mania include:

• Euphoric or irritable mood. You experience unlimited energy and excitement or irritability.
• Distractibility. You move from one activity to the next, constantly starting new projects but never finishing.
• Increased goal-directed behavior. You take on many projects and/or increase your engagement in social activities.
• Swollen self-esteem. You feel as if you can accomplish anything and/or feel that you may even possess supernatural abilities.
• Pressured speech. You may talk so loudly or quickly that you make no sense.
• Sleep issues. You can’t fall asleep or can’t stay asleep. You may be awake for days, yet you have plenty of energy.
• Engaging in risky behaviors. These can include gambling, illegal drug use, or having unsafe sex.

Signs of depression include:

• Feeling down. You may feel hopeless, empty, and worthless.
• No energy. You’re exhausted no matter how much sleep you get.
• Sleep issues. You may be unable to fall asleep or to stay asleep. Or you may sleep too much.
• Difficulty concentrating. Simple questions, tasks, or responsibilities can feel overwhelming.
• Changes in appetite. You may eat either too much or too little.
• Suicidal thoughts. Things can get so bad you may even consider suicide.

While many of these symptoms may seem to mimic other disorders, such as attention deficit disorder, generalized anxiety disorder, or borderline personality disorder, only bipolar disorder is both chronic and episodic, says Gilbert. In other words, it is a lifelong (chronic) illness that consists of mood episodes as well as periods of wellness (episodic).

An episode of depression without any symptoms of elevated mood would be called unipolar depression, says Gilbert. “Interestingly, a person who experiences at least one episode of acute mania is diagnosed as having bipolar I disorder even if they have never experienced an episode of depression,” says Gilbert.

The two most common types of bipolar disorder are:

• Bipolar I is the most serious. An individual must only experience mania. Manic episodes last at least seven days or are so severe that they require immediate hospital care. Depressive episodes last at least two weeks.
• Bipolar II is similar to bipolar I disorder but the manic symptoms are less intense and shorter in duration and are called hypomania. An individual must experience both hypomania and depression.

Diagnosing bipolar disorder can be challenging because when people experience (hypo)mania, they feel good. “Often, they feel so good that they don’t see the need to seek medical attention,” says Gilbert. While the individual themselves may not be aware of their (hypo)manic mood symptoms, others will notice a change in their behavior. “When mania becomes significantly impairing, family members often need to step in to get their loved one the medical attention that they need,” she says.

Mood stabilizers are usually the go-to medications for bipolar disorder. However, since mood stabilizers can take a bit of time to kick in, doctors often start with an antipsychotic medication because they work more quickly. Once the mood stabilizer begins to take effect, the antipsychotic may be able to be eliminated, though some people continue to need both medications to stay on track.

It’s also important to remember that individuals may respond differently to medication. The trick is to find the right combination of medications at the right dose, which can take time.

In conjunction with medication, other types of treatment may ease the symptoms of bipolar disorder, including the following:

• Electroconvulsive therapy (ECT) may be helpful for people who have intense depression that doesn’t ease with medications. It can also be helpful for those individuals, such as pregnant women, who can’t be on certain medications.
• Talk therapy can help people learn coping strategies that reduce stress. Talk therapy can also offer people emotional support.
• Lifestyle changes such as practicing self-care, sticking to a regular schedule, and eating and exercising well can also be helpful when managing bipolar disorder.

• Thinking of starting an antidepressant? Read this first.
• 5 things I wish you knew about depression.
• Can a quiz diagnose your mental health issues? Here, a psychologist weighs in.