Overview
Bipolar disorder was formerly called manic-depressive disorder. It’s a brain disorder that causes a person to experience extreme highs, and in some cases, extreme lows in mood. These shifts can affect a person’s ability to perform everyday tasks.
Bipolar disorder is a long-term condition usually diagnosed in late adolescence or early adulthood.
According to the National Institute of Mental Health,
It’s important to see a healthcare professional if you suspect you may be showing symptoms of bipolar disorder. Doing so will help you get an accurate diagnosis and the appropriate treatment.
Read on to see how healthcare providers and mental health professionals diagnose this disorder.
Current screening tests for bipolar disorder don’t perform well. The most common report is the Mood Disorder Questionnaire (MDQ).
In a 2019 study, results indicated that people who scored positive on the MDQ were as likely to have borderline personality disorder as they were to have bipolar disorder.
You can try some online screening tests if you suspect you have bipolar disorder. These screening tests will ask you a variety of questions to determine if you’re experiencing symptoms of manic or depressive episodes. However, many of these screening instruments are “home grown” and may not be valid measures of bipolar disorder.
Symptoms for shifts in mood include:
| Mania, or hypomania (less severe) | Depression |
| experiencing mild to extreme emotional highs | decreased interest in most activities |
| having higher than usual self-esteem | change in weight or appetite |
| reduced need for sleep | change in sleep habits |
| thinking fast or talking more than usual | fatigue |
| low attention span | difficulty focusing or concentrating |
| being goal-oriented | feeling guilty or worthless |
| engaging in pleasurable activities that may have negative consequences | having thoughts of suicide |
| high irritability | high irritability most of the day |
These tests should not replace a professional diagnosis. People taking the screening test are more likely to be experiencing symptoms of depression than a manic episode. As a result, a bipolar disorder diagnosis is often overlooked for a depression diagnosis.
It should be noted that a diagnosis of bipolar 1 disorder only requires a manic episode. A person with bipolar 1 may or may not ever experience a major depressive episode. A person with bipolar 2 will have a hypomanic episode preceded or followed by a major depressive episode.
Seek emergency medical attention right away if you or someone else is experiencing behavior that could lead to self-harm or harm to others, or having thoughts of suicide.
Sample questions from a screening test for bipolar disorder
Some screening questions will include asking if you’ve had episodes of mania and depression, and how they affected your day to day activities:
- Within the last 2 weeks, were you so depressed that you were unable to work or work only with difficulty and felt at least four of the following?
- loss of interest in most activities
- change in appetite or weight
- trouble sleeping
- irritability
- fatigue
- hopelessness and helplessness
- trouble focusing
- thoughts of suicide
- Do you have changes in mood that cycle between periods of high and low, and for how long do these periods last? Determining how long the episodes last is an important step in figuring out whether a person is experiencing true bipolar disorder or a personality disorder, such as borderline personality disorder (BPD).
- During your high episodes, do you feel more energetic or hyper than you would during moments of normality?
A healthcare professional can provide the best evaluation. They’ll also look at a timeline of your symptoms, any medications you’re taking, other illnesses, and family history to make a diagnosis.
When getting a diagnosis for bipolar disorder, the usual method is to first rule out other medical conditions or disorders.
Your healthcare provider will:
- perform a physical exam
- order tests to check your blood and urine
- ask about your moods and behaviors for a psychological evaluation
If your healthcare provider doesn’t find a medical cause, they may refer you to a mental health professional, such as a psychiatrist. A mental health professional may prescribe medication to treat the condition.
You may also be referred to a psychologist who can teach you techniques to help recognize and manage shifts in your mood.
The criteria for bipolar disorder are in the new edition of the Diagnostic and Statistical Manual of Mental Disorders. Getting a diagnosis may take time — even multiple sessions. The symptoms of bipolar disorder tend to overlap with those of other mental health disorders.
The timing of bipolar mood shifts isn’t always predictable. In the case of rapid cycling, moods may shift from mania to depression four or more times a year. Someone may also be experiencing a “mixed episode,” where the symptoms of mania and depression are present at the same time.
When your mood shifts to mania, you may experience a sudden abatement of depressive symptoms or suddenly feel incredibly good and energetic. But there will be clear changes in mood, energy, and activity levels. These changes aren’t always as abrupt, and may happen over the course of several weeks.
Even in the case of rapid cycling or mixed episodes, a bipolar diagnosis requires someone to experience:
- a week for an episode of mania (any duration if hospitalized)
- 4 days for an episode of hypomania
- a distinct intervening episode of depression that lasts for 2 weeks
There are four types of bipolar disorder, and the criteria for each is slightly different. Your psychiatrist, therapist, or psychologist will help you identify which type you have based on their exams.
| Type | Manic episodes | Depressive episodes |
| Bipolar 1 | last for at least 7 days at a time or are so severe that hospitalization is required. | last at least 2 weeks and may be interrupted by manic episodes |
| Bipolar 2 | are less extreme than bipolar 1 disorder (episodes of hypomania) | are often severe and alternate with hypomanic episodes |
| Cyclothymic | happen often and fit under hypomanic episodes, alternating with depressive periods | alternate with episodes of hypomania for at least 2 years in adults and 1 year in children and teenagers |
Other specified and unspecified bipolar and related disorders is another type of bipolar disorder. You can have this type if your symptoms don’t meet the three types listed above.
The best way to manage bipolar disorder and its symptoms is long-term treatment. Healthcare providers usually prescribe a combination of medication, psychotherapy, and at-home therapies.
Medications
Some medications can help with stabilizing moods. It’s important to report back often to your healthcare providers if you experience any side effects or don’t see any stabilization in your moods. Some commonly prescribed medications include:
- mood stabilizers, such as lithium (Lithobid), valproic acid (Depakene), or lamaotrigine (Lamictal)
- antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and aripiprazole (Abilify)
- antidepressants, such as Paxil
- antidepressant-antipsychotics, such as Symbyax, a combination of fluoxetine and olanzapine
- anti-anxiety medications, such as benzodiazepines (e.g., valium, or Xanax)
Other medical interventions
When medication doesn’t work, your mental health professional may recommend:
- Electroconvulsive therapy (ECT). ECT involves electrical currents being passed through the brain to induce a seizure, which can help with both mania and depression.
- Transcranial magnetic stimulation (TMS). TMS regulates mood for people who aren’t responding to antidepressants, however it’s use in bipolar disorder is still evolving and additional studies are needed.
Psychotherapy
Psychotherapy is also a key part of treating bipolar disorder. It can be carried out in an individual, family, or group setting.
Some psychotherapies that may be helpful include:
- Cognitive behavior therapy (CBT). CBT is used to help replace negative thoughts and behaviors with positive ones, learn how to cope with symptoms, and better manage stress.
- Psychoeducation. Psychoeducation is used to teach you more about bipolar disorder to help you make better decisions about your care and treatment.
- Interpersonal and social rhythm therapy (IPSRT). IPSRT is used to help you create a consistent daily routine for sleep, diet, and exercise.
- Talk therapy. Talk therapy is used to help you express your feelings and to discuss your issues in face to face setting.
At-home therapies
Some lifestyle changes can lessen the intensity of moods and frequency of cycling.
Changes include trying to:
- abstain from alcohol and commonly misused drugs
- avoid unhealthy relationships
- get at least 30 minutes of exercise a day
- get at least 7 to 9 hours of sleep per night
- eat a healthy, balanced diet that’s rich in fruits and vegetables
Talk to your healthcare provider if your medication and therapies aren’t relieving your symptoms. In some cases, antidepressants can make symptoms of bipolar disorder worse.
There are alternative medications and therapies to help manage the condition. Your healthcare provider can help you create a treatment plan that works well for you.
