Author: Claudia M. Elsig, MD

Imagine living with severe mood swings, alternating between episodes of mania and depression, and being stuck in an extreme state for weeks or even months at a time. That’s the reality for someone living with bipolar disorder. The mood swings of bipolar disorder shouldn’t be confused with life’s general ups and downs.

Bipolar is a severe mental health disorder, with mood states ranging from despair and suicidal thoughts to heightened elation and delusional ideas. Bipolar disorder is as complex as it is serious, and a surprising number of people suffer from it.

This blog explains more about the disorder, what causes it, the symptoms, what it’s like to live with bipolar, and the different treatment options.

What is bipolar disorder?

Bipolar disorder is a severe mental health condition characterised by disabling moods and changing energy levels. Someone who has bipolar disorder can swing from feeling abnormally energetic and happy to incredibly empty, lethargic, and low. It changes energy, behaviour, and how a person thinks and sleeps.

During a period of depression, a person with bipolar often has overwhelming feelings of worthlessness and can have thoughts of death or suicide. Other common symptoms during a depressive episode include:

• Feeling down, sad, worried, anxious, overwhelmed
• Low energy
• No interest in usual activities
• Forgetful
• Indecisive
• Difficulty concentrating
• Sleeping too much or too little
• Over or under-eating

During the manic phase, a person who has bipolar disorder can develop ambitious plans and ideas, be creative, and feel overjoyed or excessively irritable. They may talk a lot and speak very quickly, make impulsive decisions, and take risks.

They might also experience psychosis and hallucinations, seeing or hearing things that aren’t there or believing things that aren’t true. Other common symptoms during a manic episode include:

• Feeling euphoric
• Excessive energy
• Restlessness
• Inflated self-esteem
• Risk-taking, such as unsafe sex, gambling, spending a lot of money, or taking drugs
• Irritability and agitation
• Difficulty sleeping

The different types of bipolar disorder

In the clinical setting, bipolar disorder is usually differentiated into different types according to how often bipolar moods are experienced, their intensity, and how severely the symptoms affect the person. These include:

• Bipolar I
• Bipolar II
• Cyclothymic disorder
• Mixed bipolar state
• Rapid cycling bipolar

A Bipolar I diagnosis is a more severe form of the illness and is defined by manic episodes. There must have been at least one episode of mania lasting at least one week. There may or may not have been some depressive episodes. There can be hallucinations, and a person may even be hospitalised for their safety.

Bipolar II is characterised by at least one depressive episode and symptoms of hypomania – a noticeable change in mood and behaviour less severe than mania – which have lasted for at least four days. Bipolar II is not as extreme as bipolar I. A Cyclothymia diagnosis is given where there are hypomania and depressive episodes, but these are not severe enough to meet the diagnostic criteria of bipolar I or II.

Mixed bipolar disorder signifies manic and depressive episodes of bipolar I or II being experienced together or quickly after one another. Rapid cycling means the person with bipolar experiences many episodes of illness each year (usually four or more episodes of mania and depression in any one year) and can even have several mood swings in a single day.

What causes bipolar and who gets it?

There isn’t one specific cause behind bipolar disease. It is thought a combination of factors contributes to someone developing the illness. These factors include:

• Childhood trauma
• Stressful life events and overwhelming problems
• Brain chemistry
• Family history of bipolar (genetic)
• Medication, drugs, and alcohol

Bipolar disorder can occur at any age, including during early childhood, although it commonly develops in adolescence between the ages of 15 and 19. Also, it isn’t a gender-specific illness, so it can affect men and women equally, as well as all races, ethnic groups, and socioeconomic classes.

How many people have bipolar disorder?

According to the UK’s National Health Service, around 1 in 100 people will be diagnosed with bipolar disorder in their lifetime.¹ In 2019, the World Health Organization reported that around 40 million people in the world experienced being bipolar.²

In recent years, several celebrities have spoken out about their struggles with bipolar, including Mariah Carey, Carrie Fisher, Mel Gibson, Demi Lovato, Catherine Zeta-Jones, and Francis Ford Coppola. It is now thought that the late 19th-century artist Vincent Van Gogh had bipolar disorder, which he developed as a young adult. American soap star Billy Miller, who recently took his own life, suffered from bipolar. His mother wrote in a statement after his death about his bipolar disorder that “in the end, the disease won the fight.”³

What are the consequences of living with bipolar?

For individuals experiencing bipolar, there are many lifestyle and relationship consequences. For a partner of someone with bipolar, life can feel like an emotional rollercoaster. And of course, unpredictable behaviours play havoc with trust, which is essential in a healthy relationship. Erratic behaviour can be confusing to partners and children.

During episodes of illness, the personalities of people with bipolar disorder can change, making them sometimes abusive or even violent. During manic phases, a person with bipolar can desire frequent sex and then, during episodes of depression, avoid sexual contact altogether. Gambling is also more likely in manic phases – people with bipolar tend to spend frivolously.

Research shows at least one in ten people with bipolar disorder are at moderate to severe risk of problem gambling.⁴ Harrowing suicide stats give a sense of how serious bipolar is – researchers estimate that between 25% and 60% of individuals with bipolar disorder will attempt suicide at least once in their lives, and between 4% and 19% will complete suicide.⁵

Not only that, research shows, as Dr Brian Miller, MD, PhD MPH, writes in the Psychiatric Times, “Bipolar disorder is associated with a two- to threefold increased risk of premature mortality, including not only suicide death, but also cardiovascular disease, respiratory disease, and cancer.”⁶

What are the treatment options for bipolar disorder?

It is essential to understand that bipolar disorder is a lifelong condition that requires treatment; it won’t go away on its own. However, despite the seriousness of bipolar disorder, with proper treatment, a person with the condition can live well. Mood-stabilising drugs are prescribed to manage manic episodes and should be taken every day on a long-term basis. Additional medication may be prescribed to manage mania and depression as it happens.

Psychotherapy is a vital part of bipolar treatment. Research shows that psychotherapy, when added to medication for the treatment of bipolar disorder, consistently shows advantages over medication alone.⁷ In addition, there are lots of lifestyle choices that can help lessen the episodes and extent of bipolar mood swings. These include:

• Regular exercise
• A healthy, balanced diet
• Getting good sleep
• Having a structured daily routine
• Consistently taking medications as recommended and prescribed by your physician
• Avoiding drugs and alcohol
• Building a good support network
• Recognising and avoiding triggers
• Setting boundaries
• Practising stress management
• Planning ahead
• Practising breathwork

Getting help at CALDA

At CALDA, we use a multi-modal approach to treat bipolar disorder. Our holistic method addresses all imbalances in the organism, including nutritional deficiencies. Effective and proven therapy methods from different disciplines are combined in a finely tuned and personalised way to benefit the individual.

The treatment plan is tailored to address any underlying causes following extensive and detailed diagnostics. If you would like to know more about our programs, get in touch. We are happy to answer your questions.

References/sources:

1. National Health Service. 3 Jan 2023. Overview – Bipolar disorder. [Accessed online 15 Nov 2023]
2. World Health Organization. 8 Jun 2022. Mental Disorders. [Accessed online 15 Nov 2023]
3. Katie Kindelan. 19 Sept 2023.  Soap opera star dies by suicide: What to know about bipolar disorder. ABC News. [Accessed online 15 Nov 2023]
4. Jones L, et al. 18 Jun 2015. Gambling problems in bipolar disorder in the UK: prevalence and distribution. Br J Psychiatry. 2015 Oct;207(4):328-33.
5. Novick DM, Swartz HA, & Frank E. Feb 2010. Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar Disord. 2010 Feb;12(1):1-9.
6. Miller, B. 14 Mar 2022. Premature Mortality in Bipolar Disorder. Psychiatric Times. [Accessed online 15 Nov 2023]
7. Swartz HA, & Swanson J. 2014. Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus (Am Psychiatr Publ). 2014 Summer;12(3).