Most people experience a range of moods throughout the day based on interactions with their surroundings. A smile from a loved one can brighten your day. A traffic jam can sour it. Emotions, and the ability to control them, are an essential part of our lives. In people with bipolar disorder, their mood swings wildly and uncontrollably between depression and mania. These swings can severely handicap a person’s life, affecting personal relationships, work, and even their own wellbeing.

Bipolar disorder is a serious brain illness that affects around four percent of people in the United States: almost two million people. Because it affects brain function, bipolar disorder disrupts a person’s behavior. The effects differ from person to person, but the main symptom is the mood swings.

Though anyone can be affected by bipolar disorder, it commonly occurs between the ages of 18 and 35.

Types of Bipolar Disorder

Because the symptoms are different from person to person, doctors have categorized the illness into several types:

• Bipolar I Disorder: Manic symptoms are severe and last around seven days. A person will also suffer from weeks-long episodes of depression.
• Bipolar II Disorder: Bipolar II Disorder is not as severe at bipolar I in that there are no full manic episodes. They still experience an elevation of depressed or manic moods.
• Bipolar Disorder Not Otherwise Specified: This version of bipolar disorder is below bipolar I and II in that a person does not experience drastic mood swings and manic episodes strong enough to be diagnosed, but still has symptoms beyond that of a normal person.
• Cyclothymia: This is a mild form of bipolar disorder that lasts at least two years but is not debilitating enough to meet the requirements of bipolar disorder.
• Rapid Cycling: Rapid cycling bipolar disorder is diagnosed when a person experiences at least four episodes of mania and depression within one year. The mood swings can happen as quickly as a few hours apart and put a person through a ringer of emotions. The changes occur randomly and can get worse over time without treatment. Half of all people with bipolar disorder will experience rapid cycling at one point in their illness, and substance abuse has been shown to increase the likelihood of rapid cycling.

What is a Manic Episode?

A manic episode occurs when a person’s mood shifts to an extreme state of joy. This manic period is highlighted by changes in behavior that are excessive in the context of the situation. This includes a sense of euphoria, little or no attention span, inflated ego, and the formation of grand plans. Physically, a person can experience insomnia and restlessness, rapid speech, increased sex drive, higher vulnerability to alcohol and drug abuse, and irrational behavior.

A manic episode can last up to a week or longer, which is shorter than a depressive episode. Most people experiencing a manic episode are not aware of their condition, which can cause problems in daily life for themselves and others.

Hypomania

Hypomania can be recognized by a noticeable shift in mood, increasing a person’s productivity, self-esteem, and irrational decisions. It differs from a manic episode in that they do not interfere with daily activities. A person experiencing hypomania can still function in work and social environments without incident because symptoms of hypomania are not as extreme or disruptive as a full manic episode.

What is a Depressive Episode?

When the pendulum swings in the opposite direction of mania, depression can occur. Depression is a feeling of sadness that can continue for two weeks or longer. With bipolar disorder, depression can hit quickly without warning. The symptoms include fatigue, irrational moods like anxiety and anger, disrupted sleep patterns, restlessness, changes in eating habits, a lack of interest in things that once represented pleasure, and even suicidal thoughts.

Because a lengthy depressive episode can leave a person feeling helpless, suicide is a genuine risk associated with bipolar disorder. The disorder also frequently leads to substance abuse as a way of escaping depression. Unfortunately, abuse of alcohol or drugs only feeds further into the symptoms of depression.

Episode Triggers

The symptoms of bipolar disorder are different for each person, but it is believed manic or depressive episodes can be triggered. These triggers can be either psychological or environmental. They include:

• Stressful, life-changing events such as a wedding or trouble at work can lead to an episode.
• Antidepressants and some over-the-counter medications have been known to trigger manic episodes.
• Drinking and abusing drugs generally worsen the symptoms of bipolar disorder. Depending on the type of drug, a manic or depressive episode can be triggered. For instance, alcohol is a depressant, while cocaine is a stimulant.
• A lack of sleep can have an altering effect on a person’s mood.
• Surrounding yourself with negative, enabling people makes it easier to slip into depression.
• Manic episodes can adhere to seasons. Depression is common from fall through spring, while manic episodes are more likely in the summer.

Diagnosis

There is no blood test or brain scan available to definitively diagnose bipolar disorder, so diagnosis relies on a medical exam, a psychological exam, and lab tests. Most people see a doctor when they are depressed, which can be confused for major depression unless a complete medical history is taken.

Medical Exam

A physical exam will be performed to ensure a person’s vital signs are normal. Additionally, a complete medical history will be taken, including family history and the frequency of manic and depressive feelings. The medical exam can also reveal substance abuse issues.

Lab Tests

Blood and urine tests cannot confirm bipolar disorder, but can eliminate contributing factors of depression and mania. This helps narrow down the diagnosis to bipolar disease.

Psychological Exam

The psychological exam digs deeper into a person’s behavior to identify specific markers of bipolar disorder. This may include a mood chart, which tracks a person’s mood swings throughout a period of time.

Each type of bipolar disorder has a set of criteria established by the Diagnostic and Statistical Manual of Mental Disorders. A psychologist determines if a person meets these criteria and what type of bipolar disorder they have.

For Bipolar I disorder, a person must have had a minimum of one manic episode or one mixed episode. A major depressive episode is not necessary. Bipolar II disorder is characterized by at least one manic and depressive episode. The symptoms of bipolar II disorder interfere with a person’s daily activities. For cyclothymic disorder, a person experiences several minor manic and depressive states, but never reaches a full manic or depressive episode. Symptoms must also last for a minimum of two years for durations longer than two months at a time.

Bipolar Disorder in Children

It is possible for children to have bipolar disorder, but diagnosis is more difficult because even a normal child can have swift changes in mood. Additionally, bipolar disorder shows symptoms similar to other disorders such as attention deficit hyperactivity disorder (ADHD). Bipolar disorder in children is characterized by multiple mood swings in a day and behavior that seems out of character. For teenagers, reckless sexual and substance abuse habits can also be a marker for bipolar disorder.

The reason bipolar disorder can affect children is unclear. Studies suggest that genes play a factor. Children with a blood relative in their nuclear family are up to six times more susceptible for bipolar disorder. Chemical imbalances in the brain are also suspected. Physically, if a child with bipolar disorder experiences a traumatic event, it can trigger a manic or depressive episode.