Bipolar Disorder: Highs, Lows, And In Between

“Bipolar disorder” is a term that people can often misunderstand. You might hear someone casually say, “I’m so bipolar today,” just because they experienced some highs and lows in their moods. But bipolar disorder is far more complex than feeling happy one moment and sad the next. It’s a lifelong mental health condition that involves extreme shifts in mood, energy, and behavior, sometimes leading to serious consequences if not properly managed.

Whether you’ve been diagnosed yourself, have a family member or close friend with bipolar disorder, or want to understand more about this condition, let’s take a deeper look into the highs, the lows, and everything in between.

Symptoms of bipolar disorder

At its core, bipolar disorder is defined by extreme mood episodes, with periods of mania (highs) and depression (lows) that go beyond normal fluctuations in mood.

Hypermania (seen in bipolar I disorder)

Manic episodes that last up to one week and cause severe functional impairment, often requiring hospitalization.

During a manic episode, a person might feel on top of the world, filled with boundless energy, confidence, and grand plans. But this high isn’t just about being happy or in a good mood. It often leads to reckless decision-making and impulsive behaviors that can have serious consequences. Some common symptoms of mania include:

• Feeling euphoric or excessively irritable
• Increased energy and decreased need for sleep
• Racing thoughts and rapid speech
• Impulsivity, manifesting in poor judgment and irresponsible behaviors like overspending, risky sexual advances, reckless driving, and more
• Delusions of grandeur, where the person believes they have special powers or abilities
• An inability to recognize their behavior as problematic
• Psychotic symptoms (in severe cases) – hallucinations or delusions.

Hypomania (seen in bipolar II disorder)

Hypomanic episodes are similar to mania but less severe and can last up to four days. They do not cause major dysfunction or require hospitalization.

Key symptoms are:

• Increased energy and activity but still able to function.
• Elevated mood but no psychotic features.
• Enhanced productivity, creativity, or sociability.

Bipolar depression

On the other end of the spectrum is bipolar depression, which is just as intense as major depressive disorder but often harder to treat. Symptoms include:

• Persistent sadness or hopelessness
• Loss of interest in activities once enjoyed
• Fatigue and low energy
• Changes in sleep patterns (insomnia or excessive sleeping)
• Feelings of worthlessness or guilt
• Suicidal thoughts or behaviors

Mixed episodes and rapid cycling

Some people experience mixed episodes, where manic and depressive symptoms occur simultaneously, for example, feeling agitated and hopeless at the same time. Others experience rapid cycling, where they swing between mania and depression multiple times in a short period.

What causes bipolar disorder?

Bipolar disorder isn’t just about having extreme emotions. It’s a complex condition influenced by biological, genetic, and environmental factors.

Genetic factors

Studies suggest that bipolar disorder runs in families. If a close relative such as a parent or sibling has the disorder, the person is at higher risk of developing it themselves. However, genetics alone don’t determine everything. People with a strong family connection to relatives who have bipolar disorder may never develop the condition, and conversely, people with no family history may develop the disorder.

Brain chemistry

Neurotransmitters in the brain, like dopamine, serotonin, and norepinephrine, play a crucial role in mood regulation. In bipolar disorder, these chemicals may not be functioning properly, leading to episodes of mania or depression.

Environmental triggers

While genetics and brain chemistry set up the foundations, stressful life events can trigger bipolar episodes. This can include:

• Major life changes, such as starting college, breakup of a marriage, loss of a loved one, etc.
• Chronic stress, such as pressure at work, financial struggles, etc.
• Substance abuse can trigger the onset of the disorder or worsen symptoms.

How is bipolar disorder diagnosed?

Bipolar disorder is diagnosed using a clinical assessment, following criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Clinical Interview

A mental health professional will conduct a detailed interview, asking about:

• Mood history – past episodes of depression, mania, or hypomania.
• Family history – bipolar disorder often runs in families.
• Functioning and behavior – impact on work, relationships, and daily life.

DSM-5 Diagnostic Criteria

• Bipolar I disorder: At least one manic episode (may or may not have depressive episodes).
• Bipolar II disorder: At least one hypomanic episode AND one major depressive episode.
• Cyclothymic disorder: Chronic mood instability with hypomanic and depressive symptoms that do not meet full criteria.

Rule out other causes

Since bipolar symptoms overlap with other disorders, doctors first try to rule out:

• Major depressive disorder when no manic episodes are present.
• Schizoaffective disorder if hallucinations or delusions persist outside mood episodes.
• Substance-induced mood disorders if symptomscan be related to drug or alcohol use.
• Thyroid disorders through blood tests, since hyperthyroidism can mimic mania).

Mood questionnaires

Some common tools include:

• Mood Disorder Questionnaire (MDQ) – screens for bipolar symptoms.
• Young Mania Rating Scale (YMRS) – assesses manic severity.
• Hamilton Depression Rating Scale (HAM-D) – measures depressive symptoms.

Medical tests

Though no lab test confirms bipolar disorder, doctors may conduct:

• Blood tests to rule out thyroid issues or vitamin deficiencies.
• Brain imaging (MRI, CT scan) only in complex cases with neurological concerns.

Pharmacological treatment of bipolar disorder

There’s no cure for bipolar disorder, but with the right treatment, many people can lead stable, fulfilling lives. The key is finding a combination of treatments that work for each individual.

Mood stabilizers

Mood stabilizers are the cornerstone of bipolar treatment, primarily used to prevent both manic and depressive episodes.

Carbolith (lithium)

Lithium carbonate is one of the most well-researched and effective treatments for bipolar disorder, especially for reducing suicide risk.

✅ Pros:

• Proven long-term efficacy for both mania and depression.
• Reduces the risk of suicide in bipolar disorder.
• Can prevent future mood episodes with long-term use.
• Does not cause sedation like many antipsychotics.

❌ Cons:

• Requires regular blood monitoring to prevent toxicity.
• Can cause kidney and thyroid issues with long-term use.
• Common side effects: tremors, weight gain, excessive thirst, frequent urination.
• Narrow therapeutic range (toxicity can occur if dosage is too high).

Depakote (valproate)

Valproate is an anticonvulsant often used for bipolar I disorder, especially in rapid cycling or mixed episodes.

✅ Pros:

• Effective for manic episodes, especially in those with rapid cycling.
• Works well when lithium is not tolerated, contraindicated or not effective.
• Requires less frequent blood monitoring than lithium.

❌ Cons:

• Not as effective for bipolar depression as lithium.
• Can cause weight gain, hair loss, and hormonal changes.
• May lead to liver damage and pancreatitis (requires monitoring).
• Contraindicated in pregnancy due to risk of birth defects.

Lamictal (lamotrigine)

Another anticonvulsant, especially effective for bipolar depression.

✅ Pros:

• Works better for depression than other mood stabilizers.
• Fewer side effects than lithium or valproate.
• No significant weight gain or sedation.

❌ Cons:

• Slow dose titration required to prevent a serious side effect (Stevens-Johnson Syndrome).
• Not very effective for mania. May need to be combined with another medication.
• Requires strict adherence to dosage adjustments.

Atypical Antipsychotics

Originally designed for schizophrenia, atypical antipsychotics are now widely used in bipolar disorder, particularly for manic episodes.

Zyprexa (olanzapine)

Olanzapine is one of the most commonly prescribed antipsychotics for acute mania.

✅ Pros:

• Works quickly to reduce severe mania.
• Can be used with antidepressants for bipolar depression.
• Less risk of tremors than lithium or valproate.

❌ Cons:

• Significant weight gain and increased risk of developing diabetes.
• Can cause sedation and cognitive dulling.
• Higher risk of long-term metabolic syndrome (diabetes, high cholesterol).

Seroquel (quetiapine)

An atypical antipsychotic effective for both mania and depression.

✅ Pros:

• FDA-approved for bipolar depression.
• Effective as a monotherapy (no need for additional mood stabilizers).
• Helps with sleep disturbances common in bipolar disorder.

❌ Cons:

• Can cause significant drowsiness and fatigue.
• Weight gain and metabolic risks similar to olanzapine.
• Can cause low blood pressure and dizziness.

Risperdal (risperidone)

Risperidone is prescribed primarily for acute mania and mixed episodes.

✅ Pros:

• Rapid onset of action in reducing manic symptoms.
• Less sedating than Seroquel.
• Can be used in children and adolescents.

❌ Cons:

• Can cause increased prolactin levels, leading to hormonal side effects (breast enlargement, menstrual irregularities).
• Some risk of extrapyramidal symptoms (involuntary movements, rigidity).

Antidepressants

Antidepressants are not first-line treatments for bipolar disorder, as they can trigger manic episodes if used without a mood stabilizer. When prescribed, they are only used with caution and require close monitoring.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Examples are Prozac (fluoxetine), Zoloft (sertraline), and Escitalopram. They are often used with mood stabilizers for bipolar depression.

✅ Pros:

• Effective for depressive symptoms.
• Well-tolerated with fewer side effects than older antidepressants.
• Less risk of weight gain compared to some antipsychotics.

❌ Cons:

• Can induce mania if not combined with a mood stabilizer.
• Less effective for severe bipolar depression compared to mood stabilizers.
• May take weeks to show full effects.

Wellbutrin (bupropion)

A dopamine-norepinephrine reuptake inhibitor (NDRI) sometimes used in bipolar disorder.

✅ Pros:

• Lower risk of inducing mania compared to SSRIs.
• No weight gain or sexual side effects.

❌ Cons:

• Can worsen anxiety in some patients.
• Not as effective for severe bipolar depression.

Benzodiazepines (for acute symptoms)

Lorazepam and clonazepam can be used for short-term management of acute agitation, anxiety, or insomnia.

✅ Pros:

• Works quickly to reduce severe agitation or insomnia.
• Helps manage anxiety symptoms in bipolar disorder.
• Can be useful as an adjunct to other medications.

❌ Cons:

• Not for long-term use due to risk of dependence.
• Withdrawal symptoms if stopped suddenly.
• Can cause sedation and memory issues.

Non-pharmacological approaches

Medication alone isn’t enough. Many people with bipolar disorder are recommended:

• Cognitive Behavioral Therapy (CBT) helps recognize and manage triggers.
• Psychoeducation teaches about the disorder and improves long-term management.
• Day-time routine and sleep hygiene helps prevent mood swings by maintaining consistent sleep and daily routines.

Frequently Asked Questions about bipolar disorder

Can bipolar disorder be cured?

Bipolar disorder is a lifelong condition with no known cure, but it can be effectively managed with treatment. Many people with bipolar disorder lead fulfilling lives with proper medication, therapy, and lifestyle adjustments. The goal of treatment is to reduce the frequency and severity of mood episodes, allowing individuals to maintain stability. Some people experience long periods without significant symptoms, but stopping treatment often leads to relapse.

What’s the difference between Bipolar I and Bipolar II?

Bipolar I and Bipolar II are different in the severity of manic episodes:

• Bipolar I: Includes at least one full-blown manic episode that lasts a week or leads to hospitalization. Depressive episodes often follow but are not required for diagnosis.
• Bipolar II: Characterized by hypomania, which is a less severe form of mania, along with major depressive episodes. Hypomania doesn’t cause psychosis or hospitalization but still disrupts daily life.

How does bipolar disorder affect relationships?

Bipolar disorder can significantly impact relationships, especially if mood swings are not well managed. During manic episodes, a person may act impulsively, make risky decisions, or become irritable and aggressive. Depressive episodes may lead to withdrawal and difficulty maintaining communication. However, with honest communication, education, and treatment, many people with bipolar disorder maintain healthy relationships.

Are there any natural treatments for bipolar disorder?

While medication remains the primary treatment, certain lifestyle changes can help manage symptoms:

• Omega-3 fatty acids (found in fish oil and dietary supplements like Zoomind) have some mood-stabilizing properties.
• Regular exercise helps regulate mood and energy levels.
• Mindfulness and meditation can help manage stress.
• Consistent sleep schedule is crucial, as irregular sleep patterns can trigger mood episodes. Simple supplements like the Sleep Pack create a good biological framework for getting enough shut-eye. However, natural remedies should never replace prescribed treatments, and any supplements should be discussed with a doctor.

How can I support someone with bipolar disorder?

Supporting a person near and dear to you with bipolar disorder requires patience, understanding, and education. Here’s how you can help:

• Learn about bipolar disorder to understand what they’re experiencing.
• Encourage treatment adherence—medication and therapy are crucial.
• Be supportive but set boundaries—during manic episodes, they might make risky decisions, so setting healthy boundaries is essential.
• Be prepared for relapses. Mood swings may still happen, so having a plan for managing crises is important.
• Take care of yourself, too. Caregiver burnout is a real phenomenon, so self-care is crucial.