Bipolar disorder (depression & mania) - causes, symptoms, treatment & pathology

Maybe you’ve heard the term “bipolar” used to describe someone who’s moody, or

who has mood swings, but this colloquial use of the term is really different from bipolar


Bipolar disorder, which used to be called manic depression, is a serious mental illness

that causes a person to have dramatic shifts in emotions, mood, and energy levels: moving

from extreme lows to extreme highs.

But these shifts don’t happen moment to moment, they usually happen over several days

or weeks.

There are a few different types of bipolar disorders, but there are some common features.

First, the low moods are identical to those in a related disorder - major depressive disorder,

also known as unipolar depression.

Individuals with this can feel hopeless and discouraged, lack energy and mental focus,

and can have physical symptoms like eating and sleeping too much or too little.

But along with these lows, the thing that sets bipolar disorders apart from unipolar

depression is that individuals can have periods of high moods, which are called manic episodes

or hypomanic episodes, depending on their level of severity.

In a manic state, people can feel energetic, overly happy or optimistic, even euphoric

with really high self-esteem.

And on the surface, these might seem like very positive characteristics, but when an

individual is in a full manic episode, these symptoms can reach a dangerous extreme.

A person experiencing mania might invest all of their money in a risky business venture

or behave recklessly.

Individuals might talk pressured speech, where they talk constantly at a rapid-fire pace,

or they might have racing thoughts and might feel ‘wired,’ as if they don’t need


Manic episodes can also include delusions of grandeur, for example they might believe

that they are on a personal mission from god, or that they have supernatural power.

And they might make poor decisions without any regard for later consequences.

One way to understand these swings is by charting them on a graph.

So let’s say y-axis is mood, with mania and depression being on the far ends of the

axis, and the x-axis is time.

The average healthy individual might have normal ups and downs throughout their life,

and they might even have some pretty serious lows once-in-awhile, maybe after losing a

job or moving to a new place and feeling lonely.

An individual with unipolar depression though, might have the normal highs, but they might

have some crushing lows that last for a long period of time and may not have an obvious


Now, for the bipolar disorders, the first one is called Bipolar 1, and these are people

that have some major lows that last at least 2 weeks, and some major highs that last at

least a week or require hospitalization.

That said, untreated manic episodes can last as long as 3-6 months.

Depression is seen in most cases, but is not required for a diagnosis.

The second one is called Bipolar-2, and this is when a person experiences similar lows,

and has additional highs called “hypomania”, which are less severe manic episodes than

we see in Bipolar 1.

To qualify for a diagnosis, these hypomanic states need to last at least four days.

Once again though, these symptoms generally last a few weeks to a few months.

Alright the third one is called cyclothymia, or sometimes cyclothymic disorder, and these

individuals have milder lows as well as the milder highs or “hypomania” like you see

in Bipolar-2, and they cycle back and forth between these two over a period lasting at

least 2 years.

Sometimes, people with Bipolar disorder can show other, less common symptoms as well,

for example having what are referred to as mixed episodes—experiencing symptoms of

both depression and mania at the same time.

Another symptom they might have is rapid cycling, which describes a situation where a person

has 4 or more episodes of depression or mania within a given year.

Like most mental health conditions, the exact underlying cause of bipolar disorder isn’t

known, and there is no single “bipolar gene” identified, but it’s thought that there

are genetic and environmental factors that play a part.

For example, one interesting clue is that people with family members who have bipolar

disorder are 10 times more likely to have it themselves.

Another clue is that some drugs and medications can trigger manic episodes, like selective

serotonin reuptake inhibitors (or SSRIs).

It’s also worth mentioning that people with bipolar disorder often have other disorders

like anxiety disorders, substance use disorders, ADHD, and personality disorders as well, making

diagnosis and treatment a real challenge.

Even though there’s no cure for bipolar disorder, identifying and treating individuals

is really important, since there’s a real danger that the person could harm themselves

or commit suicide.

One of the oldest treatments is also one of the most effective treatments, and that’s

lithium salts.

Lithium acts as a mood stabilizer—smoothing out the highs and lows they experience.

That said, it is much better at treating manic rather than depressive episodes, and so individuals

who take it often have to take other medications as well, which can be problematic since some

antidepressants (like the SSRIs) can trigger manic episodes in individuals who are predisposed

to them.

Other treatment options include antipsychotics, anticonvulsants, and benzodiazepines, but

many of these—including lithium—have side effects that can be severe and lead to non-adherence

which can be dangerous for an individual.

Now, unlike certain disorders like unipolar depression, psychological interventions, like

talk therapy, or cognitive-behavioral therapy are not particularly effective in treating

the manic episodes of bipolar disorder.

Having said that, they can still be very helpful tools to help individuals with bipolar disorder

in general—especially after a manic episode has ended.

They can also help an individual handle stressful situations that might otherwise lead a manic

episode, thereby helping to prevent a potential manic episode in the first place.

Alright, so super fast recap: bipolar disorder is a mental disorder characterized by depression,

periods of lowered mood, as well as mania, periods of heightened mood.

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