Bipolar disorder is a psychiatric disorder which can range from a challenging illness to a serious mental illness. It is characterized by bouts of both depression and mania or hypomania. It should be diagnosed and managed by a psychiatric prescriber, be it a psychiatrist, psychiatric nurse practitioner, or psychiatric physician assistant. If your primary care provider or therapist suspect you have bipolar disorder, they should refer you to a psychiatric provider who can perform an assessment and prescribe medication as needed.
How do I know if I have bipolar disorder?
Many people mistakenly believe that the main feature of bipolar disorder is frequent and intense mood swings from one moment to the next. They may describe a person, or themselves, experiencing a frequent and rapidly changing mood throughout the course of a day. While this may be a feature of the disorder, it is not your clinician’s primary consideration when making the diagnosis. When screening for bipolar disorder, your clinician will be on the lookout for a history of depression as well as mania or hypomania. It is necessary for the individual to have experienced at least one episode of mania or hypomania in order to make a diagnosis of bipolar disorder. Therefore, to make an accurate diagnosis, it is very important to understand the characteristic presentations of mania.
What does mania look like?
Fundamentally, mania is an abnormal, involuntary, and prolonged elevation in mood. Individuals who experience hypomania (and mania) have periods of several consecutive days where they feel wired, energized, have a reduced need for sleep and may feel like they’re not in control of themselves. During this period of time they often exhibit an uncharacteristically inflated and excessive sense of self esteem or grandiosity. They may feel “on top of the world”, have an endless supply of energy, and commence endless or grandiose projects impulsively with no prior thought or planning. Individuals will often appear noticeably more energetic by an outside observer and may speak more quickly, have racing thoughts which may jump quickly from one idea to another, and this generally will last most of the day, every day, for the duration of the manic episode.
Because the brain’s accelerator is essentially “stuck” in the “go” position, the overstimulated and overactive mind may lead the individual to reach an uncharacteristically “egosyntonic” state of mind, having a sense that “everything I do is right”. While in this altered mental state, reckless behaviors and sleeplessness may not be seen as problematic, and individuals may be uncharacteristically difficult to be persuaded or reasoned with when evidence is strong and convincing, or even unequivocal. A person may sleep for short periods, and upon awakening the mania resumes. The severity of a person’s mania will vary from person to person and episode to episode, and each individual’s respective mood elevation may manifest itself in different ways.
Less common but more serious cases of “full blown mania” may at their peak result in periods of psychosis, hallucinations, delusional thinking, and can result in psychiatric hospitalizations, some of which the individual may not remember upon returning to their normal, stable mood. During these more severe episodes individuals may put themselves or others in danger and cause irreparable damage to their lives. Upon resolution of episodes of mania or hypomania, individuals may crash into a depressive episode. Most individuals with bipolar disorder experience depressive episodes more often than they experience mania, however, in rare cases individuals may experience only mania and report virtually no bouts of depression. Mania usually does not occur regularly. Whereas depression is difficult to endure, mania may be euphoric, enjoyable, and even productive. However, mania can also be destructive to a person’s relationships, employment, finances, health, and overall quality of life.
Does it ever get misdiagnosed?
Making the diagnosis can be difficult, and there is data to suggest that receiving a correct diagnosis takes years after the first episode. If you suspect you have bipolar disorder, the more you educate yourself on the diagnosis, especially the features of mania, the easier it will be for you and your provider to reach a consensus on a correct diagnosis. It is often difficult for individuals who experience mania to recognize and understand the symptoms at first. To further complicate diagnosis, there are other psychiatric disorders which can overlap with some of the symptoms of bipolar disorder. Individuals with ADHD can experience short periods of energy and hyperfocus which should not be confused with mania. Some individuals with major depressive disorder can also experience short periods of mood elevation which should not be confused with mania, as well as potentially severe anxiety, agitation, and mood swings which also should not be mistaken for mania. Sometimes a personality disorder or a history of trauma can be confused for bipolar disorder because of emotional challenges, reckless, impulsive, or dangerous behaviors, and mood swings. While intense anxiety, agitation, and mood swings may arise for some individuals during manic episodes, these alone in the absence of accompanying symptoms of mood elevation should not be mistaken for bipolar disorder. If an individual experiences episodes of mood elevation consistent with a manic episode while under the influence of a substance, this also should not be mistaken for bipolar disorder.
What should I expect from medication?
Diagnosing and prescribing for bipolar disorder may be an ongoing process until an effective regimen and dose of medications is found. It is common to try several different medications or combinations of medications until an effective regimen is found. Keep in mind that an effective regimen does not guarantee the disorder will be managed perfectly, and relapses may still occur. Even effective regimens may need to be changed from time to time. Many individuals with bipolar disorder need more than one mood stabilizing medication, and antidepressants may be ineffective, or in some cases, result in mood elevation. In some cases, they may be effective and helpful. Some medications for bipolar disorder require lab monitoring and regular blood tests. Others may need to be titrated carefully. Some of them may have difficult to tolerate side effects for some individuals, or even harmful side effects in rare cases. Good communication with your prescriber is key in finding a regimen that works for you.
What else do I need to know?
Your clinician understands that bipolar disorder can be very difficult to live with. They will respect your decision if you wish to move forward in your life without medication. Remember that self care is important. Sleep, diet, exercise, stress management and healthy coping mechanisms are all important in managing mood, and psychotherapy can be helpful as well. It is very important not to self medicate or abuse substances if you have bipolar disorder, as many psychoactive substances will impact mood and can result in depression and mania. They can also interact with and compromise the efficacy of medications, or cause undesirable additive effects.
