What Is Bipolar Disorder (Formerly Manic Depression)?

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated May 13, 2024by BetterHelp Editorial Team
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Bipolar disorder, formerly known as manic depression, is a prevalent and severe mental health condition characterized by significant emotional swings. Depressed mood and low energy levels are typical during depressive episodes, while elevated moods and high energy levels occur during manic or hypomanic episodes. Distinguishing bipolar disorder from related disorders, like borderline personality disorder or severe depression, requires a thorough mental health evaluation. Bipolar disorder is treatable, and many individuals find that their mood symptoms are stabilized through a combination of treatment options, such as antidepressant medication and therapy.
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People diagnosed with bipolar disorder may experience intense emotional shifts, including manic or depressive episodes, that can dramatically alter how they feel, think, and act. Shifting episodes occurring four or more times per year are classified as rapid cycling, though some bipolar disorder people can experience daily oscillations in mood. Experiencing rapid cycling does not mean the pattern is permanent or lifelong. Adjustments in bipolar disorder care, such as modifying treatment plans, may effectively reduce the occurrence of rapid cycling and help maintain a more normal mood instead of experiencing swings between manic and depressive episodes.

Depressive episodes

Sadness is a common emotion for most people, but those experiencing depressive episodes describe periods of negative thoughts that extend beyond general sadness. A five-year study of people with bipolar disorder found that it takes individuals in a depressive cycle 11 weeks, on average, from the time of initial symptoms of depression to return to a state without diagnosable mental health conditions. Many people experiencing a depressive episode, including mild depression or bipolar depression, experience some of the following symptoms:

  • Difficulty focusing
  • Low energy and/or motivation
  • Trouble sleeping, oversleeping, or general changes in sleep patterns
  • Little interest in activities that were once enjoyable
  • Feeling lonely, worthless or both
  • Change in eating habits
  • Feeling extended periods of sadness or unhappiness
  • Isolating behavior from friends, family members, and loved ones
  • Thoughts of suicide

Manic episodes

During depressive episodes, many people with bipolar disorder may experience symptoms of major depressive disorder. During manic episodes, however, symptoms are different.  

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Symptoms of manic episodes might include:

  • Impulsive decision-making
  • Racing thoughts or speaking quickly
  • Experiencing high levels of energy
  • Delusions of grandeur
  • Engaging in risky behaviors
  • Feeling extremely confident, excited, or irritable
  • Needing less sleep
  • Experiencing paranoia and/or hallucinations

Though heightened energy levels may sound like a positive emotional change to some, many people with bipolar disorder experience symptoms such as an irritable mood, anger, and a lack of control that can be challenging to manage. Bipolar I disorder is diagnosed during manic episodes.

Diagnosis

Psychosis is a mental health term that describes hallucinations and grandiose delusions. Studies suggest that half of individuals diagnosed with bipolar disorder may experience some degree of psychotic symptoms within their lifetime. Individuals experiencing psychosis may be misdiagnosed as schizophrenic or with related disorders, and this may be particularly common amongst Black and Hispanic individuals. A medical doctor should evaluate you in person, taking a careful history to make an accurate diagnosis. 80-90% of people with bipolar disorder have a family member with depression or bipolar disorder, so your doctor will also look at your family history.

Assessment standards for bipolar disorder in adults and children have improved significantly within the past decade. During assessment, a medical doctor (such as a psychiatrist) will evaluate mood fluctuations and determine if you meet the criteria for any type of bipolar disorder. Bipolar I (manic depressive), Bipolar II (major depression and less severe hypomanic cycles), or unspecified bipolar disorder are the categorizations used to classify the condition. A doctor may diagnose you with a less severe form of bipolar disorder or other mental disorders. In children, diagnosing bipolar disorder can be more challenging because they commonly experience mixed episodes with symptoms of both mania and depression. People with bipolar II disorder often have other additional mental health conditions that increase the severity of their symptoms of bipolar disorder.

How do mood swings work?

Though many people living with diagnosed bipolar disorder experience symptoms that enable early detection of a bipolar episode, mood swings can be unpredictable. They may occur gradually, or they can occur abruptly, and they can last for hours, weeks, or months at a time. As described by Dr. David A. Merrill for Forbes Health, the reoccurrence of mood swings is “the expectation, not the exception” because the disorder is characterized by these mood oscillations. A therapist can help you work to recognize overstimulation and things that may make the occurrence of episodes more likely, and you can keep a mood journal to document how your emotions change over time. With proper treatment and support from organizations like the Depression and Bipolar Support Alliance, individuals can better manage their condition and even prevent bipolar disorder episodes.

Triggers

Though there is not always a trigger for a manic or depressive episode, there can be. Changing jobs, living situations, or adjusting (or halting) medication can all be triggers. Other things, such as drug or alcohol use, traumatic experiences, changes in relationship status, lack of quality sleep, or anything else that causes heightened stress or excitement can initiate an episode. You can familiarize yourself with some of the common warning signs of a potential manic or hypomanic episode to help yourself possibly better mitigate and manage them.  

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Therapy can improve your mood stability and overall wellbeing

Treatment

Bipolar disorder is a long-term, cyclical disorder, so long-term treatment is recommended for most people. A mixture of psychotherapy and medications, such as mood stabilizers, are typically recommended. 

Medication requires careful management from a physician who is experienced in treating bipolar disorder. For example, some people may find it difficult to adhere to their medication treatment plan during phases of mood swings. In these cases, there are medication approaches that can be helpful in reducing rates of “breakthrough symptoms.” Additionally, antidepressant use is not recommended for patients with diagnosed bipolar disorder, so if you have previously been diagnosed with depression and prescribed antidepressants, your care provider may seek to change your medications or you can discuss doing so with them. 

Therapy can be a helpful strategy for people with bipolar disorder to improve wellbeing and life satisfaction. You may find therapy modalities such as interpersonal and social rhythm therapy (IPSRT) and FFT may be helpful.

An online therapist can help you learn about your disorder and develop the tools to recognize and navigate your symptoms. Cognitive behavioral therapy (CBT) is effective in reducing the severity of mania and rate of relapsing for people with bipolar disorder. A 2017 study of online CBT, which is offered from sites like BetterHelp, found that it is effective in managing symptoms of bipolar disorder. Additionally, online therapy can be less costly for some, and you may find it easier to stick with therapy sessions because it’s often more convenient.

Takeaway

Bipolar disorder, formerly called manic depression, is very common. When someone exhibits symptoms of mood swings and emotional instability, often transitioning between a manic episode and depressive episode, it's crucial to consult a mental health professional to get a proper evaluation and potentially have bipolar disorder diagnosed and their bipolar disorder treated. Symptoms are characterized by significant mood swings, and an in-person physician can provide a diagnosis and treatment plan to help you manage your disorder. Online therapy can be an effective part of your strategy to manage your symptoms and recognize early signs of a manic or depressive episode.

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