The Different Types Of Bipolar Disorder & How To Treat Them

By Michael Puskar

Updated August 10, 2019

Contrary to what many people believe, bipolar disorder is not just one condition - in fact, there are a few different ones that have some distinct characteristics that you should be aware of. The type of bipolar disorder that a person can get diagnosed with can also influence his or her course of treatment as well, which is why it is important to distinguish between them. In this article, you will learn about the various types of bipolar disorder and the methods in which they are treated.

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General Characteristics Of Bipolar Disorder

Although there are variants of the condition, bipolar disorder, as a generalized umbrella term, has some common traits and symptoms which apply to any type.

Bipolar disorder is an episodic condition that is defined by its mood swings. However, unlike how mood swings and bipolar disorder are portrayed in the media, such as being very brief and switching from one emotion to the next, these swings can last for over a week.

These episodes can be described as manic and depressive, which is why bipolar disorder is sometimes called manic-depressive disorder or manic depression by some individuals. Here are some of the symptoms for each type of episode: [1] [2]

Manic Symptoms

To meet the criteria for a manic episode, patients must exhibit at least three of the following:

  • Increased energy and a sense of euphoria and elation
  • Feeling touchy and irritable
  • Racing thoughts and speech
  • Excessive multi-tasking
  • Easily distracted
  • Inflated self-esteem and delusional and grandiose thoughts
  • An increased desire for pleasurable activities, including risky behaviors

Depressive Symptoms

To meet the criteria for a major depressive episode, patients must exhibit a minimum of five of the following:

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  • Feeling sad, down, and anxious
  • Restlessness and difficulty concentrating
  • Low energy and forgetfulness
  • A loss of interest in activities
  • Appetite changes
  • A sense of hopelessness and worthlessness
  • Preoccupation with death and suicidal ideation

You may have noticed that these depressive symptoms are identical to ones found in major depression, and you would be correct. Mania, to some degree, will always be present in bipolar disorder, and without it, it would just be depression. In some episodes, there might never be depression, but in others, they can be mixed.

In the next section, you will learn about how these kinds of episodes are essential in helping to determine which of the types of bipolar disorder a person will be diagnosed with.

The Three Main Forms Of Bipolar Disorder

Based on the episodes a person is experiencing, people are primarily grouped into one of three different categories - Bipolar I, II, and Cyclothymic Disorder; on top of these, there are a few additional ones for those who have signs that do not fit with the other selections. These are the possible options:

Bipolar I Disorder:

Bipolar I consists of manic episodes that last for a minimum of seven days, which persist for most of the day. It can also be diagnosed when the symptoms require hospital care. Individuals with Bipolar I type can also have mixed symptoms and experience depressive episodes. For a mixed episode to be present, symptoms of mania and depression must have persisted for at least one week; however, depressive episodes often last for two weeks or longer.

Bipolar II Disorder:

Depressive and hypomanic episodes characterize bipolar II, but not severe mania, which is present in bipolar I. Hypomania shares all of the same characteristics as a typical manic episode, but are less powerful and only need to last for four consecutive days, as opposed to the seven that is seen in a full-blown manic episode seen in Bipolar I. On the other hand, unlike a hypomanic episode, a major depression one must have lasted for at least two weeks. [2]

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Cyclothymic Disorder:

The cyclothymic disorder is a unique kind of bipolar disorder in that it has hypomanic and depressive symptoms that are still persistent, but they are not nearly intense enough as standard hypomanic or depressive episodes. In adults, these symptoms can last for at least two years, whereas in the youth, it may only last only for one year. Therefore, people with the cyclothymic disorder will experience many mood swings on a fairly consistent basis.

Substance/Medication-Induced Bipolar And Related Disorders

Various substances, including prescription medication, can cause bipolar symptoms in some individuals. For these people, they would be grouped here because the symptoms do not meet the criteria for regular manic, hypomanic, and depressive episodes. In the DSM-5, for these episodes, it states that the effects of any substance must not cause the symptoms. [4] [5]

Bipolar And Related Disorder Due To Another Medical Condition

Like the previous category, this one is also situational in that it is contingent on something else to get diagnosed. For instance, hypothyroidism can cause manic features in some individuals, and it would qualify them for this niche category. [3] However, some medical conditions might not be apparent right away, which could lead someone to be diagnosed with one of the primary types of bipolar disorder, if specific tests are not run.

Other Specified And Unspecified Bipolar And Related Disorders

Lastly, if a person has symptoms that do not match any of these categories above, he or she can receive this diagnosis. For example, if an individual has hypomanic symptoms that have only lasted three days, he or she can fall into this category. Nonetheless, the symptoms are enough to cause clinical distress and impairment in various aspects of life. In some cases, there may not be enough information available, yet the symptoms are present, and thus, will be grouped here. [3]

The Risk Factors For Bipolar Disorder

Currently, there is no definitive cause for bipolar disorder, but it is believed that multiple factors can play a role in the development of this condition, such as:

  • Genetics
  • Brain Structure & Chemistry
  • Stress, Abuse, and Trauma

Bipolar disorder often runs in families, and if a loved one has this condition, there is a chance there is another member with the disorder as well, either diagnosed or undiagnosed. Genetic predisposition is not caused by one single gene; instead, multiple are responsible. [1]

However, genes are not the only factor to blame here, as studies involving identical twins have shown that one can develop bipolar disorder while the other will not. While your closest family members such as siblings and parents can increase the odds of developing the condition, it is important to point out that most people will not get the bipolar disorder, despite a familial connection. [1]

How Bipolar Disorder Is Treated

Since there are different types of bipolar disorder, there can be some variation in how each one is treated; nonetheless, there is still plenty of common ground.

Because all forms of bipolar have manic properties, an antimanic agent and mood stabilizer will almost always be used to treat the symptoms of mania and the mood swings. [1] Lithium is one of the most common types of mood stabilizers used to treat bipolar disorder.

To treat the depressive symptoms, an antidepressant may also be prescribed, but not always. Some of the most commonly used antidepressants will target serotonin, a neurotransmitter in the brain associated with mood and pleasure.

Others may be provided with an antipsychotic medication if someone with bipolar disorder is also experiencing psychosis, which is a symptom found in various conditions, including substance abuse. Psychosis can make diagnosing bipolar disorder difficult at times because it can overlap with manic symptoms, such exhibiting as delusional and grandiose behavior. Some people with bipolar disorder have been misdiagnosed with schizophrenia because of this reason. [1]

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Outside of medication, people have seen significant improvements by including psychotherapy in their treatment plans. If you have been struggling with the symptoms of bipolar disorder, and you have been thinking, "I just need someone to talk to," this will most likely be one your preferred treatment options.

If you need someone to talk to, a therapist can help address and restructure your thoughts and give you the skills to handle the emotions you are currently experiencing and might again in the future.

Lastly, electroconvulsive therapy (ECT) may be used in the most severe cases where other treatment methods did not work. Some people might require different types of medications, but some rare individuals may be responsive to all of them. ECT can also be used in situations where an immediate response is needed, such as a suicide risk situation, or they are unresponsive.

"I Wish I Had Someone To Talk To" - Conclusion

While there is no cure for bipolar disorder and its different forms, these treatment methods have a high success rate, and people can manage their symptoms through a combination of medication and therapy.

Without treatment, the condition can get worse, so it is crucial to get diagnosed by a physician or mental health professional as soon as possible. Although it can be kept under control, bipolar disorder is incurable, and treatment will need to be ongoing to prevent episodes from reoccurring and produce better long-term outcomes. [2]

Medication can only be prescribed through a medical doctor such as your family physician or a psychiatrist, but psychotherapy never requires a prescription. In addition to traditional in-person sessions, having someone to talk to online is always an option, and ReGain offers online counseling and therapy services for anyone who happens to be struggling with bipolar disorder. This includes those who are being affected by it personally, or you have someone close to you with the condition.

Bipolar disorder can be difficult for all parties to cope with, especially at first, but with the right support, it can be managed. When friends and families have active involvement in the treatment process, it allows people to overcome bipolar disorder together.

References

  1. National Institute of Mental Health. (2016, April). Bipolar Disorder. Retrieved July 16, 2019, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  2. American Psychiatric Association. (2017, January). What Are Bipolar Disorders? Retrieved July 17, 2019, from https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
  3. Lojko, D., Suwalska, A., & Rybakowski, J. (2014). Bipolar and related disorders and depressive disorders in DSM-5. Psychiatr. Pol, 48(2), 245-260. Retrieved from https://pdfs.semanticscholar.org/4ff8/d2d1952e25708eddfc6ef8a2b1717d2b5c17.pdf.
  4. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 11, DSM-IV to DSM-5 Manic Episode Criteria Comparison.Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t7/
  5. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 9, DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/

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