Bipolar Disorder and Other Conditions
Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as an anxiety disorder, substance use disorder, or an eating disorder. People with bipolar disorder have an increased chance of having thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.
Psychosis: Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:
- People having psychotic symptoms during a manic episode may have the unrealistic belief that they are famous, have a lot of money, or have special powers.
- People having psychotic symptoms during a depressive episode may falsely believe they are financially ruined and penniless, have committed a crime, or have an unrecognized serious illness.
As a result, people with bipolar disorder who also have psychotic symptoms are sometimes incorrectly diagnosed with schizophrenia. When people have symptoms of bipolar disorder and also experience periods of psychosis that are separate from mood episodes, the appropriate diagnosis may be schizoaffective disorder.
Anxiety: It is common for people with bipolar disorder to also have an anxiety disorder.
Attention-Deficit Hyperactivity Disorder (ADHD): It is common for people with bipolar disorder to also have ADHD.
Misuse of Drugs or Alcohol: People with bipolar disorder may misuse alcohol or drugs and engage in other high-risk behaviors at times of impaired judgment during manic episodes. Although the negative effects of alcohol use or drug use may be most evident to family, friends, and health care providers, it is important to recognize the presence of an associated mental disorder.
Eating Disorders: In some cases, people with bipolar disorder also have an eating disorder, such as binge eating or bulimia.
Risk Factors
Researchers are studying the possible causes of bipolar disorder. Most agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness.
Brain Structure and Functioning: Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.
Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.
Treatments and Therapies
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.”
Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.
Medications
Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best.
Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.
People taking medication should:
- Talk with their health care provider to understand the risks and benefits of the medication.
- Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
- Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
- Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.
Avoid stopping a medication without talking to a health care provider first. Suddenly stopping a medication may lead to a “rebound” or worsening of bipolar disorder symptoms. For basic information about medications, visit NIMH’s Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the U.S. Food and Drug Administration (FDA) Medication Guides website.
Psychotherapy
Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. It can provide support, education, and guidance to people with bipolar disorder and their families. Treatment may include therapies such as cognitive-behavioral therapy (CBT) and psychoeducation, which are used to treat a variety of conditions.
Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy. Determining whether intensive psychotherapeutic intervention at the earliest stages of bipolar disorder can prevent or limit its full-blown onset is an important area of ongoing research.
Visit NIMH’s Psychotherapies webpage to learn about the various types of psychotherapies.
Other Treatment Options
Some people may find other treatments helpful in managing their bipolar symptoms, including:
Electroconvulsive Therapy (ECT): ECT is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. With modern ECT, a person usually goes through a series of treatment sessions over several weeks. ECT is delivered under general anesthesia and is safe. It can be effective in treating severe depressive and manic episodes, which occur most often when medication and psychotherapy are not effective or are not safe for a particular patient. ECT can also be effective when a rapid response is needed, as in the case of suicide risk or catatonia (a state of unresponsiveness).
More research is needed to determine the effects of other treatments, including:
Transcranial magnetic stimulation (TMS): TMS is a newer approach to brain stimulation that uses magnetic waves. It is delivered to an awake patient most days for 1 month. Research shows that TMS is helpful for many people with various subtypes of depression, but its role in the treatment of bipolar disorder is still under study.
Supplements: Although there are reports that some supplements and herbs may help, not enough research has been conducted to fully understand how these supplements may affect people with bipolar disorder.
It is important for a health care provider to know about all prescription drugs, over-the-counter medications, and supplements a patient is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.
Beyond Treatment: Things You Can Do
Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.
Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps – including self-reports, self- ratings, and activity data – with their health care providers and therapists.
For Immediate Help
If you are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to everyone. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.
If you are thinking about harming yourself or thinking about suicide:
- Tell someone who can help right away.
- Call your licensed mental health professional if you are already working with one.
- Call your doctor or health care provider.
- Go to the nearest hospital emergency department or call 911.
If a loved one is considering suicide:
- Do not leave him or her alone.
- Try to get your loved one to seek immediate help from a doctor, health care provider, or the nearest hospital emergency room or call 911.
- Remove access to firearms or other potential tools for suicide, including medications.
Coping with Bipolar Disorder
Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.
- Get treatment and stick with it—recovery takes time and it’s not easy. But treatment is the best way to start feeling better.
- Keep medical and therapy appointments and talk with the provider about treatment options.
- Take all medicines as directed.
- Structure activities: keep a routine for eating and sleeping, and make sure to get enough sleep and exercise.
- Learn to recognize your mood swings and warning signs, such as decreased sleep.
- Ask for help when trying to stick with your treatment.
- Be patient; improvement takes time. Social support helps.
- Avoid misuse of alcohol and drugs.
Remember: Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.