Living with bipolar disorder

Your friend recently bought a new car on a whim and announced he was leaving on a cross-country trip without planning a destination or duration. Now you discover he's uninterested in any activity and doesn't want to leave home. The spontaneous actions followed by inactivity could be a sign of a mental health condition called bipolar disorder.

Previously known as manic depression, bipolar disorder causes extreme mood swings of emotional highs and lows called episodes. The highs create a mania or hypomania state with euphoria and energy. A hypomania state is a less extreme mood shift than mania. The lows cause depression, sadness and hopelessness.

Types of bipolar disorder

The type of bipolar disorder is diagnosed based on the occurrence of mania, hypomania and depressive episodes.

People with bipolar I disorder have had at least one manic episode preceded, or followed by hypomanic or major depressive episodes.

Bipolar II disorder is a separate diagnosis and is not a milder form of bipolar I disorder. People with bipolar II disorder have had at least one major depressive episode and at least one hypomanic episode but have not had a manic episode.

For every high, there is a low

Everyone has periods of elevated mood, typically lasting for several hours. For someone with bipolar disorder, that elevated mood can last up to four days. Typical early warning signs include increased activity level and decreased need for sleep, along with an extended elevated mood.

During this time, the person may demonstrate risky behaviors, poor decision-making and an inability to think clearly. Their level of impulsivity is high, particularly with drug or alcohol use.

The body's physical response is raised, causing speech to have a quicker cadence or more force, and movement and actions to be more pronounced.

Usually, a person will spend more time in a depressive state with slowed actions, speech and responses. The person may lose interest in activities, need more sleep and experience intense sadness and hopelessness.

This is different from major depressive disorder, in which people do not experience the highs of bipolar disorder.

Risk factors for bipolar disorder

Certain factors increase the risk of developing the condition or may trigger the first episode of bipolar disorder, including:

• Drug or alcohol misuse or abuse
• Having a first-degree relative, such as a parent or sibling, with bipolar disorder
• Stressful life events paired with latent genes for bipolar disorder

Living with bipolar disorder

Getting treatment early can help prevent bipolar disorder from worsening. Knowledge is power. Learn the symptoms of the disorder to manage them better.

As part of psychotherapy, psychoeducation provides the tools needed to anticipate and control changing moods. It can increase your feelings of empowerment and hope by understanding how treatable the condition is.

These strategies can lessen disruptions in your life due to bipolar disorder:

• Avoid drugs and alcohol.
  Using alcohol or nonprescription drugs changes the chemicals in the brain. This can worsen symptoms and make them more likely to return.
• Watch for early warning signs.
  Addressing symptoms early can prevent episodes from getting worse. Over time, you may have identified a pattern to your bipolar episodes and what triggers them.
• Involve friends and family.
  Share the warning signs and triggers you have identified with family, close friends and your health care team so they can better support you. Develop a specific plan and share how you would like them to cue you into your symptoms when you show signs of mania. They often can identify the behaviors and actions that signal a mania episode first and help you prevent your symptoms from reaching the highest level.
• Engage in a purpose.
  Explore ways to create a sense of purpose by evaluating your values and beliefs. Identify what is important to you and set goals matching those ideals.
• Manage stress and recharge.
  The brain and body react similarly to positive or negative stress, which can trigger an episode. Consider keeping a daily journal or record of your feelings, mood and any activities that affect your stress level. Find a creative outlet or physical activity to channel your energy. Yoga or meditation can be helpful relaxation techniques.
• Keep a sleep schedule.
  Sleep disturbance is a core symptom of bipolar disorder. Maintaining a consistent, scheduled sleep pattern with the same sleep-wake schedule daily is vital. Getting seven to nine hours of sleep per night is important. A work schedule that requires changing shift times can predispose a person with bipolar disorder to episodes.
• Take your medications exactly as directed.
  You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects, or your symptoms may worsen or return. For some people, it can be tempting to stop medication during a manic episode because the symptoms produce a good feeling. This can lead to negative consequences, including taking longer to stabilize when back on medication.

Bipolar disorder is a lifelong condition, but it is treatable. Learn to manage your mood swings and other symptoms with the help of those who love and care for you. Call your health care team if you feel you're falling into an episode of depression or mania.

Janice Schreier is a child and adolescent clinical therapist in Psychiatry & Psychology in La Crosse, Wisconsin.