Bipolar Disorder Types And Treatments

Bipolar disorder is a serious mental health condition that can cause mood swings, changes in behavior, and cognitive challenges. An estimated 2.8% of adults in the US experience bipolar disorder, per the National Institute of Mental Health. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are three different types of bipolar disorder. Although each type of bipolar disorder has different symptoms, treatment tends to focus on symptom management, often through medication and psychotherapy. Below, explore the symptoms of each type of bipolar disorder and the treatment options available. 

Below, we’ll discuss the symptoms of each type of bipolar disorder and the treatment options available. 

Symptoms of bipolar disorder

Depressive symptoms

Someone with bipolar disorder who is experiencing a depressive episode typically has a depressed mood or finds little interest or pleasure in activities they once enjoyed. Depressive episodes can occur during both primary types of bipolar disorder. Those who experience five or more of the following symptoms nearly every day for most of the day over two weeks or more may be having a depressive episode: 

• Sadness or despair
• Sleeping too much or too little
• A lack of interest in previously enjoyed activities
• Restlessness or slowed speech or movement
• Changes in appetite
• Difficulty concentrating or making decisions
• Fatigue
• Thoughts of hopelessness or worthlessness
• Guilt 
• Thoughts of death and suicide

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Manic symptoms

During a manic episode, people with bipolar disorder may have an elevated mood or may feel more irritable. They may experience increased energy, increased goal-directed activity, or both. According to the DSM-5, the diagnosis of a manic episode requires at least three of the following symptoms (or four if the person’s mood is predominantly irritable). Episodes of mania signal the existence of bipolar I disorder, while the other two types of bipolar disorder usually feature periods of hypomania, which are less severe. Symptoms must be present most of the day, almost every day, for at least a week.

• Inflated self-esteem or grandiosity

• Flight of ideas or racing thoughts

• Distractibility

• An increase in goal-oriented activity (socially, academically, professionally, or sexually) or the opposite extreme: psychomotor agitation

• Less of a desire for sleep

• A tendency to be more talkative

• Excessive pleasurable activities

Hypomanic symptoms

People with bipolar II disorder or cyclothymic disorder may experience hypomanic episodes. During an episode of hypomania, someone with bipolar disorder may have an elevated or irritable mood with three or more of the above symptoms or four or more if their mood is irritable for at least four consecutive days. According to the DSM-5, these symptoms should “represent a noticeable change from usual behavior and be present to a significant degree.” 

Furthermore, the bipolar disorder guidelines in the DSM-5 state that the “occurrences of the manic and major depressive episode(s) are not better explained by schizoaffective disorder, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.” 

Hypomania symptoms are typically more manageable than mania symptoms. People experiencing these bipolar symptoms can usually continue their daily activities without interference from the severe symptoms associated with a severe manic episode. 

While the exact cause of bipolar disorder is unknown, certain genetic, environmental, and neurological risk factors are thought to contribute to the condition. Having a family history of bipolar disorder or other mood disorders can increase an individual’s risk of experiencing it themselves. According to the National Institute of Mental Health (NIMH), changes in the structure and function of the brain are also associated with bipolar disorder. 

Additional symptoms for people with bipolar disorder to know about

Rapid cycling occurs when someone experiences at least four episodes of manic episodes, hypomanic episodes, or depressive episodes within 12 months. Mood changes can take place within days or even hours. When four mood episodes occur within one month, this is referred to as ultra-rapid cycling. 

Some people with bipolar disorder may experience mixed episodes, sometimes known as mixed features. When this happens, the individual displays both high and low mood symptoms at the same time, either simultaneously or one right after the other. For further reading on the symptoms of bipolar disorder and related mental health conditions, consider searching through the Mental Health Information and Health Topics sections of the National Institute of Mental Health’s website. 

Types of bipolar disorder

Below are the official subtypes that an individual may be diagnosed with when receiving a bipolar disorder diagnosis. 

Bipolar I disorder

Bipolar I disorder tends to cause intense mood swings. People with this type of bipolar disorder may experience drastic changes in energy levels, being much more active during manic phases and much less active in depressed phases. With bipolar I disorder, whether in a manic state or a depressed state, a person may have trouble carrying out daily tasks and may need to be hospitalized.

According to the DSM-5’s criteria for bipolar I disorder, you only need to have had one manic episode for a diagnosis to be made. A hypomanic or depressive episode may or may not happen before or after the manic episode. While depression and hypomania tend to be common symptoms of bipolar I disorder, neither is required for a diagnosis.

Bipolar II disorder

To be diagnosed with bipolar II disorder, a person must have had at least one depressive episode and one hypomanic episode, but they should not have had a full manic episode. People with this type of bipolar disorder may be more likely to experience depression in some cases.

Cyclothymic disorder

People with cyclothymic disorder tend to have hypomanic and depressive symptoms, but less severe than the symptoms of bipolar I disorder and bipolar II disorder. For a diagnosis of cyclothymic disorder to be made, the symptoms must last for at least two years in adults. Also, the symptoms must be present for at least 50% of the time, with no symptom-free period greater than two months.

Other specified or unspecified bipolar disorder

The National Alliance on Mental Illness mentions a fourth type to the list of bipolar disorders: other specified or unspecified bipolar disorder. This type may be referred to by a clinician when they suspect bipolar disorder, but the patient doesn’t meet the criteria for bipolar I disorder, bipolar II disorder, or cyclothymia. 

Treatments for bipolar disorder

Though symptoms of mania and depression can be challenging, people with bipolar disorder can manage them so that their negative effects are limited. Bipolar disorder is a lifelong mental illness that usually requires ongoing treatment. According to the National Institute of Mental Health, treatment for bipolar disorder typically includes medications and psychotherapy.

Medications

Medications used to treat bipolar disorder may include mood stabilizers, antipsychotics, antidepressants, and anti-anxiety medications. Mood stabilizers may be used during a manic or hypomanic episode and may also reduce depression. Antipsychotics may be prescribed in conjunction with mood stabilizers and might be prescribed during a depressive phase of either bipolar I disorder or bipolar II disorder. However, a doctor may monitor the person closely to ensure they don’t experience a manic phase due to the medication. An antidepressant may be prescribed along with an antipsychotic medication or mood stabilizer in some cases. However, antidepressants also carry the risk of causing mania.

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action (including starting, stopping, or changing medication) without consulting a qualified medical professional. 

Psychotherapy

Several types of psychotherapy may help individuals manage symptoms of bipolar disorder and prevent significantly negative impacts. A therapist can also help clients address potential comorbid conditions, such as anxiety, substance use disorders, or eating disorders. Psychoeducation seeks to help a person understand the disorder, its symptoms, its effects, and the need for continuing treatment. People with bipolar disorder can participate in psychoeducation individually or choose to involve their family members, potentially helping their loved ones better understand the symptoms, effects, and treatment for this mental illness. 

If you have bipolar disorder, cognitive-behavioral therapy (CBT) may help you identify unhealthy thoughts and replace them with positive thoughts. Research suggests that cognitive-behavioral therapy can effectively reduce symptoms of bipolar depression and mania. In a review of clinical trials on the efficacy of CBT for bipolar disorder, researchers found that the modality can alleviate mood symptoms, improve quality of life, and delay episode recurrence. In CBT, you may also identify factors that incite a manic, hypomanic, or depressive episode and develop strategies to prevent or manage your symptoms during these times.

Another type of therapy that may be used for bipolar disorder is interpersonal and social rhythm therapy (IPSRT). This type of therapy typically aims to help individuals with bipolar disorder to establish routines. Routines may improve mood management. For this reason, it may help a person with bipolar disorder to establish routines related to eating, exercise, and sleep. 

Getting help for bipolar disorder

Bipolar I disorder, bipolar II disorder, cyclothymia, and other types of bipolar disorder aren't always easy to recognize, especially if you’re not experiencing extreme mood swings. Often, people can have bipolar disorder without knowing what the problem is. Other times, people might suspect they have bipolar disorder but are living with a different mental illness. 

If you’re experiencing symptoms that may indicate bipolar disorder or related disorders, it may help to talk to a mental health professional such as a psychiatrist or psychologist to determine if you have bipolar disorder, what type of bipolar disorder you have, and whether medication or therapy could be helpful.

If symptoms such as depressive episodes make it difficult to leave home for therapy, you might consider online therapy through a platform like BetterHelp, which numerous studies have shown to be effective in treating mental health conditions. One meta-analysis published in Cureus found that online cognitive behavioral therapy was effective for treating bipolar disorder, anxiety disorders, and depression, among other mental health conditions.

By connecting with a therapist for online talk therapy, you can start working on strategies to manage your bipolar disorder right from home or anywhere with an internet connection. With online therapy, you can meet with your therapist via audio, video, live chat, or a combination of these modalities. You can also message your therapist at any time through in-app messaging, and they’ll respond as soon as possible.