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, 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 may have a depressed mood or find little interest or pleasure in activities they once enjoyed. While depressive episodes can occur during both primary types of bipolar disorder, they are more common in bipolar II. 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.

• Feeling sadness or despair

• Sleeping too much or too little

• Lacking interest in activities previously enjoyed

• Restlessness or slowed speech/movement

• Experiencing changes in appetite

• Having trouble concentrating or making decisions

• Feeling fatigued

• Having feelings of worthlessness or guilt

• Having 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 feel more irritable. They may experience increased energy or increased goal-directed activity, or both. According to the DSM-5, 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, 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

• Increase in goal-oriented activity (in social, academic, or work contexts or sexually) or psychomotor agitation

• Less need 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 have been present to a significant degree.” 

Furthermore, the bipolar disorder guidelines in the DSM-5 state that the “occurrence of the manic and major depressive episode(s) is 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, changes in the structure and function of the brain are also associated with bipolar disorder. 

Additional symptoms people with bipolar disorder should know about

Rapid cycling occurs when someone experiences at least four episodes of manic episodes, hypomanic episodes, or depressive episodes within a 12-month period. Mood changes can take place within days or even hours. When four mood episodes occur within a one-month span, 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

Bipolar I disorder

Bipolar I disorder tends to cause mood swings, and they can be quite intense. 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 this, a person must have had at least one depressive episode and one hypomanic episode, but never 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 and II disorders. 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

The National Alliance on Mental Illness adds a fourth type to the list of bipolar disorders: other specified or unspecified bipolar. This type may be referred to by a clinician when they diagnose bipolar disorder but the patient doesn’t meet the criteria for bipolar I, II, 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 they include lithium, valproic acid, lamotrigine, divalproex sodium, carbamazepine, and lamotrigine.

Antipsychotics may be prescribed in conjunction with mood stabilizers. Antipsychotics include risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, lurasidone, and asenapine, may be prescribed during a depressive phase of either bipolar I disorder or bipolar II disorder, but a doctor may need to monitor the person closely to ensure that the person doesn’t switch to a manic phase. An antidepressant may be prescribed along with an antipsychotic medication or mood stabilizer.

Psychotherapy

Several types of psychotherapy can help manage the signs and symptoms of the condition and prevent bipolar disorder from having a significantly negative impact on a patient’s life. A therapist can also help participants address potential comorbid conditions, such as anxiety, substance use, 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 mental illness’ symptoms, effects, and treatment. 

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 things that trigger 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. According to the Mayo Clinic, routines can help improve mood management. For this reason, it may help for a person with bipolar disorder to establish routines related to diet, 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 it turns out that the problem is 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 you need medication and/or therapy to treat it.

If symptoms such as depressive episodes make it difficult to leave home for therapy, you might consider online therapy, 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 at BetterHelp, 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 they can.