What are the symptoms of bipolar disorder?

By Sandee LaMotte, CNN

(CNN) — It used to be called manic depression in an effort to capture the swing of emotions from intense manic highs to the lowest of lows. Today it’s called bipolar disorder, another way to describe a mental illness that has two completely different presentations.

Comedian Taylor Tomlinson, host of the new CBS late-night show, “After Midnight,” launching in early 2024, is open about her diagnosis of bipolar disorder in an Netflix special.

“Being bipolar is like not knowing how to swim. It might be embarrassing to tell people, and it might be hard to take you certain places,” Tomlinson said in her 2022 Netflix special, “Taylor Tomlinson: Look at You.” “But they have arm floaties. (Audience laughs.) And if you just take your arm floaties, you can go wherever the hell you want.”

Tomlinson is one of an estimated 40 million to 50 million people worldwide who may have bipolar disorder, according to Mount Sinai Hospital in New York City. “It typically begins in young adulthood, often takes a chronic course, and carries an increased risk of suicide, making it a major public health concern and cause of global disability,” the hospital said.

Making diagnosis and treatment more difficult — a person with bipolar disorder may go months or even years without symptoms, or may cycle through both extremes in rapid sequence, according to the National Alliance on Mental Illness. The mood swings from high to low and back again can affect a person’s behavior, judgment, energy, sleep and the ability to think clearly, experts say.

Signs of bipolar disorder: Mania

When a person with bipolar disorder is “up,” they are often euphoric — intensely happy, excited and full of energy — but unusual irritability can also be part of the swing, according to the Mayo Clinic.

A person can be manic or hypomanic, which is a less extreme form of mania, but both have the same symptoms. The person may be wired, jumpy or abnormally upbeat and confident, often with an exaggerated sense of well-being. There can be increased energy or agitation, along with distractibility, racing thoughts and little need for sleep. The person may be extremely talkative or go on spending sprees, make ill-advised investments and take sexual risks, all signs of poor decision-making.

The more extreme form of mania can cause highly noticeable problems at work, school and at home and in social situations, according to Mayo. In some cases, people in a manic phase can break from reality — hearing voices, becoming paranoid and psychotic — and require hospitalization.

Signs of bipolar disorder: Major depression

The polar opposite of the manic side of bipolar disorder are the periods of depression, often severe or “major” depression that can cause significant problems at work, school, home and in relationships.

To be diagnosed with major depression, a person must have several of the following signs:

Feeling empty, hopeless, sad and tearful, along with a loss of interest or pleasure in nearly all activities are key symptoms. Sleep can be affected — a person can have insomnia or sleep too much.

Fatigue and loss of energy is another, along with either restlessness or a slowing of behavior. Fluctuating weight is another — either significant weight gain or loss, or an increase or decrease in appetite.

Indecisiveness or a decrease in concentration and thinking skills, along with feelings of worthlessness or inappropriate guilt are more signs, as are thoughts or attempts of suicide.

Different types of bipolar disorder

There are several types of bipolar disorder, which differ by how symptoms present, according to the Mayo Clinic.

Bipolar I: People with bipolar I disorder have had at least one manic episode along with a period of major depression or less severe mania. People with bipolar I can also have an episode of psychosis in which they have a break from reality that may require hospitalization.

Bipolar II: People with bipolar II have never had a manic episode. Instead, they have had at least one major depressive episode and at least one hypomanic episode.

Cyclothymic bipolar disorder: In this form of the disease, a person cycles through many periods of less severe hypomanic episodes and periods of depressive symptoms that do not meet the criteria for major depression.

Bipolar disorder may also be caused by drugs, alcohol or medical conditions such as multiple sclerosis or stroke, Mayo noted.

How is bipolar disorder treated?

Depending on symptoms and severity, bipolar treatment has a number of treatments, some of which may be used simultaneously.

Antipsychotic medications and mood stabilizers are often prescribed, according to the National Alliance on Mental Illness. Cognitive behavior therapy and family therapy are other avenues of treatment, as are self-management techniques. Exercise, meditation, faith and prayer “can support, but not replace, treatment,” NAMI said.

A long-term study called the Systematic Treatment Enhancement Program for Bipolar Disorder has found that people “taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy.”

Is bipolar disorder genetic?

A 2021 study by the Psychiatric Genomics Consortium, an international consortium of scientists dedicated to studying the genetic basis of psychiatric disorders, found 64 DNA variations that increase risk of bipolar disorder.

Those generic variations overlapped with other mental health conditions, the study found. For example, researchers found that bipolar I disorder is genetically similar with schizophrenia, while bipolar II disorder shares more genetic similarity to major depression.

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