The Challenges of Being Up and Down


| Written by Jessica Lelinho, MA, LPC, NCC, LCADC, C-DBT

Do you feel like one minute you’re happy and then the next minute you’re sad. Feel like there are constant changes in your moods? I think it’s fair to say that we can experience shifts in our moods due to circumstances but when it becomes too frequent and too fast, we need to speak to someone about our frequent mood changes. 

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What is Bipolar Disorder?

The National Institute of Mental Health defines Bipolar Disorder as a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration which can make it difficult to carry out day-to-day tasks. Bipolar Disorder involves clear shifts and changes in mood, energy, and activity level. The moods can range from periods of extremely “up”, elated, irritable, or energized behavior known as manic episodes to periods of very “down”, sad, indifferent, or hopeless periods known as depressive episodes. Less severe manic episodes are known as hypomanic episodes. acknowledges that people who are not diagnosed with Bipolar Disorder, may also experience fluctuations in their mood which are part of commonly lived experiences, moods typically last hours rather than days and are not accompanied by extreme changes in behaviors and functioning (i.e., difficulty with daily routines and social interactions). Being diagnosed with Bipolar Disorder can disrupt relationships and can cause difficulty in work or even going to school. Bipolar Disorder commonly runs in families, about 80 to 90 percent of individuals with Bipolar Disorder have a relative with bipolar disorder or depression. Environmental factors such as: stress, sleep disruption, and drugs and alcohol may trigger mood episodes in vulnerable individuals. While the specific causes of Bipolar Disorder are unclear, both biological factors (i.e., family history of mood disorders, psychotic disorders, and substance misuse) and environmental factors increase the risk of Bipolar Disorder. Average onset of Bipolar Disorder is in the mid-20s. 

Types of Bipolar Disorder

Bipolar Disorder is categorized into three main diagnoses: Bipolar I, Bipolar II, and Cyclothymic Disorder. discusses each of the three main diagnoses.

  • Bipolar I: Individuals diagnosed with Bipolar Disorder I have experienced a manic episode. During this period of mania, individuals experience, and an extreme increase in energy and mood changes, which can include: feeling extremely happy or uncomfortably irritable. Some individuals diagnosed with Bipolar Disorder I can also experience depressive or hypomanic episodes, and periods of neutral moods. Individuals with Bipolar I, frequently have other mental health diagnoses such as: anxiety, substance use, and/or attention deficit/hyperactivity disorder (ADHD). The risk of suicide is significantly higher among individuals with Bipolar I than among the general population. 
  • Bipolar II: Individuals diagnosed with Bipolar Disorder II must have at least one major depressive episode and at least one hypomanic episode. Individuals with Bipolar II Disorder return to their usual functioning between episodes. Individuals afflicted with Bipolar II Disorder, typically seek treatment due to depressive episodes, as the hypomanic episodes often elicit feelings of pleasure and can increase performance at work or school. Most individuals diagnosed with Bipolar Disorder II, often have other mental health diagnoses such as anxiety or substance use disorder which can exacerbate the symptoms of depression or hypomania.
  • Cyclothymic Disorder: This type of Bipolar Disorder is a milder form which can involve many “mood swings” with hypomania and depressive symptoms that occur frequently. Individuals afflicted with cyclothymic disorder, experience emotional ups and downs but with less severe symptoms than Bipolar I or Bipolar II. 

Manic Episode, Hypomanic Episode or Major Depressive Episode discusses symptoms for Bipolar I. Individuals can either experience a manic episode, hypomanic episode, or depressive episode.

  • Manic Episode: A manic episode is a period of at least one week when a person is extremely high spirited or irritable most of the day for most days, possesses more energy than usual and experiences at least three of the following criteria in regards to their behaviors: decreased need for sleep (i.e., feeling energetic despite significantly less sleep than usual), increased or faster speech, uncontrollable racing thoughts or quickly changing ideas or topics when speaking, distractibility, increased activity (i.e., restlessness, working on several projects at once), increased risky or impulsive behaviors (i.e., reckless driving, spending sprees, sexual promiscuity). The changes in behavior must represent a change from their usual behavior and be clear to both family and friends. The symptoms must be severe to cause dysfunction in work, family, or social activities and responsibilities. Oftentimes, symptoms of manic episodes commonly require hospital care or hospitalization to ensure safety. In a severe manic episode, individuals can experience: disorganized thinking, false beliefs, and/or hallucinations.
  • Hypomanic Episode: Is characterized by less severe manic symptoms that need to last only four days in a row in comparison to one week for a manic episode. Symptoms of hypomania do not lead to the major problems in functioning that manic symptoms commonly cause.

Major Depressive Episode: A period of at least two weeks in which the individual experiences intense sadness or despair or a loss of interest in activities that they once enjoyed or any of the following symptoms: feelings of worthlessness or guilt, fatigue, increased or decreased sleep, increased or decreased appetite, restlessness (i.e., pacing) or slowed speech or movement, difficulty concentrating, or frequent thoughts of death or suicide.

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Statistics on Bipolar Disorder

Depression Bipolar Support Alliance (DBSA) provided the following statistics on Bipolar Disorder:

  • Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. (National Institute of Mental Health)
  • The median age of onset for bipolar disorder is 25 years (National Institute of Mental Health), although the illness can start in early childhood or as late as the 40’s and 50’s.
  • An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.
  • More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. (National Institute of Mental Health)
  • Women and people with bipolar II disorder are significantly more likely to experience periods of rapid cycling than men with the same condition. (Damone, A. L., Joham, A. E., Loxton, D., Earnest, A., Teede, H. J., & Moran, L. J. (2018). Depression, anxiety and perceived stress in women with and without PCOS: A community-based study. Psychological Medicine, 49(09))
  • Other research findings indicate that women with bipolar disorder may have more depressive episodes and more mixed episodes than do men with the illness. (Journal of Clinical Psychiatry, 58, 1995 [Suppl.15])
  • Bipolar disorder is the sixth leading cause of disability in the world. (World Health Organization)
  • Bipolar disorder results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide. (National Institute of Mental Health)
  • Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is 15 to 30%. When both parents have bipolar disorder, the risk increases to 50 to 75%. (National Institute of Mental Health)
  • Bipolar Disorder may be at least as common among youth as among adults. In a recent NIMH study, one percent of adolescents ages 14 to 18 were found to have met criteria for bipolar disorder or cyclothymia in their lifetime. (National Institute of Mental Health)
  • Some 20% of adolescents with major depression develop bipolar disorder within five years of the onset of depression. (Birmaher, B., “Childhood and Adolescent Depression: A Review of the Past 10 Years.” Part I, 1995)
  • Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder. (American Academy of Child and Adolescent Psychiatry, 1997)
  • When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, and stomachaches or tiredness; poor performance in school, irritability, social isolation, and extreme sensitivity to rejection or failure. (National Institute of Mental Health).
  • Success rates of 70 to 85% were once expected with lithium for the acute phase treatment of mania, however, lithium response rates of only 40 to 50% are now commonplace. (Surgeon General Report for Mental Health)
  • Participation in a DBSA patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. (DBSA, 1999)
  • Consumers with bipolar disorder face up to ten years of coping with symptoms before getting an accurate diagnosis, with only one in four receiving an accurate diagnosis in less than three years. (DBSA, 2000)
  • A gender bias exists in the diagnosis of bipolar disorder: women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia. (DBSA, 2000)
  • Nearly 9 out of 10 consumers with bipolar disorder are satisfied with their current medication(s), although side effects remain a problem. (DBSA, 1999)
  • Consumers who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their illness and their ability to cope with it. (DBSA, 1999)

Treatments to Address Bipolar Disorder

The Mayo Clinic discusses how treatment guided by a medical doctor specializing in mental health conditions such as a psychiatrist is beneficial. In addition, a treatment team development will also greatly assist in treating Bipolar Disorder. This treatment team will be made up of the following professionals: psychologist, social worker, and psychiatric nurse. Treatment can include:

  • Medications: Oftentimes, individuals diagnosed with Bipolar Disorder are prescribed medications that will balance the moods experienced. It’s important to note that discontinuing the medication on your own and decreasing your dose is dangerous and should be discussed with your prescribing physician before discontinuing and decreasing your dose. 
  • Continuation of Treatment: Even if you feel better, medications should still be continued. If you’re maintained on medications and you skip your medications, would put you at a high risk for relapse of your symptoms or having minor mood changes or even going into full-blown mania or depression. 
  • Day Treatment Programs: The program will provide you with support and counseling that is needed until your symptoms are under control.
  • Substance Abuse Treatment: As mentioned earlier, individuals afflicted with Bipolar Disorder can suffer from substance abuse/use. If you’re struggling with substance abuse/use including alcohol, you’ll need to address your substance abuse/use as mitigating symptoms of Bipolar Disorder and management of Bipolar Disorder can be difficult.
  • Hospitalization: Hospitalization is recommended if you’re behaving dangerously, feeling suicidal, and become detached from reality (psychotic). Engaging in treatment at a hospital can assist in keeping you calm, safe, and provide stabilization of your mood whether you’re in a manic or major depressive episode. 
  • Self Management Strategies: In addition to the utilization of other treatment modalities, successful management of your Bipolar Disorder includes: living a healthy lifestyle, such as ensuring you’re getting enough sleep, eating a healthy diet, and being physically active. Keeping to a regimented schedule, involvement in social activities, and joining a support group may also assist. 

Most of the primary treatment for Bipolar Disorder is through medications and psychological counseling (psychotherapy) to control symptoms. Additional treatment modalities for Bipolar Disorder can include education and support groups. 

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Are There Treatment Differences Between Bipolar I and Bipolar II?

The Mayo Clinic discusses treatment differences between Bipolar I and Bipolar II. Bipolar I and Bipolar II are treated similarly and few differences exist in treatment modalities other than the types of medications prescribed as medications are prescribed based on your symptoms. Common medications prescribed to treat Bipolar Disorder include: mood stabilizers, antipsychotics, antidepressants, and antidepressant-antipsychotic.

  • Mood Stabilizers: This type of medication is prescribed to control episodes of mania and hypomania. Examples of mood stabilizers include: lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, etc.), and lamotrigine (Lamictal).
  • Antipsychotics: Your prescribing doctor may prescribe an antipsychotic medication alone or in combination with mood stabilizers. Examples of antipsychotic medications include: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), cariprazine (Vraylar), or asenapine (Saphris)
  • Antidepressants: The prescribing doctor may add an antidepressant or one of the other medications utilized to treat Bipolar Disorder that has antidepressant effects to assist in management of depression. However, an antidepressant can sometimes trigger a manic episode, it will need to be prescribed with a mood stabilizer or antipsychotic used to treat Bipolar Disorder.
  • Antidepressants-Antipsychotics: The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with Bipolar I Disorder.

We all have changes in our mood at times which can be considered healthy or unhealthy. When our changes in mood become unhealthy or too often, that is when we need to gain control of it and seek professional help.

If you are looking to address your bipolar disorder, don’t hesitate to reach out for help. Engaging in therapy can lead to decreasing mental health symptoms of bipolar disorder. A licensed professional can assist you in overcoming these challenges. 

When Jessica is not providing therapy, she enjoys spending time with her family and friends, listening to country music, cooking, baking, and going to the beach.

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