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Understanding bipolar disorder

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Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs and lows. The main difference between bipolar 1 and bipolar 2 is in the nature of the highs, called manic episodes.

In both bipolar 1 and bipolar 2, manic episodes may include increased activity, energy or agitation; decreased need for sleep; appearing abnormally upbeat or jumpy and unusual talkativeness. One may also become easily distracted and have racing thoughts. Manic episodes often include poor decision-making and risky behavior.

In bipolar 1, the highs are called mania. These episodes are more severe than bipolar 2. For example, while a person with bipolar 2 may feel they need less sleep than usual during a manic episode, an individual with bipolar 1 may go for days without sleeping at all. Symptoms of mania often lead to disruption in daily life and social activities, and can cause problems in personal relationships. Mania can also trigger a break from reality — a condition known as psychosis. Symptoms of psychosis can include delusions, hallucinations and disorganized thoughts or reasoning. In some cases, psychosis may require hospitalization.

In bipolar 2, the highs are called hypomania. While the manic symptoms of bipolar 1 are usually obvious and make the need for medical intervention clear, that’s not always true of bipolar 2. Some people with hypomania are unable to recognize their symptoms. They often like feeling upbeat and energetic. In some cases, they become quite productive during hypomania and believe their ability to maintain a high level of activity is a benefit.

The lows, or depressive episodes, of bipolar 1 and bipolar 2 tend to be similar. They generally include feeling sad, hopeless or worthless; loss of interest in activities; fatigue and loss of energy; sleeping too much or not being able to sleep enough; and decreased ability to concentrate. Symptoms can be severe enough to make it hard to engage in daily routines.

Effective treatment is available for both bipolar 1 and bipolar 2. The mainstay of treatment is a combination of medication and therapy. A type of therapy that’s particularly effective for both types of bipolar disorder is interpersonal and social rhythm therapy. It emphasizes the need for consistent routines; people who have bipolar disorder often see improvement in symptoms when they establish daily routines for sleep, exercise and diet.

If you notice symptoms of bipolar in yourself, or if you suspect bipolar in a friend or family member, seek guidance from a health care provider. Although there isn’t a cure for bipolar disorder, in many people, its symptoms can be successfully controlled.

Suicidal thoughts and behavior are common among people with bipolar disorder. In those situations, it’s important to seek medical care immediately. In the U.S., the National Suicide Prevention Lifeline is available toll-free at 1-800-273-TALK (1-800-273-8255) to provide support 24/7.

Marin Veldic, M.D.

Dr. Veldic is a psychiatrist at Mayo Clinic in Rochester, Minnesota.

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