Bipolar Disorder (Type 1 and 2): Symptoms, Causes, Treatments

The bipolar disorder symptoms it is a mental illness characterized by the tendency of a person to alternate between depressive episodes and manic episodes.

In this article I will explain your symptoms, causes, treatment, diagnosis, consequences and much more.

In type 1 the person alternates depressive episodes with complete manic episodes and in type 2 alternates between depressive episodes and hippomanic (less serious) episodes.

The symptoms of this disorder are severe, different from the normal ups and downs of mood. These symptoms can result in problems in personal relationships, at work, at school, financial or even suicide.

During the depression phase, the person may experience:

  • Negative perception of life.
  • Inability to feel pleasure for life.
  • Lack of energy.
  • Crying.
  • Autolysins.
  • In extreme cases, suicide.

During the manic phase the person may experience:

  • Deny that you have any problems.
  • Acting energetically, happy or irritable.
  • Make irrational financial decisions.
  • Feel great enthusiasm.
  • Do not think about the consequences of your actions.
  • Lack of sleep.

Although there are cases of onset in childhood, the normal age of onset of type 1 are 18 years of age, while for type 2 are 22 years.

Bipolar Disorder Symptoms

About 10% of cases of bipolar disorder 2 develop and become type 1.

Although the causes are not clearly understood, genetic and environmental factors (stress, abuse in childhood) influence.

The treatment usually includes psychotherapy, medication and in cases that do not respond electroconvulsive therapy may be useful.

Bipolar Disorder Symptoms

Symptoms of depressive episodes

The signs and symptoms of the depressive phase of bipolar disorder include:

  • Persistent sadness.
  • Lack of interest in participating in pleasurable activities.
  • Apathy or indifference.
  • Anxiety or social anxiety.
  • Chronic pain or irritability.
  • Lack of motivation.
  • Guilt, hopelessness, social isolation.
  • Lack of sleep or appetite.
  • Suicidal thoughts.
  • In extreme cases there may be psychotic symptoms: delusions or hallucinations usually withdrawal.

Manic symptoms

Mania can occur in varying degrees:


It is the least severe degree of mania and lasts at least 4 days. It does not cause a marked decrease in the person’s ability to work, socialize or adapt.

It also does not require hospitalization and lacks psychotic characteristics.

In fact, general functioning may improve during a hippomanic episode and is thought to be a natural mechanism against depression.

If a hippomanic event is not followed or preceded by depressive episodes, it is not considered a problem, unless that mood is uncontrollable.

The symptoms can last from a few weeks to several months.

It is characterized by:

  • Greater energy and activation.
  • Some people may have more creativity and others may be more irritable.
  • The person can feel so good that he denies that he is going through a state of hypomania.


Mania is a period of euphoria and high mood of at least 7 days. If left untreated, an episode of mania can last for 3 to 6 months.

It is characterized by showing three or more of the following behaviors:

  • Speak fast and uninterrupted.
  • Accelerated thoughts.
  • Agitation.
  • Easy Distraction.
  • Impulsive behavior and risk.
  • Excessive money expenses.
  • Hyper sexuality.

A person with mania may also feel lack of sleep and inadequate judgment.

On the other hand, maniacs may have problems with alcohol or other substance abuse.

In extreme cases, they may experience psychosis, so that they break contact with reality while having a high state of mind.

Something is usually that the person with mania feels unparalleled or indestructible and that feels chosen to realize a goal.

Approximately 50% of people with bipolar disorder experience hallucinations or delusions, which can lead to violent behavior or psychiatric admission.

Mixed episodes

In bipolar disorder, a mixed episode is a state in which mania and depression occur at the same time.

People who experience this state may have thoughts of grandiosity while having depressive symptoms such as suicidal thoughts or guilt.

People who are in this state are at high risk of committing suicide, as they mix depressive emotions with mood swings or difficulties controlling impulses.

Causes of Bipolar Disorder

The exact causes of bipolar disorder are unclear, although they are believed to depend primarily on genetic and environmental causes.

Genetic factors

It is believed that 60-70% of the risk of developing bipolarity depends on genetic factors.

Several studies have suggested that certain genes and regions of chromosomes are related to the susceptibility to develop the disorder, each gene having a greater or lesser importance.

The risk of TB in people with relatives with TB is up to 10 times higher compared to the general population.

The research points to heterogeneity, meaning that different genes are involved in different families.

Environmental factors

Research shows that environmental factors play an important role in the development of TB, and may interact with psychosocial variables with genetic dispositions.

Recent life events and interpersonal relationships contribute to the likelihood of the occurrence of manic and depressive episodes.

It has been found that 30-50% of adults diagnosed with TB report experiences of abuse or trauma in childhood, which is related to an earlier onset of the disorder and major suicide attempts.

Evolutionary factors

From evolutionary theory one might think that the negative consequences of bipolar disorder on the ability to adapt, causes that genes are not selected by natural selection.

However, there are still high rates of TB in many populations, so there may be some evolutionary benefit.

Proponents of evolutionary medicine suggest that high TB ​​rates throughout history suggest that changes between depressed and manic states have assumed some evolutionary advantage in ancestral humans.

In people with a high degree of stress, depressed mood could serve as a defensive strategy to get away from the external stressor, reserve energy and increase sleep.

The mania could benefit from its relationship with creativity, confidence, high energy levels and increased productivity.

States of hypomania and mild depression may have certain advantages for people in a changing environment. The problem would be whether the genes responsible for those states are over activated and lead to mania and major depression.

Evolutionary biologists have proposed that TB could be an adaptation of ancestral humans to extreme northern climates during the Pleistocene.

During the hot summer, hypomania could allow you to perform many activities in a short period of time.

On the contrary, during the long winter, excessive sleep, excessive intake and lack of interest could help survival. In the absence of extreme climatic conditions, TB would be maladaptive.

Evidence for this hypothesis is the correlation between seasonality and mood swings in people with TB and low TB rates in African Americans.

Physiological, neurological and neuroendocrine factors

Brain imaging studies have shown differences in the volume of various brain regions between patients with TB and healthy patients.

Increases in the volume of the lateral ventricles, pale balloon, and increase in the rate of hyper intensities of white matter have been found.

Magnetic resonance imaging has suggested that there is abnormal modulation between the ventral prefrontal area and the limbic regions, especially the amygdale. This would contribute to poor emotional regulation and mood-related symptoms.

Moreover, there is evidence supporting the association between early stressful experiences and dysfunction of the axis hypothalamic-pituitary – adrenal, which guides his over activation.

Less common TB can occur as a result of an injury or neurological condition: brain trauma, stroke, HIV, multiple sclerosis, porphyries, and temporal lobe epilepsy.

It has been found that a neurotransmitter responsible for mood regulation, dopamine, increases its transmission during the manic phase and descends during the depressive phase.

Glutamate is increased in the left dorsolateral prefrontal cortex during the manic phase.


Bipolar disorder is not often recognized and is difficult to distinguish from unipolar depression.

Its diagnosis requires taking into account several factors: the person’s experiences, behavioral abnormalities observed by other people and signs evaluated by psychiatrists or clinical psychologists.

The most widely used diagnostic criteria are the WHO DSM and ICD-10.

Although there is no medical evidence to confirm TB, it is advisable to perform biological tests to ensure that there is no physical illness, such as hypothyroidism or hyperthyroidism, metabolic disorders, HIV or syphilis.

It is also advisable to rule out brain injuries and perform an electroencephalogram to rule out epilepsy.

According to DSM-IV, there are the following types of disorders within bipolar disorders:

  • Bipolar I disorder, single manic episode
  • Bipolar I disorder, most recent hippomanic episode
  • Bipolar I disorder, most recent manic episode
  • Bipolar disorder I, most recent mixed episode
  • Bipolar I disorder, most recent depressive episode
  • Bipolar disorder I, most recent episode not specified
  • Bipolar II disorder
  • Cyclothymiacs disorder
  • Bipolar disorder not specified.

In this section we will describe Bipolar II, the manic episode and the major depressive episode.

Diagnostic criteria for Bipolar II Disorder

  1. A) Presence of one or more major depressive episodes.
  2. B) Presence of at least one hippomanic episode.
  3. C) The affective symptoms of criteria A and B are not better explained by the presence of a causative disorder and are not superimposed on schizophrenia, a schizophreniform disorder, a delusional disorder or an unspecified psychotic disorder.
  4. E) Symptoms cause clinically significant discomfort or social, occupational, or other significant areas of the individual’s activity.

Specify the current or most recent episode:

  • Hippomanic: if the current (or most recent) episode is a hippomanic episode.
  • Depressive: if the current episode (or more recent) is a major depressive episode.

Diagnostic criteria for the manic episode (DSM-IV)

  1. A) A differentiated period of an abnormal and persistently elevated, expansive or irritable mood lasting at least one week (or any duration if hospitalization is necessary).
  2. B) Three or more of the following symptoms persisted during the period of mood disturbance (four if the mood is only irritable) and there has been a significant degree:
  • Exaggerated self-esteem or grandeur.
  • Diminution of necessity of sleep.
  • More talkative than usual or verborreico.
  • Leakage of ideas or subjective experience that thought is accelerated.
  • Distraction.
  • Increased intentional activity or psychomotor agitation.
  • Excessive involvement in pleasurable activities that have a high potential to produce serious consequences.
  1. C) The symptoms do not meet the criteria for the mixed episode.
  2. D) Mood disturbance is serious enough to cause work impairment, habitual social activities, relationships with others, or to need hospitalization to prevent damage to oneself or others, or there are psychotic symptoms.
  3. E) The symptoms are not due to the direct physiological effects of a substance or to a medical illness.

Diagnostic Criteria for Major Depressive Episode (DSM-IV)

  1. A) Presence of five or more of the following symptoms over a 2-week period, representing a change from previous activity; one of the symptoms should be 1. Depressed mood, or 2. Loss of interest or ability for pleasure:
  2. Depressed mood most of the day, almost every day as indicated by the subject (sad or empty) or the observation made by others (crying). In children or adolescents mood can be irritable.
  3. A marked decrease in interest or ability for pleasure in all or almost all activities, most of the day.
  4. Significant weight loss without regimen, or weight gain, or loss or increase in appetite almost every day. In children, the failure to achieve the expected weight gain should be assessed.
  5. Insomnia or hypersonic every day.
  6. Excessive or inappropriate feelings of worthlessness or guilt almost every day.
  7. Decreased ability to think or concentrate, or indecision, almost every day.
  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or suicide attempt, or a specific suicide plan.

B) Symptoms do not meet the criteria for a mixed episode.

  1. C) Symptoms cause clinically significant distress or impairment in social, work, or other important areas of the individual’s activity.
  2. D) The symptoms are not due to the direct physiological effects of a substance or a medical illness.
  3. E) The symptoms are not explained better by the presence of mourning, the symptoms persist for more than two months or are characterized by a marked functional incapacity, morbid preoccupations of uselessness, suicidal ideation, psychotic symptoms or psychomotor retardation.

Co morbid Disorders

Some co-occurring mental disorders can be given to TB: obsessive compulsive disorder, attention deficit hyperactivity disorder, substance abuse, premenstrual syndrome, social phobia or panic disorder.

Treatment for Major Depressive Disorder

Although TB ​​can not be cured, it can be effectively controlled over the long term with medication and psychotherapy.


Combined with medication, psychotherapy can be an effective treatment for TB.

Some psychotherapeutic treatments for TB are:

  • Family Therapy: Enhances family coping skills, such as helping the affected person or recognizing new episodes. It also improves problem solving and family communication.
  • Cognitive-behavioral therapy: allows the affected to change negative and maladaptive thoughts and behaviors.
  • Interpersonal and social rhythm therapy: improves the person’s personal relationships with others and helps control their daily routines, which can prevent depressive episodes.
  • Psycho education: educates the affected about the disorder and treatment.

According to research, medication along with intensive psychotherapy (weekly cognitive behavioral therapy) has better results than just psychotherapy or psycho education.


The symptoms of TB can be controlled with different types of medication.

Because not everyone responds in the same way to the same medication, they may have to try different drugs before finding the right one.

Keeping notes of daily symptoms, treatments, sleep patterns and other behaviors will help you to make effective decisions.

Drugs normally used for TB are antidepressants, mood stabilizers, and atypical antipsychotics.

Mood Stabilizers

They are usually the first line of treatment for TB and are generally taken for years.

Lithium was the first stabilizer approved to treat manic and depressive episodes. There are anticonvulsants that are also used as mood stabilizers:

  • Valrico acid: it is a popular alternative to lithium, although young women should be careful.
  • Lamotrigine: is effective for treating depressive symptoms.
  • Other anticonvulsants: oxcarbazepine, gabapentin, topiramate.

The use of valproic acid or lamotrigine may increase suicidal thoughts or behaviors, so be cautious in using them and observe the people who take them.

In addition, valproic acid may increase testosterone levels in adolescent girls, which can lead to a condition called polycystic ovarian syndrome, which has symptoms such as excessive body beauty, obesity or irregular menstrual cycle.

Side effects of lithium can be dry mouth, restlessness, indigestion, acne, discomfort at low temperatures, muscle or joint pain, nails or brittle hair.

When taking lithium, it is important to check your blood levels, as well as the liver and thyroid gland.

In some people, consumption of lithium can cause hypothyroidism.

The side effects of other mood stabilizers may be:

  • Dizziness.
  • Drowsiness.
  • Diarrhea.
  • Headache.
  • Acidity.
  • Constipation.
  • Nasal congestion or discharge.
  • Humor changes.

Atypical antipsychotics

These drugs are often used alongside antidepressants to treat TB. Atypical antipsychotics may be:

  • Aripiprazole: used to treat manic or mixed episodes, as well as to maintain treatment.
  • Olanzapine: may relieve symptoms of mania or psychosis.
  • Quetiapine, breathe the ziprasidone.

Side effects of atypical antipsychotics may include:

  • Blurry vision.
  • Dizziness.
  • Tachycardia.
  • Drowsiness.
  • Sensitivity to the sun.
  • Skin rash.
  • Drowsiness
  • Menstrual problems in women.
  • Changes in metabolism.
  • Weight gain.

Because of changes in weight and metabolism, it can increase the risk of developing diabetes or high cholesterol, so it is important to control glucose, weight and lipid levels.

In rare cases, long-term use of atypical antipsychotics may lead to a condition called tar dive dyskinesia, which causes uncontrollable muscle movements.


The antidepressants that are usually prescribed to treat the symptoms of bipolar depression are: paroxetine, fluoxetine, sertraline and bupropion.

Taking antidepressants alone can increase your risk of becoming manic or hippomanic. To prevent it, it is often necessary to use mood stabilizers along with antidepressants.

Side effects of antidepressants may include:

  • Sickness.
  • Headaches.
  • Agitation.
  • Sexual problems.

Patients taking antidepressants should be carefully observed because they may increase suicidal thoughts or behaviors.

If you are pregnant or have a newborn baby, consult your doctor about the treatments available.

Other treatments

  • Electroconvulsive therapy: may be useful if psychotherapy or medication does not work. It may include side effects such as disorientation, memory loss, or confusion.
  • Sleep medications: although sleep usually improves with medication, if you do not, you can use sedatives or other drugs to improve sleep.

To properly treat TB, it is necessary to make certain changes in lifestyle:

  • Stop drinking or using illegal drugs.
  • Move away from toxic personal relationships and build healthy personal relationships.
  • Do regular physical exercise and stay active.
  • Maintain healthy sleep habits.


Bipolar disorder is the sixth leading cause of disability in the world and has a prevalence of 3% of the general population.

Its incidence is equal in women and men, as well as across different cultures and ethnic groups.

Late adolescence and the onset of adulthood are ages in which more TB appears.

Risk factor’s

Risk factors that may increase the likelihood of developing TB are:

  • Having a close family member with bipolar disorder.
  • Periods of high stress.
  • Alcohol or drug abuse.
  • Vital events such as the death of a loved one or traumatic experiences.


If left untreated, TB can result in several problems affecting all vital areas:

  • Attempted suicide.
  • Legal issues.
  • Financial problems.
  • Alcohol or drug abuse.
  • Problems with family or couple relationships.
  • Social isolation.
  • Low labor productivity or at school.
  • Absence from work or training.

Tips If You Have Bipolar Disorder

It is necessary to lead a healthy lifestyle to keep TB symptoms under control, reduce symptoms and avoid relapses.

In addition to psychotherapy and medication there are other things you can do:

  • Self-education: Learn about your disorder so you can make better decisions and control it.
  • Be committed to your treatment: treatment requires a process to see improvement and requires long-term commitment. Be patient, take medication as prescribed and continue therapy.
  • Observe your symptoms and mood: if you are aware of when a mood change is occurring, you can prevent it from developing completely. Try to identify what causes manic or depressive episodes (stress, discussions, seasonal changes, lack of sleep …).
  • Create healthy habits: relate to healthy people, get enough sleep, exercise, eliminate alcohol, caffeine or sugar, go to therapy and take medication …
  • Create an emergency plan: There may be times when you fall into a depressive or manic episode. Having a plan for those crises will help you control them better.
  • Seek social support: having social support is important to staying happy and healthy. Build relationships with family and friends, go to support groups and build new personal relationships.
  • Controls stress : practices relaxation techniques and engages in leisure activities.

Tips to help a family member with bipolar disorder

Mood swings and behaviors of a person with TB affect the people around them.

They may have to face irresponsible decisions, exaggerated demands, explosive outbursts or grandiloquent behaviors. Once the mania is over, you will have to face the lack of energy of the family member to continue with a normal life.

Also Read: Major Depression: Symptoms, Causes, Treatments

However, with proper treatment most people can stabilize the mood.

Here are some ways you can help:

  • Encourage your family member to receive treatment: TB is a real illness and the sooner treatment is started, the better the prognosis.
  • Be understanding: remind the other person that you are willing to help.
  • Learn about bipolar disorder: learn about symptoms and treatment to be better prepared to help.
  • Be patient: after the start of treatment the improvement takes some time.
  • Accept the limits of the person affected: people with TB cannot control their states of mind with self-control.
  • Accept your own limits: you cannot force anyone to improve if you do not want to. You can offer support, although the recovery is in the hands of the other person.
  • Reduce Stress: Stress worsens TB.
  • Watch for signs of relapse: if treated in time, it can be prevented that an episode of depression or mania develops completely.
  • Be prepared for destructive behaviors: the person with TB can act irresponsibly or destructively in mania or depression. Being prepared for this will allow you to better face the situation.
  • Knowing what to do in a crisis: Knowing what you have to do in a crisis will help you to act correctly when one appears. Know emergency numbers for suicidal or violent behavior.
  • In the mania: avoid the discussions, show up close, prepare simple meals, and avoid the person has much stimulation.

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