- Bipolar disorder affects about 60 million people worldwide.
- There is a difference between bipolar 1 and bipolar 2.
- People with bipolar 1 experience long, severe episodes of mania.
- With bipolar 2 the mania is less severe.
Bipolar disorder is a mental health problem that affects mood. People with bipolar experience manic episodes, periods of depression, and potentially some psychotic symptoms, according to mental health charity Mind.
In the manic or hypomanic periods, they feel high and energetic, but then the depression comes and they crash back down to Earth.
Katherine Ponte, who has lived with severe bipolar 1 disorder for over 15 years, told INSIDER it’s being manic that gets you into trouble, but it’s the depression that’s the most dangerous.
“When you’re manic, you don’t think you’re gonna die, you think you’re on top of the world, you can do anything,” she said. “When you have major depression, that can kill you.”
This is what it’s like to be bipolar
Bipolar used to be called “manic depression” because of the two different states, but bipolar is now the most widely used term.
There are also two types of the disorder: bipolar 1 and bipolar 2.
Joseph F. Goldberg, a clinical Professor of psychiatry at the Icahn School of Medicine at Mount Sinai in NYC told INSIDER: “In bipolar 1 disorder the high periods cause trouble, and about half the time may involve psychosis – delusions (false beliefs) or hallucinations (false perceptions).”
With bipolar 2 disorder, the highs are milder intensity, and don’t involve psychosis.
“[They] don’t involve psychosis, and by definition aren’t disruptive to one’s functioning,” said Goldberg.
“In both conditions, depressive symptoms and episodes are similar although depression tends to be more enduring and predominating over highs in bipolar 2 than bipolar 1 disorder.”
During Ponte’s manic episodes, for instance, she made religious shrines and thought she was receiving messages about the world coming to an end.
This probably wouldn’t happen to someone with bipolar 2, as they don’t experience long manic episodes. Instead, they have hypomania, which can last for a few days.
“It can still have a disruptive effect on your life and people may notice a change in your mood and behaviour,” according to the Mind website. “But you will usually be able to continue with your daily activities without these being too badly affected.”
How bipolar is treated
Mood stabilisers are the cornerstone of treatment, said Goldberg. These are drugs that treat highs and lows.
Lithium, divalproex, and carbamazepine are some that work for the highs, which lamotrigine is used to treat the lows.
“Atypical antipsychotics are increasingly being used for both short- and long-term treatment management, regardless of the presence of psychosis,” he said.
“Our drugs are far from perfect. Many medicines have annoying side effects like weight gain, response rates are not always as dramatic in real life as they are in research studies for numerous reasons – such as the presence of additional disorders such as substance abuse – and combination drug therapies are common.”
If someone doesn’t get treatment, their manic and depressive episodes persist, and they may be hospitalised over and over again.
“Persistent symptoms can cause a downward spiral… and consequences such as work and social functioning take a toll, sometimes leading to disability, isolation and loss of social supports,” said Goldberg.
Ponte was taken to hospital and locked in isolation a few times before she found the right treatment.
“Before I was living without hope, and after was living with hope,” she said. With her organisation ForLikeMinds, Ponte aims to connect people with others who are going through something similar, and give them a future.
“We want to increase awareness of that possibility for people,” she said. “To give them that hope that they can recover from mental illness and go on to live a healthy, productive life.”
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