10 Warning Signs of Bipolar Disorder

Actor Charlie Sheen’s rants about warlocks and tiger blood spurred a national conversation about bipolar disorder, which affects nearly 6 million Americans. Here are the top symptoms and treatments…

We all have ups and downs. But the steep climbs (mania) and sudden plunges (depression) of bipolar disorder can lead to life-threatening situations.

Shirley Rogerson, 59, thought her husband of 40 years was simply prone to dark moods. At other times, he was the life of the party, telling jokes that had everyone in stitches.

But as years passed, his behavior became frightening.

“He threatened to kill himself and had hallucinations,” says Rogerson, an author and library information specialist. “Once, he saw visions of killing me and the dogs.”

Her husband was eventually diagnosed with bipolar disorder. The serious mental illness affects about 6 million women and men in the U.S., according to the Depression and Bipolar Support Alliance (DBSA). And it can be harrowing, and dangerous, for people around them.

In the manic phase, sufferers often don’t think anything’s wrong. They’re hyper-energized and brimming with confidence. But they’re not as invincible as they feel.

“Eventually, people almost always make a big mistake, such as a foolish investment or an ill-advised affair. When they realize what they’ve done, they can crash into really bad depression,” says psychiatrist Igor Galynker, M.D., Ph.D., director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York City.

What Is Bipolar Disorder?
This complex mental condition comes in various forms. These are the most common:

Bipolar I is the classic type, which used to be called manic depression. Patients typically alternate between full-blown mania and depression, which causes severe behavioral shifts. In some, those symptoms occur concurrently.

Occasionally, the mania or depression is so severe it becomes psychosis – a break with reality characterized by delusions or hallucinations.

Bipolar II is the less extreme, more common version of the disorder. Depressive episodes alternate with hypomania – a milder version of mania. People with hypomania are sometimes highly productive and function well.

“It can start out lovely,” says Cynthia Last, Ph.D., a clinical psychologist in Boca Raton, Fla., and author of When Someone You Love Is Bipolar (Guilford Press). But it inevitably leads to depression. And if left untreated, symptoms may grow more extreme, evolving into bipolar I.

Once diagnosed, bipolar disorder is often treatable with medications and psychotherapy. But warning signs of bipolar disorder are often confused with major depression, attention deficit hyperactivity disorder (ADHD), drug-induced highs or just plain moodiness.

As a result, only 1 in 4 sufferers are accurately diagnosed in less than three years, according to DBSA figures.

Recognizing the mania and depression signs of bipolar disorder is the first step to getting help. Here’s what to look for:

6 Warning Signs of Mania
1. Unusually upbeat, outgoing or irritable mood
During a manic phase, some people feel euphoric, others talk nonstop and some develop a hair-trigger temper. The key is a radical departure from the norm.

“A person who’s usually a reasonable individual may suddenly become impossible to live with,” Galynker explains.

2. Racing thoughts and speed-talking
Besides speaking quickly and jumping between ideas, a person in this phase may also be easily distracted – one reason mania is sometimes mistaken for ADHD.

“Unfortunately, the primary treatment for ADHD is stimulants, which can trigger severe symptoms in someone with bipolar disorder,” Last says.

To avoid an ADHD misdiagnosis, mental health professionals analyze how behavior has changed: Bipolar disorder is episodic, while adult ADHD usually continues from childhood.

3. Boundless energy
The extremely energetic behavior common in the manic phase often leads to rushing around and taking on new projects, however ill-advised. If the sufferer is also easily distracted, he’ll jump to new tasks before completion, Galynker says.

4. Impulsive and self-destructive behavior
Spending sprees, flagrant affairs or risky investments can all signal bipolar disorder if they’re out of character and part of a larger pattern of symptoms, Galynker says.

5. Decreased need for sleep
Sleeping only a few hours a night could be a sign of bipolar disorder – as well as depression or anxiety. How do you know the difference?

“People with insomnia typically feel very tired during the day,” says Elizabeth Brondolo, Ph.D., a psychology professor at St. John’s University in Queens, N.Y., and author of Break the Bipolar Cycle (McGraw-Hill). Someone in a manic episode may never feel exhausted.

6. Inflated sense of self-worth
An exaggerated sense of your power, knowledge or importance is common in this stage, such as believing you have a special relationship with God.

“It’s a feeling of being invincible and doing no wrong,” Galynker says.

4 Warning Signs of Depression
1. Sad, empty or hopeless mood
Many people with bipolar disorder spend most of the time depressed, Brondolo says. This relentless dark mood prevents them from taking interest or pleasure in their lives.

2. Low energy and constant fatigue
In contrast to supercharged energy during mania, this phase leaves a person feeling drained of energy and motivation. The smallest task – even getting out of bed – can seem impossible.

“A depressed person isn’t able to move forward and do what’s supposed to be done,” Brondolo says. As a result, performance at home, work or school often suffers.

3. Decreased ability to think clearly
The same mind that races from idea to idea when manic may feel paralyzed during depression, making it hard for the sufferer to remember things and make decisions.

“Depression can lead to serious disruptions in concentration and attention,” Brondolo says.

4. Suicidal thoughts and behavior
Depression often leads to dwelling on past mistakes, including blunders made while manic.

“When it gets really bad, you may feel cornered, as if all possible ways of escaping a situation are closed,” Galynker says.

That’s when suicidal thoughts can take hold. And without treatment, the risk of acting on them is high. Up to 20% of people with bipolar disorder take their lives.

Getting Help
If you recognize several warning signs of bipolar disorder in yourself or a loved one, seek help. Contact a psychiatrist or other mental health professional, or get a referral from your primary-care physician.

Several treatments are available:

Medications
These play a primary role in managing bipolar disorder. Options include:

Mood-stabilizing drugs. Usually the first choice, these include lithium, the oldest mood stabilizer, and anticonvulsants, a group of drugs originally developed to treat seizures.

Antipsychotics. Prescribed when lithium or anticonvulsants don’t work, or if the patient has symptoms of psychosis.

Antidepressants. Often combined with a mood stabilizer or antipsychotic, “there’s controversy over whether antidepressants should be used to treat depression in people with bipolar disorder,” Galynker explains. That’s because there’s a risk of switching abruptly from depression to mania.

Psychotherapy
Therapy is also crucial. Intensive therapy helps people recover faster and stay well over a one-year period, according to the largest federally funded study of bipolar disorder treatments, the Systematic Treatment Enhancement Program for Bipolar Disorder.

The three types of therapy included in the study had comparable benefits. They were:

Cognitive-behavioral therapy. Teaches people how to counteract negative thoughts and use behavioral strategies to cope with mood swings.

Interpersonal and social rhythm therapy. Advises how to maintain consistent daily routines and sleep schedules. Also works on resolving interpersonal issues and conflicts that contribute to symptoms.

Family-focused treatment. Couples or parents and children work together to manage a sufferer’s bipolar disorder in this type of therapy.

Persuading Your Mate to Seek Treatment
People with manic depression may not realize how sick they are. So if your mate is showing signs of bipolar disorder, overcoming denial and convincing him to see a mental health professional can be difficult.

Galynker recommends the following steps:

Persuasion: Start by reasoning with him. Explain that he can improve his life by getting help.

Intervention: Enlist people your mate values, such as parents, siblings and friends.

Manipulation: Present treatment as a privilege. For example, you could mention that he’ll be seeing the same doctor who treated a local celebrity.

Ultimatum: If all else fails, “tell him, ‘Either you see somebody or I’m leaving,’” Galynker says. While harsh, it may be your only option.

Once your mate gets better, you can help him stay that way. Support his healthy lifestyle choices, such as avoiding alcohol or drug abuse, keeping a regular sleep schedule and reducing stress.

Also, ask his treatment provider about early warning signs of a relapse. Then develop an emergency plan with her and your mate in case this occurs.

And remember, neither of you has to endure this illness alone. To find support in your area, visit the DBSA Chapter and Support Group Directory.

Today, Shirley Rogerson’s husband, Roger, is doing well. And he credits her with playing a pivotal role in his recovery.

“It’s great to have somebody who has stuck with me for all these years and knows me inside-out,” he says. “With bipolar, it’s always way up or way down. She helps me find the medium.”

Learn more about signs of bipolar disorder in our Mental Health Center.

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Everyone has idiosyncrasies that might lend themselves to a personality disorder.