The average person’s knowledge of bipolar disorder often comes from movies, where patients are typically depicted in one of three ways:
- Uber-creative and energetic—think Bradley Cooper in Silver Linings Playbook.
- Brilliant but paranoid—Matt Damon’s character in The Informant.
- Charmingly inept—as played by Mark Ruffalo in Infinitely Polar Bear.
Despite the protagonists’ mental health challenges, finding true love and a caring therapist usually leads to a cure … at least in Hollywood.
In real life, bipolar disorder is a condition that has to be managed. About 2% of the population—or approximately 8.5 million Americans—live with bipolar disorder, the mental health condition once known as manic depression.
It’s one of the most misunderstood and complex mental illnesses, and it’s among the 10 most debilitating noncommunicable diseases, according to the World Health Organization.
People living with bipolar disorder often have chaotic lives. They experience episodes of extreme elation (mania) and severe depression, cycling through moods and emotions that make it difficult to complete simple tasks or maintain lasting relationships.
No one would ever blame someone for having high cholesterol or back pain. Yet people living with bipolar disorder are often blamed for their symptoms. During periods of mania, they may make bad decisions with little regard for the consequences. Cycles of depression may include crying, poor eye contact with others, and a negative outlook on life. All of which may make them hard to be around.
Today, emerging research on the root causes of bipolar disorder have proven it’s an affliction, not a choice. Risk for bipolar may be carried by genes across generations, making some people susceptible and leaving others unaffected. Studies have found that genetic influence explains 60% to 80% of risk for the disorder (see: “Can bipolar be genetic?“).
We’re also learning that it doesn’t always lead to a poor quality of life. With the right treatment, people with bipolar disorder can be happy and productive.
Here are some key facts about the realities of bipolar disorder—including research into how genetics can play a role—that sheds light on this complex condition.
1. Bipolar Isn’t Just One Disorder
There is no single life event, personality type, chemical imbalance, or genetic variation that determines whether someone will or won’t develop bipolar disorder. Rather, every patient’s background and experience is unique.
Bipolar disorder is not a simple condition, but one made up of several subtypes, most commonly bipolar I and bipolar II. Here are the different types:
- Bipolar disorder type I: These patients have at least one episode of full-blown mania or manic and depressive symptoms, and often many more, over the course of a lifetime.
- Bipolar disorder type II: Patients have long episodes of depression, at least one episode of hypomania (a milder, less intense form of mania), but no full-blown manic episodes.
- Cyclothymic disorder: These patients have several hypomanic and depressive symptoms, but their symptoms don’t meet the criteria for depression or bipolar disorder type I.
- Bipolar disorder not otherwise specified: Patients have both depressive and hypomanic symptoms, but don’t meet the diagnostic criteria for bipolar disorder.
Determining how bipolar expresses itself in each individual can lead to better, more targeted treatment plans and a more accurate prognosis. New research indicates that different subtypes of bipolar disorder tend to cluster within families, suggesting that genetic testing could someday help doctors make more accurate diagnoses.
2. Bipolar Disorder Is Challenging to Diagnose
Some conditions, like hearing loss or the common cold, are fairly easy for doctors to accurately diagnosis. Bipolar is a different story, because there’s no definitive test or list of symptoms. Despite the severity and prevalence of this condition, misdiagnosis occurs in 60% of bipolar patients seeking treatment.
People spend between 5 and 10 years (or sometimes longer), on average, before getting a formal diagnosis of bipolar disorder.
The reason: They often seek help when they’re feeling down, then get treated just for their depressive symptoms. This is a problem, because the medication used to treat unipolar depression doesn’t treat bipolar disorder, and it may actually make manic symptoms worse.
Substance abuse is another factor. One study published in the journal Bipolar Disorders found that nearly half of bipolar disorder patients also have had alcohol or drug dependence problems, which can mask the underlying mental illness.
3. We’re Still Learning How to Treat Bipolar Disorder
There is no cure for bipolar disorder. Instead, it must be managed for life.
According to the National Advisory Mental Health Council, the treatment success rate is a remarkable 80%.
Treating bipolar disorder is complex, because the right treatment for one person may not help someone else. Additionally, the same treatments that alleviate depression can cause mania or mood swings. What’s more, treatments that reduce mania might cause rebound depressive episodes. While antidepressants are commonly used to treat the depressive phase of the disorder, they are not always effective.
People living with bipolar disorder are also at risk for other easier-to-spot conditions that distract from their root problems. For example, poor sleep often plays a key role in bipolar disorder, and patients may be sent home with a sleep aid rather than a mood stabilizer.
The most common treatment protocols for bipolar disorder include the following:
- Mood stabilizers, such as lithium, to reduce manic episodes and symptoms of depression. This approach alone helps about one-third of patients.
- Antipsychotic medications can help insomnia, agitation, and sometimes depression symptoms. Some people take these medications as add-ons to lithium.
- Antidepressants are sometimes used if mood stabilizers alone do not relieve depressive symptoms. They are given together with mood stabilizers or antipsychotics to prevent cycling.
- Antianxiety medications such as benzodiazepines may lesson anxiety and improve sleep, but they are usually only used for a short amount of time due to the risk of dependence and abuse.
Studies show that therapy and stress reduction can also help those with bipolar disorder. Experts say that combining talk therapy with mood-stabilizing drugs seems to be one of the most promising lines of treatment for bipolar disorder.
4. Bipolar Can Run in Families
There’s no doubt that environmental factors, such as early trauma, can increase the risk of developing bipolar disorder. But scientists are exploring the possibility of a bipolar gene or genetic pattern that can contribute to the disorder.
People are more likely to develop bipolar disorder if they have a close relative with the condition. In fact, the risk increases 5% to 10% if you have a first-degree relative with the condition, and 40% to 70% if you have a twin with the condition.
However, the association between genes and any psychiatric disorder is complex, and there is currently no definitive test or genetic screening available that can predict whether someone will develop bipolar disorder.
5. People with Bipolar Disorder Can Lead Happy, Productive Lives
Bipolar disorder symptoms can interfere with normal life and close relationships. Luckily, there are many factors that promote recovery, including a healthy diet, plenty of exercise, quality sleep, and avoiding alcohol and drugs.
One study cited the importance of a qualified, caring healthcare professional who sees you as a whole person. This can be difficult to achieve, as mental health providers are in short supply.
In a study in the Netherlands, patients who were being treated for bipolar disorder also stressed the importance of open communication with others, individualized care, and the opportunity to have a mental health institution to go to in case of crisis.
But during bouts of mania, bipolar patients may lack self-awareness and not recognize that they are ill—a symptom called anosognosia. For them, having caregivers as advocates can mean the difference between untreated symptoms and hope of relief and even recovery.
As you can see, bipolar disorders and their treatment aren’t as simple as the movies make them seem. But make no mistake: There is help—and hope.