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What Does Bipolar Disorder Look Like? That’s the Challenge.



Marked by emotional highs and lows, bipolar disorder can resemble many other mental health conditions. Here’s how to help recognize the symptoms.

Bipolar disorder has been called a chameleon of psychiatry.

From one person to the next, symptoms of mania and depression may be different, they may fade and reappear over a lifetime, and they can overlap with a range of other mental health conditions. It’s no wonder that it can take up to 10 years between the time people first experience the condition’s unusual and extreme mood shifts and when they get diagnosed.

Because bipolar disorder is so hard to pin down, many people may not even realize they have it – or know they need help. That’s why it takes a trained healthcare professional to diagnose the condition.

Yet, individuals and their families need to be aware of the signs and symptoms to make sure their loved ones are getting the care they need.

“When it comes to bipolar disorder, families can act like thermometers,” said Daniel Finch, MD, chief medical officer of CarePlus NJ, which offers integrated primary care, mental health care, and substance use rehabilitation services throughout Northern New Jersey. “They know better than anyone when something is wrong. It’s not their job to diagnose the condition, but they can encourage someone to get help.”

Here’s what bipolar disorder is and how you can help recognize it.

Bipolar disorder symptoms to watch for 

Previously called manic depression, bipolar disorder causes shifts in mood, energy, activity levels and concentration. Everyone has shifts in mood sometimes, but the ones associated with bipolar disorder can be intense enough to interfere with a person’s job, schooling, or relationships.

Bipolar disorder features episodes of mania cycling between states of depression.

During manic episodes, which can last days or even weeks, people can feel excited and full of energy – as if they are on a “high.” During a manic episode, they may:

  • Need less sleep
  • Talk very fast
  • Feel their thoughts are racing
  • Do risky things that show poor judgment, such as give away a lot of money, gamble or drink alcohol excessively, or have reckless sex

Manic episodes look different in teens with bipolar disorder. “Adolescents may act silly, but they also may be extremely irritable and experience outbursts of rage,” explained Tanya Lewis, MD, child and adolescent psychiatrist and vice president of psychiatry at CarePlus NJ.

Once the manic episodes are over, “people may crash into depression,” Dr. Finch said. During these depressive episodes, people may:

  • Feel very sad or indifferent
  • Feel slowed down or hopeless
  • Have trouble concentrating, making decisions or doing even simple things

Symptoms can vary from person to person, and there are even different kinds of bipolar disorder. The two main ones are bipolar disorder 1 (defined by manic episodes that last at least seven days or are shorter but result in a psychiatric hospitalization) and bipolar disorder 2 (defined by a pattern of depressive episodes and hypomania, a less severe form of mania).

Both kinds of bipolar disorder can lead to all types of underlying damage: irresponsible spending sprees, drug abuse, disruptions to home life. “Imagine living with someone who is up all hours of the night, making noises around the house,” Dr. Finch said. “Or they send you 100 texts in a row.”

The burden of bipolar disease can be huge, not just on a single family, but across the population when you consider that bipolar disorder is fairly common, affecting about 2 percent of both adults and adolescents in the U.S. That’s roughly six million people.

Getting the right bipolar disorder diagnosis and treatment 

The symptoms of bipolar disorder can easily be confused with those of other mental health conditions. The sadness can look like major depression, and the irritability and energy in kids can resemble the same signs in ADHD, or attention deficit hyperactivity disorder.

“What is really important for a family member is noticing an abrupt change in behavior,” Dr. Lewis said. “Then reaching out to a mental health professional to diagnose it correctly.”

The good news, Dr. Lewis added, is that bipolar disorder is very treatable. Medication – including mood stabilizers, antidepressants and antipsychotics – is often necessary to control the symptoms.

When anyone is taking these medications, especially antipsychotics that are sometimes used to treat hallucinations during manic episodes, it’s critical to be monitored by a physician. Using these types of drugs could lead to weight gain and an increased risk of diabetes and heart disease.

“Whenever we prescribe a medication, we’re always looking for the best side effect profile where the benefits outweigh the risks,” Dr. Lewis said.

For people with bipolar disorder, therapy can also be helpful – both for themselves and their families. A big piece of this is psychoeducation, or helping people understand and recognize their condition so they can better manage it.

“Having a support system in place and making necessary lifestyle changes, like getting enough sleep, can help give people control,” Dr. Finch said.

This type of holistic care is a hallmark of CarePlus NJ, recently named an Ambassador in Horizon’s Integrated Systems of Care program. At CarePlus NJ, mental health providers collaborate closely with a person’s medical doctors to make sure their physical and mental health – as well as substance use issues and social determinants of health – are managed effectively, Dr. Finch explained.

As a chronic condition, bipolar disorder may seem like a never-ending problem for those who are experiencing the emotional rises and falls. But Dr. Lewis pointed out that many people with this condition have successful careers and do well in school.

“It’s important to have hope because there is a lot of support out there,” Dr. Lewis said.

To find the support of a mental health professional, Horizon members can call 1-800-626-2212 or the number on the back of their ID card, or can find a provider on their own by using our doctor finder. Members are also encouraged to check out Horizon’s guide to accessing mental health resources during the pandemic and can find comprehensive resources in one, easy-to-navigate site – Horizon Behavioral Health℠.