Bipolar disorder is characterized by extremes in mood and related changes in behavior and thoughts. In this condition, an individual experiences both highs (mania or its milder form, hypomania), and lows (depression), or a mixture of symptoms at the same time. What is tricky about manic symptoms is that, unlike depression, they may not be recognized by individuals with the condition, and in fact the symptoms may be enjoyable to them. The symptoms of bipolar disorder come and go, but the condition itself is chronic and requires ongoing management, like diabetes does. However, with good treatment and self-management skills, individuals with bipolar disorder can lead productive and fulfilling lives.
Previously called manic depressive disorder, bipolar disorder is relatively common – about one in every hundred people (1%) develop bipolar disorder.
- Mania (highs): may include feelings of euphoria, increased energy, and a heightened sense of optimism. Often times, people feel sped up and have too much energy; they usually have little need for sleep and cannot turn off the racing thoughts in their mind. Many people also have periods of elevated energy and drive that is not pleasant but is more irritable or even depressive. Milder forms of mania are called hypomania.
- Depression (lows): consists of sad or blue moods, sometimes with a sense that things are bad and will never get better. Often people stop feeling pleasure in usual activities, become unrealistically pessimistic, hopeless, guilty, or even think about ending their lives. Sometimes there are physical changes as well, including inability to sleep and loss of appetite or eating too much.
- Other Symptoms: often accompany bipolar disorder. Common “co-travelers” with bipolar disorder include anxiety disorders such as post-traumatic stress disorder (PTSD) or substance use disorders. Occasionally individuals may experience hallucinations (voices or visions) or delusions (strange, fixed beliefs) when severely manic or depressed. These other symptoms need treatment as well.
- There is no single identifiable cause of bipolar disorder, rather a variety of individual characteristics and outside factors that likely combine to activate bipolar symptoms in a person, usually around early adulthood.
- Genetics: There is some indication that genetics plays a role in making an individual more susceptible to bipolar disorder, but researchers have been unable to find a single gene cause. It is more likely that the disorder is caused by a combination of genetic factors and environmental triggers. It is important to know, though, that just because a person has bipolar disorder does not mean that their children will—in fact, it’s more likely that they will not have the disorder.
- Biological factors: Research has linked bipolar disorder to problems with certain brain chemicals called neurotransmitters (for example, norepinephrine, serotonin, and dopamine). These neurotransmitters let brain cells communicate with one another, and research indicates that problems in this communication is in some way related to bipolar disorder.
- Psychological factors: There is no one psychological theory that can be used to explain bipolar disorder. Research has focused less on causes of the disorder and more on factors that affect its course (see next bullet). Psychological theories such as cognitive, behavior, and interpersonal theory have all been used as models for the development of treatment strategies.
- Life stressors: Research suggests that both physical stressors (like change in seasons or use of drugs) and social stressors (like family stress or job stress) can affect the course of the symptoms, sometimes even triggering an episode.
There are no laboratory tests, no brain scans, and no paper-and-pencil tests that tell you if you have bipolar disorder. Sometimes, though, brain scans are used to make sure that physical problems like a tumor are not causing the symptoms. Genetic testing available on the web cannot tell you, either; these tests tend to be a waste of money. Rather, the diagnosis is made by an experienced clinical provider from taking a careful history and interview observations. And it is not just a matter of opinion.
Making the correct clinical diagnosis is important, and good treatment leads to better outcomes. However, making a diagnosis does not mean that you become your diagnosis. It is important to explore what the condition means to your life—neither ignoring the condition nor surrendering your life and self-worth to it.
VA Programs & Services
Treatment for bipolar disorder involves working with mental health professionals to develop a plan with both medication and psychosocial interventions to achieve optimal health. Bipolar is a spectrum disorder because each person’s symptoms, life circumstances, and other health and mental health issues create a uniqueness that makes it impossible to treat everyone in the same way.
Medication is necessary in most cases. A medication that works well for one Veteran may not help another, so it is important to work closely with prescribers to find a medication that works. No one treatment is best for all Veterans. Programs and services at the VA treat each Veteran as an individual and work to determine which treatments and programs fit best with each Veterans’ personal needs and goals.
Psychological Treatments and Social Supports
Veterans can also talk with Mental Health Professionals (MHPs) about trauma they’ve experienced, substance use, challenging life circumstances, or other pain that may be affecting them. Psychosocial interventions are considered essential to promoting the recovery of Veterans who are diagnosed with bipolar disorder, and should be offered along with medications. Psychosocial interventions have been shown to improve outcomes in individuals already taking medication.
The VA provides the following psychosocial interventions for bipolar disorder:
- Psychoeducation involves teaching Veterans with bipolar disorder about the condition, treatment, and ways to recognize signs of relapse so that early intervention can be sought before a full‐blown episode occurs. Psychoeducation also may be helpful for family members.
- Life Goals helps Veterans with bipolar disorder achieve personal wellness goals through a combination of self- management skills, individualized guidance in healthy lifestyles, and symptom management. Life Goals is a brief intervention that is often provided in the context of an ongoing care management program called Life Goals Collaborative Care (LGCC). LGCC is available at a growing number of VA medical centers, including by means of videoconferencing technologies that link Veterans to centers of expertise in bipolar treatment.
- Cognitive behavioral therapy (CBT) helps Veterans diagnosed with bipolar disorder learn to change negative thought patterns and behaviors associated with the condition.
- Illness Management and Recovery (IMR) helps people obtain information and learn skills to support their mental health and recovery.
- Peer Support Technicians (also called Peer Specialists or Peer Counselors) have personal experiences with bipolar disorder and recovery, and have completed peer-counselor training. They can help Veterans navigate the VA mental health system, put Veterans in touch with community and VA resources, or assist Veterans in advocating for their needs. As a Veteran who “has been there” regarding mental illness, they can be terrific allies in a person’s recovery journey.
- Other programs aimed at housing, employment, vocational training, and health behavior change are also available to help Veterans design programming that best meets their needs and goals. Each VA has a Local Recovery Coordinator (LRC) who leads recovery discussion groups, creates special education programs, and makes recovery- focused programs available to Veterans. LRCs can help Veterans with bipolar disorder find resources to promote their recovery. They can also help you to arrange services.
- Depression and Bipolar Support Alliance (DBSA): A national organization focusing on the most prevalent mental illnesses. Provides information and links to local support groups for individuals with bipolar disorder, as well as a few brochures such as: Myths and Facts about Depression and Bipolar Disorder.
- What is bipolar disorder?: The National Alliance on Mental Illness (NAMI) describes bipolar disorder, recovery and coping strategies. NAMI is a grassroots organization dedicated to improving the lives of individuals and families affected by mental illness. NAMI provides information on symptoms, causes, diagnosis, treatment and more. The NAMI main office phone number is (703) 524-7600. The NAMI Helpline is (800) 950-6264.
- The National Institute of Mental Health (NIMH): A website full of articles, research results, and links to clinical trials on bipolar disorder.The NIMH is a national organization whose mission is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. It provides information on the latest scientific information as well as ongoing studies relevant to bipolar disorder.
- Mental Health America (MHA) – Bipolar Disorder: A nonprofit dedicated to helping all people live mentally healthier lives. Provides a number of factsheets on bipolar disorder.
- The Veterans Crisis Line is a toll-free, confidential resource that connects Veterans in crisis and their families and friends with qualified, caring VA responders. Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online at www.VeteransCrisisLine.net, or send a text message to 838255 to receive free, confidential support 24 hours a day, 7 days a week, 365 days a year, even if they are not registered with VA or enrolled in VA health care.
- The Balanced Mind Foundation: A resource for families of children with a mood disorder.
- Active Minds: Changing the conversation about mental health. A resource for college students.