Bipolar disorder was once referred to as manic-depressive illness because people who struggle with this condition cycle through periods of depression or low mood, and periods of elevated mood up to mania.
This affects how well a person is able to maintain a stable life, family, and job. The condition can make everyday tasks difficult, and radically change one’s mood, energy level, and outlook on life.
What Is Bipolar Disorder?
As medical professionals gained better insight into mental health conditions, manic-depressive disorder became bipolar disorder. There are four subsets of this condition, which have different manifestations.
- Bipolar I disorder: This form of bipolar disorder involves periods of mania lasting up to one week. Symptoms of a manic episode are typically so severe that the person develops psychosis, delusions, or a break from reality and requires hospitalization. Depressive episodes are likely to follow manic episodes and last at least two weeks. It is also possible for a person to experience periods of depression with mixed features, including anxiety, mania, or elevated energy.
- Bipolar II disorder: This form of bipolar disorder manifests primarily as depression, with interspersed periods of hypomania, which can be high-energy and disruptive to life but not as intense as mania in bipolar I.
- Cyclothymic disorder or cyclothymia: This involves a cycle of slightly milder depression interspersed with hypomania, going through several rounds for at least two years. However, symptoms in cyclothymic disorder do not meet the requirements for bipolar I or II.
- Other specified/unspecified bipolar and related disorders: This is a combination of manic and depressive periods, which does not align with the cycles in the conditions listed but is still disruptive to life, relationships, and long-term stability.
Mania and depression express slightly differently for everyone, but there are certain general signs of each condition.
- Mania: feeling “up,” “high,” and elated; excess energy; performing more activities than usual; appearing jumpy; losing sleep or having difficulty sleeping; becoming more active suddenly; talking faster; appearing agitated and irritable; experiencing more rapid thoughts; thinking one can multitask many different activities or events; spending a lot of money; and displaying other risky behaviors
- Depression: low energy or low mood; feeling sad, down, or hopeless; having paradoxical trouble sleeping or sleeping too much; loss of enjoyment in any previous activity; worry or emotional emptiness; trouble concentrating; changes in appetite (eating too much or too little); trouble thinking clearly or quickly; speaking slowly; moving little; and thoughts of death or suicide
Because both manic and depressive episodes can feel intense, and the change between these conditions can be very disruptive, people who have bipolar disorder are at greater risk for abusing drugs and alcohol to self-medicate their experiences. It is rare for substance abuse to cause bipolar disorder, although abusing drugs and alcohol will make symptoms of depression and mania worse. Between 80 percent and 90 percent of people who have bipolar disorder have a family member with either bipolar disorder or depression.
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New Orleans Drug Treatment Guide
Bipolar disorder may affect as much as 4 percent of the US population, with about 1 percent receiving a bipolar I diagnosis. Symptoms of these conditions typically appear in childhood. Substance abuse may trigger a manic episode, make depressive symptoms worse, or worsen the overall condition to the point that the individual requires hospitalization, but unlike some other mood disorders, substance abuse does not trigger bipolar disorder. This chronic mood disorder will typically have started manifesting when a person is an adolescent, although symptoms of depression will be the most likely first signs. Many people who struggle with bipolar disorder receive a diagnosis of depression first since depressive periods are typically the longest in the cycle.
Secondary mental and behavioral conditions are associated with bipolar disorder, including eating disorders, anxiety, and substance abuse. Co-occurrence of bipolar disorders with substance abuse ranges from 35 percent to 60 percent, which is a large overlap in conditions. People who receive a diagnosis of bipolar disorder from a medical professional are typically also screened for drugs and alcohol due to the high rates of co-occurrence. As with other forms of addiction, men who have bipolar disorder are at greater risk for abusing drugs or alcohol than women.One study examining adolescent substance abuse risks found that up to 34 percent of the 105 participants with bipolar disorder abused substances later in life compared to 4 percent of the 98 members in the control group. This study highlights the importance not only of early diagnosis of bipolar disorder, but also of ongoing treatment for co-occurring bipolar and substance use disorders, including education and prevention efforts.
The substances most often abused by people struggling with bipolar disorder, especially if the condition is undiagnosed, include:
- Alcohol: Those with bipolar disorder are four times more likely to frequently abuse alcohol compared to the general population.
- Nicotine, especially cigarettes: About 70 percent of people with bipolar disorder are current smokers.
- Marijuana: Those struggling with bipolar disorder are three times more likely to frequently abuse cannabis.
- Cocaine, opioids, and sedatives: Those with bipolar disorder are generally four times more likely to abuse other substances than the general population.
Those with more intense periods of mania associated with their form of bipolar disorder are six times more likely to abuse drugs during this period; however, the co-occurrence of depression and substance abuse is also very high, so any form of bipolar disorder puts a person at risk.
Treating Co-Occurring Bipolar and Substance Use Disorders
Because of the high co-occurrence of substance use disorders among people struggling with bipolar disorder, a diagnosis of bipolar disorder should be followed by an investigation of potential substance abuse. This may involve a physical exam, drug testing, completion of a questionnaire, or a review of previous medical records. It is important for an addiction specialist to perform this diagnosis.
Once both bipolar disorder and substance abuse have been appropriately diagnosed, the first step is for the person to go through detox to end their physical dependence on the substance they abuse. This may involve maintenance medications like buprenorphine, but for drugs like marijuana or stimulants, this means medical supervision without a taper.
After detox has safely been completed, entering a rehabilitation program that specializes in treating co-occurring mental health issues and substance use disorders is vital. These evidence-based programs can provide medication and psychotherapy geared toward treating bipolar disorder along with important talk therapy to overcome addiction symptoms. Medications typically prescribed to treat bipolar disorder include:
- Mood stabilizers, including lithium, Depakene, and Depakote
- Antipsychotics like Risperdal or Seroquel
- Some antidepressants
- A combination antidepressant and antipsychotic like Symbyax
- Some benzodiazepines, when carefully monitored for abuse symptoms
Long-term treatment is very important. People with a condition like bipolar disorder will need to continue working with a therapist after they have completed a rehabilitation program. Continued participation in substance abuse support groups, such as Alcoholics Anonymous or Narcotics Anonymous, can also help them to manage their substance use disorder on a long-term basis.