Health Essentials from Cleveland Clinic

Swinging wildly between euphoria and depression. Psychotic breaks. That’s how many people view bipolar disorder.

But the reality is quite different, says psychiatrist Amit Anand, MD. Here, he upends common misconceptions about the brain disorder:

Myth 1: Bipolar disorder is a severe mental illness

“Many people believe that those with bipolar disorder are out of control and psychotic,” says Dr. Anand. “But we have learned over the last few decades that milder forms of bipolar disorder are much more common.”

The two main types of bipolar illness are bipolar I and bipolar II. Beyond that, bipolar illness takes many forms.

• In bipolar I, episodes of mania and depression can be quite severe.
• In bipolar II, depression may be severe, but the highs are much milder, do not truly impair function and may even make people more productive.
• In a much larger group of people, very mild or very few symptoms of mania occur for short periods of time — not enough to warrant a diagnosis. Some of these individuals are quite successful.

“Thus, most people with bipolar disorder live in the community and may never be admitted to a psychiatric hospital,” says Dr. Anand.

Myth 2: Mood swings always mean bipolar disorder

“Mood swings happen for many different reasons, including the weather, the menstrual cycle, common medications like steroids, and substance use,” says Dr. Anand.

Moodiness can also occur with medical illnesses such as hormone disorders, autoimmune diseases and neurological problems.

And mood swings occur with other brain illnesses, such as attention-deficit hyperactivity disorder (ADHD) and certain personality disorders.

What sets bipolar disorder apart? “The illness represents a change from the usual self,” explains Dr. Anand. “Also, depression lasts for several weeks at a time, and mania lasts for several days at a time. We look for a season of summer — not one hot day.”

Myth 3: Depression and mania are cyclical

People often assume that in bipolar disorder, periods of mania alternate regularly with periods of depression.

“In bipolar disorder, mood is more often chaotic, with random combinations of symptoms,” says Dr. Anand. “It is not cyclical.”

This helps fuel the turmoil that often unravels relationships with family, friends and coworkers — even in mild cases of bipolar disorder.

That is why treatment is so important.

Myth 4: Bipolar disorder is difficult to treat

“We have very, very effective treatments for bipolar illness,” says Dr. Anand. “Patients generally respond well to mood-stabilizing drugs, sometimes combined with antidepressants and/or drugs for mania.”

Psychotherapy is always recommended, he says, and offers many benefits by:

• Providing insight into the illness. “When people with bipolar disorder are depressed, they’re aware that they are in pain,” he says. “But when they are manic and feel very, very good, they don’t see a problem.”
• Teaching stress management strategies. Learning to manage stress, which can trigger mania and depression, is vital in bipolar disorder.
• Helping with problem-solving. People with bipolar disorder can learn how to deal better with family problems and work difficulties.
• Educating people about self-care. “When you have bipolar disorder, maintaining regular daily routines is critical,” says Dr. Anand. “But many people don’t sleep or eat at the right times, which causes more mood problems and creates a vicious cycle.”

Where to get help

If you suspect that you or someone you love may have bipolar disorder, get a full evaluation from a psychiatrist.

“Too often, bipolar disorder is not diagnosed, or it is mistaken for another problem,” says Dr. Anand. “Get one good diagnostic evaluation. Then, know that some very effective treatments can help you lead a normal life, like anyone else.”