What exactly is bipolar disorder, and how do Bipolar I and Bipolar II differ?
Sullivan: Both involve episodes of depression and elevated mood, but the difference lies in how intense those elevated periods are. Bipolar I includes full manic episodes, while Bipolar II involves hypomania, which is like a milder version. Think of it this way: Someone with hypomania might impulsively treat their office to lunch, while someone in a manic state might suddenly spend thousands on yarn because they’ve decided, out of nowhere, they’re opening a knitting shop. Mania is much more disruptive and harder to manage than hypomania.
Manic episodes can be quite destructive, right?
Sullivan: Manic episodes can lead to what we call “life trashing,” making risky or impulsive decisions that can seriously affect someone’s finances, relationships or safety. And after a manic or hypomanic episode, there’s often a crash into a depressive one, which can be just as hard to manage.
What are the main symptoms of bipolar disorder?
Sullivan: People with bipolar disorder experience two types of episodes, depressive and elevated. During depressive episodes, people might feel sad or irritable, have low energy, trouble sleeping or eating and sometimes even feel hopeless or suicidal. Elevated episodes can bring high energy, euphoria or irritability, racing thoughts, little need for sleep, fast talking and impulsive behavior. Everyone’s experience is a bit different, but the goal of treatment is to help reduce how often and how severely these episodes happen.
When does it usually show up, and how can parents tell the difference between normal teen behavior and something more serious?
Sullivan: We used to think bipolar symptoms didn’t show up until early adulthood, but now we know they can start in childhood or adolescence. In younger people, symptoms can be briefer and harder to spot. One big clue is the intensity and combination of mood symptoms. At the STEADY Program, we offer thorough evaluations to help families figure out what’s going on – it’s not always a quick answer.
Dr. Batt, you’re also the medical director of the STEADY Program here at Anschutz. Can you tell us a little more about it?
Batt: STEADY (STabilizing Emerging Affective Disorders for Youth to Adults) is for kids, teens, and young adults ages 6 to 30 who either have bipolar disorder or are at high risk. We focus on early diagnosis and treatment to prevent the illness from getting worse. We also do research, like on the ketogenic diet, to explore new, more personalized treatment options. If anyone wants to learn more about the STEADY Program, they can check out our website.
How does bipolar disorder affect loved ones?
Sullivan: It really can have a wide impact. Bipolar is what we call stress-sensitive and stress-generative, meaning it can be triggered by stress and can also create more stress in a family. One of the therapies we use is Family-Focused Therapy (FFT), which helps families understand the illness, create a relapse prevention plan, and learn communication and problem-solving skills. It’s all about building a supportive, less stressful environment.
What can family and friends do to help without burning themselves out?
Sullivan: That’s where a relapse prevention plan comes in. It’s a personalized guide made with input from both the person with bipolar and their support system. For example, someone might say they need help getting out of bed during depression. A friend may not be able to come over, but they might commit to a morning check-in call. These conversations ahead of time help make sure everyone is on the same page.
Bipolar can be challenging to treat. Are there any new approaches showing promise?
Batt: It’s one of the more challenging disorders to treat, especially since we rarely have one medication that works for both depression and mania. Right now, we’re really excited about a new study on the ketogenic diet for teens and young adults with bipolar depression who haven’t responded well to medication. It’s the first pediatric study of its kind, happening across multiple sites like UCLA and the University of Pittsburgh. Medication is still key, but we’re looking into whether diet can be an extra tool when meds aren’t enough.
People often confuse bipolar disorder with borderline personality disorder. What’s the difference?
Batt: They’re quite different, though both involve mood shifts. Bipolar disorder happens in clear episodes – depression or mania – that last days or weeks. Borderline personality disorder is more about a long-term pattern in relationships and emotions. It doesn’t come and go in episodes. You also don’t see the same sleep or energy changes in borderline as you do in bipolar.
The term “bipolar” gets thrown around a lot in casual conversation. What’s the problem with that?
Batt: When people say things like “the weather is bipolar,” it really minimizes what people living with the condition go through. It’s a complex, serious illness, not just about mood swings. Using the term flippantly adds to stigma and makes it harder for people to feel understood or seek help.
Dr. Sullivan, you are also involved with the Colorado Bipolar Education Project (CoBE). What does that program entail?
Sullivan: There’s a real need for better education about bipolar disorder for patients, families, therapists and prescribers. CoBE addresses this by offering up-to-date, evidence-based resources, including patient videos, a community lecture series and customizable clinician trainings. We’re also developing a comprehensive online course with practical tools for providers. Increasingly, we’re partnering with state and national organizations to expand access to bipolar disorder education. You can learn more about CoBe on our website.
