How to Diagnose Bipolar Disorder

There’s no definitive test for bipolar disorder, so doctors will ask the patient and their loved ones about the symptoms and health history.

Medically reviewed by Michael MacIntyre, MD

Bipolar disorder is a serious mental illness that causes periods of depression, or low mood, and periods of mania, or elevated mood. There’s no definitive bipolar test, so healthcare providers diagnose bipolar disorder based on a patient’s bipolar disorder symptoms and behaviors. These reports can also help a healthcare provider distinguish between bipolar 1 vs. 2— variations in the disease that can inform treatment and prognosis. It can be helpful for healthcare providers to hear not only from the patient, but from their trusted friends and loved ones too.

Continue reading to learn more about how to diagnose bipolar disorder, including exams and health history.

Who Is a Candidate for Diagnosis?

Bipolar disorder used to be called manic depression. People with the illness can have symptoms of mania, including grandiose ideas, lots of energy and racing thoughts, and symptoms of depression, like intense despair, low energy and trouble sleeping.

There are two types of bipolar disorder. Bipolar 1, more commonly just called bipolar disorder, is diagnosed when a person has at least one episode of mania. This episode must last for seven days, or be severe enough for the person to be hospitalized. Most people with bipolar also experience periods of depression, but these aren’t needed for diagnosis.

With bipolar 2, people never reach a full manic state. Instead, they experience hypomania, a period of elevated mood that doesn’t have all the symptoms of mania. Bipolar 2 is diagnosed when a person has at least one episode of depression and one episode of hypomania. The mood swings associated with bipolar 2 are generally less severe than those in patients with bipolar 1.

What Does a Provider Need to Know to Diagnose Bipolar Disorder?

A bipolar diagnosis is most often made by a mental health professional, like a psychiatrist, psychologist, or clinical social worker. Diagnosing the illness can be difficult, since there’s not a definitive test that doctors can run to confirm or rule our a bipolar diagnosis.

Instead, health professionals rely on a host of information to make a diagnosis, including:

• A person’s symptoms: Specifically, experience of mania is needed for a bipolar diagnosis.

• Their health and behavioral history: Understanding a person’s mental health throughout their lifetime can help with the diagnosis since this disease has cycles over time.

• Family history: Bipolar disorder can run in families, and people who have a parent or sibling with the disorder are at increased risk

A patient’s health history can play a large role in diagnosing bipolar disorder. Keeping track of your mental health, sometimes known as mood charting, can help speed up diagnosis. Keep records of major changes, including any hospitalizations, periods of mania, hypomania, or depression, or major life changes, like dropping out of school or losing a job.

What Other Tests Will Providers Use to Make a Bipolar Diagnosis?

Healthcare providers can’t give one test to confirm a bipolar diagnosis, but they may recommend a mental health evaluation to aid in their diagnosis. In addition, providers will often do blood work to rule out other conditions, including hyperthyroidism. Healthcare providers will also examine mental health history to try to rule out other mental health conditions, including schizophrenia.

Do Other Illnesses Mimic Symptoms of Bipolar Disorder?

Before diagnosing bipolar disorder, doctors should rule out other conditions that can mimic the symptoms of a manic episode or bipolar disorder. Sometimes, physical conditions, including hyperthyroidism, can cause symptoms like anxiety, agitation, and weight loss that mimic the symptoms of mania. Blood tests can often rule out these conditions.

More often, symptoms of other mental illnesses can be confused with bipolar disorder. Research shows that bipolar is often misdiagnosed. About 40% of people with the condition are misdiagnosed, often with major depressive disorder or anxiety.

In addition, if a patient experiences psychosis during their depressive or manic episode, they could be misdiagnosed with schizophrenia. Psychosis, a loss of touch with reality, can include hearing voices or seeing things that others can’t see. Although the symptoms are most closely associated with schizophrenia, people with bipolar disorder can experience this, too.

Getting an accurate diagnosis is critical for treatment, so if you believe you or a loved one have been misdiagnosed, don’t be afraid to seek a second opinion. Work with a knowledgeable mental health professional who can differentiate between bipolar disorder and other conditions. Remember, your loved one might have bipolar along with other illnesses like anxiety, ADHD or substance use disorder.

Gender and Race Discrepancies in Bipolar Disorder Diagnosis

About 3% of Americans have bipolar disorder, and the condition impacts men and women equally. It’s believed that bipolar disorder impacts all racial groups at the same rate, but it can be difficult for people of color, especially Black people, to receive a diagnosis.

Research shows that Black people with bipolar disorder are more likely to be misdiagnosed with schizophrenia. This could be due to the type of symptoms that Black people experience. For example, Black patients are less likely to report typical symptoms of mania, like elevated mood and decreased need for sleep. In addition, they are more likely to report hallucinations and symptoms of psychosis than other races are.

Women who have bipolar disorder are more likely to experience depressive episodes than mania or hypomania (although they still need to experience these highs to get a diagnosis). The emphasis on depressive symptoms can make it difficult to diagnose bipolar disorder in women, and bipolar in women is often confused with major depression.

What Happens After a Bipolar Disorder Diagnosis?

Once you or your loved one has been diagnosed with bipolar disorder, your healthcare team will work to put together a treatment plan. Bipolar is a chronic, lifelong disease that will need ongoing treatment. The most successful treatment plans include medication, talk therapies, and lifestyle changes.

The treatments for bipolar disorder include:

• Medication: People with bipolar disorder often benefit from an antidepressant medication and a mood stabilizer. It’s important to take these medications together since an antidepressant alone can trigger a manic or hypomanic episode. Sometimes, anti-anxiety medication, sleep medications, and antipsychotic medications are used too. Together, these medications are known as psychotropic medications.

• Therapy: Talk therapy is often helpful for people with bipolar disorder. Cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT) and family therapy can be impactful.

• Lifestyle changes: A healthy lifestyle, including eating well, exercising, and mindfulness, can help manage bipolar symptoms. It’s also important to educate yourself about the illness and how to recognize signs of relapse

Other treatment options

Recently treatment options for bipolar have advanced. These treatments can be used alongside medication and therapy:

• Electroconvulsive therapy (ECT): This treatment uses electricity to stimulate the brain. It used to be known as shock therapy. Today, the treatment is much more controlled and effective than when it was first used. Doctors aren’t sure why it works, but it can be very effective for people with bipolar disorder who haven’t responded to other treatments.

• Repetitive transcranial magnetic stimulation (rTMS): rTMS uses magnetic stimulation to the brain. It’s not as powerful as ECT, but also has fewer side effects.

Summary

Bipolar disorder is difficult to diagnose, because it can be confused with other mental illnesses including major depression or schizophrenia. To diagnose bipolar disorder, doctors will talk with a patient about their health history and behaviors. Input from family or friends can be very helpful at that stage. Doctors will conduct a physical exam and blood tests to rule out physical illnesses, including hyperthyroidism. After diagnosis, work with your doctor to develop a treatment plan. Remember, bipolar disorder is a lifelong, chronic illness that will require ongoing support.

Read the original article on Verywell Health.