How a Person with Bipolar Disorder Thinks, an Expert Doctor Explains

How a Person with Bipolar Disorder Thinks, an Expert Doctor Explains

About the expert:

Stephen Ferber, MD, is a board-certified psychiatrist and the Assistant Director of the Psychiatric Treatment-Resistance Program at Cleveland Clinic. He completed a fellowship in Interventional Neuropsychiatry and Neuromodulation at Massachusetts General Hospital, bringing extensive expertise to the management of treatment-resistant mental health conditions. Dr. Ferber specializes in interventional psychiatry, with a particular focus on Transcranial Magnetic Stimulation (TMS), Ketamine therapy, and Electroconvulsive Therapy (ECT). His research has centered on optimizing targeting strategies in TMS, and he is an active member of both the International Society for ECT and Neurostimulation and the Clinical TMS Society.

Data shared by the World Health Organization (WHO) estimates that 40 million people live with bipolar disorder worldwide. Bipolar disorder, formerly referred to as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

 Stephen Ferber, MD, a board-certified psychiatrist and the assistant director of The Psychiatric Treatment-Resistance Program at Cleveland Clinic, helps to shed light on how a person with bipolar disorder thinks for someone who may be trying understand the emotional and mental challenges that individuals with this condition can face. Dr. Ferber says these mood shifts can deeply influence a person’s thoughts, perceptions, and behaviors, often making their experiences difficult to comprehend for others.

Ahead, Dr. Ferber shares his practiced insights into the inner experiences of individuals with bipolar disorder, as well as treatments and strategies for support.

What is bipolar disorder?

According to Dr. Ferber, “Bipolar disorder is a psychiatric condition that encompasses two main features.” These include episodes of depression and episodes of mania or hypomania.

During depressive episodes, individuals may experience symptoms such as persistent sadness, low energy, and difficulty concentrating. While these episodes resemble those seen in major depressive disorder, what distinguishes bipolar disorder is the occurrence of manic or hypomanic episodes.

Manic episodes are characterized by heightened mood, increased energy, or impulsive behavior, while hypomanic episodes are less severe but share similar characteristics. These episodes can last for days or weeks and are often followed by a return to a baseline emotional state or a transition into depression.

Dr. Ferber explains that the primary goal for doctors is to first manage and reduce the intensity of depressive and manic symptoms when they arise. Once those symptoms are fully addressed, the emphasis moves to minimizing the likelihood of future episodes and supporting long-term emotional stability.

What causes bipolar disorder

“Unfortunately, we don’t know exactly what causes it,” says Dr. Ferber. “There are varying factors.” Psychiatry as a field is still evolving in its understanding of how the brain and mind interact. “What we’re beginning to understand now is that every psychiatric or mental health condition, including bipolar disorder, is likely caused by a disorder in neural networks,” he explains.

Neural networks refer to regions of the brain that activate or deactivate together. Psychiatric symptoms may arise when these networks are overactive, underactive, firing in improper patterns, or reacting to inappropriate stimuli. Bipolar disorder, like other mental health conditions, involves abnormalities in these networks.

Research indicates irregularities in specific brain regions, including the dorsal anterior cingulate, the ventromedial prefrontal cortex, and central brainstem structures. These regions are associated with mood regulation and the production of chemicals like serotonin, norepinephrine, and dopamine. Dr. Ferber clarifies that while we know these areas and their connections are involved, the precise mechanisms of dysfunction are not yet fully understood.

Types of bipolar disorder

Bipolar disorder is often classified into two main types: bipolar I and bipolar II. Bipolar I is characterized by severe manic episodes that may require hospitalization, often accompanied by depressive episodes. In contrast, bipolar II involves a pattern of depressive episodes and milder hypomanic episodes that don’t reach the intensity of full mania.

However, the reality is more nuanced than this binary classification suggests.

Dr. Ferber highlights that bipolar disorder exists on a spectrum. At the severe end, symptoms such as risky behavior and prolonged periods without sleep make the condition obvious. On the milder end, symptoms can be subtle and harder to identify, often leading to misdiagnoses like major depressive disorder, which can delay proper treatment.

How a person with bipolar disorder thinks

How A Person With Bipolar Disorder Thinks FILMSTAX/GETTY IMAGES

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