Bipolar disorder, formerly known as manic depression, is a serious mental health condition characterized by extreme shifts in mood and energy levels. People with bipolar disorder experience distinct “highs” known as manic (or hypomanic) episodes and “lows” known as depressive episodes. These mood episodes cause significant disturbances in daily life and functioning.
Bipolar disorder is considered a lifelong, chronic illness. It is often first diagnosed in the late teens or early adult years, although it can start in children as well. An estimated 2.8% of American adults have bipolar disorder in any given year.
There are several different types of bipolar disorder that fall along a spectrum. Bipolar I involves severe manic episodes that may include psychosis as well as major depressive episodes. Bipolar II involves less intense hypomanic episodes along with depression. Cyclothymic disorder involves numerous hypomanic and depressive symptoms that do not reach the severity or duration to qualify as distinct episodes.
Bipolar disorder has a strong genetic and biological basis. Research shows that genetics account for 60-80% of risk, meaning bipolar disorder tends to run in families. However, family history alone does not mean someone will definitely develop bipolar disorder. Environmental factors and life experiences also play a role.
This raises an important question – can someone “just become” bipolar without any family history or risk factors? Or does developing bipolar disorder always involve an underlying biological vulnerability?
Is bipolar disorder something you can just “become”?
In short – no, you cannot just “become” bipolar without some preexisting vulnerability. Bipolar disorder does not just appear out of the blue in people with no biological risk factors. There are several key reasons why:
Bipolar has a strong genetic basis
As mentioned, twin studies and family research have clearly demonstrated the hereditary nature of bipolar disorder. If one identical twin has bipolar disorder, the other has a 40-70% lifetime risk of developing it. First-degree relatives (parents, siblings, children) of people with bipolar have a risk about 7 times higher than the general population.
Genes are not the whole story, but they account for the lion’s share of risk. You must have the requisite genetic vulnerability first in order to develop bipolar disorder. It is not something you can just “acquire.”
Onset is often preceded by symptoms
For many people, the onset of full-blown bipolar episodes is preceded by early warning symptoms. These include depression, anxiety, mood swings, irritability, anger issues, concentration problems, and sleep disturbances. Often there is a pattern of escalating symptoms over weeks to months before a diagnosable manic or depressive episode first occurs. Again, this indicates an underlying biological process at work, rather than a random onset.
Triggers usually involve significant life stressors
Although bipolar arises from biological factors, key life events often serve as triggers for when symptoms first emerge. Common triggers include severe stress, trauma, grief after a major loss, adjusted sleep-wake cycles, and major endocrine changes such as puberty, postpartum, and menopause. The presence of such triggers implies bipolar disorder was already there, waiting to be activated.
Late adolescent/early adult onset is typical
Bipolar disorder most often emerges between the ages of 15-25. The typical onset age implicates normal developmental and hormonal changes in the unmasking of latent bipolar disorder. This is not consistent with people randomly “becoming” bipolar without any previous vulnerability.
Subthreshold symptoms often occur first
Many people show early patterns of bipolar-like symptoms that do not fully meet diagnostic criteria. These may include depressive episodes that don’t last long enough, hypomanic-like periods that are not impairing, or rapid cycling between mood states. These subthreshold symptoms can precede a full bipolar diagnosis by 5-10 years, demonstrating an evolving illness process.
No evidence that bipolar can arise “out of the blue”
There are simply no documented cases where someone developed a full manic episode “out of nowhere” without any prior symptoms or family history. Sudden onset mania always occurs in the context of either a familial vulnerability or preceding symptoms if you look closely at the history.
Can traumatic events cause bipolar disorder?
Trauma, abuse, and extremely stressful life events do not directly cause bipolar disorder on their own. However, they can serve as potent triggers for onset or episodes in someone already at risk.
Studies show people with bipolar disorder often have higher rates of traumatic experiences such as childhood maltreatment, assault, sudden bereavement, and disrupted attachments. These traumas appear to act as “kindling”—priming vulnerable individuals for onset or recurrence.
So while trauma does not directly cause bipolar, it can unmask or worsen the expression of latent bipolar disorder. People at genetic risk are more likely to develop bipolar symptoms when faced with trauma compared to lower-risk individuals.
Possible links between trauma and bipolar
There are several ways severe stress and trauma could precipitate bipolar disorder:
– Disrupting circadian rhythms and sleep-wake cycles
– Altering levels of stress hormones like cortisol
– Causing epigenetic changes that affect gene expression
– Triggering inflammatory and immunological changes
– Unbalancing neurotransmitters like serotonin and dopamine
– Impacting parts of the brain regulating emotions
Through these biological mechanisms, trauma likely interacts with genetic risk to initiate or exacerbate bipolar disorder in predisposed individuals. But the underlying genetic diathesis must already be present.
Can substance abuse cause bipolar disorder?
Like trauma, substance abuse does not directly cause bipolar disorder by itself without any genetic risk factors. However, certain drugs can provoke or worsen manic or depressive symptoms in people who are predisposed.
Drugs with the strongest potential to trigger bipolar episodes include:
– Prescription stimulants
These drugs mimic manic effects by increasing dopamine transmission. They can induce mania-like symptoms both during use and withdrawal.
– Psilocybin (“magic mushrooms”)
These substances could provoke psychosis and mania through their effects on serotonin receptors and the “serotonin system.”
Marijuana may bring on manic symptoms in people with bipolar risk through its impact on endocannabinoid receptors in the brain. Frequent use has been associated with earlier onset of bipolar disorder.
While alcohol is a depressant, withdrawal can actually trigger mania after extended heavy drinking. Alcohol abuse can also worsen bipolar symptoms and destabilize mood.
So in summary, while substance use does not directly cause bipolar disorder, it can unmask latent bipolar in vulnerable individuals or lead to cycling between manic, depressive, and mixed episodes. People with bipolar are at high risk of abusing drugs and alcohol, which tends to worsen long-term outcomes.
Can medications cause bipolar disorder?
Certain prescription medications have been associated with triggering manic or hypomanic episodes in some people. However, again these drugs do not directly cause bipolar disorder—they are more likely to unmask bipolar symptoms in those already at risk.
Medications that can potentially provoke mania include:
All classes of antidepressants, especially tricyclics and SSRIs, have been linked to treatment-emergent mania or hypomania. This phenomenon affects a subset of vulnerable individuals.
Oral corticosteroids like prednisone and dexamethasone are tied to manic effects, likely due to their impact on dopamine receptors. Even inhaled steroids can potentially cause mood disturbances.
Decongestants, diet pills, and asthma inhalers containing compounds that activate the sympathetic nervous system may provoke hypomania in susceptible people.
As with recreational drugs, these medication-induced cases suggest an underlying liability to develop bipolar disorder, which is brought out by the pharmacological effects. The medications themselves do not actually cause bipolar in people lacking biological risk factors.
Can a head injury or medical illness cause bipolar disorder?
Rarely, a severe neurological illness or physical trauma such as traumatic brain injury (TBI) can trigger symptoms of mania. This is thought to result from damage to brain regions that regulate emotion and behavior.
However, again, there is likely some preexisting genetic/biological vulnerability at play. Research indicates that compared to the general population, patients who develop mania after brain injuries have higher rates of undiagnosed bipolar disorder prior to their trauma.
Medical conditions that can trigger secondary mania include:
– Brain tumor
– Multiple sclerosis
In these cases, treating the primary medical condition often resolves the psychiatric symptoms. But a subset of patients are left with residual bipolar illness, suggesting TBI or other neurological conditions may at times unmask an underlying diathesis.
In summary, the evidence indicates that bipolar disorder arises from an interaction between biological vulnerability and environmental triggers. Research does not support that bipolar can simply appear “out of the blue” without any prior risk factors or symptoms.
While extremely stressful life events, substance abuse, medications, and medical conditions can provoke bipolar episodes, they do so by acting on a preexisting genetic diathesis or latent disease process. Bipolar disorder likely develops over many years, although onset of diagnosable symptoms may seem abrupt.
In the vast majority of cases, a careful look at history reveals some combination of:
– Family history of bipolar disorder or related conditions
– Prodromal symptoms
– Significant life stressors occurring around first onset
For these reasons, bipolar disorder is best viewed as a progressive, genetically influenced illness rather than something people randomly “become” later in life. Awareness of risk factors and early warning signs allows for quicker diagnosis and treatment, which greatly improves long-term prognosis.