Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood and energy levels. A person with bipolar disorder experiences periods of mania (elevated moods, increased energy and activity levels) and periods of depression (low mood, low energy). These mood episodes can last for days, weeks or months and can be disabling if the person experiences severe symptoms.
During periods of mania or depression, a person with bipolar disorder may exhibit thinking and behaviors that are concerning or dangerous. In these cases, hospitalization may be necessary to keep the person and others safe. Here are some of the main reasons why someone with bipolar disorder may need to be hospitalized:
Manic Episodes
Manic episodes involve abnormally elevated or irritated moods, increased energy and activity levels, rapid speech and thoughts, impulsiveness, and other symptoms. A manic state can lead to very erratic, risky, and potentially dangerous behaviors if left untreated. Reasons for hospitalization during mania include:
- The person exhibits psychotic symptoms like hallucinations or delusions.
- They are behaving in an impulsive or reckless manner, like going on spending sprees, engaging in risky sex, driving dangerously, etc.
- They are being verbally or physically aggressive and may harm others.
- They have severe insomnia and are going days without sleep.
- They are not eating or drinking enough due to their hyperactivity.
- They are experiencing suicidal thoughts brought on by the mania.
Hospitalization allows for stabilization with medication and monitoring of dangerous behaviors during periods of severe mania. The structure and supervision provided in a hospital setting keeps the bipolar person and others safe until mood improves.
Depressive Episodes
Bipolar depression involves extremely low, sad moods, low energy, loss of interest in normal activities, and other debilitating symptoms. There are several reasons someone with bipolar disorder may need hospitalization for depression:
- They are experiencing severe suicidal thoughts or already attempting suicide.
- They are unable to properly care for themselves – not eating, drinking, bathing, etc.
- Psychosis is present, like hallucinations or delusions.
- The depression is not improving with outpatient treatment and medication.
- There is concern the person may self-harm or abuse substances.
- A depressive episode has lasted for months without relief of symptoms.
Hospitalization allows physicians to closely monitor someone with severe bipolar depression, adjust medications, and provide safety until the person is stable. Therapy and other treatments provided in a hospital can also help manage depressive episodes.
Rapid Cycling between Mood Episodes
Some people with bipolar disorder experience “rapid cycling,” which involves four or more manic/hypomanic or depressive episodes within one year. The rapid fluctuations in mood are severely destabilizing and may require hospitalization. Reasons include:
- Frequent shifts between manic and depressive states in a short timeframe.
- Severe suicidal thoughts or suicide attempts during depressive cycles.
- Harmful impulsive behaviors during manic/hypomanic episodes.
- Inability to cope with rapid, constant mood changes outside of a hospital setting.
- Medications not working well enough to manage quick cycling of moods.
Hospitalization allows physicians to monitor and control rapid cycling until moods are more stable. The structure of an inpatient program can also help the person better manage rapid shifts in emotions and energy levels.
Treatment Non-Compliance
Many people with bipolar disorder stop taking their psychiatric medications or following prescribed treatment plans when they start feeling better. However, stopping medications or treatment prematurely often causes relapse. Hospitalization may be required if the person exhibits concerning symptoms or behaviors after refusing medications or other treatment outside of a hospital setting. Reasons may include:
- Stopping medication abruptly triggers withdrawal effects or rapid cycling of moods.
- No longer following their treatment plan results in return of severe mania or depression.
- The person lacks awareness of their illness after stopping treatment (known as anosognosia).
- Psychosis or dangerous behavioral issues reemerge without proper treatment.
Reintroducing medications and treatment under inpatient medical supervision can help stabilize an uncontrolled bipolar episode brought on by non-compliance. It can also help ensure the person resumes necessary outpatient treatment upon discharge.
Comorbid Substance Abuse
Many people with bipolar disorder also struggle with co-occurring substance abuse issues. Abuse of drugs or alcohol can destabilize moods and interfere with the effects of medications. Hospitalization may be needed for reasons such as:
- Active substance abuse is making bipolar symptoms dangerous and unmanageable.
- The person exhibits suicidal thoughts or psychosis triggered by substance use.
- Medications are ineffective due to interaction effects with substances.
- Withdrawal symptoms require medical management if substances are stopped.
- 24/7 monitoring is needed to prevent access to abused substances.
Addressing substance abuse issues alongside bipolar treatment is best handled in a controlled hospital setting. This allows moods to stabilize while safely managing withdrawal effects if needed.
Pregnancy Concerns
Pregnancy in someone with untreated or unstable bipolar disorder can lead to serious risks for both mother and child. Hospitalization may be needed during pregnancy if:
- A pregnant woman experiences severe mania or psychosis that endangers herself or the fetus.
- Bipolar depression during pregnancy is contributing to lack of self-care and malnutrition.
- Medications need adjustment to reduce risks for the developing fetus.
- Suicidal thoughts put the woman and unborn baby at risk of harm.
- The woman is abusing substances that can harm fetal development.
Hospitalization allows doctors to monitor both the mother’s bipolar symptoms and the health of the fetus. Medications can be adjusted and other treatments provided in a safe setting.
Other Factors That Increase Risk
There are some additional factors that can increase the risk someone with bipolar disorder may need hospitalization. These include:
- First onset of bipolar symptoms due to greater difficulty controlling new mood episodes.
- Younger age, like diagnosis in childhood or teen years.
- Presence of ADD/ADHD or other co-occurring mental health disorders.
- Living alone or lack of family support.
- Experiencing a significant life stressor or trigger.
- A history of multiple prior hospitalizations.
While anyone with bipolar disorder could need hospitalization if symptoms become severe, these factors put people at increased risk. Inpatient treatment may be needed more frequently or readily if any of these apply.
Warning Signs That Lead to Hospitalization
Typically, the process that leads to someone getting hospitalized for bipolar disorder involves:
- Experiencing early warning signs of significant mood changes or symptoms getting worse.
- The symptoms continue progressing into problematic, high-risk behavior.
- Outpatient providers then determine the need for hospitalization and help coordinate admission.
- Law enforcement or crisis services may get involved if the person refuses voluntary admission.
Some common early warning signs that could progress to a hospitalization include:
- Sleeping too little or too much
- Isolating from friends and family
- Talking very fast or in a disorganized way
- Feeling keyed up and overly energized
- Having racing thoughts
- Exhibiting impulsive or reckless behaviors
- Abusing substances
- Feeling overly sad or worthless
- Withdrawing from normal activities
- Expressing suicidal thoughts
Paying attention to these early signs and quickly adjusting treatment as an outpatient can sometimes prevent the need for hospitalization. But if significant safety concerns develop, inpatient treatment becomes necessary.
How Hospitalization Helps
While hospitalization involves removing a person from their normal life which can feel disruptive, it serves several important functions. Main benefits include:
- Safety – 24/7 monitoring and controlled environment prevents self-harm and harm to others.
- Medication adjustment – Doctors can rapidly change medications and dosages until symptoms improve.
- Psychotherapy – Individual and group therapy helps develop coping strategies.
- Education – Psychoeducation programs teach the person and family about managing the disorder.
- Stress reduction – Away from work, school, and other stresses that worsen symptoms.
- Substance avoidance – No access to substances that destabilize moods.
- Health maintenance – Staff ensure the person eats, drinks, and tends to hygiene.
The main goal is helping the person regain mood stability and safety so they can return to their regular life. Even when disruptive, hospitalization is sometimes the best way to treat severe bipolar episodes.
Conclusion
Bipolar disorder is a condition prone to periods of debilitating highs and lows. When manic or depressive episodes become extreme, unsafe behavior can result. At that point hospitalization is often necessary to protect both the bipolar sufferer and those around them. Close monitoring, medication adjustments, psychotherapy and education provided in a hospital setting help stabilize mood swings until the person can safely return home. While hospitalization is disruptive, it can provide life-saving intervention during the most severe bipolar episodes.
