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Bipolar disorder - Symptoms and causes - Mayo Clinic

Bipolar disorder - Symptoms and causes - Mayo Clinic

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Bipolar disorder

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OverviewBipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

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SymptomsThere are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomaniaMania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episodeA major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

Marked loss of interest or feeling no pleasure in all — or almost all — activities

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorderSigns and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teensSymptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctorDespite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency helpSuicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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CausesThe exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factorsFactors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

ComplicationsLeft untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditionsIf you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

Physical health problems, such as heart disease, thyroid problems, headaches or obesity

More InformationBipolar disorder care at Mayo ClinicBipolar disorder and alcoholism: Are they related?

PreventionThere's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

Take your medications exactly as directed. You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

By Mayo Clinic Staff

Bipolar disorder care at Mayo Clinic

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Show references

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Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Dec. 2, 2016.

Bipolar disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed Dec. 2, 2016.

Bipolar disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder-tr-15-3679/index.shtml. Accessed Dec. 2, 2016.

Bipolar disorder in children and teens. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-qf-15-6380/index.shtml. Accessed Dec. 2, 2016.

Bipolar disorder. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder. Accessed Dec. 2, 2016.

AskMayoExpert. Bipolar disorder. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016. Accessed Dec. 2, 2016.

Suppes T, et al. Bipolar disorder in adults: Clinical features. http://www.uptodate.com/home. Accessed Dec. 2, 2016.

Axelson D, et al. Pediatric bipolar disorder: Overview of choosing treatment. http://www.uptodate.com/home. Accessed Dec. 2, 2016.

Birmaher B. Pediatric bipolar disorder: Epidemiology, pathogenesis, clinical manifestations, and course. http://www.uptodate.com/home. Accessed Dec. 2, 2016.

Picardi A, et al. Psychotherapy of mood disorders. Clinical Practice and Epidemiology in Mental Health. 2014;10:140.

Fountoulakis KN, et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BP-2017), part 2: Review, grading of the evidence and a precise algorithm. International Journal of Neuropsychopharmacology. In press. http://ijnp.oxfordjournals.org/content/early/2016/11/05/ijnp.pyw100.long. Accessed Dec. 6, 2016.

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Qureshi NA, et al. Mood disorders and complementary and alternative medicine: A literature review. Neuropsychiatric Disease and Treatment. 2013;9:639.

Sansone RA, et al. Getting a knack for NAC: N-acetyl-cysteine. Innovations in Clinical Neuroscience. 2011;8:10.

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Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment

Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment

Skip to main content Home Conditions Back Conditions View All ADD/ADHDAllergiesArthritisAtrial fibrillationBreast CancerCancerCrohn's DiseaseDepressionDiabetesDVTEczemaEye HealthHeart DiseaseHIV & AIDSLung DiseaseLupusMental HealthMultiple SclerosisMigrainePain ManagementPsoriasisPsoriatic ArthritisRheumatoid ArthritisSexual ConditionsSkin ProblemsSleep DisordersUlcerative Colitis View All Drugs & Supplements Back Drugs & SupplementsDrugsSupplementsPill IdentifierInteraction CheckerWell-Being Back Well-Being View All Aging WellBabyBirth ControlChildren's HealthDiet & Weight ManagementFitness & ExerciseFood & RecipesHealthy BeautyMen's HealthParentingPet HealthPregnancySex & RelationshipsTeen HealthWomen's Health View All Symptom CheckerFind a DoctorMore Back MoreNewsBlogsPodcastsWebinarsNewslettersWebMD MagazineBest HospitalsSupport GroupsOrthopedics Privacy & More Subscribe Log In Search Subscribe Bipolar DisorderReferenceBipolar Disorder Guide OverviewSymptoms & TypesTreatment Medical CareAvoiding ComplicationsLiving With View Full Guide Bipolar DisorderMedically Reviewed by Smitha Bhandari, MD on August 12, 2022 Written by WebMD Editorial Contributors What Is Bipolar Disorder?Are There Different Types of Bipolar Disorder?What Are the Symptoms of Bipolar Disorder?What Are the Causes of Bipolar Disorder?What Are Bipolar Disorder Risk Factors?How Is Bipolar Disorder Diagnosed?What Are the Treatments for Bipolar Disorder?Bipolar Disorder OutlookBipolar Disorder and Suicide10 min read What Is Bipolar Disorder?Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there)."Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life. The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes.Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.Are There Different Types of Bipolar Disorder?There are a few types of bipolar disorder, including:Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks. Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II."Unspecified" or "other specified" bipolar disorder (formerly called "bipolar disorder not otherwise specified") is now used to describe conditions in which a person has only a few of the mood and energy symptoms that define a manic or hypomanic episode, or the symptoms may not last long enough to be considered as clear-cut "episodes." Rapid cycling is not a type of bipolar disorder, but a term used to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues. What Are the Symptoms of Bipolar Disorder?In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years. How severe it gets differs from person to person and can also change over time, becoming more or less severe.Symptoms of mania ("the highs"):Excessive happiness, hopefulness, and excitementSudden changes from being joyful to being irritable, angry, and hostileRestlessnessRapid speech and poor concentrationIncreased energy and less need for sleepUnusually high sex driveMaking grand and unrealistic plansShowing poor judgmentDrug and alcohol abuseBecoming more impulsiveLess need for sleepLess of an appetiteLarger sense of self-confidence and well-beingBeing easily distractedDuring depressive periods ("the lows"), a person with bipolar disorder may have:SadnessLoss of energyFeelings of hopelessness or worthlessnessNot enjoying things they once likedTrouble concentratingForgetfulnessTalking slowlyLess of a sex driveInability to feel pleasureUncontrollable cryingTrouble making decisionsIrritabilityNeeding more sleepInsomniaAppetite changes that make you lose or gain weightThoughts of death or suicideAttempting suicide What Are the Causes of Bipolar Disorder?There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.What Are Bipolar Disorder Risk Factors?When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.Men and women are equally likely to get it. Women are somewhat more likely than men to go through "rapid cycling," which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes.  A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders. Some things that make you more likely to have bipolar disorder include:Having a family member with bipolar disorderGoing through a time of high stress or traumaDrug or alcohol abuseCertain health conditionsMany people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.How Is Bipolar Disorder Diagnosed?If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen? The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.If you have just been diagnosed with bipolar disorder, you might feel frightened. The future may seem terribly uncertain. What will this mean for your life, your family, and your job?But getting an accurate diagnosis is actually good news. It means you can finally get the treatment you need. People with bipolar disorder usually go about 10 years before being accurately diagnosed.Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.What Are the Treatments for Bipolar Disorder?Bipolar disorder can be treated. It's a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.Treatment can make a huge difference. With a combination of things -- good medical care, medication, talk therapy, lifestyle changes, and the support of friends and family -- you can feel better. Bipolar disorder -- or manic depression, as it is also still sometimes called -- has no known  cure. It is a chronic health condition that requires lifetime management.  Plenty of people with this condition do well; they have families and jobs and live normal lives.MedicationMedication is the main treatment, usually involving the following: Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium, or valproate (Depakote)Antipsychotic drugs, such as cariprazine (Vraylar), lumateperone (Caplyta), lurasidone (Latuda), olanzapine (Zyprexa), and quetiapine (Seroquel)Antidepressants Antidepressant-antipsychotic drugs, a combination of an antidepressant and a mood stabilizerAnti-anxiety medications or sleep medicines, such as sedatives like benzodiazepines It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take. Psychotherapy, or "talk therapy," is often recommended, too. There are several different types. Options can include:Interpersonal and social rhythm therapy (IPSRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode. Other treatment options for bipolar disorder can include:Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.Acupuncture. There’s some evidence that  this complementary therapy may help with the depression caused by bipolar disorder.Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example,  their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.Lifestyle changes may also help:Get regular exercise.Stay on a schedule for eating and sleeping.Learn to recognize your mood swings.Get support from friends or groups.Keep a symptom journal or chart.Learn to manage stress.Find healthy hobbies or sports.Don’t drink alcohol or use recreational drugs.Bipolar Disorder OutlookBipolar disorder can make you feel utterly alone. But that really isn't the case. More than 2 million adults in the U.S. are coping with bipolar disorder right now.It's important not to blame yourself for your condition. Bipolar disorder is a physical illness, not a sign of personal weakness. It's like diabetes, heart disease, or any other health condition. Nobody knows what causes bipolar disorder, but for many people, it is a very manageable condition.The important thing is to focus on the future. Living with bipolar disorder can be tough. But don't let it hijack your life. Instead, take action and regain control of your health. With dedication and the help of your health care providers, you can feel better again.For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.Ongoing treatment is more effective than dealing with problems as they come up. The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.Bipolar Disorder and SuicideSome people who have bipolar disorder may become suicidal.Learn the warning signs and seek immediate medical help for them:Depression (changes in eating, sleeping, activities)Isolating yourselfTalking about suicide, hopelessness, or helplessnessActing recklesslyTaking more risksHaving more accidentsAbusing alcohol or other drugsFocusing on morbid and negative themesTalking about death and dyingCrying more, or becoming less emotionally expressiveGiving away possessions 

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  Sources Update History ShareSOURCES:National Institute of Mental Health: “Bipolar Disorder,” “Bipolar Disorder In Children and Teens.”Mayo Clinic: “Bipolar Disorder,” “Bipolar Disorder and Alcoholism: Are They Related?,” “Bipolar Disorder In Children: Is It Possible?,” “Electroconvulsive Therapy (ECT).”National Center for Biotechnology Information: “Gender Differences In Bipolar Disorder,” “The Safety, Acceptability and Effectiveness of Acupuncture as an Adjunctive Treatment for Acute Symptoms in Bipolar Disorder.” American Brain Society: “Romantic Relationships With Bipolar Are Possible.”National Alliance on Mental Illness: “Bipolar Disorder: Treatment.”Current Psychiatry Reports: “Social Rhythm Therapies for Mood Disorders: an Update.”SMI Advisor: “What Does Psychoeducation for Bipolar Disorder Consist Of?”International Journal of Bipolar Disorders: “Common use of dietary supplements for bipolar disorder: a naturalistic, self-reported study.”Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.American Psychiatric Association, 2000.The Nations Voice on Mental Illness.Depression and Bipolar Support Alliance (DBSA).American Psychiatric Association.Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002.Muller-Oerlinghausen, B. The Lancet, Jan. 19, 2002.Kaufman, K. Annals of Clinical Psychiatry, June 2003.Compton, M. Depression and Bipolar Disorder, ACP Medicine.How we keep our content up to date:Our medical and editorial staff closely follow the health news cycle, new research, drug approvals, clinical practice guidelines and other developments to ensure our content receives appropriate and timely updates. August 12, 2022Medically Reviewed by: Smitha Bhandari, MD View privacy policy, copyright and trust info Share View privacy policy, copyright and trust info Next What Causes Bipolar Disorder?More on Bipolar DisorderBipolar Disorder: Symptoms, Causes, TreatmentAlternative Therapies for Bipolar DisorderAre Your Mood Swings Normal? Recommended FEATURED Top doctors in , Find more top doctors on Search Related LinksBipolar Disorder News & FeaturesBipolar Disorder ReferenceBipolar Disorder SlideshowsBipolar Disorder VideosBipolar Disorder MedicationsFind a PsychiatristADHDAnxiety & Panic DisordersCrisis AssistanceDepressionMental HealthPill IdentifierSchizophreniaSubstance Abuse and AddictionMore Related TopicsPoliciesPrivacy PolicyCookie PolicyEditorial PolicyAdvertising PolicyCorrection PolicyTerms of UseAboutContact UsAbout WebMDCareersNewsletterCorporateWebMD Health ServicesSite MapAccessibilityOur AppsWebMD MobileWebMD AppPregnancyBabyAllergyFor AdvertisersAdvertise with UsAdvertising Policy © 2005 - 2024 WebMD LLC, an Internet Brands company. All rights reserved. WebMD does not provide medical advice, diagnosis or treatment. See additional information.

Bipolar disorder - Wikipedia

Bipolar disorder - Wikipedia

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1Signs and symptoms

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1.1Manic episodes

1.2Hypomanic episodes

1.3Depressive episodes

1.4Mixed affective episodes

1.5Comorbid conditions

2Causes

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2.1Genetic

2.2Environmental

2.3Neurological

3Proposed mechanisms

4Diagnosis

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4.1Differential diagnosis

4.2Bipolar spectrum

4.3Criteria and subtypes

4.3.1Rapid cycling

4.4Coexisting psychiatric conditions

4.5Children

4.6Elderly

5Prevention

6Management

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6.1Psychosocial

6.2Medication

6.2.1Mood stabilizers

6.2.2Antipsychotics

6.2.3Antidepressants

6.2.4Combined treatment approaches

6.2.5Other drugs

6.3Children

6.4Resistance to treatment

6.5Management of obesity

7Prognosis

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7.1Functioning

7.2Recovery and recurrence

7.3Suicide

8Epidemiology

9History

10Society and culture

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10.1Cost

10.2Advocacy

10.3Notable cases

10.4Media portrayals

10.5Creativity

11Research

12See also

13Explanatory notes

14Citations

15Cited texts

16Further reading

17External links

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Bipolar disorder

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From Wikipedia, the free encyclopedia

Mental disorder that causes periods of depression and abnormally elevated mood

"Bipolar disorders" and "Manic depression" redirect here. For the medical journal, see Bipolar Disorders (journal). For the song, see Manic Depression (song).

Medical conditionBipolar disorderOther namesBipolar affective disorder (BPAD),[1] bipolar illness, manic depression, manic depressive disorder, manic–depressive illness (historical),[2] manic–depressive psychosis, circular insanity (historical),[2] bipolar disease[3]Bipolar disorder is characterized by episodes of depression and hypomania or mania.SpecialtyPsychiatrySymptomsPeriods of depression and elevated mood[4][5]ComplicationsSuicide, self-harm[4]Usual onset25 years old[4]TypesBipolar I disorder, bipolar II disorder, others[5]CausesEnvironmental and genetic[4]Risk factorsFamily history, childhood abuse, long-term stress[4]Differential diagnosisAttention deficit hyperactivity disorder, personality disorders, schizophrenia, substance use disorder[4]TreatmentPsychotherapy, medications[4]MedicationLithium, antipsychotics, anticonvulsants[4]Frequency1–3%[4][6]

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks.[4][5] If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe and does not significantly affect functioning, it is called hypomania.[4] During mania, an individual behaves or feels abnormally energetic, happy or irritable,[4] and they often make impulsive decisions with little regard for the consequences.[5] There is usually also a reduced need for sleep during manic phases.[5] During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others.[4] The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm.[4] Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.[4]

While the causes of this mood disorder are not clearly understood, both genetic and environmental factors are thought to play a role.[4] Many genes, each with small effects, may contribute to the development of the disorder.[4][7] Genetic factors account for about 70–90% of the risk of developing bipolar disorder.[8][9] Environmental risk factors include a history of childhood abuse and long-term stress.[4] The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode.[5] It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes.[10]

If these symptoms are due to drugs or medical problems, they are not diagnosed as bipolar disorder.[5] Other conditions that have overlapping symptoms with bipolar disorder include attention deficit hyperactivity disorder, personality disorders, schizophrenia, and substance use disorder as well as many other medical conditions.[4] Medical testing is not required for a diagnosis, though blood tests or medical imaging can rule out other problems.[11]

Mood stabilizers—lithium and certain anticonvulsants such as valproate and carbamazepine as well as atypical antipsychotics such as aripiprazole—are the mainstay of long-term pharmacologic relapse prevention.[12] Antipsychotics are additionally given during acute manic episodes as well as in cases where mood stabilizers are poorly tolerated or ineffective. In patients where compliance is of concern, long-acting injectable formulations are available.[12] There is some evidence that psychotherapy improves the course of this disorder.[13] The use of antidepressants in depressive episodes is controversial: they can be effective but have been implicated in triggering manic episodes.[14] The treatment of depressive episodes, therefore, is often difficult.[12] Electroconvulsive therapy (ECT) is effective in acute manic and depressive episodes, especially with psychosis or catatonia.[a][12] Admission to a psychiatric hospital may be required if a person is a risk to themselves or others; involuntary treatment is sometimes necessary if the affected person refuses treatment.[4]

Bipolar disorder occurs in approximately 2% of the global population.[16] In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males.[6][17] Symptoms most commonly begin between the ages of 20 and 25 years old; an earlier onset in life is associated with a worse prognosis.[18] Interest in functioning in the assessment of patients with bipolar disorder is growing, with an emphasis on specific domains such as work, education, social life, family, and cognition.[19] Around one-quarter to one-third of people with bipolar disorder have financial, social or work-related problems due to the illness.[4] Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society.[20] Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population.[4]

Signs and symptoms

Late adolescence and early adulthood are peak years for the onset of bipolar disorder.[21][22] The condition is characterized by intermittent episodes of mania, commonly (but not in every patient) alternating with bouts of depression, with an absence of symptoms in between.[23][24] During these episodes, people with bipolar disorder exhibit disruptions in normal mood, psychomotor activity (the level of physical activity that is influenced by mood)—e.g. constant fidgeting during mania or slowed movements during depression—circadian rhythm and cognition. Mania can present with varying levels of mood disturbance, ranging from euphoria, which is associated with "classic mania", to dysphoria and irritability.[25] Psychotic symptoms such as delusions or hallucinations may occur in both manic and depressive episodes; their content and nature are consistent with the person's prevailing mood.[4] In some people with bipolar disorder, depressive symptoms predominate, and the episodes of mania are always the more subdued hypomania type.[24]

According to the DSM-5 criteria, mania is distinguished from hypomania by the duration: hypomania is present if elevated mood symptoms persist for at least four consecutive days, while mania is present if such symptoms persist for more than a week. Unlike mania, hypomania is not always associated with impaired functioning.[12] The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode, or vice versa, remain poorly understood.[26]

Manic episodes

An 1892 color lithograph depicting a woman diagnosed with hilarious mania

Also known as a manic episode, mania is a distinct period of at least one week of elevated or irritable mood, which can range from euphoria to delirium. The core symptom of mania involves an increase in energy of psychomotor activity. Mania can also present with increased self-esteem or grandiosity, racing thoughts, pressured speech that is difficult to interrupt, decreased need for sleep, disinhibited social behavior,[25] increased goal-oriented activities and impaired judgement, which can lead to exhibition of behaviors characterized as impulsive or high-risk, such as hypersexuality or excessive spending.[27][28][29] To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work.[27][29] If untreated, a manic episode usually lasts three to six months.[30]

In severe manic episodes, a person can experience psychotic symptoms, where thought content is affected along with mood.[29] They may feel unstoppable, persecuted, or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas.[31][32] This may lead to violent behavior and, sometimes, hospitalization in an inpatient psychiatric hospital.[28][29] The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale, though questions remain about the reliability of these scales.[33]

The onset of a manic or depressive episode is often foreshadowed by sleep disturbance.[34] Manic individuals often have a history of substance use disorder developed over years as a form of "self-medication".[35]

Hypomanic episodes

An 1858 lithograph captioned 'Melancholy passing into mania'

Hypomania is the milder form of mania, defined as at least four days of the same criteria as mania,[29] but which does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features such as delusions or hallucinations, and does not require psychiatric hospitalization.[27] Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some.[36] Hypomanic episodes rarely progress to full-blown manic episodes.[36] Some people who experience hypomania show increased creativity,[29][37] while others are irritable or demonstrate poor judgment.[9]

Hypomania may feel good to some individuals who experience it, though most people who experience hypomania state that the stress of the experience is very painful.[29] People with bipolar disorder who experience hypomania tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, the individual will often deny that anything is wrong.[38] If not accompanied by depressive episodes, hypomanic episodes are often not deemed problematic unless the mood changes are uncontrollable or volatile.[36] Most commonly, symptoms continue for time periods from a few weeks to a few months.[39]

Depressive episodes

Main article: Depression (mood)

Melancholy by William Bagg, after a photograph by Hugh Welch Diamond

Symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities, excessive or inappropriate guilt, hopelessness, sleeping too much or not enough, changes in appetite and/or weight, fatigue, problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide.[40] Although the DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth.[12]

The earlier the age of onset, the more likely the first few episodes are to be depressive.[41] For most people with bipolar types 1 and 2, the depressive episodes are much longer than the manic or hypomanic episodes.[18] Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and incorrectly treated with prescribed antidepressants.[42]

Mixed affective episodes

Main article: Mixed affective state

In bipolar disorder, a mixed state is an episode during which symptoms of both mania and depression occur simultaneously.[43] Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal.[43] They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control.[43] Anxiety disorders occur more frequently as a comorbidity in mixed bipolar episodes than in non-mixed bipolar depression or mania.[43] Substance (including alcohol) use also follows this trend, thereby appearing to depict bipolar symptoms as no more than a consequence of substance use.[43]

Comorbid conditions

People with bipolar disorder often have other co-existing psychiatric conditions such as anxiety (present in about 71% of people with bipolar disorder), substance abuse (56%), personality disorders (36%) and attention deficit hyperactivity disorder (10–20%) which can add to the burden of illness and worsen the prognosis.[18] Certain medical conditions are also more common in people with bipolar disorder as compared to the general population. This includes increased rates of metabolic syndrome (present in 37% of people with bipolar disorder), migraine headaches (35%), obesity (21%) and type 2 diabetes (14%).[18] This contributes to a risk of death that is two times higher in those with bipolar disorder as compared to the general population.[18]

Substance use disorder is a common comorbidity in bipolar disorder; the subject has been widely reviewed.[44][needs update][45]

Causes

The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear.[46] Genetic influences are believed to account for 73–93% of the risk of developing the disorder indicating a strong hereditary component.[9] The overall heritability of the bipolar spectrum has been estimated at 0.71.[47] Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar I disorder, the rate at which identical twins (same genes) will both have bipolar I disorder (concordance) is around 40%, compared to about 5% in fraternal twins.[27][48] A combination of bipolar I, II, and cyclothymia similarly produced rates of 42% and 11% (identical and fraternal twins, respectively).[47] The rates of bipolar II combinations without bipolar I are lower—bipolar II at 23 and 17%, and bipolar II combining with cyclothymia at 33 and 14%—which may reflect relatively higher genetic heterogeneity.[47]

The cause of bipolar disorders overlaps with major depressive disorder. When defining concordance as the co-twins having either bipolar disorder or major depression, then the concordance rate rises to 67% in identical twins and 19% in fraternal twins.[49] The relatively low concordance between fraternal twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes.[47]

Genetic

Behavioral genetic studies have suggested that many chromosomal regions and candidate genes are related to bipolar disorder susceptibility with each gene exerting a mild to moderate effect.[50] The risk of bipolar disorder is nearly ten-fold higher in first-degree relatives of those with bipolar disorder than in the general population; similarly, the risk of major depressive disorder is three times higher in relatives of those with bipolar disorder than in the general population.[27]

Although the first genetic linkage finding for mania was in 1969,[51] linkage studies have been inconsistent.[27] Findings point strongly to heterogeneity, with different genes implicated in different families.[52] Robust and replicable genome-wide significant associations showed several common single-nucleotide polymorphisms (SNPs) are associated with bipolar disorder, including variants within the genes CACNA1C, ODZ4, and NCAN.[50][53] The largest and most recent genome-wide association study failed to find any locus that exerts a large effect, reinforcing the idea that no single gene is responsible for bipolar disorder in most cases.[53] Polymorphisms in BDNF, DRD4, DAO, and TPH1 have been frequently associated with bipolar disorder and were initially associated in a meta-analysis, but this association disappeared after correction for multiple testing.[54] On the other hand, two polymorphisms in TPH2 were identified as being associated with bipolar disorder.[55]

Due to the inconsistent findings in a genome-wide association study, multiple studies have undertaken the approach of analyzing SNPs in biological pathways. Signaling pathways traditionally associated with bipolar disorder that have been supported by these studies include corticotropin-releasing hormone signaling, cardiac β-adrenergic signaling, phospholipase C signaling, glutamate receptor signaling,[56] cardiac hypertrophy signaling, Wnt signaling, Notch signaling,[57] and endothelin 1 signaling. Of the 16 genes identified in these pathways, three were found to be dysregulated in the dorsolateral prefrontal cortex portion of the brain in post-mortem studies: CACNA1C, GNG2, and ITPR2.[58]

Bipolar disorder is associated with reduced expression of specific DNA repair enzymes and increased levels of oxidative DNA damages.[59]

Environmental

Psychosocial factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions.[60] Recent life events and interpersonal relationships likely contribute to the onset and recurrence of bipolar mood episodes, just as they do for unipolar depression.[61] In surveys, 30–50% of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated with earlier onset, a higher rate of suicide attempts, and more co-occurring disorders such as post-traumatic stress disorder.[62] Subtypes of abuse, such as sexual and emotional abuse, also contribute to violent behaviors seen in patients with bipolar disorder.[63] The number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder than in those without, particularly events stemming from a harsh environment rather than from the child's own behavior.[64] Acutely, mania can be induced by sleep deprivation in around 30% of people with bipolar disorder.[65]

Neurological

Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury including stroke, traumatic brain injury, HIV infection, multiple sclerosis, porphyria, and rarely temporal lobe epilepsy.[66]

Proposed mechanisms

Further information: Biology of bipolar disorder

Brain imaging studies have revealed differences in the volume of various brain regions between patients with bipolar disorder and healthy control subjects.

The precise mechanisms that cause bipolar disorder are not well understood. Bipolar disorder is thought to be associated with abnormalities in the structure and function of certain brain areas responsible for cognitive tasks and the processing of emotions.[23] A neurologic model for bipolar disorder proposes that the emotional circuitry of the brain can be divided into two main parts.[23] The ventral system (regulates emotional perception) includes brain structures such as the amygdala, insula, ventral striatum, ventral anterior cingulate cortex, and the prefrontal cortex.[23] The dorsal system (responsible for emotional regulation) includes the hippocampus, dorsal anterior cingulate cortex, and other parts of the prefrontal cortex.[23] The model hypothesizes that bipolar disorder may occur when the ventral system is overactivated and the dorsal system is underactivated.[23] Other models suggest the ability to regulate emotions is disrupted in people with bipolar disorder and that dysfunction of the ventricular prefrontal cortex is crucial to this disruption.[23]

Meta-analyses of structural MRI studies have shown that certain brain regions (e.g., the left rostral anterior cingulate cortex, fronto-insular cortex, ventral prefrontal cortex, and claustrum) are smaller in people with bipolar disorder, whereas other regions are larger (lateral ventricles, globus pallidus, subgenual anterior cingulate, and the amygdala). Additionally, these meta-analyses found that people with bipolar disorder have higher rates of deep white matter hyperintensities.[67][68][69][70]

Functional MRI findings suggest that the ventricular prefrontal cortex regulates the limbic system, especially the amygdala.[71] In people with bipolar disorder, decreased ventricular prefrontal cortex activity allows for the dysregulated activity of the amygdala, which likely contributes to labile mood and poor emotional regulation.[71] Consistent with this, pharmacological treatment of mania returns ventricular prefrontal cortex activity to the levels in non-manic people, suggesting that ventricular prefrontal cortex activity is an indicator of mood state. However, while pharmacological treatment of mania reduces amygdala hyperactivity, it remains more active than the amygdala of those without bipolar disorder, suggesting amygdala activity may be a marker of the disorder rather than the current mood state.[72] Manic and depressive episodes tend to be characterized by dysfunction in different regions of the ventricular prefrontal cortex. Manic episodes appear to be associated with decreased activation of the right ventricular prefrontal cortex whereas depressive episodes are associated with decreased activation of the left ventricular prefrontal cortex.[71] These disruptions often occur during development linked with synaptic pruning dysfunction.[73]

People with bipolar disorder who are in a euthymic mood state show decreased activity in the lingual gyrus compared to people without bipolar disorder.[23] In contrast, they demonstrate decreased activity in the inferior frontal cortex during manic episodes compared to people without the disorder.[23] Similar studies examining the differences in brain activity between people with bipolar disorder and those without did not find a consistent area in the brain that was more or less active when comparing these two groups.[23] People with bipolar have increased activation of left hemisphere ventral limbic areas—which mediate emotional experiences and generation of emotional responses—and decreased activation of right hemisphere cortical structures related to cognition—structures associated with the regulation of emotions.[74]

Neuroscientists have proposed additional models to try to explain the cause of bipolar disorder. One proposed model for bipolar disorder suggests that hypersensitivity of reward circuits consisting of frontostriatal circuits causes mania, and decreased sensitivity of these circuits causes depression.[75] According to the "kindling" hypothesis, when people who are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence supporting an association between early-life stress and dysfunction of the hypothalamic-pituitary-adrenal axis leading to its overactivation, which may play a role in the pathogenesis of bipolar disorder.[76][77] Other brain components that have been proposed to play a role in bipolar disorder are the mitochondria[46] and a sodium ATPase pump.[78] Circadian rhythms and regulation of the hormone melatonin also seem to be altered.[79]

Dopamine, a neurotransmitter responsible for mood cycling, has increased transmission during the manic phase.[26][80] The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic downregulation of key system elements and receptors such as lower sensitivity of dopaminergic receptors. This results in decreased dopamine transmission characteristic of the depressive phase.[26] The depressive phase ends with homeostatic upregulation potentially restarting the cycle over again.[81] Glutamate is significantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase is over.[82]

Medications used to treat bipolar may exert their effect by modulating intracellular signaling, such as through depleting myo-inositol levels, inhibition of cAMP signaling, and through altering subunits of the dopamine-associated G-protein.[83] Consistent with this, elevated levels of Gαi, Gαs, and Gαq/11 have been reported in brain and blood samples, along with increased protein kinase A (PKA) expression and sensitivity;[84] typically, PKA activates as part of the intracellular signalling cascade downstream from the detachment of Gαs subunit from the G protein complex.

Decreased levels of 5-hydroxyindoleacetic acid, a byproduct of serotonin, are present in the cerebrospinal fluid of persons with bipolar disorder during both the depressed and manic phases. Increased dopaminergic activity has been hypothesized in manic states due to the ability of dopamine agonists to stimulate mania in people with bipolar disorder. Decreased sensitivity of regulatory α2 adrenergic receptors as well as increased cell counts in the locus coeruleus indicated increased noradrenergic activity in manic people. Low plasma GABA levels on both sides of the mood spectrum have been found.[85] One review found no difference in monoamine levels, but found abnormal norepinephrine turnover in people with bipolar disorder.[86] Tyrosine depletion was found to reduce the effects of methamphetamine in people with bipolar disorder as well as symptoms of mania, implicating dopamine in mania. VMAT2 binding was found to be increased in one study of people with bipolar mania.[87]

Diagnosis

Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset can occur throughout life.[5][88] Its diagnosis is based on the self-reported experiences of the individual, abnormal behavior reported by family members, friends or co-workers, observable signs of illness as assessed by a clinician, and ideally a medical work-up to rule out other causes. Caregiver-scored rating scales, specifically from the mother, have shown to be more accurate than teacher and youth-scored reports in identifying youths with bipolar disorder.[89] Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others.

The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the World Health Organization's (WHO) International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10). The ICD-10 criteria are used more often in clinical settings outside of the U.S. while the DSM criteria are used within the U.S. and are the prevailing criteria used internationally in research studies. The DSM-5, published in 2013, includes further and more accurate specifiers compared to its predecessor, the DSM-IV-TR.[90] This work has influenced the eleventh revision of the ICD, which includes the various diagnoses within the bipolar spectrum of the DSM-V.[91]

Several rating scales for the screening and evaluation of bipolar disorder exist,[92] including the Bipolar spectrum diagnostic scale, Mood Disorder Questionnaire, the General Behavior Inventory and the Hypomania Checklist.[93] The use of evaluation scales cannot substitute a full clinical interview but they serve to systematize the recollection of symptoms.[93] On the other hand, instruments for screening bipolar disorder tend to have lower sensitivity.[92]

Differential diagnosis

Bipolar disorder is classified by the International Classification of Diseases as a mental and behavioural disorder.[94] Mental disorders that can have symptoms similar to those seen in bipolar disorder include schizophrenia, major depressive disorder,[95] attention deficit hyperactivity disorder (ADHD), and certain personality disorders, such as borderline personality disorder.[96][97][98] A key difference between bipolar disorder and borderline personality disorder is the nature of the mood swings; in contrast to the sustained changes to mood over days to weeks or longer, those of the latter condition (more accurately called emotional dysregulation) are sudden and often short-lived, and secondary to social stressors.[99]

Although there are no biological tests that are diagnostic of bipolar disorder,[53] blood tests and/or imaging are carried out to investigate whether medical illnesses with clinical presentations similar to that of bipolar disorder are present before making a definitive diagnosis. Neurologic diseases such as multiple sclerosis, complex partial seizures, strokes, brain tumors, Wilson's disease, traumatic brain injury, Huntington's disease, and complex migraines can mimic features of bipolar disorder.[88] An EEG may be used to exclude neurological disorders such as epilepsy, and a CT scan or MRI of the head may be used to exclude brain lesions.[88] Additionally, disorders of the endocrine system such as hypothyroidism, hyperthyroidism, and Cushing's disease are in the differential as is the connective tissue disease systemic lupus erythematosus. Infectious causes of mania that may appear similar to bipolar mania include herpes encephalitis, HIV, influenza, or neurosyphilis.[88] Certain vitamin deficiencies such as pellagra (niacin deficiency), vitamin B12 deficiency, folate deficiency, and Wernicke–Korsakoff syndrome (thiamine deficiency) can also lead to mania.[88] Common medications that can cause manic symptoms include antidepressants, prednisone, Parkinson's disease medications, thyroid hormone, stimulants (including cocaine and methamphetamine), and certain antibiotics.[100]

Bipolar spectrum

Since Emil Kraepelin's distinction between bipolar disorder and schizophrenia in the 19th century, researchers have defined a spectrum of different types of bipolar disorder.

Bipolar spectrum disorders include: bipolar I disorder, bipolar II disorder, cyclothymic disorder and cases where subthreshold symptoms are found to cause clinically significant impairment or distress.[5][88][91] These disorders involve major depressive episodes that alternate with manic or hypomanic episodes, or with mixed episodes that feature symptoms of both mood states.[5] The concept of the bipolar spectrum is similar to that of Emil Kraepelin's original concept of manic depressive illness.[101] Bipolar II disorder was established as a diagnosis in 1994 within DSM IV; though debate continues over whether it is a distinct entity, part of a spectrum, or exists at all.[102]

Criteria and subtypes

Simplified graphical comparison of bipolar I, bipolar II and cyclothymia[103][104]: 267 

The DSM and the ICD characterize bipolar disorder as a spectrum of disorders occurring on a continuum. The DSM-5 and ICD-11 lists three specific subtypes:[5][91]

Bipolar I disorder: At least one manic episode is necessary to make the diagnosis;[105] depressive episodes are common in the vast majority of cases with bipolar disorder I, but are unnecessary for the diagnosis.[27] Specifiers such as "mild, moderate, moderate-severe, severe" and "with psychotic features" should be added as applicable to indicate the presentation and course of the disorder.[5]

Bipolar II disorder: No manic episodes and one or more hypomanic episodes and one or more major depressive episodes.[105] Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as periods of successful high productivity and are reported less frequently than a distressing, crippling depression.

Cyclothymia: A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.[10]

When relevant, specifiers for peripartum onset and with rapid cycling should be used with any subtype. Individuals who have subthreshold symptoms that cause clinically significant distress or impairment, but do not meet full criteria for one of the three subtypes may be diagnosed with other specified or unspecified bipolar disorder. Other specified bipolar disorder is used when a clinician chooses to explain why the full criteria were not met (e.g., hypomania without a prior major depressive episode).[5] If the condition is thought to have a non-psychiatric medical cause, the diagnosis of bipolar and related disorder due to another medical condition is made, while substance/medication-induced bipolar and related disorder is used if a medication is thought to have triggered the condition.[106]

Rapid cycling

Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.[107] Rapid cycling, however, is a course specifier that may be applied to any bipolar subtype. It is defined as having four or more mood disturbance episodes within a one-year span. Rapid cycling is usually temporary but is common amongst people with bipolar disorder and affects 25.8–45.3% of them at some point in their life.[40][108] These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa).[27] The definition of rapid cycling most frequently cited in the literature (including the DSM-V and ICD-11) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes during a 12-month period.[109] The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management.[110] People with the rapid cycling or ultradian subtypes of bipolar disorder tend to be more difficult to treat and less responsive to medications than other people with bipolar disorder.[111]

Coexisting psychiatric conditions

The diagnosis of bipolar disorder can be complicated by coexisting (comorbid) psychiatric conditions including obsessive–compulsive disorder, substance-use disorder, eating disorders, attention deficit hyperactivity disorder, social phobia, premenstrual syndrome (including premenstrual dysphoric disorder), or panic disorder.[35][40][50][112] A thorough longitudinal analysis of symptoms and episodes, assisted if possible by discussions with friends and family members, is crucial to establishing a treatment plan where these comorbidities exist.[113] Children of parents with bipolar disorder more frequently have other mental health problems.[needs update][114]

Children

Main article: Bipolar disorder in children

Lithium is the only medication approved by the FDA for treating mania in children.

In the 1920s, Kraepelin noted that manic episodes are rare before puberty.[115] In general, bipolar disorder in children was not recognized in the first half of the twentieth century. This issue diminished with an increased following of the DSM criteria in the last part of the twentieth century.[115][116] The diagnosis of childhood bipolar disorder, while formerly controversial,[117] has gained greater acceptance among childhood and adolescent psychiatrists.[118] American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold reaching rates of up to 40% in 10 years around the beginning of the 21st century, while in outpatient clinics it doubled reaching 6%.[117] Studies using DSM criteria show that up to 1% of youth may have bipolar disorder.[115] The DSM-5 has established a diagnosis—disruptive mood dysregulation disorder—that covers children with long-term, persistent irritability that had at times been misdiagnosed as having bipolar disorder,[119] distinct from irritability in bipolar disorder that is restricted to discrete mood episodes.[118]

Elderly

Bipolar disorder is uncommon in older patients, with a measured lifetime prevalence of 1% in over 60s and a 12-month prevalence of 0.1–0.5% in people over 65. Despite this, it is overrepresented in psychiatric admissions, making up 4–8% of inpatient admission to aged care psychiatry units, and the incidence of mood disorders is increasing overall with the aging population. Depressive episodes more commonly present with sleep disturbance, fatigue, hopelessness about the future, slowed thinking, and poor concentration and memory; the last three symptoms are seen in what is known as pseudodementia. Clinical features also differ between those with late-onset bipolar disorder and those who developed it early in life; the former group present with milder manic episodes, more prominent cognitive changes and have a background of worse psychosocial functioning, while the latter present more commonly with mixed affective episodes,[120] and have a stronger family history of illness.[121] Older people with bipolar disorder experience cognitive changes, particularly in executive functions such as abstract thinking and switching cognitive sets, as well as concentrating for long periods and decision-making.[120]

Prevention

Attempts at prevention of bipolar disorder have focused on stress (such as childhood adversity or highly conflictual families) which, although not a diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.[122] Longitudinal studies have indicated that full-blown manic stages are often preceded by a variety of prodromal clinical features, providing support for the occurrence of an at-risk state of the disorder when an early intervention might prevent its further development and/or improve its outcome.[123][124]

Management

Main article: Treatment of bipolar disorder

The aim of management is to treat acute episodes safely with medication and work with the patient in long-term maintenance to prevent further episodes and optimise function using a combination of pharmacological and psychotherapeutic techniques.[12] Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (local legislation permitting) involuntary. Long-term inpatient stays are now less common due to deinstitutionalization, although these can still occur.[125] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or an Assertive Community Treatment team, supported employment, patient-led support groups, and intensive outpatient programs. These are sometimes referred to as partial-inpatient programs.[126] Compared to the general population, people with bipolar disorder are less likely to frequently engage in physical exercise. Exercise may have physical and mental benefits for people with bipolar disorder, but there is a lack of research.[127][128][129]

Psychosocial

Psychotherapy aims to assist a person with bipolar disorder in accepting and understanding their diagnosis, coping with various types of stress, improving their interpersonal relationships, and recognizing prodromal symptoms before full-blown recurrence.[9] Cognitive behavioral therapy (CBT), family-focused therapy, and psychoeducation have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge.[130] Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a therapeutic alliance in support of recovery.[131]

Medication

Lithium is often used to treat bipolar disorder and has the best evidence for reducing suicide.

Medications are often prescribed to help improve symptoms of bipolar disorder. Medications approved for treating bipolar disorder including mood stabilizers, antipsychotics, and antidepressants. Sometimes a combination of medications may also be suggested.[12] The choice of medications may differ depending on the bipolar disorder episode type or if the person is experiencing unipolar or bipolar depression.[12][132] Other factors to consider when deciding on an appropriate treatment approach includes if the person has any comorbidities, their response to previous therapies, adverse effects, and the desire of the person to be treated.[12]

Mood stabilizers

Lithium and the anticonvulsants carbamazepine, lamotrigine, and valproic acid are classed as mood stabilizers due to their effect on the mood states in bipolar disorder.[111] Lithium has the best overall evidence and is considered an effective treatment for acute manic episodes, preventing relapses, and bipolar depression.[133][134] Lithium reduces the risk of suicide, self-harm, and death in people with bipolar disorder.[135] Lithium is preferred for long-term mood stabilization.[61] Lithium treatment is also associated with adverse effects and it has been shown to erode kidney and thyroid function over extended periods.[12] Valproate has become a commonly prescribed treatment and effectively treats manic episodes.[136] Carbamazepine is less effective in preventing relapse than lithium or valproate.[137][138] Lamotrigine has some efficacy in treating depression, and this benefit is greatest in more severe depression.[139] Lamotrigine may have a similar effectiveness to lithium for treating bipolar disorder, however, there is evidence to suggest that lamotrigine is less effective at preventing recurrent mania episodes.[140] Lamotrigine treatment has been shown to be safer compared to lithium treatment, with less adverse effects. Valproate and carbamazepine are teratogenic and should be avoided as a treatment in women of childbearing age, but discontinuation of these medications during pregnancy is associated with a high risk of relapse.[18] The effectiveness of topiramate is unknown.[141] Carbamazepine effectively treats manic episodes, with some evidence it has greater benefit in rapid-cycling bipolar disorder, or those with more psychotic symptoms or more symptoms similar to that of schizoaffective disorder.

Mood stabilizers are used for long-term maintenance but have not demonstrated the ability to quickly treat acute bipolar depression.[111]

Antipsychotics

Antipsychotic medications are effective for short-term treatment of bipolar manic episodes and appear to be superior to lithium and anticonvulsants for this purpose.[61] Atypical antipsychotics are also indicated for bipolar depression refractory to treatment with mood stabilizers.[111] Olanzapine is effective in preventing relapses, although the supporting evidence is weaker than the evidence for lithium.[142] A 2006 review found that haloperidol was an effective treatment for acute mania, limited data supported no difference in overall efficacy between haloperidol, olanzapine or risperidone, and that it could be less effective than aripiprazole.[143]

Antidepressants

Antidepressants are not recommended for use alone in the treatment of bipolar disorder and do not provide any benefit over mood stabilizers.[12][144] Atypical antipsychotic medications (e.g., aripiprazole) are preferred over antidepressants to augment the effects of mood stabilizers due to the lack of efficacy of antidepressants in bipolar disorder.[111] Treatment of bipolar disorder using antidepressants carries a risk of affective switches; where a person switches from depression to manic or hypomanic phases.[18] The risk of affective switches is higher in bipolar I depression; antidepressants are generally avoided in bipolar I disorder or only used with mood stabilizers when they are deemed necessary.[18] There is also a risk of accelerating cycling between phases when antidepressants are used in bipolar disorder.[18]

Combined treatment approaches

Antipsychotics and mood stabilizers used together are quicker and more effective at treating mania than either class of drug used alone. Some analyses indicate antipsychotics alone are also more effective at treating acute mania.[12] A first-line treatment for depression in bipolar disorder is a combination of olanzapine and fluoxetine.[132]

Other drugs

Short courses of benzodiazepines are used in addition to other medications for calming effect until mood stabilizing become effective.[145] Electroconvulsive therapy (ECT) is an effective form of treatment for acute mood disturbances in those with bipolar disorder, especially when psychotic or catatonic features are displayed. ECT is also recommended for use in pregnant women with bipolar disorder.[12] It is unclear if ketamine (a common general dissociative anesthetic used in surgery) is useful in bipolar disorder.[132] Gabapentin and pregabalin are not proven to be effective for treating bipolar disorder.[146][147][148]

Children

Treating bipolar disorder in children involves medication and psychotherapy.[117] The literature and research on the effects of psychosocial therapy on bipolar spectrum disorders are scarce, making it difficult to determine the efficacy of various therapies.[149] Mood stabilizers and atypical antipsychotics are commonly prescribed.[117] Among the former, lithium is the only compound approved by the FDA for children.[115] Psychological treatment combines normally education on the disease, group therapy, and cognitive behavioral therapy.[117] Long-term medication is often needed.[117]

Resistance to treatment

The occurrence of poor response to treatment in has given support to the concept of resistance to treatment in bipolar disorder.[150][151] Guidelines to the definition of such treatment resistance and evidence-based options for its management were reviewed in 2020.[152]

Management of obesity

A large proportion (approximately 68%) of people who seek treatment for bipolar disorder are obese or overweight and managing obesity is important for reducing the risk of other health conditions that are associated with obesity.[153] Management approaches include non-pharmacological, pharmacological, and surgical. Examples of non-pharmacological include dietary interventions, exercise, behavioral therapies, or combined approaches. Pharmacological approaches include weight-loss medications or changing medications already being prescribed.[154] Some people with bipolar disorder who have obesity may also be eligible for bariatric surgery.[153] The effectiveness of these various approaches to improving or managing obesity in people with bipolar disorder is not clear.[153]

Prognosis

A lifelong condition with periods of partial or full recovery in between recurrent episodes of relapse,[40][155] bipolar disorder is considered to be a major health problem worldwide because of the increased rates of disability and premature mortality.[155] It is also associated with co-occurring psychiatric and medical problems, higher rates of death from natural causes (e.g., cardiovascular disease), and high rates of initial under- or misdiagnosis, causing a delay in appropriate treatment and contributing to poorer prognoses.[4][41] When compared to the general population, people with bipolar disorder also have higher rates of other serious medical comorbidities including diabetes mellitus, respiratory diseases, HIV, and hepatitis C virus infection.[156] After a diagnosis is made, it remains difficult to achieve complete remission of all symptoms with the currently available psychiatric medications and symptoms often become progressively more severe over time.[92][157]

Compliance with medications is one of the most significant factors that can decrease the rate and severity of relapse and have a positive impact on overall prognosis.[158] However, the types of medications used in treating BD commonly cause side effects[159] and more than 75% of individuals with BD inconsistently take their medications for various reasons.[158] Of the various types of the disorder, rapid cycling (four or more episodes in one year) is associated with the worst prognosis due to higher rates of self-harm and suicide.[40] Individuals diagnosed with bipolar who have a family history of bipolar disorder are at a greater risk for more frequent manic/hypomanic episodes.[160] Early onset and psychotic features are also associated with worse outcomes,[161][162] as well as subtypes that are nonresponsive to lithium.[157]

Early recognition and intervention also improve prognosis as the symptoms in earlier stages are less severe and more responsive to treatment.[157] Onset after adolescence is connected to better prognoses for both genders, and being male is a protective factor against higher levels of depression. For women, better social functioning before developing bipolar disorder and being a parent are protective towards suicide attempts.[160]

Functioning

Changes in cognitive processes and abilities are seen in mood disorders, with those of bipolar disorder being greater than those in major depressive disorder.[163] These include reduced attentional and executive capabilities and impaired memory.[164] People with bipolar disorder often experience a decline in cognitive functioning during (or possibly before) their first episode, after which a certain degree of cognitive dysfunction typically becomes permanent, with more severe impairment during acute phases and moderate impairment during periods of remission. As a result, two-thirds of people with BD continue to experience impaired psychosocial functioning in between episodes even when their mood symptoms are in full remission. A similar pattern is seen in both BD-I and BD-II, but people with BD-II experience a lesser degree of impairment.[159]

When bipolar disorder occurs in children, it severely and adversely affects their psychosocial development.[118] Children and adolescents with bipolar disorder have higher rates of significant difficulties with substance use disorders, psychosis, academic difficulties, behavioral problems, social difficulties, and legal problems.[118] Cognitive deficits typically increase over the course of the illness. Higher degrees of impairment correlate with the number of previous manic episodes and hospitalizations, and with the presence of psychotic symptoms.[165] Early intervention can slow the progression of cognitive impairment, while treatment at later stages can help reduce distress and negative consequences related to cognitive dysfunction.[157]

Despite the overly ambitious goals that are frequently part of manic episodes, symptoms of mania undermine the ability to achieve these goals and often interfere with an individual's social and occupational functioning. One-third of people with BD remain unemployed for one year following a hospitalization for mania.[166] Depressive symptoms during and between episodes, which occur much more frequently for most people than hypomanic or manic symptoms over the course of illness, are associated with lower functional recovery in between episodes, including unemployment or underemployment for both BD-I and BD-II.[5][167] However, the course of illness (duration, age of onset, number of hospitalizations, and the presence or not of rapid cycling) and cognitive performance are the best predictors of employment outcomes in individuals with bipolar disorder, followed by symptoms of depression and years of education.[167]

Recovery and recurrence

A naturalistic study in 2003 by Tohen and coworkers from the first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. Within two years, 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery.[168]

Symptoms preceding a relapse (prodromal), especially those related to mania, can be reliably identified by people with bipolar disorder.[169] There have been intents to teach patients coping strategies when noticing such symptoms with encouraging results.[170]

Suicide

Bipolar disorder can cause suicidal ideation that leads to suicide attempts. Individuals whose bipolar disorder begins with a depressive or mixed affective episode seem to have a poorer prognosis and an increased risk of suicide.[95] One out of two people with bipolar disorder attempt suicide at least once during their lifetime and many attempts are successfully completed.[50] The annual average suicide rate is 0.4%-1.4%, which is 30 to 60 times greater than that of the general population.[16] The number of deaths from suicide in bipolar disorder is between 18 and 25 times higher than would be expected in similarly aged people without bipolar disorder.[171] The lifetime risk of suicide is much higher in those with bipolar disorder, with an estimated 34% of people attempting suicide and 15–20% dying by suicide.[16]

Risk factors for suicide attempts and death from suicide in people with bipolar disorder include older age, prior suicide attempts, a depressive or mixed index episode (first episode), a manic index episode with psychotic symptoms, hopelessness or psychomotor agitation present during the episodes, co-existing anxiety disorder, a first degree relative with a mood disorder or suicide, interpersonal conflicts, occupational problems, bereavement or social isolation.[18]

Epidemiology

Burden of bipolar disorder around the world: disability-adjusted life years per 100,000 inhabitants in 2004   <180   180–185   185–190   190–195   195–200   200–205   205–210   210–215   215–220   220–225   225–230   >230

Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1 to 3% in the general population.[6][172][173] However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0.8% of the population experience a manic episode at least once (the diagnostic threshold for bipolar I) and a further 0.5% have a hypomanic episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1% of the population, adding up to a total of 6.4%, were classified as having a bipolar spectrum disorder.[174] A more recent analysis of data from a second US National Comorbidity Survey found that 1% met lifetime prevalence criteria for bipolar I, 1.1% for bipolar II, and 2.4% for subthreshold symptoms.[175] Estimates vary about how many children and young adults have bipolar disorder.[118] These estimates range from 0.6 to 15% depending on differing settings, methods, and referral settings, raising suspicions of overdiagnosis.[118] One meta-analysis of bipolar disorder in young people worldwide estimated that about 1.8% of people between the ages of seven and 21 have bipolar disorder.[118] Similar to adults, bipolar disorder in children and adolescents is thought to occur at a similar frequency in boys and girls.[118]

There are conceptual and methodological limitations and variations in the findings. Prevalence studies of bipolar disorder are typically carried out by lay interviewers who follow fully structured/fixed interview schemes; responses to single items from such interviews may have limited validity. In addition, diagnoses (and therefore estimates of prevalence) vary depending on whether a categorical or spectrum approach is used. This consideration has led to concerns about the potential for both underdiagnosis and overdiagnosis.[176]

The incidence of bipolar disorder is similar in men and women[177] as well as across different cultures and ethnic groups.[178] A 2000 study by the World Health Organization found that prevalence and incidence of bipolar disorder are very similar across the world. Age-standardized prevalence per 100,000 ranged from 421.0 in South Asia to 481.7 in Africa and Europe for men and from 450.3 in Africa and Europe to 491.6 in Oceania for women. However, severity may differ widely across the globe. Disability-adjusted life year rates, for example, appear to be higher in developing countries, where medical coverage may be poorer and medication less available.[179] Within the United States, Asian Americans have significantly lower rates than their African American and European American counterparts.[180] In 2017, the Global Burden of Disease Study estimated there were 4.5 million new cases and a total of 45.5 million cases globally.[181]

History

Main article: History of bipolar disorder

German psychiatrist Emil Kraepelin first distinguished between manic–depressive illness and "dementia praecox" (now known as schizophrenia) in the late 19th century.

In the early 1800s, French psychiatrist Jean-Étienne Dominique Esquirol's lypemania, one of his affective monomanias, was the first elaboration on what was to become modern depression.[182] The basis of the current conceptualization of bipolar illness can be traced back to the 1850s. In 1850, Jean-Pierre Falret described "circular insanity" (la folie circulaire, French pronunciation: [la fɔli siʁ.ky.lɛʁ]); the lecture was summarized in 1851 in the Gazette des hôpitaux ("Hospital Gazette").[2] Three years later, in 1854, Jules-Gabriel-François Baillarger (1809–1890) described to the French Imperial Académie Nationale de Médecine a biphasic mental illness causing recurrent oscillations between mania and melancholia, which he termed la folie à double forme (French pronunciation: [la fɔli a dubl fɔʀm], "madness in double form").[2][183] Baillarger's original paper, "De la folie à double forme", appeared in the medical journal Annales médico-psychologiques (Medico-psychological annals) in 1854.[2]

These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926), who, using Kahlbaum's concept of cyclothymia,[184] categorized and studied the natural course of untreated bipolar patients. He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.[185]

The term "manic–depressive reaction" appeared in the first version of the DSM in 1952, influenced by the legacy of Adolf Meyer.[186] Subtyping into "unipolar" depressive disorders and bipolar disorders has its origin in Karl Kleist's concept – since 1911 – of unipolar and bipolar affective disorders, which was used by Karl Leonhard in 1957 to differentiate between unipolar and bipolar disorder in depression.[187] These subtypes have been regarded as separate conditions since publication of the DSM-III. The subtypes bipolar II and rapid cycling have been included since the DSM-IV, based on work from the 1970s by David Dunner, Elliot Gershon, Frederick Goodwin, Ronald Fieve, and Joseph Fleiss.[188][189][190]

Society and culture

See also: List of people with bipolar disorder, Category:Books about bipolar disorder, and Category:Films about bipolar disorder

Singer Rosemary Clooney's public revelation of bipolar disorder made her an early celebrity spokesperson for mental illness.[191]

Cost

The United States spent approximately $202.1 billion on people diagnosed with bipolar I disorder (excluding other subtypes of bipolar disorder and undiagnosed people) in 2015.[156] One analysis estimated that the United Kingdom spent approximately £5.2 billion on the disorder in 2007.[192][193] In addition to the economic costs, bipolar disorder is a leading cause of disability and lost productivity worldwide.[20] People with bipolar disorder are generally more disabled, have a lower level of functioning, longer duration of illness, and increased rates of work absenteeism and decreased productivity when compared to people experiencing other mental health disorders.[194] The decrease in the productivity seen in those who care for people with bipolar disorder also significantly contributes to these costs.[195]

Advocacy

There are widespread issues with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder.[196] In 2000, actress Carrie Fisher went public with her bipolar disorder diagnosis.[197][198] She became one of the most well-recognized advocates for people with bipolar disorder in the public eye and fiercely advocated to eliminate the stigma surrounding mental illnesses, including bipolar disorder.[199] Stephen Fried, who has written extensively on the topic, noted that Fisher helped to draw attention to the disorder's chronicity, relapsing nature, and that bipolar disorder relapses do not indicate a lack of discipline or moral shortcomings.[199] Since being diagnosed at age 37, actor Stephen Fry has pushed to raise awareness of the condition, with his 2006 documentary Stephen Fry: The Secret Life of the Manic Depressive.[200][201] In an effort to ease the social stigma associated with bipolar disorder, the orchestra conductor Ronald Braunstein cofounded the ME/2 Orchestra with his wife Caroline Whiddon in 2011. Braunstein was diagnosed with bipolar disorder in 1985 and his concerts with the ME/2 Orchestra were conceived in order to create a welcoming performance environment for his musical colleagues, while also raising public awareness about mental illness.[202][203]

Notable cases

Numerous authors have written about bipolar disorder and many successful people have openly discussed their experience with it. Kay Redfield Jamison, a clinical psychologist and professor of psychiatry at the Johns Hopkins University School of Medicine, profiled her own bipolar disorder in her memoir An Unquiet Mind (1995).[204] It is likely that Grigory Potemkin, Russian statesman and alleged husband of Catherine the Great, suffered from some kind of bipolar disorder.[205] Several celebrities have also publicly shared that they have bipolar disorder; in addition to Carrie Fisher and Stephen Fry these include Catherine Zeta-Jones, Mariah Carey, Kanye West,[206] Jane Pauley, Demi Lovato,[199] Selena Gomez,[207] and Russell Brand.[208]

Media portrayals

Several dramatic works have portrayed characters with traits suggestive of the diagnosis which have been the subject of discussion by psychiatrists and film experts alike.

In Mr. Jones (1993), (Richard Gere) swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the syndrome.[209] In The Mosquito Coast (1986), Allie Fox (Harrison Ford) displays some features including recklessness, grandiosity, increased goal-directed activity and mood lability, as well as some paranoia.[210] Psychiatrists have suggested that Willy Loman, the main character in Arthur Miller's classic play Death of a Salesman, has bipolar disorder.[211]

The 2009 drama 90210 featured a character, Silver, who was diagnosed with bipolar disorder.[212] Stacey Slater, a character from the BBC soap EastEnders, has been diagnosed with the disorder. The storyline was developed as part of the BBC's Headroom campaign.[213] The Channel 4 soap Brookside had earlier featured a story about bipolar disorder when the character Jimmy Corkhill was diagnosed with the condition.[214] 2011 Showtime's political thriller drama Homeland protagonist Carrie Mathison has bipolar disorder, which she has kept secret since her school days.[215] The 2014 ABC medical drama, Black Box, featured a world-renowned neuroscientist with bipolar disorder.[216]

In the TV series Dave, the eponymous main character, played by Lil Dicky as a fictionalized version of himself, is an aspiring rapper. Lil Dicky's real-life hype man GaTa also plays himself. In one episode, after being off his medication and having an episode, GaTa tearfully confesses to having bipolar disorder. GaTa has bipolar disorder in real life but, like his character in the show, he is able to manage it with medication.[217]

Creativity

Main article: Creativity and mental illness § Bipolar disorder

A link between mental illness and professional success or creativity has been suggested, including in accounts by Socrates, Seneca the Younger, and Cesare Lombroso. Despite prominence in popular culture, the link between creativity and bipolar has not been rigorously studied. This area of study also is likely affected by confirmation bias. Some evidence suggests that some heritable component of bipolar disorder overlaps with heritable components of creativity. Probands of people with bipolar disorder are more likely to be professionally successful, as well as to demonstrate temperamental traits similar to bipolar disorder. Furthermore, while studies of the frequency of bipolar disorder in creative population samples have been conflicting, full-blown bipolar disorder in creative samples is rare.[218]

Research

Research directions for bipolar disorder in children include optimizing treatments, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder and improving diagnostic criteria.[117] Some treatment research suggests that psychosocial interventions that involve the family, psychoeducation, and skills building (through therapies such as CBT, DBT, and IPSRT) can benefit in addition to pharmacotherapy.[149]

See also

Psychiatry portalPsychology portalMedicine portal

List of people with bipolar disorder

Outline of bipolar disorder

Bipolar I disorder

Bipolar II disorder

Bipolar NOS

Cyclothymia

Bipolar disorders research

Borderline personality disorder

Emotional dysregulation

Mood (psychology)

Mood swing

International Society for Bipolar Disorders

Explanatory notes

^ Catatonia is a syndrome characterized by profound unresponsiveness or stupor with abnormal movements in a person who is otherwise awake.[15]

Citations

^ Gautam S, Jain A, Gautam M, Gautam A, Jagawat T (January 2019). "Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents". Indian Journal of Psychiatry. 61 (Suppl 2): 294–305. doi:10.4103/psychiatry.IndianJPsychiatry_570_18. PMC 6345130. PMID 30745704.

^ a b c d e Edward Shorter (2005). A Historical Dictionary of Psychiatry. New York: Oxford University Press. pp. 165–166. ISBN 978-0-19-517668-1.

^ Coyle N, Paice JA (2015). Oxford Textbook of Palliative Nursing. Oxford University Press, Incorporated. p. 623. ISBN 9780199332342.

^ a b c d e f g h i j k l m n o p q r s t u v w x Anderson IM, Haddad PM, Scott J (December 27, 2012). "Bipolar disorder". BMJ (Clinical Research Ed.). 345: e8508. doi:10.1136/bmj.e8508. PMID 23271744. S2CID 22156246.

^ a b c d e f g h i j k l m n American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123–154. ISBN 978-0-89042-555-8.

^ a b c Schmitt A, Malchow B, Hasan A, Falkai P (February 2014). "The impact of environmental factors in severe psychiatric disorders". Frontiers in Neuroscience. 8 (19): 19. doi:10.3389/fnins.2014.00019. PMC 3920481. PMID 24574956.

^ Goodwin GM (2012). "Bipolar disorder". Medicine. 40 (11): 596–598. doi:10.1016/j.mpmed.2012.08.011.

^ Charney A, Sklar P (2018). "Genetics of Schizophrenia and Bipolar Disorder". In Charney D, Nestler E, Sklar P, Buxbaum J (eds.). Charney & Nestler's Neurobiology of Mental Illness (5th ed.). New York: Oxford University Press. p. 162. ISBN 9780190681425.

^ a b c d Bobo WV (October 2017). "The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update". Mayo Clinic Proceedings (Review). 92 (10): 1532–1551. doi:10.1016/j.mayocp.2017.06.022. PMID 28888714.

^ a b Van Meter AR, Youngstrom EA, Findling RL (June 2012). "Cyclothymic disorder: a critical review". Clinical Psychology Review. 32 (4): 229–243. doi:10.1016/j.cpr.2012.02.001. PMID 22459786.

^ NIMH (April 2016). "Bipolar Disorder". National Institutes of Health. Archived from the original on July 27, 2016. Retrieved August 13, 2016.

^ a b c d e f g h i j k l m n Grande I, Berk M, Birmaher B, Vieta E (April 2016). "Bipolar disorder". Lancet. 387 (10027): 1561–1572. doi:10.1016/S0140-6736(15)00241-X. PMID 26388529. S2CID 205976059.

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Cited texts

Brown MR, Basso MR (2004). Focus on Bipolar Disorder Research. Nova Science Publishers. ISBN 978-1-59454-059-2.

Goodwin FK, Jamison KR (2007). Manic–depressive illness: bipolar disorders and recurrent depression (2nd. ed.). Oxford University Press. ISBN 978-0-19-513579-4. OCLC 70929267. Retrieved April 2, 2016.

Jamison KR (1995). An Unquiet Mind: A Memoir of Moods and Madness. New York: Knopf. ISBN 978-0-330-34651-1.

Millon T (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. ISBN 978-0-471-01186-6.

Robinson DJ (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Michigan: Rapid Psychler Press. ISBN 978-1-894328-07-4.

Further reading

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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, et al. (November 2017). "The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research". Bipolar Disorders. 19 (7): 524–543. doi:10.1111/bdi.12556. PMC 5716873. PMID 28944987.

External links

Bipolar disorder at Wikipedia's sister projects

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ClassificationDICD-11: 6A60, 6A61ICD-10: F31ICD-9-CM: 296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.8OMIM: 125480 309200MeSH: D001714DiseasesDB: 7812SNOMED CT: 13746004External resourcesMedlinePlus: 000926eMedicine: med/229Patient UK: Bipolar disorder

vteMental disorders (Classification)Adult personality and behaviorSexual

Ego-dystonic sexual orientation

Paraphilia

Fetishism

Voyeurism

Sexual maturation disorder

Sexual relationship disorder

Other

Factitious disorder

Munchausen syndrome

Gender dysphoria

Intermittent explosive disorder

Dermatillomania

Kleptomania

Pyromania

Trichotillomania

Personality disorder

Childhood and learningEmotional and behavioral

ADHD

Conduct disorder

ODD

Emotional and behavioral disorders

Separation anxiety disorder

Movement disorders

Stereotypic

Social functioning

DAD

RAD

Selective mutism

Speech

Cluttering

Stuttering

Tic disorder

Tourette syndrome

Intellectual disability

X-linked intellectual disability

Lujan–Fryns syndrome

Psychological development(developmental disabilities)

Pervasive

Specific

Mood (affective)

Bipolar

Bipolar I

Bipolar II

Bipolar NOS

Cyclothymia

Depression

Atypical depression

Dysthymia

Major depressive disorder

Melancholic depression

Seasonal affective disorder

Mania

Neurological and symptomaticAutism spectrum

Autism

Asperger syndrome

High-functioning autism

PDD-NOS

Savant syndrome

Dementia

AIDS dementia complex

Alzheimer's disease

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Delirium

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AnxietyPhobia

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Social phobia

Anthropophobia

Specific social phobia

Specific phobia

Claustrophobia

Other

Generalized anxiety disorder

OCD

Panic attack

Panic disorder

Stress

Acute stress reaction

PTSD

Dissociative

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Dissociative identity disorder

Dissociative fugue

Psychogenic amnesia

Somatic symptom

Body dysmorphic disorder

Conversion disorder

Ganser syndrome

Globus pharyngis

Psychogenic non-epileptic seizures

False pregnancy

Hypochondriasis

Mass psychogenic illness

Nosophobia

Psychogenic pain

Somatization disorder

Physiological and physical behaviorEating

Anorexia nervosa

Bulimia nervosa

Rumination syndrome

Other specified feeding or eating disorder

Nonorganic sleep

Hypersomnia

Insomnia

Parasomnia

Night terror

Nightmare

REM sleep behavior disorder

Postnatal

Postpartum depression

Postpartum psychosis

Sexual dysfunctionArousal

Erectile dysfunction

Female sexual arousal disorder

Desire

Hypersexuality

Hypoactive sexual desire disorder

Orgasm

Anorgasmia

Delayed ejaculation

Premature ejaculation

Sexual anhedonia

Spontaneous orgasm

Pain

Nonorganic dyspareunia

Nonorganic vaginismus

Psychoactive substances, substance abuse and substance-related

Drug overdose

Intoxication

Physical dependence

Rebound effect

Stimulant psychosis

Substance dependence

Withdrawal

Schizophrenia, schizotypal and delusionalDelusional

Delusional disorder

Folie à deux

Psychosis andschizophrenia-like

Brief reactive psychosis

Schizoaffective disorder

Schizophreniform disorder

Schizophrenia

Childhood schizophrenia

Disorganized (hebephrenic) schizophrenia

Pseudoneurotic schizophrenia

Simple-type schizophrenia

Other

Catatonia

Symptoms and uncategorized

Impulse-control disorder

Klüver–Bucy syndrome

Psychomotor agitation

Stereotypy

vteMood disorderSpectrumBipolar disorder

Bipolar I

Bipolar II

Cyclothymia

Bipolar NOS

Childhood

Hypomania

Mania

Mixed affective state

Rapid cycling

Depression

Major depressive disorder

Dysthymia

Seasonal affective disorder

Atypical depression

Melancholic depression

Major depressive episode

Depression in childhood and adolescence

Comorbidities

Schizoaffective disorder

Symptoms

Delusion

Depression (differential diagnoses)

Emotional dysregulation

Anhedonia

Dysphoria

Suicidal ideation

Hallucination

Mood swing

Sleep disorder

Hypersomnia

Insomnia

Psychosis

Psychotic depression

Racing thoughts

Reduced affect display

Diagnosis

Bipolar Spectrum Diagnostic Scale

Child Mania Rating Scale

General Behavior Inventory

Hypomania Checklist

Mood Disorder Questionnaire

Rating scales for depression

Young Mania Rating Scale

TreatmentAnticonvulsants

Carbamazepine

Lamotrigine

Oxcarbazepine

Valproate

Sodium valproate

Valproate semisodium

Sympathomimetics,SSRIs and similar

Bupropion

Dextroamphetamine

Escitalopram

Fluoxetine

Methylphenidate

Sertraline

Other mood stabilizers

Antipsychotics

Atypical antipsychotics

Lithium

Lithium carbonate

Lithium citrate

Lithium sulfate

Lithium toxicity

Non-pharmaceutical

Clinical psychology

Cognitive behavioral therapy

Dialectical behavior therapy

Electroconvulsive therapy

Involuntary commitment

Light therapy

Psychotherapy

Transcranial magnetic stimulation

History

Emil Kraepelin

Frederick K. Goodwin

John Cade

Karl Leonhard

Kay Redfield Jamison

Mogens Schou

Authority control databases: National

Spain

France

BnF data

Germany

Israel

United States

Japan

Czech Republic

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Bipolar Disorder - National Institute of Mental Health (NIMH)

Bipolar Disorder - National Institute of Mental Health (NIMH)

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Home > Mental Health Information > Health Topics > Bipolar Disorder

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What is bipolar disorder?

What are the signs and symptoms of bipolar disorder?

What are the risk factors for bipolar disorder?

How is bipolar disorder treated?

How can I find a clinical trial for bipolar disorder?

Where can I learn more about bipolar disorder?

Bipolar Disorder

What is bipolar disorder?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as “other specified and unspecified bipolar and related disorders.”Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

What are the signs and symptoms of bipolar disorder?

People with bipolar disorder experience periods of unusually intense emotion and changes in sleep patterns and activity levels, and engage in behaviors that are out of character for them—often without recognizing their likely harmful or undesirable effects. These distinct periods are called mood episodes. Mood episodes are very different from the person’s usual moods and behaviors. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

Symptoms of a Manic Episode

Symptoms of a Depressive Episode

Feeling very up, high, elated, or extremely irritable or touchy

Feeling very down or sad, or anxious

Feeling jumpy or wired, more active than usual

Feeling slowed down or restless

Having a decreased need for sleep

Having trouble falling asleep, waking up too early, or sleeping too much

Talking fast about a lot of different things (“flight of ideas”)

Talking very slowly, feeling unable to find anything to say, or forgetting a lot

Racing thoughts

Having trouble concentrating or making decisions

Feeling able to do many things at once without getting tired

Feeling unable to do even simple things

Having excessive appetite for food, drinking, sex, or other pleasurable activities

Having a lack of interest in almost all activities

Feeling unusually important, talented, or powerful

Feeling hopeless or worthless, or thinking about death or suicide

Sometimes people have both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. During an episode with mixed features, people may feel very sad, empty, or hopeless while at the same time feeling extremely energized.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar II disorder experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Diagnosis

Receiving the right diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a health care provider is the first step. The health care provider can complete a physical exam and other necessary medical tests to rule out other possible causes. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important.

Find tips to help prepare for and get the most out of your visit with your health care provider.

Bipolar disorder and other conditions

Many people with bipolar disorder also have other mental disorders or conditions such as anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), misuse of drugs or alcohol, or eating disorders. Sometimes people who have severe manic or depressive episodes also have symptoms of psychosis, which may include hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example, someone having psychotic symptoms during a depressive episode may falsely believe they are financially ruined, while someone having psychotic symptoms during a manic episode may falsely believe they are famous or have special powers.

Looking at a person’s symptoms over the course of the illness and examining their family history can help a health care provider determine whether the person has bipolar disorder along with another disorder.

What are the risk factors for bipolar disorder?

Researchers are studying possible causes of bipolar disorder. Most agree that there are many factors that are likely to contribute to a person’s chance of having the disorder.

Brain structure and functioning: Some studies show that the brains of people with bipolar disorder differ in certain ways from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these brain differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene causes the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

How is bipolar disorder treated?

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called talk therapy.Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.MedicationCertain medications can help manage symptoms of bipolar disorder. Some people may need to try different medications and work with their health care provider to find the medications that work best.The most common types of medications that health care providers prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium or valproate can help prevent mood episodes or reduce their severity. Lithium also can decrease the risk of suicide. Health care providers may include medications that target sleep or anxiety as part of the treatment plan.Although bipolar depression is often treated with antidepressant medication, a mood stabilizer must be taken as well—taking an antidepressant without a mood stabilizer can trigger a manic episode or rapid cycling in a person with bipolar disorder.Because people with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania, it is important for health care providers to take a careful medical history to ensure that bipolar disorder is not mistaken for depression.People taking medication should:Talk with their health care provider to understand the risks and benefits of the medication.Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.It is important to talk to a health care provider before stopping a prescribed medication. Stopping a medication suddenly may lead symptoms to worsen or come back. You can find basic information about medications on NIMH's medications webpage. Read the latest medication warnings, patient medication guides, and information on newly approved medications on the Food and Drug Administration (FDA) website. PsychotherapyPsychotherapy, also called talk therapy, can be an effective part of treatment for people with bipolar disorder. Psychotherapy is a term for treatment techniques that aim to help people identify and change troubling emotions, thoughts, and behaviors. This type of therapy can provide support, education, and guidance to people with bipolar disorder and their families.Cognitive behavioral therapy (CBT) is an important treatment for depression, and CBT adapted for the treatment of insomnia can be especially helpful as part of treatment for bipolar depression.Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy.Learn more about the various types of psychotherapies.Other treatment optionsSome people may find other treatments helpful in managing their bipolar symptoms:Electroconvulsive therapy (ECT) is a brain stimulation procedure that can help relieve severe symptoms of bipolar disorder. Health care providers may consider ECT when a person’s illness has not improved after other treatments, or in cases that require rapid response, such as with people who have a high suicide risk or catatonia (a state of unresponsiveness).Repetitive transcranial magnetic stimulation (rTMS) is a type of brain stimulation that uses magnetic waves to relieve depression over a series of treatment sessions. Although not as powerful as ECT, rTMS does not require general anesthesia and has a low risk of negative effects on memory and thinking.Light therapy is the best evidence-based treatment for seasonal affective disorder (SAD), and many people with bipolar disorder experience seasonal worsening of depression or SAD in the winter. Light therapy may also be used to treat lesser forms of seasonal worsening of bipolar depression.Unlike specific psychotherapy and medication treatments that are scientifically proven to improve bipolar disorder symptoms, complementary health approaches for bipolar disorder, such as natural products, are not based on current knowledge or evidence. Learn more on the National Center for Complementary and Integrative Health website .Finding treatmentA family health care provider is a good resource and can be the first stop in searching for help. Find tips to help prepare for and get the most out of your visit.To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), visit the SAMHSA online treatment locator , or text your ZIP code to 435748.Learn more about finding help on the NIMH website.If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.Coping with bipolar disorderLiving with bipolar disorder can be challenging, but there are ways to help make it easier.Work with a health care provider to develop a treatment plan and stick with it. Treatment is the best way to start feeling better.Follow the treatment plan as directed. Work with a health care provider to adjust the plan, as needed.Structure your activities. Try to have a routine for eating, sleeping, and exercising.Try regular, vigorous exercise like jogging, swimming, or bicycling, which can help with depression and anxiety, promote better sleep, and support your heart and brain health.Track your moods, activities, and overall health and well-being to help recognize your mood swings.Ask trusted friends and family members for help in keeping up with your treatment plan.Be patient. Improvement takes time. Staying connected with sources of social support can help.Long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

How can I find a clinical trial for bipolar disorder?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.To learn more or find a study, visit:NIMH’s Clinical Trials webpage: Information about participating in clinical trialsClinicaltrials.gov: Current Studies on Bipolar Disorder : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the countryJoin a Study: Bipolar Disorder – Adults: List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about bipolar disorder?

Free Brochures and Shareable ResourcesBipolar Disorder: A brochure on bipolar disorder that offers basic information on signs and symptoms, treatment, and finding help. Also available en español.Bipolar Disorder in Children and Teens: A brochure on bipolar disorder in children and teens that offers basic information on signs and symptoms, treatment, and finding help. Also available en español.Bipolar Disorder in Teens and Young Adults: Know the Signs: An infographic presenting common signs and symptoms of bipolar disorder in teens and young adults. Also available en español.Shareable Resources on Bipolar Disorder: Digital resources, including graphics and messages, to help support bipolar disorder awareness and education.MultimediaNIMH Experts Discuss Bipolar Disorder in Adults: Learn the signs and symptoms, risk factors, treatments of bipolar disorder, and the latest NIMH-supported research in this area.Mental Health Minute: Bipolar Disorder in Adults: A minute-long video to learn about bipolar disorder in adults.NIMH Expert Discusses Bipolar Disorder in Adolescents and Young Adults: A video with an expert who explains the signs, symptoms, and treatments of bipolar disorder.Research and StatisticsJournal Articles : This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).Bipolar Disorder Statistics: An NIMH webpage that provides information on the prevalence of bipolar disorder among adults and adolescents.Last Reviewed: February 2024

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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What’s Bipolar Disorder? How Do I Know If I Have It?

What’s Bipolar Disorder? How Do I Know If I Have It?

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A Quiz for TeensAre You a Workaholic?How Well Do You Sleep?Tools & ResourcesHealth NewsFind a DietFind Healthy SnacksDrugs A-ZHealth A-ZConnectFind Your Bezzy CommunityBreast CancerInflammatory Bowel DiseasePsoriatic ArthritisMigraineMultiple SclerosisPsoriasisFollow us on social mediaHealthlineHealth ConditionsDiscoverPlanConnectSubscribeFitnessGet MotivatedCardioStrength TrainingYogaRest and RecoverHolistic FitnessExercise LibraryFitness NewsYour Fitness ToolkitEverything You Need to Know About Bipolar DisorderMedically reviewed by Nicole Washington, DO, MPH — By Kimberly Holland and Crystal Raypole and Alina Sharon — Updated on January 25, 2023TypesSymptomsMania and hypomaniaDepressive episodesIn men vs. womenRacial disparitiesIn children and teensTreatmentCauses and risk factorsPreventionCo-occurring conditionsCoping tipsTakeawayBipolar disorder is a mental health condition marked by large shifts in mood from mania to depression. Although bipolar disorder can be challenging to manage, many effective treatments and strategies are available.Bipolar disorder isn’t a rare condition. In fact, the National Institute of Mental Health says that 2.8% of U.S. adults — or about 5 million people — have a bipolar disorder diagnosis. The condition used to be known as manic depression and bipolar disease.Key symptoms of bipolar disorder include:episodes of mania, or extremely elevated moodepisodes of depression, or low moodThese episodes may last from a few days to several weeks or longer.If you’re living with bipolar disorder, the following treatment options can help you learn to manage mood episodes, which can improve not only your symptoms but also your overall quality of life.Types of bipolar disorderThere are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.Bipolar IBipolar I is defined by the appearance of at least one manic episode. You may experience hypomanic episodes, which are less severe than manic episodes, or major depressive periods before and after the manic episode. A person can also go through a long period of stable mood before experiencing either mania or depression.This type of bipolar disorder affects people of all sexes equally.Are sex and gender the same thing?People often use the terms sex and gender interchangeably, but they have different meanings:“Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.“Gender” refers to a person’s identity and how they feel inside. Examples include man, woman, nonbinary, agender, bigender, genderfluid, pangender, and trans. A person’s gender identity may differ from the sex they were assigned at birth. Was this helpful?Bipolar IIPeople with bipolar II experience one major depressive episode that lasts at least 2 weeks. They also have at least 1 hypomanic episode that lasts about 4 days. According to a 2017 review, this type of bipolar disorder may be more common in females.CyclothymiaPeople with cyclothymia experience some symptoms of hypomania and depression, but not enough to characterize an episode of hypomania or depression.These episodes also involve symptoms that are shorter and less severe than the episodes associated with bipolar I or bipolar II disorder. Most people with this condition experience no mood symptoms for 1 to 2 months at a time.Your doctor can explain more about what kind of bipolar disorder you have when discussing your diagnosis. Some people experience distinct mood symptoms that resemble but don’t align with these three types. If that’s the case for you, you might get a diagnosis of:other specified bipolar and related disordersunspecified bipolar and related disordersLearn more about the types of bipolar disorder.Bipolar disorder symptomsTo receive a diagnosis of bipolar disorder, you must experience at least one period of mania or hypomania. These both involve feelings of excitement, impulsivity, and high energy, but hypomania is considered less severe than mania. Mania symptoms can affect your day-to-day life at work or home. Hypomania symptoms typically don’t cause as much disruption, but they can still be distressing.Some people living with bipolar disorder also experience major depressive episodes or “down” moods.These three main symptoms — mania, hypomania, and depression — are the main features of bipolar disorder. Different types of bipolar disorder involve different combinations of these symptoms.Bipolar I symptomsAccording to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a diagnosis of bipolar I disorder requires the following:at least one episode of mania that lasts at least 1 weeksymptoms that affect daily functionsymptoms that don’t relate to another medical or mental health condition or substance useYou could also experience symptoms of psychosis or both mania and depression (known as mixed features). These symptoms can have more impact on your life. If you have them, it’s worth reaching out for professional support as soon as possible.While you don’t need to experience episodes of hypomania or depression to receive a bipolar I diagnosis, many people with bipolar I do report these symptoms.Bipolar II symptomsA diagnosis of bipolar II requires:at least one episode of hypomania that lasts 4 days or longer and involves 3 or more symptoms of hypomaniahypomania-related changes in mood and usual function that others can notice, though these may not necessarily affect your daily lifeat least one episode of major depression that lasts 2 weeks or longerat least one episode of major depression involving five or more key depression symptoms that have a significant impact on your day-to-day lifesymptoms that don’t relate to another medical or mental health condition or substance useBipolar II can also involve symptoms of psychosis, but only during an episode of depression. You could also experience mixed mood episodes, which means you’ll have symptoms of depression and hypomania simultaneously.With bipolar II, though, you won’t experience mania. If you have a manic episode, you’ll receive a diagnosis of bipolar I.Cyclothymia symptomsA diagnosis of cyclothymia requires:periods of hypomanic symptoms and periods of depression symptoms, off and on, over 2 years or longer (1 year for children and adolescents)symptoms that never meet the full criteria for an episode of hypomania or depressionsymptoms that are present for at least half of the 2 years and never absent for longer than 2 months at a timesymptoms that don’t relate to another medical or mental health condition or substance usesymptoms that cause significant distress and affect daily lifeFluctuating mood symptoms characterize cyclothymia. These symptoms may be less severe than those of bipolar I or II. Still, they tend to last longer, so you’ll generally have less time when you experience no symptoms.Hypomania may not have a big impact on your daily life. Depression, on the other hand, often leads to more serious distress and affects day-to-day function, even if your symptoms don’t qualify for a major depressive episode.If you do experience enough symptoms to meet the criteria for a hypomanic or depressive episode, your diagnosis will likely change to another type of bipolar disorder or major depression, depending on your symptoms.Mania and hypomaniaAn episode of mania often involves an emotional high. You might feel excited, impulsive, euphoric, and full of energy. You might also feel jumpy or notice your thoughts seem to race. Some people also experience hallucinations and other symptoms of psychosis.Manic episodes can involve behavior that’s more impulsive than usual, often because you feel invincible or untouchable. Commonly cited examples of this kind of behavior include:having sex without using a barrier methodmisusing alcohol and drugs going on spending spreesBut impulsiveness can also show up in plenty of other ways. Maybe you:quit your job abruptlytake off on a road trip by yourself without telling anyonemake a big investment on a whimdrive much faster than usual, well above the speed limitparticipate in extreme sports you wouldn’t ordinarily considerWhile there are many reasons why a person might engage in these behaviors, the key to mania is that these are not things you would choose to engage in periods of stable mood.Hypomania, generally associated with bipolar II disorder, involves many of the same symptoms, though they’re less severe. Unlike mania, hypomania often doesn’t lead to consequences at work, school, or in your relationships. Episodes of hypomania don’t involve psychosis. They typically won’t last as long as episodes of mania or require inpatient care.With hypomania, you might feel very productive and energized, but you may not notice other changes in your mood. People who don’t know you well may not, either. Those closest to you, however, will usually pick up on your shifting mood and energy levels.Major depressive episodesA “down” change in mood can leave you feeling lethargic, unmotivated, and sad.Bipolar-related episodes of major depression will involve at least five of these symptoms:a lasting low mood marked by deep sadness, hopelessness, or feelings of emptinessloss of energya sense of feeling slower than usual or persistent restlessnesslack of interest in activities you once enjoyedperiods of too little or too much sleepa sense of guilt or worthlessnesstrouble concentrating, focusing, and making decisionsthoughts of death, dying, or suicidechanges in appetite or weightNot everyone with bipolar disorder experiences major depressive episodes, though many people do. Depending on your type of bipolar disorder, you might experience only a few symptoms of depression but not the full five needed for a major episode.It’s also worth noting that sometimes, but not always, the euphoria of mania can feel enjoyable. Once you get treatment for mania, the symptom-free mood you experience might feel more like a “down” shift, or a period of depression, than a more typical mood state.While bipolar disorder can cause a depressed mood, bipolar disorder and depression have one major difference. With bipolar disorder, you might have “up” and “down” mood states. With depression, though, your mood and emotions might remain “down” until you get treatment.Discover the differences between bipolar disorder and depression.Bipolar disorder symptoms in women vs. menMost research suggests that males and females receive bipolar disorder diagnoses roughly equally, though some studies suggest it may be more prevalent in females. However, the main symptoms of the disorder may vary, depending on the sex you were assigned at birth and your gender.Females with bipolar disorder tend to receive diagnoses later in life, often in their 20s or 30s. Sometimes, they might first notice symptoms during pregnancy or after childbirth. They’re also more likely to be diagnosed with bipolar II than bipolar I.Additionally, females living with bipolar disorder tend to experience:milder episodes of maniamore depressive episodes than manic episodesrapid cycling, or four or more episodes of mania and depression in 1 yearmore co-occurring conditionsFemales with bipolar disorder may also experience relapse more often, partly due to hormone changes related to menstruation, pregnancy, and menopause. In terms of bipolar disorder, relapse means having a mood episode after not having one for some time.Get the facts about bipolar disorder in females.Males with bipolar disorder, on the other hand, may:get a diagnosis earlier in lifeexperience less frequent but more severe episodes, especially manic episodesbe more likely to also have a substance use disordershow more aggression during episodes of maniaBipolar disorder in historically marginalized groupsResearch shows that people from historically marginalized groups, particularly those of African ancestry, are frequently misdiagnosed with other conditions like schizophrenia, especially if they exhibit symptoms of psychosis.While the symptoms of bipolar disorder can vary somewhat from person to person and can depend on the type, there are clear criteria for diagnosis. Research also suggests 50-75% of people living with bipolar disorder will experience some symptoms of psychosis, but this is stable across all racial and ethnic groups. Both these factors suggest that bias may play a role in this frequent misdiagnosis.Bipolar disorder in children and teensDiagnosing bipolar disorder in children is controversial, largely because children don’t always display the same bipolar disorder symptoms as adults. Their moods and behaviors may also not follow the standards doctors use to diagnose the disorder in adults.Many bipolar disorder symptoms that occur in children also overlap with symptoms of other conditions that commonly occur in children, such as attention deficit hyperactivity disorder (ADHD).However, in the last few decades, doctors and mental health professionals have come to recognize the condition in children. A diagnosis can help children get treatment, but reaching a diagnosis may take many weeks or months. It may be worth seeking care from a professional who specializes in treating children with mental health conditions.Like adults, children with bipolar disorder experience extreme mood shifts. They can appear very happy and show signs of excitable behavior, or seem very tearful, low, and irritable.All children experience mood changes, but bipolar disorder causes distinct and noticeable mood symptoms. Mood changes are also usually more extreme than a child’s typical change in mood.Manic symptoms in childrenSymptoms of mania in children can include:acting very silly and feeling overly happytalking fast and rapidly changing subjectshaving trouble focusing or concentratingengaging in behaviors that can have harmful effectshaving a very short temper that leads quickly to outbursts of angerhaving trouble sleeping and not feeling tired after sleep lossDepressive symptoms in childrenWith bipolar disorder, symptoms of depressive episodes in children can include:moping around, acting very sad, or crying frequentlysleeping too much or too littlehaving little energy for usual activities or showing no signs of interest in anythingcomplaining about not feeling well, including having frequent headaches or stomachachesfeelings of worthlessness or guilteating too little or too muchthoughts of death or suicideOther possible diagnosesSome of the behavior issues you notice in your child could suggest other mental health conditions, such as ADHD or depression. It’s also possible for children to have bipolar disorder with another condition.Your child’s doctor can offer more guidance and support with noting and tracking your child’s behaviors, which can help them find the right diagnosis.The correct diagnosis can play a major role in finding the most effective treatment for your child. Treatment, of course, can make a big difference in your child’s symptoms, not to mention their quality of life.Read more about bipolar disorder in children.Symptoms in teensShifting hormones, plus the life changes that naturally happen with puberty, can make teens seem extremely emotional from time to time.Yet drastic or rapidly fluctuating changes in mood may suggest a more serious condition, such as bipolar disorder, rather than typical teenage development.A bipolar disorder diagnosis is most common during the late teen and early adult years.Common symptoms of mania in teenagers include:being very happy“acting out” or misbehavingtaking part in behaviors that may have a harmful effect, like substance usethinking about sex more than usualbecoming overly sexual or sexually activehaving trouble sleeping, without signs of fatigue or being tiredhaving a very short temperhaving trouble staying focused or getting distracted easilyCommon symptoms of a depressive episode include:sleeping too much or too littleeating too much or too littlefeeling very sad and showing little excitabilitywithdrawing from activities and friendsthinking or talking about death and suicideRemember that many of these signs, like experimenting with substances and thinking about sex, aren’t uncommon teenage behaviors. But if they seem part of a larger pattern of shifting moods or start to affect their day-to-day life, they could be a sign of bipolar disorder or another condition.Learn more about bipolar disorder in teenagers and how to treat it.Bipolar disorder treatmentSeveral treatments can help you manage bipolar disorder symptoms. These include medications, counseling, and lifestyle measures. Some natural remedies can also have benefits.MedicationsRecommended medications may include:mood stabilizers, such as lithium (Lithobid)antipsychotics, such as olanzapine (Zyprexa)antidepressant-antipsychotics, such as fluoxetine-olanzapine (Symbyax)benzodiazepines, a type of anti-anxiety medication used for short-term treatmentPsychotherapyRecommended therapy approaches may include:Cognitive behavioral therapyCognitive behavioral therapy is a type of talk therapy that helps you identify and address unhelpful thoughts and change unwanted behavior patterns.Therapy offers a safe space to discuss ways to manage your symptoms. Your therapist can also offer support with:understanding thought patternsreframing distressing emotionslearning and practicing more helpful coping strategiesGet tips on finding the right therapist.PsychoeducationPsychoeducation is a therapeutic approach centered around helping you learn about a condition and its treatment. This knowledge can go a long way toward helping you and the supportive people in your life recognize early mood symptoms and manage them more effectively.Interpersonal and social rhythm therapyInterpersonal and social rhythm therapy focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics could lead to fewer mood episodes and less severe symptoms.Online therapy optionsInterested in online therapy? Our review of the best teletherapy options can help you find the right fit.Was this helpful?Other optionsOther approaches that can help ease symptoms include:electroconvulsive therapysleep medicationssupplementsacupunctureNatural remedies for bipolar disorderSome natural remedies might also help with bipolar disorder symptoms.You’ll always want to check with your doctor or psychiatrist before trying these remedies, though. In some cases, they could interfere with any medications you’re taking.The following herbs and supplements may help stabilize your mood and reduce symptoms of bipolar disorder when combined with medication and therapy:Omega-3: Some 2016 research suggests that taking an omega-3 supplement may help with symptoms of bipolar I. However, a 2021 study found weak support for using the supplement to treat depression symptoms in bipolar disorder.Rhodiola rosea: A 2013 review suggests this plant may help with moderate depression, so it could help treat depression associated with bipolar disorder, but this, too, has not been substantiated with newer research.S-adenosylmethionine (SAMe): SAMe is an amino acid supplement that may help ease symptoms of major depression and other mood disorders. However, it can induce mania and may interact with other medications. You should consult with a doctor before trying SAMe or any other herbal or natural remedies to help you manage your bipolar symptoms.Looking for more options? Consider these 10 alternative treatments.Lifestyle changesSome studies suggest that lifestyle measures can help reduce the severity of your bipolar disorder symptoms. These can include the following:eating a balanced dietgetting at least 150 minutes of exercise a weekmanaging your weightgetting weekly counseling or therapyThat said, the improvements reported by many of these studies were not significant, indicating that lifestyle interventions alone may not be enough to manage the condition. They may work better when combined with other treatments.Causes and risk factorsBipolar disorder is a fairly common mental health condition, but experts have yet to determine why some people develop the condition.Some potential causes of bipolar disorder include:GeneticsIf your parent or sibling has bipolar disorder, you’re more likely to develop the condition. The risk of developing bipolar disorder is 10% to 25% if one of your parents has the condition.Keep in mind, though, that most people who have a history of bipolar disorder in their family history don’t develop it.Learn more about the hereditary aspect of bipolar disorder.Your brainYour brain structure may affect your risk of developing bipolar disorder. Irregularities in brain chemistry, or the structure or functions of your brain, may increase this risk.Environmental factorsIt’s not just what’s in your body that can affect your chances of developing bipolar disorder. Outside factors can also play a part. These might include:extreme stresstraumatic experiencesphysical illnessLearn more about the potential causes of bipolar disorder.Can you prevent bipolar disorder?Once you begin to experience mood episodes, you can take steps to help reduce the severity of those episodes and lower your chances of experiencing additional mood episodes. But you can’t always prevent mood episodes entirely or keep the condition from developing in the first place.Future research may reveal more about the specific causes of bipolar disorder and give researchers more insight into potential ways of preventing the condition.Common co-occurring conditionsSome people living with bipolar disorder also have other mental health conditions. A 2019 research review suggests that anxiety disorders are among the most common.Other conditions that might occur alongside bipolar disorder include:substance use disorderseating disordersspecific phobiaADHDSymptoms of these conditions might show up more severely depending on your mood state. Anxiety, for example, tends to happen more commonly with depression, while substance use might be more likely with mania.If you have bipolar disorder, you may also have a higher chance of developing certain medical conditions, including:migraineheart diseasediabetesthyroid disordersTips for coping and supportIf you’ve noticed symptoms of bipolar disorder, a good first step involves reaching out to a doctor or therapist as soon as possible.Similarly, if a friend or loved one has symptoms, consider encouraging them to connect with a therapist as soon as possible. It never hurts to remind them that they have your understanding and support.Here’s how you can support a loved one living with bipolar disorder.Always take suicidal thoughts and behavior seriouslyIt’s not uncommon to have thoughts of suicide during an episode of depression or a mixed features mood episode.Remember that you’re not alone, and help is available 24/7, 365 days a year. To get confidential support, reach out to the Suicide and Crisis Lifeline at 988 or text “HOME” to 741741.If you think someone is at immediate risk of hurting themselves or someone else:Stay with them if you can. If not, call for help and support.Remove any guns, knives, medications, or other things that may cause harm.Listen, but don’t judge, argue, threaten, or yell.Learn more about helping someone during a crisis and get more crisis resources.Was this helpful?Living with bipolar disorderTreatment can help you manage mood episodes and cope with the symptoms they cause.Creating a care team can help you get the most out of treatment. Your team might involve:your primary doctora psychiatrist who manages your medicationsa therapist or counselor who provides talk therapyother professionals or specialists, such as a sleep specialist, acupuncturist, or massage therapista bipolar disorder support group or community of other people also living with bipolar disorderYou may need to try a few treatments before you find one that leads to improvement. Some medications work well for some people but not others. In a similar vein, some people find CBT very helpful, while others may see little improvement.It’s always best to be open with your care team about what works and what doesn’t. If something doesn’t help or makes you feel even worse, don’t hold back from letting them know. Your mental health matters and your care team should always support you in finding the most helpful approach.A little self-compassion can go a long way, too. Remember that bipolar disorder, like any other mental health condition, didn’t happen by choice. It’s not caused by anything you did or didn’t do.It’s OK (and pretty common) to feel frustrated when treatment doesn’t seem to work. Try to have patience and treat yourself kindly as you explore new approaches.Bipolar disorder and relationshipsBipolar disorder can affect your relationships. But these effects might appear most clearly in your closest relationships, like those with family members and romantic partners.When it comes to managing a relationship while living with bipolar disorder, honesty can always help. Being open about your condition can help your partner better understand your symptoms and how they can offer support.You might consider starting with a few basic details, including:how long you’ve had the conditionhow episodes of depression usually affect youhow episodes of mania usually affect youyour treatment approach, including therapy, medication, and coping strategiesanything they can do to helpWant more tips on maintaining a healthy relationship when you or a partner has bipolar disorder? Our guide can help.The bottom lineBipolar disorder is a lifelong condition, but that doesn’t mean it has to completely disrupt your life. While living with bipolar disorder certainly creates some challenges, sticking with your treatment plan, practicing regular self-care, and leaning on your support system can boost your overall well-being and keep symptoms to a minimum.Educating yourself and your loved ones about the condition can also have a lot of benefits. Get started with these resources:Depression and Bipolar Support AllianceHelp with Bipolar DisorderInternational Bipolar Foundation Last medically reviewed on January 25, 2023How we reviewed this article:SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Akinhanmi MO, et al. (2018). Racial disparities in bipolar disorder treatment and research: A call to action.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175457/Amamou B, et al. (2018). Unipolar mania: A particular aspect of bipolar disorder in Tunisia.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953021/Bains N, et al. (2022). Major depressive disorder.https://www.ncbi.nlm.nih.gov/books/NBK559078/Bauer IE, et al. (2017). Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744495/Bielecki JE, et al. (2022). Cyclothymic disorder.https://www.ncbi.nlm.nih.gov/books/NBK557877/Bipolar disorder. (n.d.).https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtmlBipolar disorder in children and teens. (2020).https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens/index.shtmlDailey MW, et al. (2022). Mania.https://www.ncbi.nlm.nih.gov/books/NBK493168/Dell'Osso B, et al. (2021). Has bipolar disorder become a predominantly female gender related condition? Analysis of recently published large sample studies.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779377Elowe J, et al. (2022). Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder.https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00280-6Jain A, et al. (2022). Bipolar affective disorder.https://www.ncbi.nlm.nih.gov/books/NBK558998/Menculini G, et al. (2022). Sex differences in bipolar disorders: Impact on psychopathological features and treatment response.https://www.frontiersin.org/articles/10.3389/fpsyt.2022.926594/fullNaguy A. (2017). Bipolar in women: Any gender-based difference?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461862/Parial S. (2015). Bipolar disorder in women.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539870/Qureshi NA, et al. (2013). Mood disorders and complementary and alternative medicine: a literature review.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660126/Sarris J, et al. (2022). Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.https://www.tandfonline.com/doi/pdf/10.1080/15622975.2021.2013041?needAccess=trueShah N, et al. (2017). Clinical practice guidelines for management of bipolar disorder.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310104/Shakeri J, et al. (2016). Effects of omega-3 supplement in the treatment of patients with bipolar I disorder.https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4882968/Spoorthy MS, et al. (2019). Comorbidity of bipolar and anxiety disorders: An overview of trends in research.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323556/Sylvia LG, et al. (2019). Pilot study of a lifestyle intervention for bipolar disorder: Nutrition exercise wellness treatment (new tx).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676479/Table 3.4 DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison. (2016).https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t4/?report=objectonlyTable 3.8 DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison. (2016).https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t9/?report=objectonlyTable 11 DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison. (2016).https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t7/?report=objectonlyVan Meter AR, et al. (2012). Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609426/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.Current VersionJan 25, 2023Written ByKimberly Holland, Crystal Raypole, Alina SharonEdited ByAlina SharonMedically Reviewed ByNicole Washington, DO, MPHCopy Edited BySiobhan DeRemerNov 29, 2021Written ByKimberly Holland, Crystal RaypoleEdited ByKelly MorrellMedically Reviewed ByTiffany Taft, PsyDCopy Edited ByEmily SchalkVIEW ALL HISTORY Share this articleMedically reviewed by Nicole Washington, DO, MPH — By Kimberly Holland and Crystal Raypole and Alina Sharon — Updated on January 25, 2023Read this nextAsk the Expert: What Are Mood Stabilizers for Bipolar Depression and How Do They Work?A psychiatrist answers common questions about mood stabilizers for bipolar depression.READ MOREFinding Your Own Support When You Care for a Person Living with Bipolar DisorderMedically reviewed by Tiffany Taft, PsyDCaring for a loved one who has bipolar disorder can be overwhelming and take a toll on your own mental health. These resources can help you find…READ MORECan a Brain Scan Detect Bipolar Disorder?Medically reviewed by Seunggu Han, M.D.Brain scans are an essential part of bipolar disorder research, but not of diagnosis. Psychiatrists usually diagnose bipolar disorder based on your…READ MOREWhere Do I Even Start? Managing Bipolar Disorder and WorkMedically reviewed by Nicole Washington, DO, MPHBipolar disorder is a mental condition causing severe shifts in mood. Learn how can to overcome the challenges of working with bipolar disorder.READ MORECan You Have Bipolar Disorder and an Anxiety Disorder at the Same Time?Medically reviewed by Marney A. White, PhD, MSDiscover the relationship between bipolar and anxiety disorders, which can often co-occur. Learn about shared symptoms, challenges, therapy, and more.READ MORECan I Get Bipolar Disorder Later in Life?Medically reviewed by Timothy J. Legg, PhD, PsyDWhile more common earlier in life, some people are diagnosed with bipolar disorder when they’re older. Learn more about late onset bipolar disorder…READ MORE‘Reacher’ Star Alan Ritchson Shares How He Manages Living with Bipolar DisorderAlan Ritchson, star of Amazon’s hit series, ‘Reacher,’ is sharing new details of how he manages living with bipolar disorder.READ MOREAbout UsContact UsPrivacy PolicyPrivacy SettingsAdvertising PolicyHealth TopicsMedical AffairsContent IntegrityNewsletters© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. See additional information.© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. 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Symptoms and Warning Signs of Bipolar Disorder

Symptoms and Warning Signs of Bipolar Disorder

Health ConditionsFeaturedBreast CancerIBD MigraineMultiple Sclerosis (MS)Rheumatoid ArthritisType 2 DiabetesSponsored TopicsArticlesAcid RefluxADHDAllergiesAlzheimer's & DementiaBipolar DisorderCancerCrohn's DiseaseChronic PainCold & FluCOPDDepressionFibromyalgiaHeart DiseaseHigh CholesterolHIVHypertensionIPFOsteoarthritisPsoriasisSkin Disorders and CareSTDsDiscoverWellness TopicsNutritionFitnessSkin CareSexual HealthWomen's HealthMental Well-BeingSleepProduct ReviewsVitamins & SupplementsSleepMental HealthNutritionAt-Home TestingCBDMen’s HealthOriginal SeriesFresh Food FastDiagnosis DiariesYou’re Not AlonePresent TenseVideo SeriesYouth in FocusHealthy HarvestThrough An Artist's EyeFuture of HealthPlanHealth ChallengesMindful EatingSugar SavvyMove Your BodyGut HealthMood FoodsAlign Your SpineFind CarePrimary CareMental HealthOB-GYNDermatologistsNeurologistsCardiologistsOrthopedistsLifestyle QuizzesWeight ManagementAm I Depressed? A Quiz for TeensAre You a Workaholic?How Well Do You Sleep?Tools & ResourcesHealth NewsFind a DietFind Healthy SnacksDrugs A-ZHealth A-ZConnectFind Your Bezzy CommunityBreast CancerInflammatory Bowel DiseasePsoriatic ArthritisMigraineMultiple SclerosisPsoriasisFollow us on social mediaHealthlineHealth ConditionsDiscoverPlanConnectSubscribeCould It Be Bipolar Disorder? Signs to Look forMedically reviewed by Karin Gepp, PsyD — By Kerry Weiss — Updated on January 13, 2023SymptomsCommon signsWhat it feels likeTalk with your doctorSummaryBipolar disorder is marked by mood highs and lows. However, the condition can be difficult to diagnose, as symptoms vary, and can often be caused by other conditionsWhat’s bipolar disorder?Bipolar disorder is a mental health condition that involves significantly high and low moods. Highs are periods of mania or hypomania, while lows are periods of depression. The changes in mood may also become mixed, so you might feel elated and depressed at the same time.The National Institute of Mental Health estimates that around 4.4% of adults in the United States experience bipolar disorder at some time. The symptoms usually appear between the ages of 18 to 29 years, but they can occur at any age, including childhood and the teenage years.Bipolar disorder can be hard to diagnose, but there are signs or symptoms that you can look for.Bipolar disorder symptomsThe signs and symptoms of bipolar disorder are varied. Many of these symptoms can also be caused by other conditions, making this condition hard to diagnose. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lays out the criteria for diagnosing bipolar disorder.Types and symptomsThere are four common types of bipolar disorder. Bipolar I and II are the most common types.Bipolar ITo have bipolar I, a person must experience manic episodes. In order for an event to be considered a manic episode, it must:include shifts in mood or behaviors that are unlike the person’s usual behaviorbe present most of the day, nearly every day during the episodelast at least 1 week, or be so extreme that the person needs immediate hospital carePeople with bipolar I typically have depressive episodes as well, but a depressive episode isn’t required to make the bipolar I diagnosis. For a diagnosis of bipolar I, the person should not have another condition that could explain the symptoms.Bipolar IIBipolar II also involves high and low moods, but depressive symptoms are more likely to dominate, and its manic symptoms are less severe. This less severe type of mania is known as hypomania.For a diagnosis of bipolar II disorder, a person must:have experienced at least one episode of major depressionhave had at least one episode of hypomanianot have another condition that could explain the symptomsCyclothymic disorderCyclothymic disorder involves changes in mood and shifts similar to bipolar I and II, but the shifts may be less dramatic. A person with cyclothymic disorder will have had symptoms of hypomania and episodes of depression for at least 2 years, or 1 year for children and teens.Bipolar disorder not otherwise specifiedBipolar disorder not otherwise specified is a general category for a person who only has symptoms of bipolar disorder that don’t match the three other categories. The symptoms are not enough to make a diagnosis of one of the other three types.Common signs of bipolar disorderThe signs of bipolar disorder can generally be divided into those for mania and those for depression.10 signs of maniaMania can cause other symptoms as well, but 10 of the key signs of this phase of bipolar disorder are:feeling overly happy or “high” for long periods of timefeeling jumpy or “wired”having a reduced need for sleeptalking very fast, often with racing thoughts and rapid changes of topicfeeling extremely restless or impulsivebecoming easily distractedfeelings of grandiosity, which is when you feel you’re very important or have important connectionsfeeling as if you can do anythingengaging in risky behavior, like having impulsive sex, gambling with life savings, or going on big spending spreeshaving a low appetite10 signs of depressionLike mania, depression can cause other symptoms as well, but here are 10 of the key signs of depression from bipolar disorder:feeling sad or hopeless for long periods of timewithdrawing from friends and familylosing interest in activities that you once enjoyedhaving a significant change in appetitefeeling severe fatigue or lack of energyfeeling slowed down and unable to carry out simple taskstalking slowlysleeping too much or too littlehaving problems with memory, concentration, and decision makingthinking about death or suicide or attempting suicideAn extremely high or low mood can sometimes involve hallucinations or delusions, known as psychosis. During a manic period the person may have delusions of grandeur. For example, they may believe they’re very important or have special powers. A person with depressive psychosis might believe they’ve committed a crime or are financially ruined. The person may also see, hear, or smell things that are not there. Substance useSubstance use disorder involves the use of substances like drugs or alcohol in a way that’s harmful for the person’s mental and physical health. Studies suggest that substance use disorder may be three to six times higher among people with bipolar disorder than in the general population.Having bipolar disorder alongside a substance use disorder can make it harder to treat either condition. It can also affect the outcome of each disorder. People with both disorders are more likely to have a lower quality of life, a less stable progression through treatment, and are more likely to consider suicide.Having a substance use disorder can also make it harder to get an accurate diagnosis. A doctor may have difficulty identifying which symptoms are due to bipolar disorder and which stem from substance use.Learn about the link between bipolar disorder and alcohol use disorder.Bipolar disorder or depression?Doctors sometimes find it hard to distinguish between bipolar disorder and depression. This can lead to misdiagnosis. People with bipolar disorder are more likely to seek help during a low mood because depression is more likely to have a negative impact on their health and well-being. During a high mood, they may feel exceptionally well.Factors that increase the chance of misdiagnosis include the following:Depression is the dominant mood.Depression is the first episode you have.You have experienced mania or hypomania but not realized it could be significant.It’s essential to get an accurate diagnosis in order to work out a treatment plan. Antidepressants may not be effective in treating bipolar disorder.In addition, some antidepressant medications can trigger a first manic or hypomanic episode if you’re susceptible to them. This could complicate both treatment and outcomes.If you go to see your doctor with depression, be sure to tell them about any of the following, as these can help get an accurate diagnosis:a family history of bipolar disorder or other mental health conditionsany other conditions that affect your mental or physical well-beingany medications, drugs, or other substances you’re taking or have used in the past if you’ve already tried antidepressants and they didn’t helpLearn how bipolar disorder is diagnosed.Symptoms in children and teensSymptoms of bipolar disorder usually emerge in early adulthood, though they can occur at any age. Sometimes, they can appear in children.Signs that a child may have bipolar disorder include:getting much more excited or irritable than other childrenhaving high and low moods that seem extreme compared with other childrenhaving mood changes that affect their behavior at school or homeChildren or teens who are experiencing a high mood may:appear excessively happy or silly for long periodshave a short tempertalk rapidly about many different thingshave difficulty sleeping but not be sleepyhave difficulty focusing on an activityhave racing thoughtsseem excessively interested in risky activities or take unusual risks Those with a low mood may:often feel sad for no apparent reasonhave a short temper or show hostility or angercomplain about aches and painssleep more than usualeat more or less than usualhave difficulty focusingfeel hopeless or worthlesshave difficulty maintaining relationshipshave little energylose interests in things they used to enjoythink about death or suicideThere are many reasons why children and teens can experience mood changes or moods that seem extreme. The hormonal changes in puberty can lead to fluctuations in mood. The symptoms of attention deficit hyperactivity disorder (ADHD) and other conditions can resemble those of bipolar disorder. If you’re concerned about yourself or a young person, seek medical help early. Whatever the reason for mood changes in a young person, getting a correct diagnosis can help manage the symptoms and prevent long-term complications.Suicide preventionIf you or someone you know is considering suicide or self-harm, please seek support:Dial 988 to reach the Suicide & Crisis Lifeline.Text “HOME” to the Crisis Textline at 741-741.Not in the United States? Find a helpline in your country with Befrienders Worldwide.Call 911 or your local emergency number if you feel it’s an emergency.While you wait for help to arrive, stay with someone if you can. Remove any weapons or substances that can cause harm. Remember, you are not alone.Was this helpful?What bipolar disorder feels likeHealthline connected with people living with bipolar disorder to hear a little bit about their experiences and feelings. Here’s what they shared: “I have found my bipolar disorder to be exhilarating, dark, and painful. I found that one of the benefits of this disorder was the creativity, energy, and euphoria that came with the mania. For the longest time, I didn’t realize that this was mania.”— MelissaWas this helpful?Bipolar disorder can affect many different aspects of day-to-day life, including energy levels and sleep. “It can be difficult to physically move. I tend to sleep 10, or even 12 hours a day.”— ErinWas this helpful?Intense feelings — from feeling like you can do anything to feeling hopeless — are among the most common experiences shared by many people living with bipolar disorder. “Everyone’s self-esteem fluctuates somewhat. But [with bipolar disorder] you are feeling on top of the world, like you can do no wrong and are the ‘best’ at everything one minute, and completely hopeless and self-flagellating the next.”— SueWas this helpful?Talk with your doctorIf you think that you or a loved one has signs or symptoms of bipolar disorder, your first step should be to talk with your doctor. Only a trained medical professional can diagnose this disorder, and diagnosis is key to getting proper treatment. Medication, therapy, or other treatment options can help you or your loved one manage symptoms and maximize quality of life.Learn more about treatments for bipolar disorder.SummaryBipolar disorder is a mental health condition that involves high and low moods. There are different types of bipolar disorder. Depending on the type, signs and symptoms can range from mania to depression. Symptoms of bipolar disorder can be similar to those of other conditions, including depression, substance use disorder, or ADHD. Getting a correct diagnosis can be challenging but is essential for getting the right treatment. Last medically reviewed on January 13, 2023How we reviewed this article:SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.American Psychiatric Association. (2013). Diagnostic and statistical manual on mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.Bipolar disorder. (n.d.).https://www.nimh.nih.gov/health/statistics/bipolar-disorderBipolar disorder. (2022).https://www.nimh.nih.gov/health/topics/bipolar-disorderBipolar disorder in children and teens. (2020).https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teensFornaro M, et al. (2016). The prevalence and predictors of bipolar and borderlinepersonality disorders comorbidity: Systematic review and meta-analysis.https://www.sciencedirect.com/science/article/abs/pii/S016503271531291X?via%3DihubJain A, et al. (2022). Bipolar affective disorder.https://www.ncbi.nlm.nih.gov/books/NBK558998/Moot W, et al. (2021). Functional and mood outcomes in bipolar disorder patients with and without substance use disorders undergoing psychotherapy.https://www.frontiersin.org/articles/10.3389/fpsyt.2021.661458/fullParial S. (2015). Bipolar disorder in women.https://journals.lww.com/indianjpsychiatry/Fulltext/2015/57002/Bipolar_disorder_in_women.11.aspxRolin D, et al. (2020). Is it depression or bipolar depression?https://journals.lww.com/jaanp/Fulltext/2020/10000/Is_it_depression_or_is_it_bipolar_depression_.12.aspxOur experts continually monitor the health and wellness space, and we update our articles when new information becomes available.Current VersionJan 13, 2023Written ByKerry WeissEdited ByKerry WeissMedically Reviewed ByKarin Gepp, PsyDCopy Edited BySuan PinedaNov 22, 2021Written ByThe Healthline Editorial TeamEdited ByYvette BrazierMedically Reviewed ByKarin Gepp, PsyDCopy Edited ByConnor RiceVIEW ALL HISTORY Share this articleMedically reviewed by Karin Gepp, PsyD — By Kerry Weiss — Updated on January 13, 2023Read this nextHow to Recognize and Treat Bipolar Disorder in TeensMedically reviewed by Timothy J. Legg, PhD, PsyDIf your teenager is experiencing regular mood swings, it may be more than just growing pains. Learn the signs of bipolar disorder in teens.READ MORESigns of Bipolar MisdiagnosisA bipolar misdiagnosis is not uncommon, especially if the diagnosis occurs before a person's first manic episode. READ MORECan I Get Bipolar Disorder Later in Life?Medically reviewed by Timothy J. Legg, PhD, PsyDWhile more common earlier in life, some people are diagnosed with bipolar disorder when they’re older. Learn more about late onset bipolar disorder…READ MOREWhat Is Bipolar Depression?Medically reviewed by Nicole Washington, DO, MPHBipolar depression has the same symptoms of major depression, but is accompanied by mania or hypomania. READ MORE‘Reacher’ Star Alan Ritchson Shares How He Manages Living with Bipolar DisorderAlan Ritchson, star of Amazon’s hit series, ‘Reacher,’ is sharing new details of how he manages living with bipolar disorder.READ MOREPeople with Perinatal or Postpartum Depression Face Higher Suicide RiskA new study shows women with perinatal depression are associated with a greater risk of dying by suicide, particularly during the first year of their…READ MOREAbout UsContact UsPrivacy PolicyPrivacy SettingsAdvertising PolicyHealth TopicsMedical AffairsContent IntegrityNewsletters© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. See additional information.© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. See additional information.AboutCareersAdvertise with usOUR BRANDSHealthlineMedical News TodayGreatistPsych CentralBezzy

Bipolar disorder - Diagnosis and treatment - Mayo Clinic

Bipolar disorder - Diagnosis and treatment - Mayo Clinic

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DiagnosisTo determine if you have bipolar disorder, your evaluation may include:

Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.

Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.

Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.

Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnosis in childrenAlthough diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.

Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.

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TreatmentTreatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:

Medications. Often, you'll need to start taking medications to balance your moods right away.

Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.

Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.

Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.

Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.

MedicationsA number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.

Medications may include:

Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).

Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.

Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic.

Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.

Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.

Finding the right medicationFinding the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, there are several others to try.

This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Side effectsMild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects.

Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.

Medications and pregnancyA number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.

Discuss treatment options with your doctor before you become pregnant, if possible. If you're taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away.

PsychotherapyPsychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.

Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.

Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment.

Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Other treatment optionsDepending on your needs, other treatments may be added to your depression therapy.

During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide.

Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants.

Treatment in children and teenagersTreatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes:

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.

Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder.

Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child.

Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

More InformationBipolar disorder care at Mayo ClinicBipolar medications and weight gainBipolar treatment: I vs. IICognitive behavioral therapyElectroconvulsive therapy (ECT)PsychotherapyTranscranial magnetic stimulationShow more related information

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Lifestyle and home remediesYou'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.

Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.

Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do.

Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder.

Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.

Alternative medicineThere isn't much research on alternative or complementary medicine — sometimes called integrative medicine — and bipolar disorder. Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder.

If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first:

Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.

Be honest with your doctors and mental health professionals. Tell them exactly which alternative or complementary treatments you use or would like to try.

Be aware of potential dangers. Alternative and complementary products aren't regulated the way prescription drugs are. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your doctor about the risks, including possible serious interactions with medications.

Coping and supportCoping with bipolar disorder can be challenging. Here are some strategies that can help:

Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. Help educate your family and friends about what you're going through.

Stay focused on your goals. Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.

Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.

Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.

Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

Preparing for your appointmentYou may start by seeing your primary care doctor or a psychiatrist. You may want to take a family member or friend along to your appointment, if possible, for support and to help remember information.

What you can doBefore your appointment, make a list of:

Any symptoms you've had, including any that may seem unrelated to the reason for the appointment

Key personal information, including any major stresses or recent life changes

All medications, vitamins, herbs or other supplements you're taking, and the dosages

Questions to ask your doctor

Some questions to ask your doctor may include:

Do I have bipolar disorder?

Are there any other possible causes for my symptoms?

What kinds of tests will I need?

What treatments are available? Which do you recommend for me?

What side effects are possible with that treatment?

What are the alternatives to the primary approach that you're suggesting?

I have these other health conditions. How can I best manage these conditions together?

Should I see a psychiatrist or other mental health professional?

Is there a generic alternative to the medicine you're prescribing?

Are there any brochures or other printed material that I can have?

What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctorYour doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

When did you or your loved ones first begin noticing your symptoms?

How frequently do your moods change?

Do you ever have suicidal thoughts when you're feeling down?

Do your symptoms interfere with your daily life or relationships?

Do you have any blood relatives with bipolar disorder or depression?

What other mental or physical health conditions do you have?

Do you drink alcohol, smoke cigarettes or use recreational drugs?

How much do you sleep at night? Does it change over time?

Do you go through periods when you take risks that you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

By Mayo Clinic Staff

Bipolar disorder care at Mayo Clinic

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Show references

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Birmaher B. Pediatric bipolar disorder: Epidemiology, pathogenesis, clinical manifestations, and course. http://www.uptodate.com/home. Accessed Dec. 2, 2016.

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Fountoulakis KN, et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BP-2017), part 2: Review, grading of the evidence and a precise algorithm. International Journal of Neuropsychopharmacology. In press. http://ijnp.oxfordjournals.org/content/early/2016/11/05/ijnp.pyw100.long. Accessed Dec. 6, 2016.

Beyer JL, et al. Nutrition and bipolar depression. Psychiatric Clinics of North America. 2016;39:75.

Qureshi NA, et al. Mood disorders and complementary and alternative medicine: A literature review. Neuropsychiatric Disease and Treatment. 2013;9:639.

Sansone RA, et al. Getting a knack for NAC: N-acetyl-cysteine. Innovations in Clinical Neuroscience. 2011;8:10.

Sylvia LG, et al. Nutrient-based therapies for bipolar disorder: A systematic review. Psychotherapy and Psychosomatics. 2013;82:10.

Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 27, 2016.

Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 4, 2017.

Post RM. Bipolar disorder in adults: Choosing maintenance treatment. http://www.uptodate.com/home. Accessed Jan. 4, 2016.

Janicak PG. Bipolar disorder in adults and lithium: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Jan. 4, 2017.

Stovall J. Bipolar disorder in adults: Pharmacotherapy for acute mania and hypomania. http://www.uptodate.com/home. Accessed Jan. 4, 2017.

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What is bipolar disorder?

What is bipolar disorder?

Signs and symptoms of bipolar disorder

Types of bipolar disorder

Getting an accurate diagnosis

Is it bipolar disorder or depression?

Bipolar disorder and suicide

Causes and triggers

Treatment

Bipolar Disorder

Bipolar Disorder Symptoms, Causes, Types, and Diagnosis

Do you have bipolar disorder? Is it bipolar I or bipolar II? Here’s how to recognize the signs and symptoms of manic depression, including mania, hypomania, bipolar depression, and cyclothymia.

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Melinda Smith, M.A., Jeanne Segal, Ph.D. and Lawrence Robinson

What is bipolar disorder?

Signs and symptoms of bipolar disorder

Types of bipolar disorder

Getting an accurate diagnosis

Is it bipolar disorder or depression?

Bipolar disorder and suicide

Causes and triggers

Treatment

What is bipolar disorder?

We all have our ups and downs, but with bipolar disorder (once known as manic depression or manic-depressive disorder) these peaks and valleys are more severe. Bipolar disorder causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they can interfere with your job or school performance, damage your relationships, and disrupt your ability to function in daily life.

During a manic episode, you might impulsively quit your job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.

The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting in unnecessary suffering. Since bipolar disorder tends to worsen without treatment, it’s important to learn what the symptoms look like. Recognizing the problem is the first step to feeling better and getting your life back on track.

Myths and facts about bipolar disorder

Myth:

People with bipolar disorder can't get better or lead a normal life.

Fact:

Many people with bipolar disorder have successful careers, happy family lives, and satisfying relationships. Living with bipolar disorder is challenging, but with treatment, healthy coping skills, and a solid support system, you can live fully while managing your symptoms.

Myth:

People with bipolar disorder swing back and forth between mania and depression.

Fact:

Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms.

Myth:

Bipolar disorder only affects mood.

Fact:

Bipolar disorder also affects your energy level, judgment, memory, concentration, appetite, sleep patterns, sex drive, and self-esteem. Additionally, bipolar disorder has been linked to anxiety, substance abuse, and health problems such as diabetes, heart disease, migraines, and high blood pressure.

Myth:

Aside from taking medication, there is nothing you can do to control bipolar disorder.

Fact:

While medication is the foundation of bipolar disorder treatment, therapy and self-help strategies also play important roles. You can help control your symptoms by exercising regularly, getting enough sleep, eating right, monitoring your moods, keeping stress to a minimum, and surrounding yourself with supportive people.

Signs and symptoms of bipolar disorder

Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.

There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

Mania symptoms

In the manic phase of bipolar disorder, it's common to experience feelings of heightened energy, creativity, and euphoria. If you're experiencing a manic episode, you may talk a mile a minute, sleep very little, and be hyperactive. You may also feel like you're all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. You may behave recklessly during a manic episode: gambling away your savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. You may also become angry, irritable, and aggressive—picking fights, lashing out when others don't go along with your plans, and blaming anyone who criticizes your behavior. Some people even become delusional or start hearing voices.

Common signs and symptoms of mania include:

Feeling unusually “high” and optimistic OR extremely irritable.

Unrealistic, grandiose beliefs about one's abilities or powers.

Sleeping very little, but feeling extremely energetic.

Talking so rapidly that others can't keep up.

Racing thoughts; jumping quickly from one idea to the next.

Highly distractible, unable to concentrate.

Impaired judgment and impulsiveness.

Acting recklessly without thinking about the consequences.

Delusions and hallucinations (in severe cases).

Hypomania symptoms

Hypomania is a less severe form of mania. In a hypomanic state, you'll likely feel euphoric, energetic, and productive, but will still be able to carry on with your day-to-day life without losing touch with reality. To others, it may seem as if you're merely in an unusually good mood. However, hypomania can result in bad decisions that harm your relationships, career, and reputation. In addition, hypomania often escalates to full-blown mania or is followed by a major depressive episode.

Bipolar depression symptoms

In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments.

Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse—triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. With bipolar depression, you may move and speak slowly, sleep a lot, and gain weight. In addition, you're more likely to develop psychotic depression—a condition in which you lose contact with reality—and to experience major problems in work and social functioning.

Common symptoms of bipolar depression include:

Feeling hopeless, sad, or empty

Irritability

Inability to experience pleasure

Fatigue or loss of energy

Physical and mental sluggishness

Appetite or weight changes

Sleep problems

Concentration and memory problems

Feelings of worthlessness or guilt

Thoughts of death or suicide

Symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Types of bipolar disorder

Since symptoms can vary so much from person to person, bipolar disorder is often broken down into different types, identified by the pattern of mania and depression.

Bipolar I Disorder (mania or a mixed episode)

This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.

Bipolar II Disorder (hypomania and depression)

In Bipolar II disorder, you don't experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.

Cyclothymia (hypomania and mild depression)

Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.

Unspecified or other types

If you experience symptoms that do not fit into another category, or they stem from another medical condition, such as substance abuse, your doctor may diagnose unspecified bipolar disorder.

What is rapid cycling?

Some people with bipolar disorder develop “rapid cycling” where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.

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Getting an accurate diagnosis

Getting an accurate diagnosis for bipolar disorder isn't always easy. The mood swings of bipolar disorder can be difficult to distinguish from other problems such as major depression, ADHD, and borderline personality disorder. For many people with bipolar disorder, it takes time and numerous doctor visits before the problem is correctly identified and treated.

Making the diagnosis of bipolar disorder can be tricky even for trained professionals, so it's best to see a psychiatrist with experience treating bipolar disorder rather than a family doctor or another type of physician. A psychiatrist specializes in mental health and is more likely to know about the latest research and treatment options.

[Read: Bipolar Disorder Test]

What to expect during the diagnostic exam

A diagnostic exam for bipolar disorder generally consists of the following:

Psychological evaluation – The doctor or bipolar disorder specialist will conduct a complete psychiatric history. You will answer questions about your symptoms, the history of the problem, any treatment you've previously received, and your family history of mood disorders.

Medical history and physical – There are no lab tests for identifying bipolar disorder, but your doctor should conduct a medical history and physical exam in order to rule out illnesses or medications that might be causing your symptoms. Screening for thyroid disorders is particularly important, as thyroid problems can cause mood swings that mimic bipolar disorder.

In addition to taking your psychiatric and medical history, your doctor may also talk to family members and friends about your moods and behaviors. Often, those close to you are able to give a more accurate and objective picture of your symptoms.

Are your symptoms caused by something else?

Medical conditions and medications that can mimic the symptoms of bipolar disorder include:

Thyroid disorders

Neurological disorders

Vitamin B12 deficiency

Drugs for Parkinson's disease

Corticosteroids

Antidepressants

Anti-anxiety drugs

Adrenal disorders (e.g. Addison's disease, Cushing's syndrome)

Is it bipolar disorder or depression?

Bipolar disorder is commonly misdiagnosed as depression since most people with bipolar disorder seek help when they're in the depressive stage of the illness. When they're in the manic stage, they don't recognize the problem. What's more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic.

Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse. So it's important to see a mood disorder specialist who can help you figure out what's really going on.

Do I have depression or bipolar disorder?

Indicators that your depression is really bipolar disorder include:

You've experienced repeated episodes of major depression.

You had your first episode of major depression before age 25.

You have a first-degree relative with bipolar disorder.

When you're not depressed, your mood and energy levels are higher than most people's.

When you're depressed, you oversleep and overeat.

Your episodes of major depression are short (less than 3 months.)

You've lost contact with reality while depressed.

You've had postpartum depression before.

You've developed mania or hypomania while taking an antidepressant.

Your antidepressant stopped working after several months.

Bipolar disorder and suicide

The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.

Suicide warning signs include:

Talking about death, self-harm, or suicide.

Feeling hopeless or helpless.

Feeling worthless or like a burden to others.

Acting recklessly, as if one has a “death wish”.

Putting affairs in order or saying goodbye.

Seeking out weapons or pills that could be used to commit suicide.

Take any thoughts or talk of suicide seriously

If you or someone you care about is suicidal, call the 988 Suicide and Crisis Lifeline in the U.S. at 988 or visit IASP or Suicide.org to find a helpline in your country. You can also read Suicide Prevention.

Causes and triggers

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.

External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

Stress. Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes—either good or bad—such as getting married, going away to college, losing a loved one, getting fired, or moving.

Substance Abuse. While substance abuse doesn't cause bipolar disorder, it can bring on an episode or worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

Medication. Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

Seasonal Changes. Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.

Sleep Deprivation. Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

Treatment

If you spot the symptoms of bipolar disorder in yourself or someone else, don't wait to get help. Ignoring the problem won't make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. But bipolar disorder is highly treatable, so diagnosing the problem and starting treatment as early as possible can help prevent these complications.

If you're reluctant to seek treatment because you like the way you feel when you're manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.

Treatment basics

Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it's important to continue treatment even when you're feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.

Hotlines and support

In the U.S.

Call the NAMI HelpLine at 1-800-950-6264 or find DBSA Chapters/Support Groups in your area. (Depression and Bipolar Support Alliance)

UK

Call the peer support line at 0333 323 3880 and leave a message for a return call or Find a Support Group near you. (Bipolar UK)

Australia

Call the Sane Helpline at 1800 187 263 or find a local Support Group. (Bipolar Australia)

Canada

Visit Finding Help for links to provincial helplines and support groups. (Mood Disorders Society of Canada)

India

Call the Vandrevala Foundation Helpline (India) at 1860 2662 345 or 1800 2333 330

Last updated or reviewed on February 5, 2024

More Information

Helpful links

Bipolar Disorder

- Symptoms, causes, and treatment. (National Institute of Mental Health)

Rapid Cycling

- Signs, symptoms, and causes of rapid cycling in bipolar disorder. (Depression and Bipolar Support Alliance)

Bipolar

- Workbook and other self-help resources. (Centre for Clinical Interventions)

References

Bipolar and Related Disorders. (2013) In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association.

Link

“NIMH » Bipolar Disorder.” Accessed October 20, 2021.

Link

Butler, Mary, Snezana Urosevic, Priyanka Desai, Scott R. Sponheim, Jonah Popp, Victoria A. Nelson, Viengneesee Thao, and Benjamin Sunderlin. “Treatment for Bipolar Disorder in Adults: A Systematic Review.” Agency for Healthcare Research and Quality (AHRQ), August 7, 2018.

Link

Tondo, Leonardo, Gustavo H. Vázquez, and Ross J. Baldessarini. “Depression and Mania in Bipolar Disorder.” Current Neuropharmacology 15, no. 3 (April 2017): 353–58.

Link

Solé, Brisa, Esther Jiménez, Carla Torrent, Maria Reinares, Caterina Del Mar Bonnin, Imma Torres, Cristina Varo, et al. “Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies.” The International Journal of Neuropsychopharmacology 20, no. 8 (August 1, 2017): 670–80.

Link

Vieta, Eduard, Estela Salagre, Iria Grande, André F. Carvalho, Brisa S. Fernandes, Michael Berk, Boris Birmaher, Mauricio Tohen, and Trisha Suppes. “Early Intervention in Bipolar Disorder.” The American Journal of Psychiatry 175, no. 5 (May 1, 2018): 411–26.

Link

Bobo, William V. “The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update.” Mayo Clinic Proceedings 92, no. 10 (October 2017): 1532–51.

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Bonnín, Caterina Del Mar, María Reinares, Anabel Martínez-Arán, Esther Jiménez, Jose Sánchez-Moreno, Brisa Solé, Laura Montejo, and Eduard Vieta. “Improving Functioning, Quality of Life, and Well-Being in Patients With Bipolar Disorder.” The International Journal of Neuropsychopharmacology 22, no. 8 (August 1, 2019): 467–77.

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Rolin, Donna, Jessica Whelan, and Charles B. Montano. “Is It Depression or Is It Bipolar Depression?” Journal of the American Association of Nurse Practitioners 32, no. 10 (October 2020): 703–13.

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Hearing, CM, WC Chang, KL Szuhany, T Deckersbach, AA Nierenberg, and LG Sylvia. “Physical Exercise for Treatment of Mood Disorders: A Critical Review.” Current Behavioral Neuroscience Reports 3, no. 4 (December 2016): 350–59.

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Melo, Matias Carvalho Aguiar, Elizabeth De Francesco Daher, Saulo Giovanni Castor Albuquerque, and Veralice Meireles Sales de Bruin. “Exercise in Bipolar Patients: A Systematic Review.” Journal of Affective Disorders 198 (July 2016): 32–38.

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Overview - Bipolar disorder

Bipolar disorder is a mental health condition that affects your moods, which can swing from 1 extreme to another. It used to be known as manic depression.

Symptoms of bipolar disorder

People with bipolar disorder have episodes of:depression – feeling very low and lethargicmania – feeling very high and overactiveSymptoms of bipolar disorder depend on which mood you're experiencing.Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer).

Depression

You may initially be diagnosed with clinical depression before you have a manic episode, after which you may be diagnosed with bipolar disorder.During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.If you're feeling suicidal, call 999 or go to your nearest A&E department as soon as possible.If you're feeling very depressed, contact a GP, your care co-ordinator or speak to a local mental health crisis team as soon as possible.Find a local NHS urgent mental health helplineYou could also get help from NHS 111 if you're not sure what to do or if you cannot speak to your local NHS urgent mental health helpline.You can call 111 or get help from 111 online.If you want to talk to someone confidentially, call the Samaritans free on 116 123. You can talk to them 24 hours a day, 7 days a week.Or visit the Samaritans website or email jo@samaritans.org.

Mania

During a manic phase of bipolar disorder, you may:feel very happyhave lots of energy, ambitious plans and ideasspend large amounts of money on things you cannot afford and would not normally wantIt's also common to:not feel like eating or sleepingtalk quicklybecome annoyed easilyYou may feel very creative and view the manic phase of bipolar as a positive experience.But you may also experience symptoms of psychosis, where you see or hear things that are not there or become convinced of things that are not true.

Treatments for bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.But there are several options for treating bipolar disorder that can make a difference.They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.The following treatment options are available:medicine to prevent episodes of mania and depression – these are known as mood stabilisers, and you take them every day on a long-term basismedicine to treat the main symptoms of depression and mania when they happenlearning to recognise the triggers and signs of an episode of depression or maniapsychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationshipslifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleepIt's thought using a combination of different treatment methods is the best way to control bipolar disorder.Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.This includes self-help and learning to deal with the practical aspects of a long-term condition.

Find out more about living with bipolar disorder

Bipolar disorder and pregnancy

Bipolar disorder, like all other mental health problems, can get worse during pregnancy. But specialist help is available if you need it.Find out more:Tommy's: bipolar disorder in pregnancyBipolar UK: bipolar disorder, pregnancy and childbirth

What causes bipolar disorder?

The exact cause of bipolar disorder is unknown, although it's believed a number of things can trigger an episode.These include:extreme stressoverwhelming problemslife-changing eventsgenetic and chemical factors

Who's affected

Bipolar disorder is fairly common, and around 1 in every 100 people will be diagnosed with it at some point in their life.Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19.Men and women from all backgrounds are equally likely to develop bipolar disorder.The pattern of mood swings in bipolar disorder varies widely. For example, some people only have a couple of bipolar episodes in their lifetime and are stable in between, while others have many episodes.

Bipolar disorder and driving

If you have bipolar disorder, you must inform the Driver and Vehicle Licensing Agency (DVLA) as it may affect your driving.Find out more about bipolar disorder and driving on GOV.UK

Information:

Social care and support guideIf you:need help with day-to-day living because of bipolar disordercare for someone regularly because they have bipolar disorder (including family members)Our guide to care and support explains your options and where you can get support.

More in

Bipolar disorder

Overview - Bipolar disorder

Symptoms - Bipolar disorder

Causes - Bipolar disorder

Diagnosis - Bipolar disorder

Treatment - Bipolar disorder

Living with - Bipolar disorder

Page last reviewed: 3 January 2023

Next review due: 3 January 2026

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Updated on January 08, 2021

Bipolar disorder is a mental health condition defined by periods (or episodes) of extreme mood disturbances that affect mood, thoughts, and behavior. There are two main types of bipolar disorders. Bipolar I disorder involves episodes of severe mania and often depression. Bipolar II disorder involves a less severe form of mania called hypomania. There is also a third type known as cyclothymic disorder.

Estimates suggest that around 4.4% of U.S. adults will have bipolar disorder at some point in their lives. Genetics are thought to play a significant role, although brain abnormalities and environmental factors also contribute as causes of bipolar disorder. Mood stabilizers are usually the first-line treatment, but electroconvulsive therapy (ECT) may be used to address severe symptoms.

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Frequently Asked Questions

What causes bipolar disorder?

The exact causes of bipolar disorder are not entirely understood. Research has shown that genetics play a significant role. Other causes include changes in the brain as well as environmental factors including childhood trauma or stress caused by major life changes. Understanding the causes may help scientists develop ways to prevent or treat the condition.

Learn More:

Understanding the Causes of Bipolar Disorder

Is bipolar disorder genetic?

Research suggests there is a strong genetic component in bipolar disorder. Twin studies have found that when one identical twin has the condition, the likelihood that their twin sibling will also have it is around 40%. While there is a genetic vulnerability, inherited factors interact with environmental influences that can play a role in triggering the disorder’s onset.

Learn More:

Can You Inherit Bipolar Disorder?

How is bipolar disorder treated?

Bipolar disorder is typically treated with medications and sometimes electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), therapy, and psychoeducation. Common medications include mood stabilizers or anticonvulsants, as well as second or third generation antipsychotics. Antidepressants are typically avoided if possible due to risks including mania and rapid cycling.

Learn More:

Treatment Options for Bipolar Disorder

Is bipolar disorder considered a disability?

Your condition may be considered a disability that is protected by the Americans with Disabilities Act (ADA) or qualifies you for disability payments. If your disability substantially limits your work, you may be able to request reasonable accommodations from your employer. You may qualify for disability benefits if your condition makes it impossible for you to maintain employment.

Learn More:

Does Bipolar Disorder Qualify You for Disability?

How do you know if you're bipolar?

Only a doctor or qualified mental health professional can diagnose you with bipolar disorder. You may want to see your doctor if you are experiencing symptoms of mania, depression, or both. Symptoms of mania can include talking excessively, racing thoughts, decreased sleep, and delusions. Symptoms of depression may include fatigue, prolonged sadness, and loss of interest in activities.

Learn More:

Symptoms of Bipolar Disorder

Key Terms

Bipolar 1 Disorder

Bipolar 2 Disorder

Cyclothymic Disorder

Mania

Hypomania

Depression

Psychotherapy

Major Depressive Disorder

Psychiatric Assessment

Mood Charting

Bipolar 1 Disorder

This type of bipolar disorder involves the presence of at least one manic episode. Manic episodes may last seven days or longer or be severe enough that a person requires acute care. People usually experience depressive episodes as well, but they may also have mixed episodes where they experience depression and mania at the same time.

Bipolar 2 Disorder

This type of bipolar disorder is marked by periods of depressive and hypomanic episodes without periods of full-blown mania. It involves at least one episode of depression that lasts at least two weeks and one episode of hypomania that lasts for at least four days. During hypomanic episodes, people have symptoms of mania but are still able to function.

Cyclothymic Disorder

This condition, also known as cyclothymia, is marked by periods of cycling between hypomania and depressive symptoms. These symptoms are persistent and  last for at least two years, but they do not meet the criteria to qualify for a diagnosis as a hypomanic or depressive episode. People who have cyclothymic disorder may have a higher risk for later developing bipolar disorder.

Diagnostic Criteria for Cyclothymic Disorder

Mania

Mania is a phase of bipolar disorder that involves elevated periods of mood, energy, thoughts, and other behaviors. Common symptoms of mania include rapid and excessive talking, grandiose thoughts and beliefs, decreased sleep, flights of ideas or racing thoughts, an inability to keep still, and trouble concentrating.

Signs of Bipolar Mania

Hypomania

Hypomania is a symptom of bipolar disorder that involves racing thoughts, impulsive and other out of character behaviors, and elevated moods. It is marked by increased excitability, irritability, and excess energy. People may seem restless, overly talkative, highly distracted, or overly focused on specific activities. A decreased need for sleep, engaging in risky behaviors, and inappropriate social behavior can also be symptoms.

What Is Hypomania?

Depression

Depression is characterized by a persistent low mood and loss of interest in activities that can have a significant impact on a person's ability to function in daily life. Bipolar depression typically presents with increased sleep, increased appetite (often with carbohydrate cravings), and increased rejection sensitivity.

Can Depression Turn Into Bipolar Disorder?

Psychotherapy

Psychotherapy is an approach to the treatment of mental illness that focuses on thoughts, emotions, and behaviors. For bipolar disorder, psychotherapy often focuses on helping people identify and manage their moods and identify the triggers that contribute to depressive, manic, or hypomanic episodes.

What Is Psychotherapy?

Major Depressive Disorder

Major depressive disorder involves persistently low mood and loss of interest in activities. These symptoms can lead to both physical and behavioral symptoms including poor concentration, low energy, changes in sleep, changes in appetite, poor self-esteem, and difficulty managing daily tasks. Treatment often involves medication, psychotherapy, or a combination of the two.

Symptoms of Depression

Psychiatric Assessment

A psychiatric assessment involves gathering information about mental health symptoms in order to make a diagnosis. An assessment often involves getting a physical exam, providing a medical history, and answering questions about the nature, duration, and severity of your symptoms. A mental health professional can then use this information to make a diagnosis and recommend a treatment plan.

Is There a Mental Illness Test?

Mood Charting

If you have bipolar disorder, charting your moods can be a useful way to look at symptom patterns over time. Monitoring your symptoms on an ongoing basis allows you to learn to recognize stressful life events that may trigger the onset of symptoms. Printable mood charts can be helpful, but there are also mobile apps available.

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Page Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC. 2013.

National Institute of Mental Health. Bipolar disorder. Updated November 2017.

National Institute of Mental Health. Bipolar disorder. Updated January 2020.

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