Bipolar Disorder

Do you have periods of time when you feel unusually “up” (happy and outgoing, or irritable), and other periods when you feel “down” (unusually sad or anxious)? During “up” periods, do you experience increased energy or activity and a decreased need for sleep? During “down” times, do you feel low energy, hopelessness, or have thoughts of death or suicide?

If fluctuating mood and energy levels cause distress or interfere with daily functioning, it may be a sign of bipolar disorder.

What Is Bipolar Disorder?

Bipolar disorder is a mental illness that can be chronic (persistent or constantly recurring) or episodic (occurring occasionally and at irregular intervals). It was previously referred to as manic-depressive disorder or manic depression.

Everyone experiences normal ups and downs. With bipolar disorder, the range of mood changes can be extreme.

People with bipolar disorder may experience:

• Manic episodes — unusually elevated or irritable mood with increased activity levels

• Depressive episodes — sadness, hopelessness, or very low activity levels

• Hypomanic episodes — similar to manic episodes but less severe

• Mixed episodes — symptoms of mania and depression occurring at the same time

Symptoms often begin in late adolescence or early adulthood, although children may also experience bipolar symptoms. Bipolar disorder usually requires lifelong treatment and does not go away on its own. With appropriate care, many people experience improved functioning and quality of life.

Symptoms of Bipolar Disorder

Mood episodes last at least one to two weeks, sometimes longer. During an episode, symptoms occur most of the day, nearly every day, and represent a noticeable change in mood and behavior.

Symptoms of a Manic Episode

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

• Feeling jumpy or wired

• Decreased need for sleep

• Racing thoughts

• Talking fast about many different topics

• Excessive involvement in pleasurable activities (spending, sex, risk-taking)

• Feeling unusually important, talented, or powerful

• Increased goal-directed activity

• Being easily distracted

Symptoms of a Depressive Episode

• Feeling very down, sad, anxious, or empty

• Feeling slowed down or restless

• Trouble concentrating or making decisions

• Sleeping too little or too much

• Loss of interest in most activities

• Low energy or fatigue

• Feeling hopeless or worthless

• Thinking about death or suicide

Between episodes, mood may return to a healthy baseline. Without adequate treatment, episodes may become more frequent over time.

Types of Bipolar Disorder

There are three primary types of bipolar disorder:

Bipolar I Disorder

Defined by manic episodes lasting at least 7 days (most of the day, nearly every day) or manic symptoms severe enough to require hospitalization. Depressive episodes usually occur as well and typically last at least 2 weeks. Rapid cycling refers to experiencing four or more episodes of mania or depression within a year.

Bipolar II Disorder

Defined by a pattern of depressive and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes seen in Bipolar I disorder.

Cyclothymic Disorder (Cyclothymia)

Defined by recurrent hypomanic and depressive symptoms that are not intense enough or do not last long enough to meet criteria for full episodes.

Other specified and unspecified bipolar and related disorders refer to symptoms that do not fit neatly into the above categories but still cause impairment.

What Causes Bipolar Disorder?

The exact cause is unknown. Research suggests a combination of factors may contribute:

Genetics

Bipolar disorder often runs in families. People with certain genes are more likely to develop the condition. However, genes alone do not determine who develops bipolar disorder.

Brain Structure and Function

Studies suggest differences in brain structure and function among people with bipolar disorder. Ongoing research aims to better understand these differences and improve treatment.

How Is Bipolar Disorder Diagnosed?

Diagnosis involves evaluation by a qualified health care provider or mental health professional. Assessment may include:

• A physical exam

• Medical testing to rule out other conditions

• Review of symptoms and mood history

• Evaluation of severity, duration, and frequency of episodes

Misdiagnosis can occur because bipolar symptoms may resemble those of other mental or medical conditions, including thyroid disorders, substance use, schizophrenia, or major depressive disorder.

Conditions That Can Co-Occur

Many individuals with bipolar disorder also experience:

• Anxiety disorders

• Attention-deficit/hyperactivity disorder (ADHD)

• Substance misuse

• Eating disorders

Some people may experience psychotic symptoms (hallucinations or delusions), especially during severe mood episodes.

How Is Bipolar Disorder Treated?

Treatment helps many people, including those with severe forms of the illness. Treatment typically includes medication, psychotherapy, or both.

Medications

Commonly prescribed medications include:

• Mood stabilizers (e.g., lithium, valproate)

• Atypical antipsychotics

• Antidepressants (usually in combination with a mood stabilizer to prevent triggering mania)

Lithium has been shown to reduce suicide risk. Some individuals require multiple medication trials to determine the most effective option.

For updated medication safety information, visit the U.S. Food and Drug Administration (FDA).

Psychotherapy

Psychotherapy (talk therapy) helps individuals identify and change troubling thoughts, emotions, and behaviors. Effective approaches may include:

• Interpersonal and social rhythm therapy

• Cognitive behavioral therapy (CBT)

• CBT for insomnia (particularly helpful in bipolar depression)

Learn more about psychotherapy at: https://www.nimh.nih.gov/health/topics/psychotherapies

Other Treatments

Additional treatments may include:

• Electroconvulsive therapy (ECT) — used for severe or treatment-resistant cases

• Transcranial magnetic stimulation (TMS) — brain stimulation using magnetic waves

• Light therapy — particularly helpful for seasonal patterns of depression

For information about complementary health approaches, visit National Center for Complementary and Integrative Health.

Coping With Bipolar Disorder

Living with bipolar disorder can be challenging, but the following may help:

• Stay consistent with treatment

• Keep medical and therapy appointments

• Take medications as prescribed

• Maintain regular routines for sleep, eating, and exercise

• Engage in regular physical activity

• Track mood changes

• Seek social support

• Be patient — improvement takes time

Long-term, ongoing treatment can help manage symptoms and support a healthy life.

If You Are in Immediate Distress

If you or someone you know is in immediate distress or thinking about self-harm:

Call or text 988 (Suicide & Crisis Lifeline), visit https://988lifeline.org or call 911 in a medical emergency.