Bipolar
Disorder
Do you have periods of time when you feel unusually “up” (happy and
outgoing, or irritable), but other periods when you feel “down”
(unusually sad or anxious)? During the “up” periods, do you have
increased energy or activity and feel a decreased need for sleep, while
during the “down” times you have low energy, hopelessness, and
sometimes suicidal thoughts? Do these symptoms of fluctuating mood
and energy levels cause you distress or affect your daily functioning?
Some people with these symptoms have a lifelong but treatable mental
illness called bipolar disorder.
What is bipolar disorder?
Bipolar disorder is a mental illness that can be chronic (persistent or constantly
reoccurring) or episodic (occurring occasionally and at irregular intervals). People
sometimes refer to bipolar disorder with the older terms “manic-depressive
disorder” or “manic depression.”
Everyone experiences normal ups and downs, but with bipolar disorder, the
range of mood changes can be extreme. People with the disorder have manic
episodes, or unusually elevated moods in which the individual might feel very
happy, irritable, or “up,” with a marked increase in activity level. They might also
have depressive episodes, in which they feel sad, indifferent, or hopeless,
combined with a very low activity level. Some people have hypomanic episodes,
which are like manic episodes, but not severe enough to cause marked
impairment in social or occupational functioning or require hospitalization.
Most of the time, bipolar disorder symptoms start during late adolescence or early
adulthood. Occasionally, children may experience bipolar disorder symptoms.
Although symptoms may come and go, bipolar disorder usually requires lifelong
treatment and does not go away on its own. Bipolar disorder can be an important
factor in suicide, job loss, ability to function, and family discord. However, proper
treatment can lead to better functioning and improved quality of life.
What are the symptoms of bipolar disorder?
Symptoms of bipolar disorder can vary. An individual with the disorder may have
manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has
both manic and depressive symptoms. These mood episodes cause symptoms
that last a week or two, or sometimes longer. During an episode, the symptoms
last every day for most of the day. Feelings are intense and happen with changes
in behavior, energy levels, or activity levels that are noticeable to others. In
between episodes, mood usually returns to a healthy baseline. But in many cases,
without adequate treatment, episodes occur more frequently as time goes on.
Symptoms of a Manic Episode Symptoms of a Depressive Episode
Feeling very up, high, elated, Feeling very down or sad,
extremely irritable, or touchy or anxious
Feeling jumpy or wired, or being Feeling slowed down or restless
more active than usual
Racing thoughts Trouble concentrating or making
decisions
Decreased need for sleep Trouble falling asleep, waking up too
early, or sleeping too much
Talking fast about a lot of different Talking very slowly, feeling unable to
things (“flight of ideas”) find anything to say, or forgetting a lot
Excessive appetite for food, drinking, Lack of interest in almost all activities
sex, or other pleasurable activities
Feeling able to do many things at Unable to do even simple things
once without getting tired
Feeling unusually important, talented, Feeling hopeless or worthless, or
or powerful thinking about death or suicide
Some people with bipolar disorder may have milder symptoms than others. For
example, hypomanic episodes may make an individual feel very good and
productive; they may not feel like anything is wrong. However, family and friends
may notice the mood swings and changes in activity levels as unusual behavior,
and depressive episodes may follow hypomanic episodes.
Types of Bipolar Disorder
People are diagnosed with three basic types of bipolar disorder that involve clear
changes in mood, energy, and activity levels. These moods range from manic
episodes to depressive episodes.
● Bipolar I disorder is defined by manic episodes that last at least 7 days (most
of the day, nearly every day) or when manic symptoms are so severe that
hospital care is needed. Usually, separate depressive episodes occur as well,
typically lasting at least 2 weeks. Episodes of mood disturbance with mixed
features are also possible. The experience of four or more episodes of mania
or depression within a year is termed “rapid cycling.”
● Bipolar II disorder is defined by a pattern of depressive and hypomanic episodes,
but the episodes are less severe than the manic episodes in bipolar I disorder.
● Cyclothymic disorder (also called cyclothymia) is defined by recurrent
hypomanic and depressive symptoms that are not intense enough or do not
last long enough to qualify as hypomanic or depressive episodes.
“Other specified and unspecified bipolar and related disorders” is a diagnosis
that refers to bipolar disorder symptoms that do not match the three major types
of bipolar disorder.
What causes bipolar disorder?
The exact cause of bipolar disorder is unknown. However, research suggests that
a combination of factors may contribute to the illness.
Genes
Bipolar disorder often runs in families, and research suggests this is mostly
explained by heredity—people with certain genes are more likely to develop
bipolar disorder than others. Many genes are involved, and no one gene can
cause the disorder.
But genes are not the only factor. Studies of identical twins have shown that one
twin can develop bipolar disorder while the other does not. Though people with a
parent or sibling with bipolar disorder are more likely to develop it, most people
with a family history of bipolar disorder will not develop it.
Brain Structure and Function
Research shows that the brain structure and function of people with bipolar
disorder may differ from those of people who do not have bipolar disorder or
other mental disorders. Learning about the nature of these brain changes helps
researchers better understand bipolar disorder and, in the future, may help
predict which types of treatment will work best for a person with bipolar disorder.
How is bipolar disorder diagnosed?
To diagnose bipolar disorder, a health care provider may complete a physical
exam, order medical testing to rule out other illnesses, and refer the person for an
evaluation by a mental health professional.
Bipolar disorder is diagnosed based on the severity, length, and frequency of an
individual’s symptoms and experiences over their lifetime.
Some people have bipolar disorder for years before it’s diagnosed for several
reasons. People with bipolar II disorder may seek help only for depressive
episodes and hypomanic episodes may go unnoticed.
Misdiagnosis may happen because some bipolar disorder symptoms are like
those of other illnesses. For example, people with bipolar disorder who also have
psychotic symptoms can be misdiagnosed with schizophrenia. Some health
conditions, such as thyroid disease, can cause symptoms like those of bipolar
disorder. The effects of recreational and illicit drugs can sometimes mimic or
worsen mood symptoms.
Conditions That Can Co-Occur With Bipolar Disorder
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, such as
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 symptoms over the course of the illness and the person’s family
history can help determine whether a person has bipolar disorder along with
another disorder.
How is bipolar disorder treated?
Treatment helps many people, even those with the most severe forms of bipolar
disorder. Mental health professionals treat bipolar disorder with medications,
psychotherapy, or a combination of treatments.
Medications
Certain medications can help control the symptoms of bipolar disorder. Some
people may need to try several different medications before finding the ones that
work best. The most common types of medications that doctors 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. While bipolar depression is often treated with
antidepressant medication, a mood stabilizer must be taken as well, as an
antidepressant alone can trigger a manic episode or rapid cycling in a person
with bipolar disorder. Medications that target sleep or anxiety are sometimes
added to mood stabilizers as part of a treatment plan.
Talk with your health care provider to understand the risks and benefits of each
medication. Report any concerns about side effects to your health care provider
right away. Avoid stopping medication without talking to your health care provider
first. Read the latest medication warnings, patient medication guides, and
information on newly approved medications on the Food and Drug Administration
(FDA) website at [Link]/drugsatfda.
Psychotherapy
Psychotherapy (sometimes called “talk therapy”) is a term for various treatment
techniques that aim to help a person identify and change troubling emotions,
thoughts, and behaviors. Psychotherapy can offer support, education, skills, and
strategies to people with bipolar disorder and their families.
Some types of psychotherapy can be effective treatments for bipolar disorder
when used with medications, including interpersonal and social rhythm therapy,
which aims to understand and work with an individual’s biological and social
rhythms. Cognitive behavioral therapy (CBT) is an important treatment for
depression, and CBT adapted for the treatment of insomnia can be especially
helpful as a component of the treatment of bipolar depression. Learn more about
psychotherapy at [Link]/psychotherapies.
Other Treatments
Some people may find other treatments helpful in managing their bipolar
disorder symptoms.
● Electroconvulsive therapy (ECT) is a brain stimulation procedure that can help
relieve severe symptoms of bipolar disorder. ECT is usually only considered if
an individual’s illness has not improved after other treatments such as
medication or psychotherapy, or in cases that require rapid response, such as
with suicide risk or catatonia (a state of unresponsiveness).
● Transcranial Magnetic Stimulation (TMS) is a type of brain stimulation that
uses magnetic waves, rather than the electrical stimulus of ECT, to relieve
depression over a series of treatment sessions. Although not as powerful as
ECT, TMS does not require general anesthesia and presents little risk of
memory or adverse cognitive effects.
● Light Therapy is the best evidence-based treatment for seasonal affective
disorder (SAD), and many people with bipolar disorder experience seasonal
worsening of depression in the winter, in some cases to the point of SAD. Light
therapy could also be considered for lesser forms of seasonal worsening of
bipolar depression.
Complementary Health Approaches
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. For more information, visit the National Center for
Complementary and Integrative Health website at [Link].
Coping With Bipolar Disorder
Living with bipolar disorder can be challenging, but there are ways to help
yourself, as well as your friends and loved ones.
● Get treatment and stick with it. Treatment is the best way to start feeling better.
● Keep medical and therapy appointments and talk with your health care
provider about treatment options.
● Take medication as directed.
● Structure activities. Keep 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 is healthy for your
heart and brain.
● Keep a life chart to help recognize your mood swings.
● Ask for help when trying to stick with your treatment.
● Be patient. Improvement takes time. Social support helps.
Remember, bipolar disorder is a lifelong illness, but long-term, ongoing treatment
can help manage symptoms and enable you to live a healthy life.
Are there clinical trials studying bipolar disorder?
NIMH supports a wide range of research, including clinical trials that look at new
ways to prevent, detect, or treat diseases and conditions—including bipolar
disorder. 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 to help others in the future. Researchers at NIMH and
around the country conduct clinical trials with patients and healthy volunteers.
Talk to a health care provider about clinical trials, their benefits and risks, and
whether one is right for you. For more information, visit [Link]/
clinicaltrials.
Finding Help
Behavioral Health Treatment Services Locator
This online resource, provided by the Substance Abuse and Mental Health
Services Administration, can help you locate mental health treatment facilities
and programs. Find a facility in your state at [Link]
For additional resources, visit [Link]/findhelp.
Talking to a Health Care Provider About Your Mental Health
Communicating well with a health care provider can improve your care and help
you both make good choices about your health. Find tips to help prepare for and
get the most out of your visit at [Link]/talkingtips. For additional
resources, including questions to ask a provider, visit the Agency for Healthcare
Research and Quality website at [Link]/questions.
If you or someone you know is in immediate distress or is thinking about
hurting themselves, call the National Suicide Prevention Lifeline toll-free at
1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to
741741) or use the Lifeline Chat on the National Suicide Prevention
Lifeline website at [Link] If you suspect a
medical emergency, seek medical attention or call 911 immediately.
Reprints
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permission from NIMH. We encourage you to reproduce and use NIMH
publications in your efforts to improve public health. If you do use our materials, we
request that you cite the National Institute of Mental Health. To learn more about
using NIMH publications, refer to [Link]/reprints.
For More Information
NIMH website
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MedlinePlus (National Library of Medicine)
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8088