Bipolar disorder is a chronic mood disorder that causes intense shifts in mood, energy levels and behavior. Manic and hypomanic episodes are the main sign of the condition, and most people with bipolar disorder also have depressive episodes. The condition is manageable with medications, talk therapy, lifestyle changes and other treatments.
Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.
There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder aren’t always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.
A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode.
Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
People who are in manic states may indulge in activities that cause them physical, social or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly. They also occasionally develop psychotic symptoms, such as delusions and hallucinations, which can cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder.
People with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesn’t last as long as manic episodes and it doesn’t interfere with daily functioning as much.
During a depressive episode, you experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression, such as:
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In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using “manic-depressive illness” or “manic depression” to describe bipolar disorder. There are several reasons for this shift, including:
There are four types of bipolar disorder, including:
While borderline personality disorder (BPD) and bipolar disorder have similar symptoms and are often confused for each other, they’re distinct conditions.
BPD involves a longstanding pattern of abrupt, moment-to-moment swings in moods, behavior and self-image that are often triggered by conflicts in interactions with other people. Nonsuicidal self-injury is also common in BPD but not in bipolar disorder.
Bipolar disorder is different from BPD because it involves distinct, longer-lasting episodes of mania/hypomania and/or depression. Several things can trigger manic or depressive episodes, such as sleep changes, stress, medications and substance use.
Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s.
Although bipolar disorder affects people assigned female at birth (AFAB) and people assigned male at birth (AMAB) in equal numbers, the condition tends to affect them differently.
People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called “rapid cycling.” Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population.
People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.
Bipolar disorder affects approximately 5.7 million adult Americans or about 2.6% of the U.S. population.
The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while people with bipolar II disorder or cyclothymia experience hypomanic episodes.
But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states don’t always follow a set pattern, and depression doesn’t always follow manic phases. A person may also experience the same mood state several times — with periods of euthymia in between — before experiencing the opposite mood.
Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.
An important aspect of the mood changes is that they’re a departure from your regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression.
The severity of the depressive and manic phases can differ from person to person and in the same person at different times.
Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
Signs and symptoms of a manic episode include:
Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger — some people become suicidal in manic episodes, not just depressive episodes.
If a person is having an intense manic episode, especially if they’re experiencing hallucinations and delusions, they may need to be hospitalized to protect themselves and others from possible harm.
Some people with bipolar disorder have milder manic-like symptoms. This is called hypomania. With hypomania, you may feel very good and find that you can get a lot done. People with hypomania can often function well in social situations or at work.
You may not feel like anything is wrong during a hypomanic episode. But your family and friends may notice your mood swings and activity level changes and think that they’re unusual for you. After hypomania, you might experience severe depression.
The symptoms of depressive episodes in bipolar disorder are the same as those of major depression. They include:
If you’re experiencing suicidal ideation (thoughts of suicide), it’s important to seek immediate care. Call 911 or the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24 hours a day, seven days a week.
The symptoms of a mixed episode include both manic and depressive symptoms together. During a mixed episode, you have the negative feelings and thoughts that come with depression but also feel agitated, restless and high energy.
People who experience mixed episodes often describe it as the worst part of bipolar disorder.
Scientists don’t yet know the exact cause of bipolar disorder.
But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions — more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesn’t necessarily mean you’ll also develop it.
Other factors that scientists think contribute to the development of bipolar disorder include:
Scientists are currently performing research to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset and what role they may play in its treatment.
To diagnose bipolar disorder, your healthcare provider may use many tools, including:
To be diagnosed with bipolar disorder, you must have experienced at least one episode of mania or hypomania. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.
To determine what type of bipolar disorder you may have, your mental health provider assesses the pattern of symptoms and how much they affect your life during the most severe episodes.
People with bipolar disorder are more likely to also have the following mental health conditions:
Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for healthcare providers to properly diagnose people with bipolar disorder.
People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD).
Because of this, it’s important to be honest and thorough when explaining all of your symptoms and experiences when talking with your healthcare provider. It can also be helpful to include a loved one who may be able to provide additional details about your mental health history in your discussions with your provider.
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of the following therapies:
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, it’s important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder don’t have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
If you have other mental health conditions in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat the conditions. For example, the antidepressants healthcare providers prescribe to treat obsessive-compulsive disorder (OCD) and the stimulants they prescribe to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode.
Again, even though it may be difficult to treat these conditions, it’s not impossible. Be sure to stay committed to finding a treatment plan that works for you.
Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder.
Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family.
Different types of therapy for bipolar disorder include:
Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best.
Medications healthcare providers generally prescribe to treat bipolar disorder include:
If you’re taking medication for bipolar disorder, you should:
People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.
Types of mood stabilizers and their brand names include:
Lithium is one of the most widely prescribed and studied medications for treating bipolar disorder. Lithium is a natural salt and will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the manic symptoms are fully managed. Because of this, healthcare providers often prescribe other drugs like antipsychotic drugs or antidepressant drugs to help manage symptoms.
Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high.
Anything that lowers the level of sodium in your body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a toxic buildup of lithium in your body. Be aware of these conditions and alert your doctor if you’re on lithium and experience them.
The following are signs of lithium toxicity (lithium overdose). Call your healthcare provider immediately or go to the nearest emergency room if you experience:
Healthcare providers often prescribe second-generation or atypical neuroleptics (antipsychotics) in combination with a mood stabilizer for people with bipolar disorder. These medications help with both manic and depressive episodes.
Only four of these drugs are U.S. Food and Drug Administration (FDA)-approved to help treat bipolar depression, including:
Healthcare providers sometimes prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.
Antidepressants are never used as the only medication to treat bipolar disorder because only taking an antidepressant drug can trigger a manic episode.
Side effects of bipolar disorder medications are common and vary by medication. It’s important to talk with your healthcare provider about what you can expect when taking certain medications. It’s also important to tell them if you’re experiencing side effects.
Never stop taking your medication unless your healthcare provider tells you to do so. Abruptly stopping medication can cause severe side effects and trigger severe episodes.
The most common side effects of bipolar disorder medications include:
Other treatment options your healthcare provider may consider for treating bipolar disorder include:
Your healthcare team will likely recommend making lifestyle changes to stop patterns of behavior that worsen the symptoms of bipolar disorder. Some of these lifestyle changes include:
Unfortunately, there’s no known way to prevent bipolar disorder because scientists don’t know its exact cause.
But it’s important to know the signs and symptoms of bipolar disorder and to seek early intervention.
The prognosis for bipolar disorder is often poor unless it’s properly treated. Many people with bipolar disorder who receive appropriate treatment can live fulfilling and productive lives.
Bipolar disorder results in approximately nine years reduction in expected life span, and as many as1 in 5 people with bipolar disorder commit suicide. An estimated 60% of all people with bipolar disorder have drug or alcohol dependence.
This is why it’s essential to seek medical care and stay committed to treatment for bipolar disorder.
Regular and continued use of medication can help reduce episodes of mania and depression. By knowing how to recognize the symptoms and triggers of these episodes, there’s a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays and suicide.
If you’ve been diagnosed with bipolar disorder, you’ll need to see your healthcare team regularly throughout your life to make sure your treatment is working well for you. This team may include your:
If you’re experiencing any of these situations, it’s essential to call 911 or get to the nearest emergency room:
A note from Cleveland Clinic
Bipolar disorder is a lifelong illness. But long-term, ongoing treatment, such as medication and talk therapy, can help manage your symptoms and enable you to live a healthy, purposeful life. It’s important to see your healthcare team regularly to monitor your treatment plan and symptoms. Know that your healthcare providers and loved ones are there to support you.
Last reviewed by a Cleveland Clinic medical professional on 04/12/2022.
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