Bipolar Disorder

Bipolar disorder, formerly known as manic depression, is a mental health disorder that causes strong mood swings. You may have episodes of mania (a period of high energy and euphoria) and depression (a period of low mood and low energy).

This condition affects millions of people worldwide. In the U.S., about 3 out of every 100 adults have bipolar disorder in a given year.

During mania, you may feel full of energy, act without thinking or feel unusually happy. During depression, you may feel sad, tired or hopeless. In between mood shifts, you may have periods of a steadier mood, called euthymia.

These shifts can last for days, weeks or months. They may affect your daily life and routine. A healthcare provider can help you manage symptoms.

Types of bipolar disorder

There are four main types. Each type involves mood shifts, but the patterns are different:

• Bipolar I disorder: You have at least one manic episode. It lasts at least seven days. It may be severe enough that you need hospital care. You also have episodes of depression. You don’t need a depressive episode to get this diagnosis. You may have mixed states (both manic and depressive symptoms at the same time).
• Bipolar II disorder: You have episodes of depression and hypomania (a milder form of mania). But you never had a full manic episode. While hypomania is less severe than mania, bipolar II can still be very impairing, often because depressive episodes are more frequent or long-lasting.
• Cyclothymic disorder (cyclothymia): You have ongoing mood swings that last for two years or more. Your mood shifts between hypomania and mild depression. You may have short periods of steady mood (euthymia), but these periods usually last fewer than eight weeks.
• Other specified or unspecified bipolar and related disorders: You have mood episodes that don’t fit the exact patterns of bipolar I, bipolar II or cyclothymia.

Bipolar disorder symptoms

Bipolar disorder causes episodes that shift your mood, energy and activity levels. These episodes can last days, weeks or months. They’re a clear change from your usual self and can affect your daily life.

Not everyone has the same pattern. Some people move between episodes often. Others may stay in one mood state for a long time, with periods of steady mood (euthymia) in between.

Signs and symptoms of manic episodes

Mania can happen many times over a lifetime or only rarely. Symptoms may include:

• Feeling extremely happy or excited
• Sudden mood changes, such as going from joyful to angry
• Restlessness
• Rapid speech and racing thoughts
• High energy and little need for sleep
• Impulsive or risky behavior
• Making big or unrealistic plans
• Feeling unusually important or powerful
• Hallucinations or delusions

You may not see the negative effects of your actions. Mania can also increase suicide risk. Severe episodes may require hospital care.

Signs and symptoms of hypomania

Hypomania is a milder form of mania. You may feel very good, energized or productive. You may still function well at work or in social settings.

You might not notice a problem, but others may see changes in your mood or behavior. A depressive episode may follow hypomania.

Signs and symptoms of depressive episodes

Depressive episodes are the same as major depression. Symptoms may include:

• Deep sadness
• Low energy or fatigue
• Loss of motivation
• Feelings of hopelessness or worthlessness
• Loss of interest in things you used to enjoy
• Trouble concentrating or making decisions
• Crying spells
• Irritability
• Sleeping too much or too little
• Appetite changes
• Thoughts of death or suicide

If you have thoughts of suicide, call or text the Suicide and Crisis Lifeline at 988 (U.S.) right away.

Signs and symptoms of a mixed episode

Mixed episodes include symptoms of both mania and depression at the same time. You may feel low or hopeless, but also restless, agitated and full of energy. Many people describe mixed episodes as very challenging.

What is rapid cycling in bipolar disorder?

Rapid cycling is when you have four or more mood episodes (mania or depression) in one year. Different things may trigger it, like:

• Addictive substance use
• Changes to your sleep routine
• Some antidepressant use
• Stress

Bipolar disorder causes

There isn’t one single cause of bipolar disorder. It likely develops because several factors add up over time.

• Genetics: Bipolar disorder can run in biological families. Many genes may raise your risk. But having these genes doesn’t mean you’ll definitely develop the condition.
• Epigenetics: This is how your lifestyle affects your DNA. Your genes can shift in how active they are based on stress, illness or other life events.
• Brain chemistry: You may have differences in neurotransmitters (brain chemicals that help control mood), like dopamine and serotonin. These chemicals affect energy, motivation and emotional balance.
• Brain structure and connections: Some brain scans show small differences in certain brain areas and in the connections that help those areas communicate.
• Other body and brain changes: Researchers are studying other causes, like how your brain changes over time or how your body handles stress. Some studies also look at cell damage and energy problems inside your brain. These may add to the risk, but don’t act alone.

As healthcare providers don’t know what causes this condition, there’s no way to prevent it.

Risk factors of bipolar disorder

Bipolar disorder can affect anyone. Symptoms often start in your teens or early adulthood, but some people don’t get a diagnosis until later in life.

Certain factors may raise your chances of developing it, including:

• Childhood trauma (emotional abuse or emotional neglect in childhood)
• Family history (genetics play a strong role)
• Gene changes (many gene variations link, but no single gene causes it)
• Major life challenges (like losing a loved one, going through a divorce or experiencing unemployment)

Bipolar disorder affects males and females in similar numbers, but it can affect them in different ways. For example, females may switch moods more quickly. Females may also have more periods of depression than males with this condition.

Complications of bipolar disorder

Mood episodes may cause the following:

• Increased risk of suicide or self-harm
• Accidents or injuries during manic or mixed episodes
• Problems at work or school, relationship difficulties or financial issues

If you ever have thoughts of harming yourself, call or text 988 (U.S.) or go to the nearest emergency room. Help is available 24/7.

The following conditions commonly happen alongside bipolar disorder:

• Anxiety disorders
• Heart disease
• Migraines
• Overweight, obesity or binge eating disorder
• Substance use disorders

How doctors diagnose bipolar disorder

A healthcare provider diagnoses this condition by learning about your symptoms, your history and how your mood changes over time. Your doctor may offer blood or urine tests to check for other causes of mood changes, like medical conditions or substance use. There isn’t a test or brain scan that can diagnose this condition.

Your provider may refer you to a mental health provider. They’ll ask detailed questions about past mood episodes, including times when you felt very “up” or very “down.” They may also ask to speak with someone close to you because loved ones may notice changes you might not.

You may fill out a screening questionnaire in your provider’s office. They may also ask you to keep a log of how you feel and how you sleep between appointments. These can help them learn more about what’s going on.

It can take time to diagnose bipolar disorder because its symptoms look like other mental health conditions. Your provider will track your mood over time to see if you’ve had manic or hypomanic episodes. These are required for a diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

How is bipolar disorder treated?

Treatment for this condition may include a combination of the following:

• Therapy
• Medications

In some cases, a healthcare provider may recommend a hospital stay or joining an outpatient program, especially during a mood episode. These settings help you stay safe, steady your mood and get care from people who understand what you’re going through.

Therapy for bipolar disorder

Talk therapy (psychotherapy) can help you understand and manage your emotions, thoughts and behaviors. You’ll work with a mental health professional, like a psychologist or psychiatrist, who can offer support and guidance.

Common types of therapy include:

• Cognitive behavioral therapy (CBT): CBT helps you look at your thoughts and feelings. You learn how your thoughts affect your actions. This therapy teaches you how to replace unhelpful patterns with healthier habits.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT helps you stabilize your daily routines and manage stress. It teaches skills that support regular sleep, healthy habits and staying consistent with your medication. These skills may help lower your risk of future mood episodes.
• Family therapy: This therapy includes your loved ones or caregivers. You learn about bipolar disorder together and practice communication and problem-solving skills as a team.

Bipolar disorder medication

Medications may help manage symptoms. You might need to try more than one medication, with your provider’s guidance, before finding what works best for you.

Common medications include:

• Mood stabilizers (like lithium, valproic acid and carbamazepine)
• Atypical antipsychotics (like cariprazine, lurasidone, quetiapine and olanzapine-fluoxetine)
• Antidepressants with a mood stabilizer (antidepressants alone could trigger mania, but using them with a mood stabilizer may reduce symptoms)

Other bipolar treatments

If medications don’t help enough, your provider might suggest other treatments, like:

• Electroconvulsive therapy (ECT): ECT uses a small, controlled electric current to trigger a brief seizure. It’s safe and very effective for medication-resistant symptoms. You’ll get general anesthesia, so you’ll be asleep and won’t feel anything.
• Transcranial magnetic stimulation (TMS): TMS uses a magnetic coil placed on your scalp to stimulate parts of your brain involved in mood. Providers use it for depression that hasn’t improved with medication. It doesn’t require anesthesia and isn’t painful.
• Ketamine therapy: Low-dose ketamine, given through an IV, may provide short-term relief for depression or suicidal thoughts.

When should I see my healthcare provider?

If you have bipolar disorder, you’ll need regular visits with your healthcare team. These check-ins make sure your treatment is working and that symptoms stay manageable.

Call 911 (or your local emergency services number) or go to the nearest emergency room if you have any of the following:

• Thoughts of death or suicide
• Thoughts or plans to hurt yourself
• Hallucinations or delusions

Some medications may cause side effects. Your provider will let you know about these before you start a new treatment. For example, if you take lithium, there’s a risk of lithium toxicity. You should get help right away if you notice the following:

• Confusion
• Severe vomiting
• Strong muscle twitching
• Vision changes

What can I expect if I have bipolar disorder?

Bipolar disorder is a serious, long-term condition without a cure. It can affect your daily life if it isn’t well managed. Some complications may also affect life expectancy. People with bipolar disorder have a higher risk of suicide, so providers take mood changes and suicidal thoughts very seriously.

Treatment can help you feel steadier and safer. Taking your medication as directed may reduce mood swings. You should take your medication as prescribed, even if you feel well.

Knowing your symptoms and triggers could help you catch mood changes early. This may stop episodes from lasting too long or leading to a hospital stay.

It’s important to stay engaged in your treatment plan and reach out for care when something doesn’t feel right. Your healthcare team is there to support you.