What is bipolar disorder?

Bipolar disorder (formerly known as manic depression or manic-depressive illness) is a lifelong mood disorder and mental health condition that causes dramatic changes in mood, energy level, thought patterns, and behavior. These changes can last for hours, days, weeks, or months and affect your ability to perform daily tasks. There are several types of bipolar disorder, with patients experiencing wide swings in mood, called hypomanic/manic and depressive episodes. However, people with bipolar disorder are not always in a hypomanic/manic or depressed state. They also experience periods of normal mood, called euthymia.

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Manic Episode

Mania is a period of abnormally high or irritable moods, with extreme changes in mood, thoughts, energy, talkativeness, and activity levels. This heightened physical and mental activity and behavior is different from normal and can be noticed by others.

Depressive Episode

During a depressive episode, you feel low or depressed and/or lose interest in most activities, as well as many other symptoms of depression, such as:

• Fatigue.
• Changes in appetite.
• Feelings of worthlessness and hopelessness.

What are the types of bipolar disorder?

There are four types of bipolar disorder, including:

• Bipolar I: People with bipolar I have experienced one or more manic episodes. Most people with bipolar I have both manic and depressive episodes, but a depressive episode is not required for the diagnosis. Depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episode must last at least seven days or be severe enough to require hospitalization. People with bipolar I may also experience mixed states (manic and depressive symptoms occurring at the same time).
• Bipolar II: People with bipolar II experience depressive episodes and hypomanic episodes. But they never experience the typical manic episodes of bipolar I. Although hypomania is less impairing than mania, bipolar II tends to be more severe than bipolar I because people with bipolar II more often experience chronic depression.
• Cyclothymic disorder (Cyclothymic disorder): People with cyclothymic disorder have chronically unstable mood states. They experience periods of hypomania and mild depression for at least two years. People with cyclothymic disorder may have brief periods of normal mood (euthymic mood), but these periods last less than eight weeks.
• Other specified and unspecified bipolar and related disorders: If a person does not meet the diagnostic criteria for bipolar I, II, or cyclothymic disorder, but still experiences clinically significant periods of abnormally elevated mood, they are considered to have other specified or unspecified bipolar disorder.

Who does bipolar disorder affect?

Bipolar disorder can affect anyone. The average age of onset is 25, but rarely, the disorder can begin as early as early childhood or as late as age 40 or 50. Although bipolar disorder affects an equal number of people assigned female at birth (AFAB) and those assigned male at birth (AMAB), the disorder tends to affect them differently.

AFAB people with bipolar disorder may have faster mood shifts. If a person with bipolar disorder experiences four or more episodes of mania or depression in a year, it is called "rapid cycling." Differences in sex hormone and thyroid hormone levels, plus the tendency of AFAB people to take antidepressants, may cause this population to cycle through moods more quickly. AFAB people with bipolar disorder may experience more depressive episodes than AMAB people. Bipolar disorder affects approximately 5.7 million American adults, or about 2.6% of the U.S. population.

Symptoms and causes

What are the signs and symptoms of bipolar disorder?

The classic symptom of bipolar I disorder is a manic episode that lasts at least a 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 at the same time. These changing mood states don't always follow a set pattern, and depression doesn't always follow a manic phase. A person may also experience the same mood state several times before experiencing the opposite mood—with a period of emotional calm in between. Mood changes in bipolar disorder can last for weeks, months, or sometimes even years.

An important aspect of mood changes is that they are different from normal and last for a long time. Mania may last for days or weeks, while depression may last for weeks or months. The severity of depression and mania phases can vary from person to person and even within the same person at different times.

Signs and symptoms of a manic episode

Some people with bipolar disorder will have many manic or hypomanic episodes in their lifetime; others may experience them rarely.Signs and symptoms of a manic episode include:

• Excessive happiness, hope, and excitement.
• Sudden and dramatic changes in mood, such as going from happy to angry and hostile.
• Irritability.
• Speech and racing thoughts.
• More energy and less need for sleep.
• Impulsiveness and poor judgment, such as quitting a job suddenly.
• Making grandiose, unrealistic plans.
• Reckless and risky behavior, such as drug and alcohol abuse and unsafe or unprotected sex.
• Feelings of being unusually important, talented, or powerful.
• Psychosis – hallucinations and delusions (in the most severe manic episodes).

Most of the time, people experiencing a manic episode are unaware of the negative consequences of their behavior. Suicide is an ever-present danger for people with bipolar disorder – some people become suicidal during a manic episode, not just during a depressive episode. If a person has a severe manic episode, especially with hallucinations and delusions, they may need to be hospitalized to protect themselves and others from possible harm.

Signs and symptoms of a depressive episode

Symptoms of a depressive episode in bipolar disorder are the same as those of major depressive disorder. They include:

• Uncontrollable sadness.
• Low energy and easy fatigue.
• Lack of motivation.
• Feelings of hopelessness or worthlessness.
• No longer enjoying things that used to be pleasurable for you.
• Difficulty concentrating and making decisions.
• Uncontrollable crying.
• Irritability.
• Increased need for sleep.
• Insomnia or sleeping too much.
• Changes in appetite, resulting in weight loss or gain.
• Thoughts about death or suicide (suicidal ideation).

If you have suicidal ideation (suicidal thoughts), get help right away. Call 911 or the Suicide Crisis Hotline 988. There are people available to talk to you 24 hours a day, 7 days a week.

What causes bipolar disorder?

Scientists don't know the exact cause of bipolar disorder. But they do believe that bipolar disorder has a large genetic component. Bipolar disorder is considered one of the most heritable mental illnesses—more than two-thirds of people with bipolar disorder have at least one close relative with the disorder. However, just because your relative has bipolar disorder doesn't necessarily mean you will develop the disorder, too.

Other factors that scientists believe contribute to the development of bipolar disorder include:

• Changes in the brain: Researchers have found subtle differences in the average size or activity of certain structures in the brain of people with bipolar disorder. However, brain scans can't diagnose the condition.
• Environmental factors such as trauma and stress: Stressful events (such as the death of a loved one, serious illness, divorce, or financial problems) can trigger a manic or depressive episode. Therefore, stress and trauma can also be a reason for the development of bipolar disorder.

Scientists are currently conducting research to determine how these factors relate to bipolar disorder, how they may help prevent episodes of bipolar disorder, and what role they may play in treatment.

Diagnosis and Testing

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, your healthcare provider may use a number of tools, including:

• Physical exam: A detailed medical history, including questions about your symptoms, lifetime medical history, experiences, and family history.
• Medical tests: Such as blood tests to rule out other conditions that may be causing your symptoms, such as an overactive thyroid gland.
• Mental health evaluation: Your healthcare provider may perform an evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist.

To be diagnosed with bipolar disorder, you must have experienced at least one manic or hypomanic episode. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may have. To determine which type of bipolar disorder you have, your mental health provider will assess the pattern of symptoms and how much they affect your life during your worst episodes.

People with bipolar disorder are more likely to have the following mental health conditions:

Anxiety.

• Attention deficit hyperactivity disorder (ADHD).
• Post-traumatic stress disorder (PTSD).
• Substance use disorder/dual diagnosis.

For this reason, and because memory is often impaired during mania and people cannot remember experiencing mania, it can be difficult for healthcare providers to correctly diagnose people with bipolar disorder. People with bipolar disorder who experience severe manic episodes and hallucinations may be misdiagnosed with schizophrenia. Bipolar disorder may also be misdiagnosed as borderline personality disorder (BPD).

Therefore, it is important to honestly and thoroughly explain all of your symptoms and experiences when talking to your healthcare provider. It is also helpful to have loved ones who can provide more details about your mental health history during discussions with your provider.

Management and Treatment

How is bipolar disorder treated?

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan often includes a combination of the following therapies:

• Psychotherapy (talk therapy).
• Medications.
• Self-management strategies, such as education and identifying early signs of an episode or possible triggers of an episode.
• Helpful lifestyle habits, such as exercise, yoga, and meditation. These can support treatment, but they are not a replacement for it.
• Other treatments, such as electroconvulsive therapy (ECT), may be used in cases where medications are not working well or symptoms need to be controlled quickly to prevent harm.

Bipolar disorder is a lifelong illness, so treatment is a lifelong commitment. Sometimes it may take months or even years for you and your healthcare provider to find a comprehensive treatment plan that works best for you. While this can be frustrating, it is important to continue with treatment.

Manic and depressive episodes often recur over time. Many people with bipolar disorder do not experience mood changes between episodes, but some may experience lingering symptoms. Continuing treatment over the long term can help control these symptoms. If you have other mental illnesses in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat those conditions. For example, antidepressants prescribed by healthcare providers to treat obsessive-compulsive disorder (OCD) and stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode.

Again, while these illnesses may be difficult to treat, they are not impossible. Be sure to stick with it to find a treatment plan that works for you.

What types of therapy are available to treat bipolar disorder?

Psychotherapy, also called "talk therapy," can be an effective part of a treatment plan for people with bipolar disorder.

Psychotherapy refers to a range of therapeutic techniques designed 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 treatment for bipolar disorder include:

• Psychoeducation: Psychoeducation is a way for mental health professionals to teach people about mental health conditions. Because bipolar disorder is a complex illness, understanding the illness and how it affects your life can help you and your loved ones better manage and cope with it.
• Interpersonal and Social Rhythm Therapy (IPSRT): This therapy is designed to help you improve your mood by understanding and using your biological and social rhythms. IPSRT is an effective treatment for people with mood disorders, including bipolar disorder. It emphasizes techniques to improve medication adherence (taking medications regularly), manage stressful life events, and reduce social rhythm dysrhythms (day-to-day differences in habitual behaviors). IPSRT teaches you skills that will allow you to protect yourself from future manic or depressive episodes.
• Family therapy: This therapy is for adults and children with bipolar disorder and their caregivers. During treatment, your loved one will attend therapy sessions with you for psychoeducation about bipolar disorder, communication improvement training, and problem-solving skills training.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented therapy. Your therapist or psychologist will help you take a closer look at your thoughts and emotions. You will gradually learn how your thoughts affect your behavior. With CBT, you can move away from negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

What medications can treat bipolar disorder?

Certain medications can help control the symptoms of bipolar disorder. You may need to try several different medications under the guidance of your healthcare provider to find the one that works best.

Medications commonly prescribed by healthcare providers to treat bipolar disorder include:

• Mood stabilizers.
• Second-generation (“atypical”) neuroleptics (also called antipsychotics).
• Antidepressants.

If you are taking medication to treat bipolar disorder, you should:

Talk to your healthcare provider about the risks, side effects, and benefits of the medication.

Tell your healthcare provider about any prescription, over-the-counter medications, or supplements you’re taking.

If you experience a concerning side effect, tell your healthcare provider right away. They may need to change your dosage or try a different medication.

Remember, medications for bipolar disorder must be taken consistently and as prescribed.

What lifestyle changes can help treat bipolar disorder?

Your healthcare team may recommend lifestyle changes to stop behavioral patterns that exacerbate symptoms of bipolar disorder. These lifestyle changes include:

• Abstaining from alcohol and/or recreational drugs and tobacco: It’s critical to abstain from alcohol and drugs, including tobacco, because they can interfere with medications you may be taking. They can also worsen bipolar disorder and trigger mood episodes.
• Maintain a healthy sleep schedule: Bipolar disorder can greatly affect your sleep patterns, and changes in sleep frequency can even trigger bipolar disorder. Make a priority of a regular sleep schedule that includes going to bed and waking up at the same time each day.
• Exercise: Exercise has been shown to improve mood and mental health, so it may help manage symptoms associated with bipolar disorder. Since weight gain is a common side effect of bipolar medications, exercise may also help manage your weight.
• Keep a journal or mood chart: Recording your daily thoughts, feelings, and behaviors can help you understand how well your treatment is working and/or help you identify potential triggers for a manic or depressive episode.
• Meditation: Meditation has been shown to be effective in improving depression associated with bipolar disorder.
• Manage stress and maintain healthy relationships: Stress and anxiety can worsen mood symptoms for many people with bipolar disorder. It is important to manage stress in healthy ways and eliminate stressors when possible.It’s important to maintain healthy relationships with supportive friends and family and to let go of toxic relationships with people who cause stress in your life.

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Summary:

Bipolar disorder is a lifelong illness. But long-term, ongoing treatment, such as medication and talk therapy, can help manage symptoms so you can live a healthy, meaningful 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 have your back.

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