Bipolar Disorder

Medically Reviewed by Zilpah Sheikh, MD on May 17, 2024
Written by Alyson Powell Key
13 min read

Bipolar disorder, formerly called manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling hopeless and sluggish. Between those periods, their mood is usually stable. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.

The word "manic" describes the times when someone with bipolar disorder shows an extreme level of activity, energy, mood, or behavior. These feelings can also involve irritability and impulsive or reckless decision making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there).

"Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word "depressive" describes the times when the person feels depressed. Those symptoms are the same as those described in major depressive disorder or clinical depression, a condition in which someone never has manic or hypomanic episodes.

Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.

There are a few types of bipolar disorder, including:

Bipolar I

With this type, you have manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks. 

Bipolar II

Bipolar II means you've experienced a major depressive episode and at least one hypomanic episode, but you've never had mania.

Cyclothymic disorder

This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.

Unspecified or other specified bipolar disorder

Formerly called bipolar disorder not otherwise specified, this type now describes conditions in which a person has only a few of the mood and energy symptoms that define a manic or hypomanic episode, or the symptoms may not last long enough to be considered clear-cut episodes.

Rapid cycling 

This is not a type of bipolar disorder but a term doctors use to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as dual diagnosis, requires help from a specialist who can address both issues. 

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

How serious it gets differs from person to person and can also change over time, becoming more or less severe.

Symptoms of mania:

  • Happiness, hopefulness, and excitement

  • Sudden changes from being joyful to being irritable, angry, and hostile

  • Restlessness

  • Rapid speech and poor concentration

  • Increased energy and less need for sleep

  • Unusually high sex drive

  • Making grand and unrealistic plans

  • Showing poor judgment

  • More likely to use drugs and alcohol

  • Becoming more impulsive

  • Less need for sleep

  • Less of an appetite

  • A larger sense of self-confidence and well-being

  • Being easily distracted

  • Feeling invincible

  • Feeling like you can perform tasks beyond your usual abilities

  • Feeling hyper-focused and determined to finish tasks or projects 

During depressive periods, a person with bipolar disorder may have:

  • Loss of energy

  • Feelings of hopelessness or worthlessness

  • Less enjoyment of things they once liked

  • Trouble concentrating

  • Forgetfulness

  • Talking slowly

  • Less of a sex drive

  • Inability to feel pleasure

  • Uncontrollable crying

  • Trouble making decisions

  • Irritability

  • A need for more sleep

  • Insomnia

  • Appetite changes that make you lose or gain weight

  • Thoughts of death or suicide

  • Attempts at suicide

  • Low self-esteem or confidence

  • Feelings of guilt

Bipolar symptoms in children

Kids with bipolar disorder have many of the same high and low symptoms as adults. They include intense happiness, racing thoughts, and reckless behavior during a manic episode, and sadness, anger, and low energy during a depressive episode. You may also see your child act sillier than usual or complain of physical pain like a stomachache or headache. 

The signs and symptoms of bipolar disorder might be similar to those of other common disorders in young people, like ADHD, behavior issues, depression, and anxiety disorders.

There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.

Difficult experiences in childhood, like abuse or losing someone important, can make it more likely for you to form bipolar disorder. Stressful events can also make symptoms worse. If someone in your family has bipolar disorder, you might be more likely to have it too, but it's not just about genetics – your environment matters too. Some medications, alcohol, and drugs can make bipolar symptoms show up or get worse, so it's important to talk to your doctor about any concerns.

When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.

Men and women are equally likely to get it. Women are somewhat more likely than men to go through rapid cycling, which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.

Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes. 

A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders. 

Many people with the condition misuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had and any mental illnesses that run in the family. 

Bipolar test

The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.

Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are mood highs or lows and changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

If you have just been diagnosed with bipolar disorder, the future may seem uncertain. What will this mean for your life, family, and job?

But getting an accurate diagnosis is good news. It means you can finally get the treatment you need. People with bipolar disorder usually go about 10 years before being accurately diagnosed.

Bipolar disorder diagnosis in children

Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.

If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.

You can treat bipolar disorder. It's a long-term condition that needs ongoing care. People who have four or more mood episodes in a year or who also have drug or alcohol problems can have forms of the illness that are much harder to treat.

Treatment can make a huge difference. With a combination of things -- good medical care, medication, talk therapy, lifestyle changes, and the support of friends and family -- you can feel better. Bipolar disorder has no known cure. It's an ongoing health condition that requires lifetime management.  Many people with this condition do well; they have families and jobs and live normal lives.

Bipolar disorder medication

Medication is the main treatment, usually involving the following:

It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.

Therapy

Psychotherapy, or "talk therapy," is often recommended, too. There are several different types. Options can include:

  • Interpersonal and social rhythm therapy (IPSRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.

  • Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.

  • Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.

  • Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode.

Bipolar disorder treatment without medication

Other treatment options for bipolar disorder include:

  • Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.

  • Acupuncture. There’s some evidence that this complementary therapy may help with the depression caused by bipolar disorder.

  • Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example, their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.

Lifestyle changes may also help:

  • Get regular exercise.

  • Stay on a schedule for eating and sleeping.

  • Learn to recognize your mood swings.

  • Get support from friends or groups.

  • Keep a symptom journal or chart.

  • Learn to manage stress.

  • Find healthy hobbies or sports.

  • Don’t drink alcohol or use recreational drugs.

Treatment for kids

Your child's doctor will tailor treatment based on their symptoms, medication effects, and other factors. Typically, treatment involves: 

  • Medication

  • Therapy

  • Psychoeducation

  • Support from family, friends, teachers, and counselors

Hospitalization for bipolar

If you're in danger, feeling suicidal, or losing touch with reality, your doctor might suggest going to the hospital for psychiatric treatment. Being in the hospital can help keep you safe and calm and stabilize your mood.

Clinical trials for bipolar

Clinical trials are research studies that explore new ways to prevent, detect, or treat diseases. They aim to find out if these methods are safe and work well. Researchers conduct many studies involving patients and healthy volunteers. You can contribute to future medical breakthroughs in bipolar disorder by taking part in a clinical trial. Talk to your doctor to learn more about the pros and cons.

Bipolar disorder is a lifelong condition, but making changes in your day-to-day life can help keep it in check. Here are some ideas:

Understand your moods

  • Keep track of your moods over time to understand patterns.
  • Identify triggers like stress, life changes, or lack of sleep.
  • Recognize warning signs such as changes in sleep or eating patterns.

Take practical steps

  • Stick to a routine for stability.
  • Manage stress.
  • Address financial concerns by getting advice and support.
  • Plan ahead for crises when you're feeling well.

Focus on your physical health

  • Prioritize sleep, a balanced diet, and regular exercise.

Build support

  • Build a support network of trusted people who can offer understanding and assistance.
  • Find peer support through organizations, online forums, or local groups for people living with bipolar disorder.

Bipolar disorder stigma

You may often face stereotypes and discrimination because of your condition. Studies show that stigma, both from society and from themselves, can make it harder for people with bipolar disorder to function well in daily life. You could have more anxiety, struggle at work, and feel more depressed. Stigma can come from family, friends, and even doctors. Younger people with bipolar disorder tend to face more stigma, which can make it harder for them to stick to their treatment.

Women with bipolar disorder have a higher chance of getting sick after childbirth. Some things raise your odds, like a history of severe postpartum illness in your family. Symptoms can vary and may include depression, mania, or a mix of both, often starting shortly after birth. 

While doctors know childbirth triggers these episodes, the exact reasons aren't clear. It may involve hormones, sleep, or the stress of a new baby. Planning a pregnancy is ideal -- talk to your doctor about staying well during pregnancy and managing health problems after birth. 

During pregnancy, it's crucial to communicate your bipolar disorder to your friends and family and address stress. Medication decisions during pregnancy are complex, balancing the pros and cons for both you and your baby. Starting or continuing medication may be necessary, with guidance from your doctor. If you're pregnant or breastfeeding, talk to your doctor about medications that are safe to take. 

Supporting a loved one with bipolar disorder involves: 

  • Educating yourself about the condition and its treatment
  • Encouraging them to seek professional help promptly
  • Being understanding and patient throughout their journey

Learning about bipolar disorder helps you provide better support, while urging them to seek help early can improve the outcome of their condition. Being there for them, offering understanding and patience, is crucial as recovery takes time and setbacks are part of the process. Managing bipolar disorder is a lifelong commitment, and your ongoing support can make a big difference.

Bipolar disorder can trigger other serious health problems, including:

Self-harm

Self-harm is when you hurt yourself on purpose without wanting to die. Researchers don't know much about how self-harm relates to mood problems like bipolar disorder, but one small study looked at how they're connected. Results showed that people with bipolar disorder are more likely to have hurt themselves in the past than those with only depression. Researchers also tied self-harm more strongly to acting without thinking.

Bipolar disorder and suicide

Living with bipolar disorder means you could become suicidal. Learn the warning signs and get help right away for them:

  • Depression (changes in eating, sleeping, activities)

  • Isolating yourself

  • Talking about suicide, hopelessness, or helplessness

  • Acting recklessly

  • Taking more risks

  • Having more accidents

  • Missing alcohol or other drugs

  • Focusing on morbid and negative topics

  • Talking about death and dying

  • Crying more, or becoming less emotionally expressive

  • Giving away possessions

 

Bipolar disorder can make you feel utterly alone. But that really isn't the case. More than 2 million adults in the U.S. are coping with bipolar disorder right now.

It's important not to blame yourself for your condition. Bipolar disorder is a physical illness, not a sign of personal weakness. It's like diabetes, heart disease, or any other condition. Nobody knows what causes bipolar disorder, but for many people, it is a very manageable condition.

The important thing is to focus on the future. Living with bipolar disorder can be tough. But don't let it hijack your life. Instead, take action and regain control of your health. With dedication and the help of your health care providers, you can feel better again.

For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.

Ongoing treatment is more effective than dealing with problems as they come up. 

The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.