Bipolar Disorder

Bipolar Disorder: Symptoms, Types, Causes, Treatment, and More

This condition is characterized by extreme highs and lows in mood.

Brian P. Dunleavy
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Bipolar disorder is a mental health condition that causes extreme shifts in a person's mood and energy level. A person with bipolar disorder may experience periods with an extremely elevated or irritable mood (called manic episodes, or mania) as well as episodes of depression.

These shifts are more severe than the normal changes in mood that affect everyone. They can involve impaired thinking and behavior, and can affect your ability to function day to day.

Common Questions & Answers

What are the different types of bipolar disorder?
There are four types. Bipolar I, considered the most severe, involves at least one manic episode. Bipolar II is characterized by at least one major depressive episode and one episode of hypomania. Cyclothymia is a milder form, and in a fourth "unspecified" type, a person has abnormal mood elevations but doesn't fit the criteria for a certain type.
What are early signs of bipolar disorder?
Manic episodes are more severe in bipolar I but occur in both types. Symptoms include extreme energy, distraction, irritability, or recklessness that lasts at least a week. Depressive symptoms in both types can include sustained loss of interest in activities, trouble concentrating, hopelessness, sleep and appetite changes, and thoughts of suicide.
What causes bipolar disorder?
Researchers don't know exactly what causes bipolar disorder, but it is connected to genetics and the structure and function of the brain. Environmental factors likely also play a role. People with a history of other mental health conditions (such as anxiety disorder, ADHD, and PTSD) seem to have a greater risk of developing bipolar disorder.
Is bipolar disorder genetic?
Research suggests that bipolar disorder runs in families, but the genetic component is complex. The risk is greater if you have a first-degree relative (such as a sibling or parent) with the disorder. But even if you have a close relative with the condition, chances are that you won't develop it yourself.
Is there a difference between bipolar disorder and manic depression?
Manic depression was the original name for the disorder, but mental health professionals changed the name to bipolar disorder in the 1980s to better reflect the symptoms of the condition. Bipolar disorder is now the preferred term and the one officially used in diagnosis.

Signs and Symptoms of Bipolar Disorder

There are different types of bipolar disorder, differing in symptoms and severity. A hallmark of every type is discrete mood episodes that are interspersed with periods of normal, level mood and function. Your doctor will diagnose your condition on the basis of the length, frequency, and pattern of episodes of your mania and depression.

Bipolar I is marked by manic episodes, and the vast majority of people with bipolar I also experience major depressive episodes. Bipolar II is characterized by major depressive episodes as well as episodes of hypomania (which is less severe than full mania) and in-between periods of a stable mood. With cyclothymia, a milder form of bipolar disorder, less severe hypomanic and depressive episodes alternate for at least two years in adults and at least one year in children and teens.

When a person doesn’t meet the criteria for any of the other types of bipolar disorder but still experiences periods of a significant, abnormal elevation in mood, they may be diagnosed with "other specified and unspecified bipolar and related disorders."

Learn More About the Types of Bipolar Disorder and Cyclothymia

A manic episode consists of at least a week of abnormally and persistently elevated or irritable mood, with increased goal-directed activity or energy; multiple other symptoms are present most of the day each day. For an episode to be considered manic, it must cause severe impairment or hospitalization or include some psychotic features. A hypomanic episode is similar but is not as intense or disabling and is shorter in duration, lasting at least four days.

You may feel easily distracted, as though your thoughts are racing, and be excessively talkative. You may also need less sleep. And along with an inflated sense of self-confidence, you might engage in pleasurable but reckless, risky behaviors with negative consequences.

Manic episodes involve a distinct and observable change in mood and functioning, and are severe enough to result in problems in your daily activities or to require hospitalization to prevent harm to yourself or others. A manic episode may also trigger a break from reality (psychosis), including hallucinations or delusions.

Symptoms of a major depressive episode include a loss of interest in regular activities you normally derive pleasure in or purpose from, significant changes in weight or appetite, changes in sleep, restlessness or fatigue, feelings of emptiness and worthlessness, trouble concentrating, and thoughts of suicide. Five or more of these sustained and disruptive symptoms every day over a two-week period, with at least one of the symptoms being depressed mood, is considered a major depressive episode.

Learn More About the Symptoms of Bipolar Disorder

Causes and Risk Factors of Bipolar Disorder

Researchers aren't sure what exactly causes bipolar disorder, but there appears to be an association between the condition and genetics, brain structure, and brain function.

Bipolar disorder often runs in families. Approximately 80 to 90 percent of people with the condition have a relative who has bipolar disorder or depression.

But a family history of bipolar disorder doesn't mean that you'll definitely be diagnosed with it. In fact, most people with a family history of bipolar disorder don't develop the condition.

The genetic components thought to be at work are complicated, but certain gene mutations appear to be involved in the development of the condition. In a study published in May 2019 in Nature Genetics, researchers found 30 gene mutations that could contribute to bipolar disorder.

The role of epigenetics, which according to MedlinePlus are the DNA modifications that do not change the DNA sequence but do regulate gene activity, has also been the subject of more and more research, including a study published in 2018 in Clinical Practice and Epidemiology in Mental Health.

In addition to genetic factors, environmental factors are likely to be involved to a degree.

Studies using brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), have attempted to reveal how the brains of people with bipolar disorder differ from the brains of healthy people or those with other mental disorders.

In neuroimaging studies, researchers have identified changes in cortical thickness as well as changes in the connectivity of brain regions responsible for emotional processing, emotional regulation, and reward processing among people with bipolar disorder. One MRI study published in Dialogues of Clinical Neuroscience found that the brains of adults with bipolar disorder have a prefrontal cortex that's smaller than — and doesn't function as well as — the prefrontal cortex of adults who don't have bipolar disorder.

The prefrontal cortex governs the brain's executive functions, such as problem-solving and decision-making. Other studies using neuroimaging, such as one published in the Journal of Affective Disorders, have found brain differences between those with bipolar I and bipolar II.

People with a history of other mental health disorders — including anxiety, attention deficit hyperactivity disorder, and post-traumatic stress disorder — appear to be at an increased risk of developing bipolar disorder, though these links are still being studied.

A number of symptoms or situations that result from bipolar disorder can also be triggers for the disorder. Changes in sleep patterns, blowout arguments with coworkers or loved ones, high stress or traumatic events, alcohol abuse, certain medication interactions, shifts in season, and the hormonal changes of pregnancy can all put you at a greater risk of a manic or depressive episode.

Learn More About Causes and Triggers of Bipolar Disorder

How Is Bipolar Disorder Diagnosed?

It’s important to seek emergency medical help if you’re afraid you might hurt yourself or attempt suicide. In some instances, hospitalization may be necessary. But in many cases, outpatient treatment of bipolar disorder is successful.

When to See a Doctor

It can be difficult to recognize the extent to which mood swings are affecting the quality of your life. The Mayo Clinic notes that some people with manic symptoms enjoy the euphoric feelings and highs of productivity. But the fallout is often an emotional crash that may have financial, legal, or interpersonal consequences.

Bipolar disorder won’t go away on its own, but help from a mental health professional can get the symptoms under control.

Diagnosis typically involves these components:

  • A physical exam
  • A psychiatric evaluation

There is no single bipolar disorder test, but blood tests and neuroimaging may be used to rule out other conditions. Bipolar symptoms can resemble those of other disorders, which can make it challenging to properly diagnose the condition.

In children and teens, symptoms of bipolar disorder may be especially hard to distinguish from normal mood changes and behaviors. Children and teens in a manic episode may be irritable and short-tempered, have trouble sleeping and staying focused, and engage in risky behaviors. Those experiencing a depressive episode may complain of stomachaches and headaches, experience changes in eating habits, have little energy and interest in activities they usually enjoy, have thoughts about death and suicide.

Check in with your doctor if your child is having mood swings that are more severe or significantly different from their usual ups and downs.

Learn More About Diagnosing Bipolar Disorder

Treatment and Medication Options for Bipolar Disorder

Treatment can involve a combination of mood-balancing medication, psychotherapy, brain stimulation therapies, and certain lifestyle changes and complementary health approaches.

Medication Options

Mood stabilizers, antipsychotics, antidepressants, and antianxiety drugs are the types of medication prescribed for bipolar disorder, sometimes in combination with one another. These drugs can have a variety of side effects, and finding the right drug therapy can be challenging and take some time. It’s important, though, not to stop taking your medication without talking to your doctor, even if you’re feeling better.

Common medications for bipolar disorder are:

In instances where drug therapy isn’t as effective as it could be, brain stimulation therapies, such as electroconvulsive therapy or transcranial magnetic stimulation, might be recommended options.

Additional and Complementary Therapies

In conjunction with medication, some form of psychotherapy or counseling will likely be recommended by your doctor. A common option is cognitive behavioral therapy, in which a psychiatrist or psychologist will help you identify episode triggers and work to develop behavioral strategies for managing your condition.

Making certain lifestyle changes may also be necessary, such as quitting drugs and alcohol, avoiding certain foods, or making sure you’re exercising regularly. Seeking out educational resources and a community of support can help you understand how to live with the condition and cope with symptoms.

Learn More About Treatments for Bipolar Disorder

Duration of Bipolar Disorder

While symptoms can intensify and subside, bipolar disorder is a lifelong condition that typically doesn’t go away on its own. But with treatment, it can be managed.

Liife With Bipolar Disorder

Adherence — taking your medication, keeping your appointments with your doctor or therapist — is key. Sticking to routines can be helpful, too, especially when it comes to recognizing changes in mood. And setting a sleep schedule is important, particularly when it comes to sleep and wake cycles.

The Relationship Between Bipolar Disorder and Sex Drive

During manic episodes, people with bipolar disorder may engage in certain impulsive behaviors. For some people, this kind of behavior can involve a preoccupation with sex and a heightened sex drive, leading to unprotected sex or risky sexual situations with potentially damaging consequences, both physical and emotional. Hypersexuality, or an increased interest in sex, is known to be a symptom of bipolar disorder, though the research on the subject is limited.

Learn More About Bipolar Disorder and Sex Drive

Complications of Bipolar Disorder

Bipolar disorder can increase your risk of other conditions. According to the National Institute of Mental Health, this includes thyroid disease, migraine, heart disease, diabetes, and obesity.

Other conditions — such as anxiety disorder, post-traumatic stress disorder, attention deficit disorder, and substance abuse disorders — also tend to co-occur with bipolar disorder, which can make treatment challenging.

Research and Statistics: Who Has Bipolar Disorder?

The National Institute of Mental Health (NIMH) estimates that 2.8 percent of U.S. adults have had bipolar disorder in the past year.

 According to the National Alliance on Mental Illness, the average age of onset is 25, though it can occur in teenagers and, less commonly, in children.

More than 80 percent of all cases of the disorder are classified as severe, according to the NIMH.

Gender Differences in Bipolar Disorder

Although bipolar disorder is equally prevalent in men and women, and the symptoms are the same, the disorder appears to have some gender-related differences. Research suggests that women have an increased risk of bipolar II, rapid cycling, and mixed episodes. Perhaps the most significant distinction involves reproductive health and choices, as treatment for pregnant women with bipolar disorder can be challenging.

What Is the Difference Between Bipolar Disorder and Manic Depression?

You may have heard the term "manic depression" used to describe a mental health disorder with similar symptoms as bipolar disorder. In fact, bipolar disorder was officially known as manic depression until the 1980s, when mental health professionals decided to change the name of the illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the guide that mental health professionals use to assist in diagnosis. They felt the term "bipolar disorder" more accurately described the condition and its symptoms.

It's also been argued that the older term carries a stigma in popular culture and that both "manic" and "depression" are now used to describe everyday feelings and emotions. As a result, bipolar disorder is now the preferred term and the one that healthcare professionals use in diagnosis.

Resources for Managing Bipolar Depression

Living with bipolar disorder comes with a variety of challenges for both you and your loved ones. Fortunately, there are a number of good sources of accurate information on the condition, as well as organizations that provide emotional support and suggestions for seeking financial assistance if needed.

Learn More About Resources for Bipolar Disorder

Resources We Love

National Alliance on Mental Illness

This national advocacy and education organization is a one-stop shop where you can find comprehensive information on bipolar disorder, tips on treatment and support, and links to relevant discussion groups.

American Psychiatric Association

Looking for the most clinical information on the condition? The American Psychiatric Association provides a succinct breakdown of the different types of bipolar disorder.

Harvard University Medical School

Whether you're decoding the symptoms, looking for the right treatment (psychotherapy included), or dealing with the prognosis, Harvard University experts help you understand when it’s time to call a professional and get help.

Resources for Family and Friends

Depression and Bipolar Support Alliance

The mission of the Depression and Bipolar Support Alliance is to educate, support, and help people living with a mood disorder and the people closest to them. This community-like website offers in-person and online support groups, as well as videos, programs, and a “Wellness Toolbox” for family and friends.

bpHope.com

bpHope.com is an online community that aims to raise awareness of bipolar disorder and to provide hope and empowerment to people with bipolar disorder, their families, caregivers, and healthcare providers. It offers updates about new research and advances in the bipolar disorder space, first-person profiles, and a variety of blog posts written by people with bipolar disorder. Check out some recent articles published on bpHope.com about managing anger and irritability, everything you've ever wanted to know about bipolar depression, and ways to support a loved one with bipolar disorder.

Bipolar Disorder Advocates

The Bipolar Barbie

The Bipolar Barbie is a brutally honest Australian woman sharing her journey in the form of heartfelt Instagram captions and inspirational YouTube videos that intend to break the stereotypes and stigma surrounding the condition. From the struggles of being in a relationship, to dealing with anxiety at work, to how having pets greatly improved her symptoms, she tells it all.

So Bipolar

This young mom of three says she’s #unashamed of having bipolar disorder. You can follow her journey on Instagram and learn how to love and understand someone dealing with the constant (and unexpected) ups and downs of the condition. Her blog is easy to read and full of insights.

TED Talks on Bipolar Disorder

Laura Bain: Living With Bipolar Type II

Laura Bain turned her struggle with bipolar II into an inspirational talk that will leave you with goose bumps and greater appreciation for women with this condition.

Sherpas: Climbing the Mountain of Bipolar

A caring teacher “comes out” of the manic depression closet she had been hiding in to describe her ups and downs, her “manic trips,” and how she hopes her personal story will resonate with others dealing with bipolar disorder.

Lithium: An Unexpected Journey

A former particle physicist gives a humorous narrative on lithium — one of the most common treatments for bipolar disorder — and why you don’t think about it until you can’t live without it. Or can you?

Useful App

eMoods Bipolar Mood Tracker

Keeping track of mood swings when you're suffering from bipolar disorder can be an anxiety trigger in itself. This data storage system can make the task more bearable for those living with the condition. Best thing about this app? You can send monthly reports directly to your doctor with one click.

Clinical Trials Study Finder

National Institute of Mental Health

Want to get involved? In addition to detailed symptom and treatment information about bipolar disorder, this branch of the National Institute of Health provides information on clinical trials and how to become part of a study.

Additional reporting by Deborah Shapiro and Cristy Marrero.

Editorial Sources and Fact-Checking

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