Bipolar Disorder

Medically Reviewed by Zilpah Sheikh, MD on January 07, 2024
10 min read

Bipolar disorder is a mental health condition that used to be called manic depression. If you have it, your moods can swing between periods of extreme highs (called mania or hypomania) and extreme lows. These aren't usual "ups and downs." When you feel "up," you may have extreme joy or crankiness and so much energy that you don't want to sleep. During your "down" times, you may feel sad, hopeless, or have thoughts of suicide. 

There isn't a cure for bipolar disorder. It's a condition you have throughout your life. But with long-term medication and therapy, it can be managed well.

Bipolar disorder is a complex condition. Experts haven't found an exact cause for it, but several things likely play a role, including:

  • Your genes. Studies show that bipolar disorder can run in families. It's not because of a single gene that you inherit from your parents, but likely several. And genes aren't the only factor.
  • Childhood trauma. Some experts think there could be a link between childhood trauma (like emotional, physical, or sexual abuse) and bipolar disorder. But more research needs to be done.
  • Stress. Either one very stressful event, like the loss of a loved one, or ongoing daily stress, like worries about money, may help trigger bipolar disorder symptoms. 
  • How your brain works. If you have bipolar disorder, your brain may work differently than someone who doesn't have this condition. For instance, the brain chemicals that control how your brain functions could be out of balance.

The following may raise your risk of bipolar disorder:

  • A family history. For instance, if a direct relative (like a parent or sibling) has it, you're more likely to be diagnosed too.
  • A traumatic event or time of intense stress.
  • Drug or alcohol use. More studies need to be done to prove this link. But alcohol and drugs (both recreational and some prescription types) can cause side effects that look like symptoms of bipolar disorder.

Not all experts agree on how to classify the different kinds of bipolar disorder. But until more is understood about this condition, these are the types that are recognized: 

Bipolar I

If you have this kind:

  • Your manic periods (when you feel really "up" ) last at least a week. During this time, your symptoms could be intense enough to need urgent medical care. For instance, you may lose touch with reality, and see and hear things that aren't there. This is called psychosis.
  • You may also have depressive ("down") periods. Some people have manic and depressive symptoms at the same time.

If you go through four or more cycles of mania and and depression in a year, it's known as "rapid cycling."

Bipolar II

While mania is the main symptom of bipolar I disorder, bipolar II has less intense periods known as hypomania. These "high" periods might not disrupt your work or personal life and don't include delusions or hallucinations.

You could be diagnosed with bipolar II if:

  • Your symptoms of hypomania last at least 4 days.
  • You've had at least one episode of major depression.

It's important to note that bipolar II isn't a "milder" form of bipolar disorder. Although the manic episodes you have are less extreme than someone living with bipolar I, the "down" periods can last longer and be harder to manage.

Cyclothymic disorder

You have this type of bipolar disorder if:

  • You've had hypomanic and depressive episodes for 2 years or longer (for adults) or 1 year for children and teens.
  • Your symptoms are less intense or don't last long enough for you to be diagnosed with bipolar I or bipolar II.

Cyclothymic disorder can sometimes turn into into one of the other kinds of bipolar disorder.

Unspecified bipolar disorder

If your symptoms don't match any of the above types, you may be told that you have an "unspecified" type of bipolar disorder.

Bipolar disorder usually appears between ages 15 and 24 and persists through a lifetime. It's rare that newly diagnosed mania is seen in young children or in adults over age 65.

The intensity of symptoms is different for everyone and can also change over time. You could have a few mild symptoms. Or you could have intense periods that disrupt your work and make your daily life more of a challenge. 

Because bipolar disorder symptoms can come and go, long-term treatment is key, even when you're feeling well. Hospital care may be needed at times to help you balance your mood during a manic or depressive period.

Mood episodes

When your usual mood changes to mania, hypomania, or depression, it's called a mood episode. (You can also have a "mixed" episode which includes both "up" and "down" symptoms.) Your symptoms could last a week or two. They could also last much longer. Without treatment, you're likely to have more frequent mood episodes.

Here are some common symptoms you could have when your mood shifts.

Mania symptoms

The signs of mania in bipolar disorder include:

  • Feeling very excited, joyful, or like you're on a "high" 
  • Feeling very touchy or cranky
  • Acting rude or hostile toward others
  • Having very fast (racing) thoughts
  • Feeling extra-talented, special, powerful, or important (grandiose beliefs)
  • Feeling like you can't be harmed
  • An increased sex drive
  • Talking faster and louder than usual
  • Feeling jumpy
  • Feeling more energetic or active than usual
  • Acting on impulse (like spending way more money than usual)
  • An increase in risk taking (for instance, overusing drugs or alcohol or putting yourself in harm's way)
  • Feeling like you need less sleep due to your high energy

Hypomania symptoms

A hypomania episode is milder than a period of mania. The signs can include:

  • Feeling very happy or excited
  • Feeling more productive than usual
  • Getting easily distracted
  • Getting obsessed with an interest or activity
  • Finding it hard to sit still (for instance, pacing or fidgeting)
  • Having higher self-esteem than usual
  • Talking more or faster than usual (Others may have a hard time getting a word in.)
  • Having lots of thoughts at once
  • Acting on impulse and doing things you may regret later
  • Not sleeping a lot but still feeling rested

In some cases, you might not notice some of these changes until someone close to you points them out.

Depression symptoms

The clinical depression symptoms seen with bipolar disorder are the same as those seen in major depressive disorder. They include:

  • Less of an appetite and/or weight loss, or overeating and weight gain
  • Having a hard time concentrating, remembering, and making decisions
  • Fatigue, decreased energy, or feeling "slowed down"
  • Feeling guilty, worthless, helpless, or hopeless
  • Trouble falling asleep (insomnia) early-morning awakening, or oversleeping
  • Loss of interest or pleasure in hobbies and activities that you usually enjoy, including sex
  • Physical symptoms that don't respond to treatment, like headaches, digestive disorders, and chronic pain
  • Sad, anxious, or "empty" moods that don't go away
  • Finding it hard to be still 
  • Feeling cranky
  • Thoughts of death or suicide
  • Suicide attempts

Mixed episode

Some people have manic and depression symptoms at the same time. For instance, you might have a lot of energy and many ideas coming to you at once, while also feeling overwhelmed with anxiety and sadness. 

It's also possible to have a high mood episode right after a low period, or vice versa. Some people shift moods the same day, or even sooner. 

If you live with bipolar disorder, a treatment plan is essential to manage your symptoms. Still, there may be times when you also need some extra help. Thoughts of suicide are common when you're having a depressive episode.

  • If you begin feeling depressed, call your doctor. Explain the symptoms you're having and ask if they can see you as soon as possible.
  • If you have thoughts of hurting yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline. It's free and open 24 hours a day, 7 days a week.
  • If you feel that you or someone else is in immediate danger, call 911 or get to an emergency room as soon as you can.

Getting a diagnosis of bipolar disorder can take time. Many of the symptoms you may have during manic or depressive episodes can look like signs of other mental health conditions including anxiety, ADHD (attention deficit hyperactivity disorder), autism, and depression.

Bipolar disorder test

There's no blood test or brain scan that can diagnose bipolar disorder. After doing a physical exam, your doctor will ask about your symptoms, personal medical history, and family health. Some lab tests may be done to rule out medical conditions that could affect your mood. 

Then, your doctor may suggest that you speak to a mental health provider, like a psychiatrist, who will ask you more questions about your thoughts and feelings. They may suggest that you keep track of your moods for a while to see if any patterns emerge. Or they may ask to talk with some of your family members so they can get more insight into your moods. 

Your doctor will take into account how severe your symptoms are,  how long they last, and how often they happen. To be diagnosed with bipolar disorder, your symptoms must match the ones listed in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Based on your symptoms, your doctor could suggest:

Medication for bipolar disorder

Many prescription medications can help lessen your symptoms. For instance:

  • Mood stabilizers like lithium can help lessen or prevent mood episodes. They're often prescribed as a long-term treatment.
  • Antidepressants can help boost your depressed mood. They must be taken with a mood stabilizer so they don't trigger a depressive episode.
  • Anticonvulsants are another type of drug that can help keep your mood steady. Your doctor might prescribe this type if lithium doesn't work for you.
  • Antipsychotics are often given during a manic or hypomanic episode, especially if you're experiencing a break from reality.

Your doctor may also give you a medicine to help relieve other issues you're having, like anxiety or trouble sleeping. 

Talk therapy

Talking to a mental health expert can help you better understand and manage bipolar disorder. Your doctor could suggest that you try:

  • Cognitive behavioral therapy (CBT): You'll get a better idea of how your thoughts, feelings, and behaviors impact each other.
  • Interpersonal and social rhythm therapy: You'll focus on improving your relationships with others while building a daily routine for sleep, waking up, and exercise. Studies show that both of these can help stabilize your moods. 
  • Psychoeducation:  Either by yourself or with a group of others, you'll learn what may trigger your mood episodes and ways you can manage them.
  • Family therapy: In family therapy sessions, your loved ones can better understand what you're feeling and how to support you. Hearing their point of view may help you commit to your treatment plan.

Electroconvulsive therapy (ECT)

Electrical currents can be safely used to change your brain chemistry and improve your symptoms. ECTis often an option when you haven't gotten better with other types of treatment.

Repetitive transcranial magnetic stimulation (rTMS)

Special magnetic pulses can stimulate parts of your brain that help control your moods. rTMS is noninvasive, which means that it's done on the outside of your body and no surgery is involved.

Light therapy

Being exposed to special light can affect your circadian rhythms (your internal body clock, housed in your brain, that impacts how you function).

Day treatment programs

Some clinics and treatment centers offer a program that can provide daily support and therapy to help improve your symptoms. Talk to your doctor and therapist about the options near you.

Hospitalization

If your symptoms become severe, a hospital may be the best place to keep you safe until your mood returns to a healthy baseline.

Without treatment, bipolar disorder can severely impact your personal life. You could face complications like legal problems, money concerns, issues at work and school, and strained relationships with loved ones. Unmanaged symptoms can also raise your risk of alcohol and drug abuse and suicide.

If you live with bipolar disorder, many strategies can help you manage your symptoms. For instance, you can:

  • Know the early signs of a mood episode. This can help you take steps to get support right away (like calling your doctor).
  • Find ways to deal with stress. Talk to your doctor or therapist about how you can take care of yourself when you feel stressed.
  • Get moving. Regular exercise, whether high-impact kinds like running or swimming or gentle types like yoga, can help lessen symptoms of anxiety and depression.
  • Keep a routine. Try to go to bed, wake up, eat meals, and exercise at the same time every day. 
  • Avoid drugs and alcohol. They can make your symptoms worse.
  • Find a support system. Being open with friends and family can help them understand what you're going through and know how to help you. You could also join a support group with others living with bipolar disorder.
  • Stick with treatment, even when you feel good. Managing symptoms of bipolar can be a challenge. Don't stop or change any of your medications without talking to your doctor.

Unfortunately, it's common for people living with bipolar disorder to face a lack of understanding, negative beliefs, and discrimination. That can start to affect your quality of life and how you interact with other people at work, school, and in your personal life. You may even face stigma within your own family.

As public awareness about bipolar disorder grows,  the stigma around it will hopefully lessen over time. Until then, talk to your doctor and therapist about steps you can take to feel more comfortable with your diagnosis and treatment.

Bipolar disorder is a mental health condition that causes extreme shifts in your mood. While there's no cure, it's treatable with medication and therapy. Finding a doctor and therapist you trust and building a strong support system will help you stick to your treatment plan and manage your symptoms throughout your life.