Bipolar disorder is a mental health condition characterized by unusually large shifts in an individual’s mood, concentration, energy and activity level.
Bipolar disorder is a long-term mood disorder characterized by major fluctuations in mood — both high and low — that can impact daily functioning and behavior.
Although bipolar disorder is a chronic mental health condition, treatments are available to help manage it. This includes medication, psychotherapy, and lifestyle strategies.
Bipolar disorder is a serious mental health condition affecting 2.8 percent of adults in the United States. It involves episodes of mania (extreme highs) and depression (intense lows).
This condition was formerly referred to as manic depression.
People with bipolar disorder may experience rapid cycling between these abnormal mood states. If a person experiences four or more episodes of mania or depression in a year, they are diagnosed as having the rapid cycling variant of bipolar disorder.
Signs of bipolar disorder generally emerge in young adulthood. Research suggests that 70 percent of people with bipolar disorder experience their first manic episode between 15 and 24 years old, though it can happen later in life.
Severe bipolar episodes can profoundly impact a person’s ability to think clearly and make sound judgments. They may cause irritability and withdrawal and, in some cases, lead to psychosis that requires hospitalization.
We’ll unpack the differences between the types of bipolar disorder (bipolar I versus II and cyclothymia). We’ll also explain the risk factors and potential causes, and then go over treatment options and coping strategies.
The types of bipolar disorder include:
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder or cyclothymia
Bipolar disorder unspecified
Here’s what to know.
Bipolar I is thought to be the most common type of bipolar disorder. It’s characterized by episodes of mania that last for a minimum of seven days (or are severe enough to require hospitalization).
Typically, patients with bipolar I will have depressive episodes as well — though not always.
This subtype of bipolar disorder involves episodes of depression and episodes of elevated mood that don’t meet the full criteria for mania. These are known as hypomanic episodes (hypo means “below”).
Hypomanic episodes in bipolar II may not last as long as full manic episodes, though that’s not always the case. While bipolar I doesn’t always involve depressive episodes, bipolar II does.
You can think of this third type of bipolar disorder as a chronic yet milder version involving mood shifts between depressed mood and hypomania. With cyclothymia, people experience persistent, mild levels of depression and elevated mood that are present for at least two years.
The two-year symptom period may be interrupted for a few weeks at a time — when things feel more like a stable baseline.
This final category of bipolar disorder subtypes is the net that catches anything that doesn’t fit into the first three categories.
Unspecified or other types of bipolar disorder are when a patient doesn’t meet the criteria specified above but still sees the periods of abnormal mood elevation characteristic of bipolar disorders.
The single most telling symptom of bipolar disorder is the episodic oscillation between high and low mood states — characteristic shifts between depression, normal mood, and mania.
We’ll break down the symptoms of bipolar disorder by episodes of mania and episodes of depression.
Symptoms of a manic episode can include:
Impaired or poor judgment (doing things you wouldn’t normally do while in a stable mood), recklessness, and impulsivity
Feeling like you don’t need sleep
Racing thoughts, speaking quickly, or being very distractible
Being full of energy and wanting to do many things at once
Increased desire to partake in pleasure-seeking activities like spending money, eating indulgently, having sex, and drinking alcohol without considering the consequences
Inflated sense of self
For those having a hypomanic episode, these symptoms are often present, but they may not last as long.
Also, they don’t interfere substantially in a person's ability to function on a day-to-day basis. In many cases, the person experiencing them may not even realize it, thinking they’re functioning at their peak capacity. But others can tell something is seriously wrong.
Bipolar disorder can also involve depressive episodes, which have the same symptoms that people with major depressive disorder experience.
Symptoms of a depressive episode can include:
Feeling down, anxious, or irritable
Feeling indecisive or having difficulty making decisions
Sleep disturbances like insomnia or oversleeping
Loss of interest in activities or doing anything, even simple tasks
Anhedonia (inability to experience pleasure)
Ruminative thoughts involving feelings of loss, guilt, or failure
Feelings of helplessness and worthlessness
Lack of focus
Suicidal thoughts or frequent thoughts of death
For most people with bipolar disorder, their first episode is usually a depressive one. This can lead to an incorrect diagnosis of major depressive disorder. It can sometimes take years to get the right diagnosis.
Other symptoms of bipolar disorder can include things like:
Severe mania. Severe symptoms of mania can lead to psychosis and necessitate hospitalization. Research shows that 50 to 75 percent of people with bipolar disorder experience psychotic symptoms at some point in the course of their illness, like delusions or hallucinations.
Simultaneous depressive and manic symptoms. Some people might have a mix of both symptoms of depression and manic symptoms at the same time. Mixed features (as well as rapid cycling) are more common in women with bipolar disorder.
Suicidal thoughts or behaviors. Research suggests that bipolar poses the highest risk of suicide of any mental health condition. There isn’t much data distinguishing between suicide rates in bipolar I versus II, but researchers believe 25 and 60 percent of people with bipolar disorder will attempt suicide.
If you or someone you know is self-harming or experiencing suicidal thoughts, call emergency services immediately. You can also get help by calling the Suicide and Crisis Lifeline at 988.
Experts haven’t identified one exact cause of bipolar disorder. But like most other mental disorders, several things might increase a person’s risk of developing the illness. This includes an interaction of genetics, brain health or brain function, and environmental factors or lifestyle.
Is bipolar disorder genetic? Yes, partly. Research shows that genetics play a significant role.
In other words, if your parents or siblings have bipolar, or you have a family history of it, there’s a larger chance you might one day as well.
Older twin studies suggest that 79 percent to 93 percent of the risk of bipolar disorder is genetic. A more recent twin study identified specific genes associated with bipolar disorder.
Even so, researchers acknowledge that genetics aren’t the only predictive indicators of bipolar, as many people from families with bipolar histories never develop the disorder themselves. And it’s possible to have bipolar disorder without a family history of it.
Brain function and structure may also play a role in bipolar disorder, but researchers know very little about this.
Some studies have found differences in brain structure and activity in those with bipolar disorder. However, these differences haven’t led to a way to diagnose bipolar disorder. It’s possible that brain structure abnormalities may go away with treatment, especially treatment with the mood stabilizer lithium.
There may also be imbalances in mood-regulating neurotransmitters (brain chemicals) like dopamine and serotonin. But this isn’t well understood, either.
More research is needed to better understand how genetics and brain structure play a role in bipolar disorder so healthcare providers can better diagnose and treat it in the future.
While environmental factors aren’t thought to cause bipolar disorder, they may trigger an episode in someone who already has the illness. We’ll explore how environmental stressors play a role in this mental health condition in the risk factors section ahead.
Like many other mood disorders, the causes of bipolar are similar to the risk factors.
Some other environmental or lifestyle risk factors that could increase the risk of triggering a mood episode:
Stressful events. Stressful life events have been associated with an increased risk of developing bipolar disorder symptoms in someone who has this diagnosis. For instance, the recent passing of an immediate relative (like a partner or sibling), relationship issues, illness, or financial problems.
Illicit drug use and substance abuse. In one study, cannabis use was associated with an increased risk of psychotic symptoms during manic episodes. Another review found a link between cannabis use and an increased risk of developing mania and experiencing more severe symptoms. Other illicit drugs, including opioids and stimulants, have also been linked with triggering bipolar disorder episodes. The odds are even higher with drug dependence (commonly referred to as addiction).
Childhood maltreatment. Some research shows that experiencing childhood trauma and abuse may increase the risk of developing bipolar later on in vulnerable individuals. How and why this association exists is unclear.
Sleep deprivation. Research has shown that a lack of sleep or sleep disturbances can trigger a manic episode in people who have bipolar disorder.
Many people with bipolar disorder have one or more other mental health disorders that occur at the same time. Common comorbid conditions include:
Anxiety disorders, like generalized anxiety disorder, panic disorder, and phobias
Substance abuse and substance use disorders
Eating disorders
Attention-deficit/hyperactivity disorder (ADHD)
Certain medical conditions have also been associated with bipolar disorder, including irritable bowel syndrome (IBS), asthma, obesity, and migraines.
You or a loved one are showing signs of bipolar disorder. What’s next in managing this mental health condition? The first is getting a formal diagnosis, which will lead to treatment options.
Unfortunately, there aren’t any blood tests, brain scans, or other laboratory tests that can help a healthcare provider make a diagnosis of bipolar disorder. Instead, the diagnosis is made using a diagnostic interview.
Additional information is gathered from family and friends. This latter source of information is crucial because when people with bipolar disorder experience elevated mood states, they’re often unaware of it.
To be diagnosed with bipolar I disorder, you need to have experienced at least one manic episode lasting at least a week, characterized by symptoms that substantially interfere with daily functioning — and that can’t be attributed to another physical illness, mental health condition, or substance use.
To be diagnosed with bipolar II, you’d need to have:
At least one episode of hypomania lasting at least four days, but the episode can’t be severe enough to meet the full criteria for mania (that would lead to a diagnosis of bipolar I)
At least one episode of depression lasting at least two weeks
Noticeable changes in mood and uncharacteristic behaviors
Your healthcare provider will also make sure the symptoms you display aren’t related to another physical illness, mental health condition, or substance use.
To be diagnosed with cyclothymia, hypomanic and mild depressive episodes must alternate back and forth for at least two years.
Once you’ve been formally diagnosed with bipolar disorder, your provider or team of providers will help you come up with a treatment plan for managing your symptoms.
Treating bipolar disorder focuses on managing the severity and frequency of mood episodes rather than making the disorder go away entirely. Treatments can be very effective, but we don’t have a cure yet.
As such, a treatment plan for bipolar disorder prioritizes keeping the patient safe, ensuring the safety of those around them, and reducing the frequency and severity of episodes of depression and episodes of mania or hypomania.
Treatment is usually multifaceted, involving a combination of medications, therapy, and other interventions if needed.
Treatment for bipolar disorder is still a developing field. And some of the go-to medications for regulating bipolar disorder symptoms, like depressive symptoms, aren’t effective on their own.
For instance, there isn’t much evidence that antidepressants work well in treating bipolar disorder. Antidepressants by themselves shouldn’t be used to treat bipolar disorder because they elevate the risk of triggering a manic episode.
That said, mood stabilizers and anticonvulsants show remarkable benefits for bipolar patients. Some examples of mood stabilizers:
Carbamazepine (Equetro®)
Lamotrigine (Lamictal®)
Lithium (Eskalith®, Lithobid®)
Some studies show that the most effective treatment results from medication have been seen from combinations of mood stabilizers and antipsychotic medications like:
Aripiprazole (Abilify®)
Olanzapine (Zyprexa®)
Cariprazine (Vraylar®)
Lurasidone (Latuda®)
Quetiapine ER (Seroquel XR®)
Risperidone (Risperdal®)
Side effects vary depending on the type of medication used. Some common side effects of bipolar medications include weight gain and fatigue or drowsiness. These side effects can usually be managed effectively and often get better with time.
Treatment is closely monitored by a psychiatrist or psychiatric nurse practitioner.
Research shows that combining talk therapy with medication can help bipolar patients stick to their drug treatment, help ease some of the symptoms, and teach them how to manage the condition better.
Some forms of therapy for bipolar treatment include:
Cognitive behavioral therapy (CBT). CBT therapists help you identify how negative thinking leads to harmful behaviors and emotions, aiming to break this cycle. Studies show that CBT, along with medication, is generally helpful for most people with bipolar disorder, except those with very severe mania.
Dialectical behavioral therapy (DBT). DBT is all about helping you cope with stress, regulate emotions, and improve relationships. Though initially designed to address suicidal behavior in women and those with borderline personality disorder, it’s also been adapted to treat other mental health conditions, like bipolar disorder.
Family-focused therapy (FFT). Since bipolar disorder can affect interpersonal relationships, some may find that this form of therapy helps them improve their close relationships.
Electroconvulsive therapy (ECT). ETC, or shock therapy, is considered effective for the most treatment-resistant symptoms of bipolar, like life-threatening mania and psychosis.
Transcranial magnetic stimulation (TMS). This stimulation technique uses magnetic pulses to stimulate the parts of the brain involved in mood regulation and cognitive function. TMS isn’t FDA-approved to treat bipolar disorder, but some research is promising.
Ketamine. The FDA hasn’t approved ketamine to treat bipolar disorder. However, it’s been used off-label to manage pain and depression since the 1970s and may have antidepressant and anti-suicidal effects.
Psychoeducation. Whether through personal research, support groups, or psychotherapy, learning about your mental health condition can help you identify triggers, feel less alone, and find useful resources.
Regardless of which options might work for you or a loved one with bipolar disorder, working with a healthcare professional is essential. Keep in mind, it may take some trial and error to figure out what treatment plan works best for each individual.
Though it can’t always be prevented, bipolar disorder can be effectively managed through the variety of treatment options we mentioned above and the support of a mental health professional or healthcare provider.
There are also steps you can take to prevent the symptoms of a manic episode or a depressive episode from worsening.
Research shows that it can help to make some behavioral adjustments, like:
Improving sleep with sleep hygiene improvements. Lack of sleep can potentially trigger mania for those with bipolar disorder. To improve sleep hygeine, establish a routine in a quiet, dark, and consistent environment. Avoid stimulants (like caffeine), daytime napping, alcohol, and screens before bed.
Money management planning. Developing a plan to limit access to financial resources during a manic or hypomanic phase can be helpful for people whose symptoms lead to overspending or impulse spending.
Identifying and avoiding triggers. Knowing what situations, places, things, or people may be associated with either euphoria or dysphoria can help you make healthier lifestyle choices.
If you or a loved one is struggling with symptoms of depression or thoughts of suicide and need someone to talk to right away, help is available. Check out the resources below:
Call or text the Suicide and Crisis Lifeline using 988
Call the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline by dialing 1-800-662-HELP (4357)
Contact the National Alliance on Mental Illness (NAMI) Helpline by dialing 1-800-950-NAMI (6264) or texting “HelpLine” to 62640.
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