Bipolar Disorders

Learn about the signs, risk factors, treatment, recovery, and social supports for bipolar disorders.

Learn more about bipolar disorders:

Definition

Bipolar disorder, sometimes called manic-depressive disorder, is a mental disorder that involves unusual shifts in mood, energy, activity levels, and the way a person thinks. These shifts include periods when the person feels manic (extremely “up,” energized, irritable) and periods when the person feels depressed (“down,” hopeless, irritable, sad, and apathetic).

In some cases, the person with bipolar disorder has symptoms of mania for a short time and the symptoms do not cause as much distress and disruption. This is called hypomania. For some people, the symptoms keep them from participating in everyday life. Others have mild symptoms that cause less impairment. The symptoms can also cause a person to do harmful and dangerous things they would otherwise not do.

Bipolar disorder is a leading cause of disability and suicide.

Bipolar disorders are often classified in the following ways:

  • Bipolar I: The person has at least one manic episode and usually a depressive episode
  • Bipolar II: The person has at least one each of a hypomanic and a depressive episode; depressive episodes occur more often than hypomanic episodes; the person has no manic episodes
  • Cyclothymia: The person has hypomanic and depressive symptoms over two or more years (one year for youth)

Signs and Symptoms

A person with bipolar disorder will experience times when they have symptoms of mania, hypomania, or depression. These mood episodes can change rapidly and are clearly different from the person’s typical moods and behaviors.

Mania and Hypomania

During mania or hypomania, a person feels energized. Their mood is “very high” or sometimes irritable. In this state, the person often lacks awareness of their disorder. A person with bipolar disorder has several of the following symptoms:

  • Inflated self-esteem and self-worth, feeling invulnerable, with special abilities that are much greater than those of other people
  • Needing much less sleep than usual, not feeling tired or feeling completely rested after a few hours of sleep
  • Being more talkative than usual, talking rapidly and non-stop
  • Racing thoughts, inability to stop or control thoughts
  • Distractibility, trouble maintaining focus or conversations
  • Intolerance, lack of patience, being easily irritated
  • Increase in focused activities, wanting to achieve certain things, such as winning money at the casino, or becoming more creative than usual
  • Involvement in dangerous and risky activities, such as gambling, having a lot of sex, using alcohol or drugs, or trying dangerous stunts

The symptoms of hypomania can be briefer, less severe, and cause less disruption in a person’s life. Sometimes when a person is severely manic, they feel paranoid, suspicious of others, or very anxious.

Depression

A person with bipolar disorder sometimes feels very sad, anxious, irritable, hopeless, or numb. A person with bipolar disorder has more days of depression than mania or hypomania. A person with bipolar disorder who has depression has several of the following symptoms for at least two weeks:

  • Feeling depressed or hopeless nearly all day, every day
  • Loss of interest and pleasure in almost all activities they previously enjoyed or withdrawal from friends and social activities
  • Weight and appetite change
  • Sleep disturbance, being unable to sleep or sleeping too much
  • Restlessness and lethargy, either feeling twitchy and restless or as though their muscles and body don’t want to move at all
  • Anger and irritability, with a low tolerance for everyday situations
  • Fatigue, even right after waking up
  • Feelings of worthlessness and guilt, or blaming themselves for things that are not their fault
  • Lack of concentration, being indecisive, and unable to think through a situation or focus on a problem
  • Reoccurring thoughts of death, often wishing they were dead, or thinking about suicide

Episodes with Mixed Features

A person with bipolar disorder may have symptoms of mania and depression at the same time. This is called an episode with mixed features. During such an episode, the person may feel very sad, empty, or hopeless, while also feeling extremely energized.

Rapid Cycling

People who have four or more manic or hypomanic and depressive episodes in one year are described as rapid cycling.

Bipolar Disorder with Psychotic Symptoms

Sometimes, a person with severe episodes of mania, hypomania, or depression also has psychotic symptoms, such as hallucinations (seeing, hearing, or feeling things that are not actually there) or delusions (believing something that is not real and that others do not see).

The psychotic symptoms tend to match the person’s extreme mood. For example, someone having psychotic symptoms during a manic episode may believe they are famous, have a lot of money, or have special powers. Someone having psychotic symptoms during a depressive episode may falsely believe they are ruined and penniless, or have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms can be misdiagnosed with schizophrenia.

Risk Factors

Bipolar disorders may affect up to 4% of people in the general population. Bipolar I affects up to 1% of the population. The first symptoms of bipolar disorder can occur in childhood. Bipolar disorders often start in the teenage years or in the early 20s. After having mania or hypomania, a person is more likely to have another episode of mania, hypomania, or depression.

For statistics on adults and children with bipolar disorder, visit Bipolar Disorder from the National Institute of Mental Health (NIMH).

Scientists are studying possible causes of bipolar disorder. There is no single cause. Multiple factors are involved, as described below.

Brain Structure and Functioning

There is strong evidence that bipolar disorders are related to how the brain functions. In some people, mania, hypomania, or depression is a direct result of brain injury or a disease that affects the brain. Learning more about these differences can help scientists better understand bipolar disorder and predict which treatments will work best for which people.

Genetics

Bipolar disorder tends to run in families. A person with a parent who has bipolar disorder is 10 times more likely to have bipolar disorder than a person in the general population. But most people with a family history of bipolar disorder do not develop the illness. Certain genes increase the risk of bipolar disorder. But genes are not the only risk factor. In studies of identical twins, if one twin develops bipolar disorder, the other twin does not always do so, even though identical twins share the same genes.

Gender-related Factors

Bipolar I is equally likely in males and females, but Bipolar II affects more females than males. Females with bipolar disorder are more likely than males to have rapid cycling and depressive symptoms, and to have eating disorders. Compared with males, females with bipolar disorder also have a higher risk of alcohol use disorders.

Suicide Risk

Suicide is a major health concern for people with bipolar disorder and is preventable. For people with bipolar disorder, the lifetime risk of suicide is estimated to be at least 15 times greater than the general population. Bipolar disorder may account for up to 1 in 4 suicides. The percentage of days spent in a depressive episode and a history of suicide attempts are linked to greater suicide risk.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Anxiety and ADHD

A person with bipolar disorder has a higher risk of having an anxiety disorder or attention deficit hyperactivity disorder (ADHD).

Substance Use

A person with bipolar disorder may report using alcohol or drugs to address or “self-medicate” their symptoms. Substance use problems are more common with bipolar disorder than with any other diagnosis, and make bipolar disorder symptoms worse.

Other Factors

People with bipolar disorder often report experiencing trauma. Trauma can occur before or after a diagnosis of bipolar disorder.

Also, people with bipolar disorder often are involved with the criminal justice system. The symptoms of bipolar disorder, especially during hypomania and mania, may increase the chance that a person will be arrested by police and have other legal problems.

Evidence-based Treatments

Treatment for those with bipolar disorder focuses on helping the person better control their mood swings and other bipolar symptoms. The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.

A person-centered effective treatment plan usually includes using both medication and psychotherapy, ensuring that the person has a support system, and helping the person engage in meaningful activities.

A long-term relationship with a qualified physician is important for effective treatment. Bipolar disorder is a lifelong illness, with repeated episodes of mania and depression. Between episodes, many people with bipolar disorder are free of mood changes, but some people have lingering symptoms. Long-term, continuous treatment helps to control these symptoms. Effective treatment can help a person achieve their recovery goals.

Psychotherapy

In combination with medication, psychotherapy—sometimes called “talk therapy”—can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Visit Psychotherapies from NIMH to learn about psychotherapies.

Psychotherapies used as part of a treatment plan for a person with bipolar disorder include:

Cognitive behavioral therapy focuses on a person’s thoughts and beliefs, and how they influence mood and actions. It aims to change a person’s thinking to be more adaptive and healthy.

Family psychoeducation and skill building includes family members in therapy sessions to learn about the disorder and its treatment. This can improve communication and problem-solving for managing symptoms.

Interpersonal and social rhythm therapy focuses on improving relationships, sleep, and daily routines and activities.

Psychoeducation provides training about health disorders and how to manage symptoms.

Medication

Different types of medications can help control symptoms of bipolar disorder. A person may need to try several medications to find ones that work best. Medications that are generally used to treat bipolar disorder include:

  • Lithium
  • Mood stabilizers
  • Second generation antipsychotics
  • Antidepressants

People with bipolar disorder may have trouble sleeping. Sometimes the medication they take for bipolar symptoms causes sleep problems. If sleeplessness does not improve, a doctor may suggest a change in medications, or prescribe sedatives or a sleep medication.

For basic information about medications, visit Mental Health Medications from NIMH. For up-to-date information on medications, side effects, and warnings, access the Food and Drug Administration.

Other Treatment Options

Electroconvulsive Therapy (ECT) can provide relief for people with severe bipolar disorder not helped by standard psychotherapies or medications. Sometimes ECT is used for bipolar symptoms when other illnesses or pregnancy make taking medications too risky. ECT may cause short-term side effects, including confusion, disorientation, and memory loss.

Safety planning involves developing strategies to limit the risks of danger to self and others. Safety planning may include a crisis plan or removal of dangerous items or weapons from places where the person can access them.

Behavior Health Advance Directive

A person with bipolar disorder is encouraged to create a behavioral health advance directive, stating:

  • Where they wish to receive care
  • What treatments they want
  • Who can make legal healthcare decisions for them, if they cannot do so due to their illness

Advance directive laws vary across states. Learn more about advance directives for behavioral health.

Complementary Therapies and Activities

Complementary therapies and activities can help people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, see the National Center for Complementary and Integrative Health.

Maintaining a life/mood chart provides a record of daily mood symptoms, treatments, sleep patterns, and life events. This can help people and their healthcare professionals track and treat bipolar disorder symptoms more effectively. A regular routine for sleep, physical activity, meals, and engagement in school, work, and volunteerism can be helpful in managing symptoms.

Folate, Vitamin B, and Omega-3 supplements may be helpful for people with depression or bipolar disorder when used with standard care.

Exercise and aerobic activity is often recommended to help with symptoms of bipolar disorder, especially during periods of depression.

Self-education or learning more about bipolar disorder through books, videos, and online resources can be helpful. Bibliotherapy is increasingly used in mental health care. It encourages a person to think about how their life relates to the content of books, poetry, and other written materials. This can help a person learn new coping strategies, change behaviors, and reduce distress.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, see the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Bipolar disorder is a chronic condition that needs lifelong management. However, recovery is possible. Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope
  • Enjoying life

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and help people find and connect with local resources. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Here are resources for people with bipolar disorder and their families:

Future Directions in Research and Treatment

Researchers are exploring the causes of bipolar disorders. Studies of brain function may help understand who is at risk for this illness, its course, and new forms of treatment. Studies of genetics and biomarkers are clarifying differences in bipolar disorder symptoms. Genetic studies aim to better understand how bipolar disorder affects people in the same family. Studies of sleep, lifestyle, diet, exercise, family support, and environment aim to improve overall functioning.

Studies are needed to learn how to help people live healthy lives and promote opportunities for full participation in society.

Finding Treatment

Consult a healthcare professional who has training and experience working with bipolar disorder. For general information on mental illnesses and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the NIMH Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 05/12/2017