Do you feel very happy and outgoing—or very irritable—on some days, but unusually sad or anxious on other days? Do the “up” periods go along with increased energy or activity? Do the “downs” go along with low energy, hopelessness, or inability to enjoy what you usually like to do, and sometimes suicidal thoughts? Do these mood swings make it hard to sleep, stay focused, or get things done? Some people with these symptoms have a lifelong but treatable mental disorder called bipolar disorder.
Bipolar disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals) mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manic depression, which are older terms.
Everyone goes through normal ups and downs, but bipolar disorder is different. The range of mood changes can be extreme. In manic episodes, someone might feel very happy, irritable, or “up,” and there is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent, or hopeless, in combination with a very low activity level. Some people have hypomanic episodes, which are like manic episodes, but less severe and troublesome.
Most of the time, bipolar disorder develops or starts during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come and go, bipolar disorder usually requires lifetime treatment and does not go away on its own. Bipolar disorder can be an important factor in suicide, job loss, and family discord, but proper treatment leads to better outcomes.
The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Mood episodes are intense. The feelings are intense and happen along with changes in behavior, energy levels, or activity levels that are noticeable to others.
|Symptoms of a Manic Episode||Symptoms of a Depressive Episode|
|Feeling very up, high, elated, or extremely irritable or touchy||Feeling very down or sad, or anxious|
|Feeling jumpy or wired, more active than usual||Feeling slowed down or restless|
|Racing thoughts||Trouble concentrating or making decisions|
|Decreased need for sleep||Trouble falling asleep, waking up too early, or sleeping too much|
|Talking fast about a lot of different things (“flight of ideas”)||Talking very slowly, feeling like you have nothing to say, or forgetting a lot|
|Excessive appetite for food, drinking, sex, or other pleasurable activities||Lack of interest in almost all activities|
|Thinking you can do a lot of things at once without getting tired||Unable to do even simple things|
|Feeling like you are unusually important, talented, or powerful||Feeling hopeless or worthless, or thinking about death or suicide|
Some people with bipolar disorder may have milder symptoms than others with the disorder. For example, hypomanic episodes may make the individual feel very good and be very productive; they may not feel like anything is wrong. However, family and friends may notice the mood swings and changes in activity levels as behavior that is different from usual, and severe depression may follow mild hypomanic episodes.
There are three basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior or increased activity levels (manic episodes) to very sad, “down,” hopeless, or low activity-level periods (depressive episodes). People with bipolar disorder also may have a normal (euthymic) mood alternating with depression. Four or more episodes of mania or depression in a year are termed “rapid cycling.”
Many people with bipolar disorder also may have other mental health disorders or conditions such as:
Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. For example, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosed with schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moods and other symptoms of bipolar disorder. Street drugs sometimes can mimic, provoke, or worsen mood symptoms.
Looking at symptoms over the course of the illness (longitudinal follow-up) and the person’s family history can play a key role in determining whether the person has bipolar disorder with psychosis or schizophrenia.
The exact cause of bipolar disorder is unknown. However, research suggests that there is no single cause. Instead, a combination of factors may contribute to bipolar disorder.
Bipolar disorder often runs in families, and research suggests that this is mostly explained by heredity—people with certain genes are more likely to develop bipolar disorder than others. Many genes are involved, and no one gene can cause the disorder.
But genes are not the only factor. Some studies of identical twins have found that even when one twin develops bipolar disorder, the other twin may not. Although people with a parent or sibling with bipolar disorder are more likely to develop the disorder themselves, most people with a family history of bipolar disorder will not develop the illness.
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
To diagnose bipolar disorder, a doctor or other health care provider may:
A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. Some people have bipolar disorder for years before it is diagnosed. This may be because:
Treatment helps many people, even those with the most severe forms of bipolar disorder. Doctors treat bipolar disorder with medications, psychotherapy, or a combination of treatments.
Certain medications can help control the symptoms of bipolar disorder. Some people may need to try several different medications and work with their doctor before finding the ones that work best. The most common types of medications that doctors prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium can help prevent mood episodes or reduce their severity when they occur. Lithium also decreases the risk for suicide. Additional medications that target sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan.
Talk with your doctor or a pharmacist to understand the risks and benefits of each medication. Report any concerns about side effects to your doctor right away. Avoid stopping medication without talking to your doctor first.
Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can offer support, education, skills, and strategies to people with bipolar disorder and their families. Psychotherapy often is used in combination with medications; some types of psychotherapy (e.g., interpersonal, social rhythm therapy) can be an effective treatment for bipolar disorder when used with medications.
Some people may find other treatments helpful in managing their bipolar symptoms, including:
Not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder. Talk to your doctor before taking any supplement. Certain medications and supplements taken together can cause serious side effects or life-threatening drug reactions. Visit the National Center for Complementary and Integrative Health for more information.
The National Institute of Mental Health (NIMH) is a federal research agency and cannot provide medical advice or referrals to practitioners. However, there are tools and resources available that may help you find a provider or treatment. You can also:
Call the toll-free National Suicide Prevention Lifeline at 800-273-TALK (8255), available 24 hours a day, seven days a week. This service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 800-799-4889. All calls are free and confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates, or dial 911 in an emergency.
Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.
Remember, bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.
The National Institute of Mental Health (NIMH) conducts and supports research on bipolar disorder that increases our understanding of its causes and helps develop new treatments. Researchers continue to study genetics and bipolar disorder, brain function, and symptoms in children and teens who have bipolar disorder, as well as family history in health and behavior.
Learn more about NIMH’s research priorities and current studies.
Clinical research is medical research that involves people like you. People volunteer to participate in carefully conducted investigations that ultimately uncover better ways to treat, prevent, diagnose, and understand human disease. Clinical research includes trials that test new treatments and therapies as well as long-term natural history studies, which provide valuable information about how disease and health progress.
Please Note: Decisions about participating in a clinical trial and determining which ones are best suited for you are best made in collaboration with your licensed health professional.
NIMH researchers conduct studies in a wide range of areas related to the brain and mental disorders. The studies usually take place at the NIH Clinical Center in Bethesda, MD, and may require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with a clinician. Visit www.nimh.nih.gov/health/trials/index.shtml or www.nimh.nih.gov/joinastudy for more information.
To find a clinical trial near you, you can visit www.clinicaltrials.gov. This website is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from health professionals.
Talk to your doctor about clinical trials, their benefits and risks, and whether one is right for you. Learn more about clinical trials by visiting the following websites:
Through clinical trials, researchers are making discoveries that can be used in everyday practice to help people.
The Substance Abuse and Mental Health Services Administration provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov. For additional resources, visit www.nimh.nih.gov/findhelp.
Asking questions and providing information to your doctorealth care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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NIH Publication No. 19-MH-8088
Revised October 2018
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