Bipolar disorder

Formerly known as manic depression and manic-depressive illness, bipolar disorder is a chronic (long-term) mental illness that causes noticeable fluctuations in mood, energy levels, and concentration. These fluctuations can be described in two general categories:

• Extreme highs of euphoria, animated behavior, or irritability, known as mania or manic episodes. Hypomania is another type of high that’s less intense than mania.
• Deep lows of sadness or indifference, referred to as major depression or depressive episodes  

Everyone experiences highs and lows in response to changing life circumstances, but the symptoms of bipolar disorder differ from everyday mood swings. The American Psychiatric Association (APA) explains:

• Manic episodes last seven or more days and involve a clear increase in energy, mood, or irritability.
• Hypomanic episodes last four or more days and involve noticeable but less-severe manic symptoms that don’t significantly interfere with daily functioning.
• Depressive episodes last at least two weeks and involve deep sadness or loss of interest in once-enjoyable activities, among other symptoms of depression. These episodes tend to occur more often than mania or hypomania.

Manic, hypomanic, and depressive episodes can be rare or take place multiple times over the course of a year. Between these highs and lows, many people with bipolar disorder experience few or no symptoms. Experiencing four or more episodes of depression or mania within one year is referred to as “rapid cycling.”

Who does bipolar disorder affect?

Bipolar disorder can affect anyone at any age, although the average age of onset is 25. In some cases, symptoms of this mood disorder may begin to appear early in childhood. Though uncommon, bipolar disorder can develop in a person’s 40s or 50s. If you have a close blood relative (such as a parent or sibling) with bipolar disorder, you’re more likely to have the disorder yourself.

How common is bipolar disorder?

The National Institute of Mental Health (NIMH) says bipolar disorder affects 5.7 million people in the U.S., ages 18 and older in any given year, or about 2.8 percent of the adult population. An estimated 4.4 percent of U.S. adults experience bipolar disorder at some point in their lives.

What's the difference between borderline personality disorder and bipolar disorder?

Bipolar disorder is a mood disorder that generally affects people assigned male at birth (AMAB) and people assigned female at birth (AFAB) equally. Borderline personality disorder is a personality disorder that is diagnosed more often in people AFAB. Both bipolar disorder and borderline personality disorder cause dramatic mood swings, but the symptoms and treatment of these conditions differ.

Bipolar disorder is characterized by distinct episodes of highs and lows that aren’t necessarily tied to specific events. Between these episodes, people are typically able to function as usual. The symptoms of borderline personality disorder, on the other hand, are frequently present and involve more depression and anger than elation or energy. These mood swings are often tied to “trigger events” that others may view as small or insignificant—for instance, a friend not responding to a text message may prompt overwhelming feelings of dejection, despair, and worthlessness.

In general, borderline personality disorder is viewed as more complex and difficult to treat than bipolar disorder. While bipolar disorder is usually responsive to medication, borderline personality disorder treatment typically focuses on psychological approaches such as talk therapy. Medication is not an effective treatment for borderline personality disorder, although some medicines may be helpful in reducing symptoms like anxiety.

Back to top

There are three main types of bipolar disorder:

Bipolar I

Bipolar I disorder is defined by manic episodes. These may be severe and require hospitalization. Hypomanic and depressive episodes can also occur, and sometimes, mania may happen alongside a depressive episode, which is known as a mixed episode or agitated depression. In between manic and depressive episodes, people with bipolar I disorder usually experience neutral moods.

Bipolar II

Bipolar II disorder is characterized by depressive episodes and hypomanic episodes. Mania does not occur. Many people with bipolar II disorder initially seek treatment for depression, since hypomania can sometimes feel satisfying and even increase productivity at work or school.

Anxiety or substance use disorders are common among people with bipolar II disorder.

Cyclothymia

Cyclothymia is a milder type of bipolar disorder that’s defined as having at least two years of frequently occurring depressive and hypomanic symptoms. These symptoms don’t qualify as episodes, however, and are less severe than those of bipolar I and bipolar II disorders. Cyclothymia is also referred to as cyclothymic disorder.  

It’s possible for someone to experience bipolar disorder symptoms that don’t fit into the condition’s three main types. Such cases are known medically as “other specified and unspecified bipolar and related disorders.”

Back to top

Bipolar disorder symptoms can vary from person to person. In general, symptoms are categorized under mania, hypomania, depression, and psychosis.

Mania and hypomania

The APA defines mania as feeling unusually high-spirited, energized, or irritable, along with at least three of the following symptoms:

• Being easily distracted
• Having a reduced urge to sleep
• Talking faster or more often than usual
• Experiencing restlessness or increased activity
• Having racing thoughts or frequently changing topics when speaking
• Engaging in risky behaviors, such as making extravagant purchases or driving too fast 

Symptoms of mania are well-defined and are a clear departure from the person’s typical behavior. Other possible signs of a manic episode include feeling wired or overly talented, confident, or important. Some people with mania also have an excessive appetite for food, sex, or other pleasing activities.

Hypomania refers to manic symptoms that are less severe and don’t disrupt daily life, although they’re still noticeable to friends and family. Someone with hypomania or mania may insist nothing is wrong.

Major depression

A major depressive episode (sometimes called bipolar depression) is defined by the APA as a two-week period of experiencing at least five of the following symptoms every day or almost every day:

• Intense, deep sadness
• Loss of interest in favorite activities or difficulty finding pleasure
• Fatigue
• Trouble concentrating or making decisions
• Sleeping too little or too much
• Feeling guilty or worthless
• Increased or decreased appetite, which may result in weight changes
• Restlessness or slow movement or speech
• Persistent thoughts of death or suicide   

Other possible symptoms of bipolar depression include anxiety, forgetfulness, hopelessness, difficulty making conversation, or feeling unable to perform simple tasks.

Psychosis

Psychosis refers to delusions and hallucinations that cause a person to detach from reality. Psychotic symptoms most often associated with bipolar disorder include:

• Hearing voices that aren’t real (auditory verbal hallucinations)
• Seeing things that don’t exist (visual hallucinations)
• Mistakenly believing ordinary things have hidden meanings or messages (referential delusions)
• Unfoundedly believing someone is trying to cause harm or spy on you (persecutory delusions)
• Inaccurately believing you are especially powerful, wealthy, or gifted (grandiose delusions)

Psychosis is most likely to occur during a manic episode, although it’s possible to have psychotic symptoms during a depressive episode. One 2022 review of 339 studies published in World Journal of Psychiatry found that more than half of the people with bipolar disorder and about two-thirds of those with bipolar I experienced psychotic symptoms during their lifetime.

Back to top

The exact cause of bipolar disorder isn’t fully understood, although an imbalance of chemicals in the brain may play a role. Researchers have identified two key contributors to this mood disorder:

Genetics

Bipolar disorder is one of the most heritable mood disorders. In fact, 80 to 90 percent of people with bipolar disorder have a blood relative with bipolar disorder or depression, according to the APA.

Recent research also suggests the genetic component of this condition may be even stronger than previously thought. In a large-scale study conducted by the Psychiatric Genomics Consortium, experts found 64 genetic locations (genes or other DNA segments of interest) associated with bipolar disorder—around twice as many found in previous studies. 

Still, no single gene is fully responsible for bipolar disorder, and being related to someone with bipolar disorder doesn’t mean you’re sure to be diagnosed. It’s also possible to develop bipolar disorder if you don’t have any close relatives with the condition.

Brain size, structure, and function

Researchers have found that people with bipolar disorder have subtle differences in brain size, structure, and functioning than those without the condition. That said, brain scans can’t identify bipolar disorder, and more research on this subject is needed.

Back to top

Many cases of bipolar disorder have a genetic basis, which means you’re at a higher risk if you have a first-degree blood relative (such as a parent or sibling) with this condition. Still, certain behaviors and environmental factors can trigger an episode of bipolar disorder or increase a person’s risk of developing the condition, including:

• Drug use or excessive alcohol consumption
• Going through trauma or prolonged periods of high stress
• Adverse childhood experiences, including witnessing or experiencing abuse, neglect, or violence at a young age

Back to top

Some people are diagnosed with bipolar disorder after seeking treatment for depression symptoms. In other cases, manic symptoms can necessitate professional medical care and lead to a bipolar disorder diagnosis.  

In general, diagnosing bipolar disorder begins with a visit to a healthcare provider (HCP). This professional will gather information about your symptoms and personal and family medical histories. A physical exam or blood test may be conducted to screen for possible conditions that could be contributing to your symptoms, such as hyperthyroidism.

Your HCP may also perform a mental health evaluation or refer you to a licensed mental health provider who specializes in diagnosing and treating mood disorders. This could be a psychologist or a clinical social worker. You might also see a medical doctor called a psychiatrist if prescription medicine will be needed as part of your bipolar disorder treatment plan.

Bipolar disorder is typically diagnosed after a thorough review of symptoms, traumatic or stressful life experiences, and family medical history. HCPs and mental health professionals generally refer to bipolar disorder criteria described in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A person must have experienced at least one episode of hypomania or mania to be diagnosed with bipolar disorder.  

Because bipolar disorder is a complex disease that can involve intense feelings of sadness, it’s sometimes misdiagnosed as depression. In some cases, it may take several months or years for people with bipolar disorder to receive an accurate diagnosis. Being honest and precise about your symptoms, life experiences, and personal and family medical histories can help your HCP correctly evaluate your condition and recommend appropriate bipolar disorder treatment.

Back to top

Untreated or poorly managed bipolar disorder has the potential to cause problems that affect every area of life, including broken relationships, struggles at work or school, and financial woes. A particularly concerning complication of this mood disorder is thoughts of self-harm or suicide.

As many as one in five people with bipolar disorder commits suicide, according to the NIMH. Out of 34,719 people with the condition included in a 2019 review and analysis of studies published in Epidemiology and Psychiatric Sciences, close to 34 percent attempted suicide during their lifetimes.

The condition is also associated with a decreased lifespan. The NIMH notes that bipolar disorder reduces a person’s lifespan by 9.2 years, on average.

Common co-occurring conditions

There are multiple mental health concerns that tend to occur alongside bipolar disorder. These include:

• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Substance use disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Eating disorders such as binge eating

Physical health concerns that are sometimes associated with bipolar disorder include obesity, headaches, heart disease, and thyroid issues.

Back to top

Bipolar disorder won’t improve without treatment, so it’s important to promptly speak with an HCP if you or someone you know experiences possible symptoms of this condition. If left untreated, bipolar disorder can interfere with your ability to maintain healthy relationships and tend to responsibilities at work, school, or home. An effective treatment plan can balance your mood and help you live a productive and healthy life.

When to call 911

Severe manic or depressive episodes may warrant emergency care. If you or someone you know is experiencing suicidal thoughts or behavior, call 911 or seek help from a loved one immediately. You can also call or text 988 in the U.S. to connect with the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline). Additionally, you can chat with a crisis counselor online using the lifeline’s chat feature. All of these services are completely free, confidential, and available 24/7.    

If someone you know is experiencing severe manic or psychotic symptoms that may require hospitalization, the National Alliance on Mental Illness recommends calling 911 and informing the dispatcher that a mental health crisis is occurring. Many cities have crisis intervention team (CIT) programs with law enforcement professionals who are trained to safely handle psychiatric emergencies.

Back to top

Your bipolar disorder treatment plan will be unique to you. No two cases of the condition are exactly alike, so finding the proper combination of medication and psychotherapy may take some time. With patience and support, you can discover the best bipolar disorder treatment approach for your needs.

Medication for bipolar disorder

Medication is a primary form of treatment for bipolar disorder. There are several classes of drugs that are used to help manage bipolar disorder symptoms. Factors such as your age, overall health, symptoms, and what type of bipolar disorder you have will influence what type and dosage of medication may be right for you.

Mood stabilizers  

Mood stabilizers help even out the highs and lows of bipolar disorder. They’re particularly helpful in preventing or reducing the intensity of manic and hypomanic episodes, although they can take several weeks or months to take full effect.

Lithium—a natural salt—is among the most widely prescribed and evaluated medications for bipolar disorder. Other commonly used mood stabilizers include:

• Valproic acid
• Divalproex sodium
• Carbamazepine 
• Lamotrigine 

Antipsychotics

First developed to treat schizophrenia, antipsychotic medication can be helpful for people with bipolar disorder who experience racing thoughts, hallucinations, delusions, or other psychotic or manic symptoms. Antipsychotic medications are sometimes considered a type of mood stabilizer since they help to steady mood swings. They may also provide relief from depressive episodes.

Antipsychotic medications that are commonly prescribed to treat bipolar disorder include:

• Olanzapine
• Risperidone
• Quetiapine
• Aripiprazole
• Ziprasidone
• Lurasidone
• Asenapine 
• Cariprazine
• Lumateperone

Antidepressants

Antidepressants can help treat bipolar depression by increasing the levels of certain chemicals (neurotransmitters) in the brain, including serotonin, dopamine, and norepinephrine. These medications may take a few months to provide meaningful relief from symptoms, although newer types of medications such as intranasal esketamine can usually take effect in one to two weeks.

Selective serotonin reuptake inhibitors (SSRIs)—drugs that boost serotonin levels in the brain—are a type of antidepressant that may be used to help relieve bipolar depression. These drugs include:

• Escitalopram
• Fluoxetine
• Citalopram
• Sertraline
• Paroxetine

Antidepressants must be paired with a mood stabilizer or antipsychotic medication in people with bipolar disorder. If taken alone, antidepressants may trigger mania. A combination medication of fluoxetine and olanzapine (known as an antidepressant-antipsychotic) can be prescribed in some cases.

Anti-anxiety drugs

Anti-anxiety medications such as benzodiazepines can help ease anxious feelings and improve sleep quality in some people with bipolar disorder. Still, they’re generally viewed as a short-term treatment option.

Side effects of bipolar disorder medications

Any type of medication has the potential to cause side effects, and bipolar medications are no exception. Some possible side effects of drugs used to treat bipolar disorder include:

• Sleepiness
• Dry mouth
• Constipation
• Blurred vision
• High or low blood pressure
• High blood sugar
• Changes in weight
• Dizziness
• Reduced sexual desire
• Restlessness or a strong urge to move or pace (akathisia)

Talk to your HCP if you experience side effects while taking medication for bipolar disorder. While some side effects tend to last, others may go away after a few weeks or can be relieved by adjusting dosages. Drinking alcohol or using recreational drugs can interfere with medications and cause complications, so be sure you understand what substances must be avoided while receiving treatment.

It’s also important to let your HCP know if you’re pregnant or plan on becoming pregnant, or if you’re taking any other medicines, including over-the-counter medications, dietary supplements, herbs, or essential oils. Remember to never pause medications or adjust dosages without first speaking with your HCP. Abruptly stopping some bipolar disorder medications can trigger severe episodes or withdrawal symptoms.

Psychotherapy for bipolar disorder

Many people with bipolar disorder benefit from psychotherapy, especially when combined with medication and support from loved ones. Psychotherapy—also known as talk therapy—is conducted by a mental health provider such as a psychiatrist, psychologist, or licensed clinical social worker. It generally involves discussing your life experiences and answering questions about your thoughts and feelings. In short, psychotherapy is designed to help you identify and change problematic emotions, thoughts, and behaviors for the better.

There are multiple types of psychotherapy that can help people with bipolar disorder, including:

Cognitive behavioral therapy (CBT): The goal of CBT is to recognize unhealthy thoughts and behaviors and replace them with positive and beneficial ones. With CBT, you can change how you view a negative situation and learn how to better react to certain circumstances. CBT tailored to address insomnia can also be helpful in treating bipolar depression.

Interpersonal and social rhythm therapy (IPSRT): A newer approach to bipolar disorder psychotherapy, IPSRT focuses on improving mood by learning how to respond to stress and disruptions to daily rhythms. This can help you avoid or reduce the severity of manic or depressive episodes.  

Family-focused therapy: Involving family in therapy sessions can help your loved ones better support you through the ups and downs of bipolar disorder. For example, family members can learn how to improve communication skills, spot the warning signs of a manic or depressive episode, and help you navigate difficult symptoms. 

Psychoeducation: Simply learning about bipolar disorder and its causes, symptoms, and treatment options may help you feel more in control and give your loved ones valuable insight on your condition.   

Light therapy: Light therapy—which entails sitting next to a special light source for at least 30 minutes every morning—is a highly effective treatment option for seasonal affective disorder. Because many people with bipolar disorder experience seasonal depression, light therapy may be used to improve symptoms during winter months.

Finding the right mental health provider and type of therapy to treat your bipolar disorder may take a few tries, so don’t be discouraged if you need to switch therapists or attempt a different approach.

Other bipolar disorder treatments

Some people with bipolar disorder find it helpful to add other therapies to their treatment plan, such as: 

Electroconvulsive therapy (ECT): This brain stimulation procedure may be beneficial if you have bipolar disorder symptoms that are severe or don’t respond well to other treatments. During ECT, you’ll be placed under general anesthesia while small electrodes are positioned in precise locations on your scalp. A gentle electric current is then sent through the electrodes to stimulate the brain and trigger seizure activity for less than one minute.  

The results of this therapy are promising. Clinical research shows ECT provides significant symptom relief for more than 80 percent of patients with uncomplicated but severe depression, according to the APA. The U.S. Food and Drug Administration (FDA) has approved ECT for use in people ages 13 and older with depressive episodes from bipolar disorder or depression.

Repetitive transcranial magnetic stimulation (rTMS): Another form of brain stimulation, rTMS uses low-intensity magnetic pulses to stimulate specific areas of the brain. It’s a non-invasive procedure that doesn’t require anesthesia and is approved by the FDA to treat patients with depressive episodes who are already taking at least one antidepressant. The strength of the magnetic field you’ll be exposed to during an rTMS procedure is about the same as that of a magnetic resonance imaging (MRI) scan.

Back to top

There’s no way to definitively prevent bipolar disorder, but seeking treatment at the first sign of symptoms can help stop the condition from worsening. If you or someone you know is experiencing possible symptoms of bipolar disorder, reach out to your HCP or mental health provider for assistance. The sooner the condition is diagnosed, the faster treatment can begin and relief can be experienced.

Back to top

Bipolar disorder is a lifelong condition that can’t be cured, but it can be managed. Many people respond well to treatment and enjoy a positive quality of life. If you have bipolar disorder, it’s important to follow your HCP’s treatment guidance and ask for help when you need it. You may need to adjust therapies or medication dosages if symptoms change or worsen. Check with your HCP before stopping or altering any treatments.

Back to top

A bipolar disorder diagnosis may feel scary or unpredictable, but it’s important to remember you’re not alone. Mental illnesses are relatively common, and many people achieve professional and personal success while living with bipolar disorder.

There are several ways you can help manage your bipolar disorder symptoms and improve your well-being. In addition to receiving clinical treatment, some people with this condition find it helpful to do the following:

• Structure each day, including setting routines for eating, exercising, and going to bed.
• Keep track of moods in a journal and note how daily activities influence them.
• Exercise regularly and briskly, if you’re able. Jogging, power walking, swimming, bicycling, and lifting weights, for example, can help reduce anxiety, promote brain health, and improve sleep.  
• Find healthy outlets to channel energy, such as joining a recreational basketball league or attending art classes.
• Incorporate stress-relieving techniques into daily practice, such as meditation, yoga, and tai-chi.
• Avoid alcohol and recreational drug use, as well as misuse of any drug or substance.
• Eat a varied diet with plenty of nutrient-rich foods.
• Keep caffeine and added sugar to a minimum.

You may want to ask trusted friends or family to support you in your bipolar treatment journey. For example, loved ones can provide encouragement and reminders as you attend therapy sessions or try out different medications. Joining an online or in-person support group for bipolar disorder and connecting with people who face similar challenges may also be helpful. With patience and support, bipolar disorder can be effectively managed.

Back to top

• Tips for Caregivers of People Living with Bipolar Disorder
• Bipolar Disorder: Should You Get a Second Opinion?   
• Why It Can Be Difficult to Diagnose Bipolar Disorder