What is bipolar disorder?

Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. Bipolar disorder is also known as bipolar disease or manic depression.
People with bipolar disorder may have trouble managing everyday life tasks at school or work, or maintaining relationships. There’s no cure, but there are many treatment options available that can help to manage the symptoms. Learn the signs of bipolar disorder to watch for.

Bipolar disorder facts

Bipolar disorder isn’t a rare brain disorder. In fact, 2.8 percent of U.S. adults — or about 5 million people — have been diagnosed with it. The average age when people with bipolar disorder begin to show symptoms is 25 years old.
Depression caused by bipolar disorder lasts at least two weeks. A high (manic) episode can last for several days or weeks. Some people will experience episodes of mood swings several times a year, while others may experience them only rarely. Here’s what having bipolar disorder feels like for some people.

Bipolar symptoms

There are three main symptoms that can occur with bipolar disorder: mania, hypomania, and depression.
While experiencing mania, a person with bipolar disorder may feel an emotional high. They can feel excited, impulsive, euphoric, and full of energy. During manic episodes, they may also engage in behavior such as:
  • spending sprees
  • unprotected sex
  • drug use
Hypomania is generally associated with bipolar II disorder. It’s similar to mania, but it’s not as severe. Unlike mania, hypomania may not result in any trouble at work, school, or in social relationships. However, people with hypomania still notice changes in their mood.
During an episode of depression you may experience:
  • deep sadness
  • hopelessness
  • loss of energy
  • lack of interest in activities they once enjoyed
  • periods of too little or too much sleep
  • suicidal thoughts
Although it’s not a rare condition, bipolar disorder can be hard to diagnose because of its varied symptoms. Find out about the symptoms that often occur during high and low periods.

Bipolar symptoms in women

Men and women are diagnosed with bipolar disorder in equal numbers. However, the main symptoms of the disorder may be different between the two genders. In many cases, a woman with bipolar disorder may:
  • be diagnosed later in life, in her 20s or 30s
  • have milder episodes of mania
  • experience more depressive episodes than manic episodes
  • have four or more episodes of mania and depression in a year, which is called rapid cycling
  • experience other conditions at the same time, including thyroid disease, obesity, anxiety disorders, and migraines
  • have a higher lifetime risk of alcohol use disorder
Women with bipolar disorder may also relapse more often. This is believed to be caused by hormonal changes related to menstruation, pregnancy, or menopause. If you’re a woman and think you may have bipolar disorder, it’s important for you to get the facts. Here’s what you need to know about bipolar disorder in women.

Bipolar symptoms in men

Men and women both experience common symptoms of bipolar disorder. However, men may experience symptoms differently than women. Men with bipolar disorder may:
  • be diagnosed earlier in life
  • experience more severe episodes, especially manic episodes
  • have substance abuse issues
  • act out during manic episodes
Men with bipolar disorder are less likely than women to seek medical care on their own. They’re also more likely to die by suicide.

Types of bipolar disorder

There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is defined by the appearance of at least one manic episode. You may experience hypomanic or major depressive episodes before and after the manic episode. This type of bipolar disorder affects men and women equally.

Bipolar II

People with this type of bipolar disorder experience one major depressive episode that lasts at least two weeks. They also have at least one hypomanic episode that lasts about four days. This type of bipolar disorder is thought to be more common in women.

Cyclothymia

People with cyclothymia have episodes of hypomania and depression. These symptoms are shorter and less severe than the mania and depression caused by bipolar I or bipolar II disorder. Most people with this condition only experience a month or two at a time where their moods are stable.
When discussing your diagnosis, your doctor will be able to tell you what kind of bipolar disorder you have. In the meantime, learn more about the types of bipolar disorder.

Bipolar disorder in children

Diagnosing bipolar disorder in children is controversial. This is largely because children don’t always display the same bipolar symptoms as adults. Their moods and behaviors may also not follow the standards doctors use to diagnose the disorder in adults.
Many bipolar symptoms that occur in children also overlap with symptoms from a range of other disorders that can occur in children, such as attention deficit hyperactivity disorder (ADHD).
However, in the last few decades, doctors and mental health professionals have come to recognize the condition in children. A diagnosis can help children get treatment, but reaching a diagnosis may take many weeks or months. Your child may need to seek special care from a professional trained to treat children with mental health issues.
Like adults, children with bipolar disorder experience episodes of elevated mood. They can appear very happy and show signs of excitable behavior. These periods are then followed by depression. While all children experience mood changes, changes caused by bipolar disorder are very pronounced. They’re also usually more extreme than a child’s typical mood swing.

Manic symptoms in children

Symptoms of a child’s manic episode caused by bipolar disorder can include:
  • acting very silly and feeling overly happy
  • talking fast and rapidly changing subjects
  • having trouble focusing or concentrating
  • doing risky things or experimenting with risky behaviors
  • having a very short temper that leads quickly to outbursts of anger
  • having trouble sleeping and not feeling tired after sleep loss

Depressive symptoms in children

Symptoms of a child’s depressive episode caused by bipolar disorder can include:
  • moping around or acting very sad
  • sleeping too much or too little
  • having little energy for normal activities or showing no signs of interest in anything
  • complaining about not feeling well, including having frequent headaches or stomachaches
  • experiencing feelings of worthlessness or guilt
  • eating too little or too much
  • thinking about death and possibly suicide

Other possible diagnoses

Some of the behavior issues you may witness in your child could be the result of another condition. ADHD and other behavior disorders can occur in children with bipolar disorder. Work with your child’s doctor to document your child’s unusual behaviors, which will help lead to a diagnosis.
Finding the correct diagnosis can help your child’s doctor determine treatments that can help your child live a healthy life. Read more about bipolar disorder in children.

Bipolar disorder in teens

Angst-filled behavior is nothing new to the average parent of a teenager. The shifts in hormones, plus the life changes that come with puberty, can make even the most well-behaved teen seem a little upset or overly emotional from time to time. However, some teenage mood swings may be the result of a more serious condition, such as bipolar disorder.
A bipolar disorder diagnosis is most common during the late teens and early adult years. For teenagers, the more common symptoms of a manic episode include:
  • being very happy
  • “acting out” or misbehaving
  • taking part in risky behaviors
  • abusing substances
  • thinking about sex more than usual
  • becoming overly sexual or sexually active
  • having trouble sleeping but not showing signs of fatigue or being tired
  • having a very short temper
  • having trouble staying focused, or being easily distracted
For teenagers, the more common symptoms of a depressive episode include:
  • sleeping a lot or too little
  • eating too much or too little
  • feeling very sad and showing little excitability
  • withdrawing from activities and friends
  • thinking about death and suicide
Diagnosing and treating bipolar disorder can help teens live a healthy life. Learn more about bipolar disorder in teenagers and how to treat it.

Bipolar and depression

Bipolar disorder can have two extremes: up and down. To be diagnosed with bipolar, you must experience a period of mania or hypomania. People generally feel “up” in this phase of the disorder. When you’re experiencing an “up” mood swing, you may feel highly energized and be easily excitable.
Some people with bipolar disorder will also experience a major depressive episode, or a “down” mood. When you’re experiencing a “down” mood swing, you may feel lethargic, unmotivated, and sad. However, not all people with bipolar disorder who have this symptom feel “down” enough to be labeled depressed. For instance, for some people, once their mania is treated, a normal mood may feel like depression because they enjoyed the “high” caused by the manic episode.
While bipolar disorder can cause you to feel depressed, it’s not the same as the condition called depression. Bipolar disorder can cause highs and lows, but depression causes moods and emotions that are always “down.” Discover the differences between bipolar disorder and depression.

Causes of bipolar disorder

Bipolar disorder is a common mental health disorder, but it’s a bit of a mystery to doctors and researchers. It’s not yet clear what causes some people to develop the condition and not others.
Possible causes of bipolar disorder include:

Genetics

If your parent or sibling has bipolar disorder, you’re more likely than other people to develop the condition (see below). However, it’s important to keep in mind that most people who have bipolar disorder in their family history don’t develop it.

Your brain

Your brain structure may impact your risk for the disease. Abnormalities in the structure or functions of your brain may increase your risk.

Environmental factors

It’s not just what’s in your body that can make you more likely to develop bipolar disorder. Outside factors may contribute, too. These factors can include:
  • extreme stress
  • traumatic experiences
  • physical illness
Each of these factors may influence who develops bipolar disorder. What’s more likely, however, is that a combination of factors contributes to the development of the disease. Here’s what you need to know about the potential causes of bipolar disorder.

Is bipolar hereditary?

Bipolar disorder can be passed from parent to child. Research has identified a strong genetic link in people with the disorder. If you have a relative with the disorder, your chances of also developing it are four to six times higher than people without a family history of the condition.
However, this doesn’t mean that everyone with relatives who have the disorder will develop it. In addition, not everyone with bipolar disorder has a family history of the disease.
Still, genetics seem to play a considerable role in the incidence of bipolar disorder. If you have a family member with bipolar disorder, find out whether screening might be a good idea for you.

Bipolar diagnosis

A diagnosis of bipolar disorder I involves either one or more manic episodes, or mixed (manic and depressive) episodes. It may also include a major depressive episode, but it may not. A diagnosis of bipolar II involves one or more major depressive episodes and at least one episode of hypomania.
To be diagnosed with a manic episode, you must experience symptoms that last for at least one week or that cause you to be hospitalized. You must experience symptoms almost all day every day during this time. Major depressive episodes, on the other hand, must last for at least two weeks.
Bipolar disorder can be difficult to diagnose because mood swings can vary. It’s even harder to diagnose in children and adolescents. This age group often has greater changes in mood, behavior, and energy levels.
Bipolar disorder often gets worse if it’s left untreated. Episodes may happen more often or become more extreme. But if you receive treatment for your bipolar disorder, it’s possible for you to lead a healthy and productive life. Therefore, diagnosis is very important. See how bipolar disorder is diagnosed.

Bipolar symptoms test

One test result doesn’t make a bipolar disorder diagnosis. Instead, your doctor will use several tests and exams. These may include:
  • Physical exam. Your doctor will do a full physical exam. They may also order blood or urine tests to rule out other possible causes of your symptoms.
  • Mental health evaluation. Your doctor may refer you to a mental health professionalsuch as a psychologist or psychiatrist. These doctors diagnose and treat mental health conditions such as bipolar disorder. During the visit, they will evaluate your mental healthand look for signs of bipolar disorder.
  • Mood journal. If your doctor suspects your behavior changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. The easiest way to do this is to keep a journal of how you’re feeling and how long these feelings last. Your doctor may also suggest that you record your sleeping and eating patterns.
  • Diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an outline of symptoms for various mental health disorders. Doctors can follow this list to confirm a bipolar diagnosis.
Your doctor may use other tools and tests to diagnose bipolar disorder in addition to these. Read about other tests that can help confirm a bipolar disorder diagnosis.

Bipolar disorder treatment

Several treatments are available that can help you manage your bipolar disorder. These include medications, counseling, and lifestyle changes. Some natural remedies may also be helpful.

Medications

Recommended medications may include:
  • mood stabilizers, such as lithium (Lithobid)
  • antipsychotics, such as olanzapine (Zyprexa)
  • antidepressant-antipsychotics, such as fluoxetine-olanzapine (Symbyax)
  • benzodiazepines, a type of anti-anxiety medication such as alprazolam (Xanax) that may be used for short-term treatment

Psychotherapy

Recommended psychotherapy treatments may include:

Cognitive behavioral therapy

Cognitive behavioral therapy is a type of talk therapy. You and a therapist talk about ways to manage your bipolar disorder. They will help you understand your thinking patterns. They can also help you come up with positive coping strategies.

Psychoeducation

Psychoeducation is a kind of counseling that helps you and your loved ones understand the disorder. Knowing more about bipolar disorder will help you and others in your life manage it.

Interpersonal and social rhythm therapy

Interpersonal and social rhythm therapy (IPSRT) focuses on regulating daily habits, such as sleeping, eating, and exercising. Balancing these everyday basics can help you manage your disorder.

Other treatment options

Other treatment options may include:
  • electroconvulsive therapy (ECT)
  • sleep medications
  • supplements
  • acupuncture

Lifestyle changes

There are also some simple steps you can take right now to help manage your bipolar disorder:
  • keep a routine for eating and sleeping
  • learn to recognize mood swings
  • ask a friend or relative to support your treatment plans
  • talk to a doctor or licensed healthcare provider
Other lifestyle changes can also help relieve depressive symptoms caused by bipolar disorder. Check out these seven ways to help manage a depressive episode.

Natural remedies for bipolar disorder

Some natural remedies may be helpful for bipolar disorder. However, it’s important not to use these remedies without first talking with your doctor. These treatments could interfere with medications you’re taking.
The following herbs and supplements may help stabilize your mood and relieve symptoms of bipolar disorder:
  • Fish oil. A 2013 study shows that people who consume a lot of fish and fish oil are less likely to develop bipolar disease. You can eat more fish to get the oil naturally, or you can take an over-the-counter (OTC) supplement.
  • Rhodiola rosea. This research also shows that this plant may be a helpful treatment for moderate depression. It may help treat depressive symptoms of bipolar disorder.
  • S-adenosylmethionine (SAMe). SAMe is an amino acid supplement. The researchshows it can ease symptoms of major depression and other mood disorders.
Several other minerals and vitamins may also reduce symptoms of bipolar disorder. Here’s 10 alternative treatments for bipolar disorder.

Tips for coping and support

If you or someone you know has bipolar disorder, you’re not alone. Bipolar disorder affects about 60 million people around the world.
One of the best things you can do is to educate yourself and those around you. There are many resources available. For instance, SAMHSA’s behavioral health treatment services locatorprovides treatment information by ZIP code. You can also find additional resources at the site for the National Institute of Mental Health.
If you think you’re experiencing symptoms of bipolar disorder, make an appointment with your doctor. If you think a friend, relative, or loved one may have bipolar disorder, your support and understanding is crucial. Encourage them to see a doctor about any symptoms they’re having. And read how to help someone living with bipolar disorder.
People who are experiencing a depressive episode may have suicidal thoughts. You should always take any talk of suicide seriously.
If you think someone is at immediate risk of self-harm or hurting another person:
  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.
If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Bipolar and relationships

When it comes to managing a relationship while you live with bipolar disorder, honesty is the best policy. Bipolar disorder can have an impact on any relationship in your life, perhaps especially on a romantic relationship. So, it’s important to be open about your condition.
There’s no right or wrong time to tell someone you have bipolar disorder. Be open and honest as soon as you’re ready. Consider sharing these facts to help your partner better understand the condition:
  • when you were diagnosed
  • what to expect during your depressive phases
  • what to expect during your manic phases
  • how you typically treat your moods
  • how they can be helpful to you
One of the best ways to support and make a relationship successful is to stick with your treatment. Treatment helps you reduce symptoms and scale back the severity of your mood swings. With these aspects of the disorder under control, you can focus more on your relationship.
Your partner can also learn ways to promote a healthy relationship. Check out this guide to maintaining healthy relationships while coping with bipolar disorder, which has tips for both you and your partner.

Living with bipolar disorder

Bipolar disorder is a chronic mental illness. That means you’ll live and cope with it for the rest of your life. However, that doesn’t mean you can’t live a happy, healthy life.
Treatment can help you manage your mood swings and cope with your symptoms. To get the most out of treatment, you may want to create a care team to help you. In addition to your primary doctor, you may want to find a psychiatrist and psychologist. Through talk therapy, these doctors can help you cope with symptoms of bipolar disorder that medication can’t help.
You may also want to seek out a supportive community. Finding other people who’re also living with this disorder can give you a group of people you can rely on and turn to for help.
Finding treatments that work for you requires perseverance. Likewise, you need to have patience with yourself as you learn to manage bipolar disorder and anticipate your mood swings. Together with your care team, you’ll find ways to maintain a normal, happy, healthy life.
While living with bipolar disorder can be a real challenge, it can help to maintain a sense of humor about life. For a chuckle, check out this list of 25 things only someone with bipolar disorder would understand.