What is bipolar disorder?
Bipolar disorder, once known as manic depression, affects approximately 5.7 million adult Americans (about 2.6% of the U.S. population age 18 and older) each year. Symptoms typically begin around age 25.
It is characterized by significant mood swings, including episodes of depression and mania lasting days to weeks. Depressive episodes involve low mood, energy, and motivation. Manic episodes involve high energy, optimism, and sometimes impulsive or irrational behavior. Severe episodes may include psychotic symptoms such as hallucinations or delusions.
Many people with bipolar disorder also experience anxiety disorders, substance use disorders, or ADHD. The risk of suicide is significantly higher than in the general population.
Types of bipolar disorder
- Bipolar I Disorder: At least one full manic episode, possibly preceded or followed by hypomanic or depressive episodes. Manic episodes are often severe and may require hospitalization.
- Bipolar II Disorder: At least one hypomanic episode and one major depressive episode, without full mania.
- Cyclothymic Disorder: Frequent periods of hypomanic and depressive symptoms that are less severe, lasting at least two years (one year in children).
Rapid cycling (four or more episodes per year) can occur in any type.
What causes bipolar disorder?
The exact cause is unknown, but several factors contribute:
Genetics
Bipolar disorder often runs in families. If one parent has it, risk is about 10%; if both parents have it, risk rises to 40–70%.
Biological factors
Brain structure and chemistry may play a role, involving imbalances in neurotransmitters such as dopamine, serotonin, and norepinephrine.
Environmental factors
- Stressful life events (loss, trauma, financial stress)
- Substance abuse (alcohol, drugs)
- Childhood trauma or neglect
- Seasonal patterns (depressive in fall/winter, manic in spring/summer)
Psychological factors
Personality traits like high neuroticism, negative thinking, and poor coping skills may influence risk and course.
What are the symptoms?
Manic episode symptoms
- Elevated or irritable mood
- Increased energy and activity
- Reduced need for sleep
- Racing thoughts and rapid speech
- Inflated self-esteem or grandiosity
- Impulsivity and high-risk behaviors
- Distractibility
- Increased goal-directed activity
Depressive episode symptoms
- Persistent sadness or hopelessness
- Loss of interest in activities
- Fatigue or low energy
- Sleep disturbances (insomnia or hypersomnia)
- Appetite or weight changes
- Difficulty concentrating
- Feelings of worthlessness or guilt
- Agitation or slowed movement
- Suicidal thoughts or behaviors
Mixed episode symptoms
Features of mania and depression occurring simultaneously or in rapid sequence.
How is bipolar disorder diagnosed?
Clinical interview
A mental health professional gathers detailed history of mood, behavior, and functioning, often using a mood diary.
Medical and psychiatric history
- Past diagnoses and treatments
- Family history of mood disorders
- Physical exam and lab tests to rule out other conditions (thyroid, neurological)
Diagnostic criteria (DSM-5)
- Bipolar I: At least one manic episode
- Bipolar II: At least one hypomanic and one major depressive episode
- Cyclothymic: Two years of fluctuating mild hypomanic and depressive symptoms
How is bipolar disorder treated?
Treatment is lifelong and may include:
Medications
- Mood stabilizers (lithium, valproic acid, carbamazepine, lamotrigine)
- Atypical antipsychotics (olanzapine, quetiapine, risperidone, clozapine)
- Antidepressants (often with mood stabilizer to avoid triggering mania)
- Benzodiazepines (short-term for anxiety or agitation)
Psychotherapy
- Cognitive Behavioral Therapy (CBT)
- Interpersonal and Social Rhythm Therapy (IPSRT)
- Family-focused therapy
- Psychoeducation
- Support groups
Lifestyle changes
- Regular sleep patterns
- Balanced diet and regular exercise
- Stress management (mindfulness, meditation, yoga)
- Time management and routine
Other treatments
- Electroconvulsive therapy (ECT)
- Transcranial magnetic stimulation (TMS)
- Light therapy for seasonal mood changes
Sources
- National Institute of Mental Health (NIMH). Bipolar disorder. Accessed August 5, 2024.
- Depression and Bipolar Support Alliance. Bipolar Disorder Statistics. Accessed August 5, 2024.
- National Alliance on Mental Illness (NAMI). Bipolar Disorder. Accessed August 5, 2024.
- Jain A, et al. Bipolar affective disorder. NIMH. Accessed August 5, 2024.