Bipolar Disorder Explained
Bipolar disorder is a serious mental health condition that involves cycling mood changes. It is a mood disorder. Bipolar disorder affects a person’s mood and interferes with their ability to function effectively in everyday life. According to the National Alliance on Mental Illness, bipolar disorder occurs in equal numbers in males and females (assigned at birth).
A person with bipolar disorder experiences alternating episodes of mania and depression. Periods of intense mania involve a very high level of energy, alertness, and excitability, along with an extremely elevated mood. Episodes of depression can include a low energy level and overwhelming, persistent feelings of sadness and despair.
Some people with bipolar disorder may experience a combination of symptoms of mania and depression. This is called a mixed state. In some cases, there is a rapid shifting from symptoms of mania to symptoms of depression. This is called rapid cycling.
Bipolar disorder is a lifelong condition. However, an ongoing treatment plan can help manage the symptoms.
Complications of bipolar disorder are potentially serious, even life threatening. Complications include delirium, paranoia, suicidal thoughts, and, in extreme cases, suicide attempts.
Seek immediate medical care if you or someone you know is delirious, delusional, or experiencing thoughts of harming oneself or suicide. Also seek help if there are thoughts of wanting to harm someone else.
The severity and symptoms of bipolar disorder vary from person to person. However, symptoms generally affect mood, energy, and functioning.
Bipolar disorder involves periods of intense mania or euphoria that alternate with episodes of depression. Symptoms of bipolar disorder interfere with your ability to function as you usually would in relationships and everyday activities.
A specific diagnosis of bipolar disorder depends on the type and severity of the symptoms.
Manic episode symptoms
A manic episode must last at least 1 week to warrant a diagnosis of bipolar disorder. Symptoms must be severe enough to interfere with usual function, including work, home life, and social activity. Symptoms must also mark a clear change from a person’s typical behavior.
Symptoms of a manic episode of bipolar disorder include:
- need for less sleep
- uncontrollable racing thoughts or rapid change of topics when speaking
- increased or faster speech
- restlessness or increased activity
- increased risk-taking behavior
Hypomanic episode symptoms
In a hypomanic episode, symptoms of mania are less severe and typically do not interfere with day-to-day functioning. In fact, people sometimes mistake hypomanic episodes for enjoyable periods of energy and productivity. This can cause a delay in a diagnosis of bipolar disorder. A diagnosis follows a more severe manic episode or a depressive episode.
Major depressive episode symptoms
For a diagnosis of bipolar disorder, a major depressive episode must last at least 2 weeks. It also must include five or more of these symptoms:
- intense feelings of sadness or despair
- loss of interest in activities that were formerly enjoyed
- feelings of worthlessness or guilt
- increased or decreased sleep
- increased or decreased appetite
- slowed speech or movement
- difficulty concentrating
- frequent thoughts of death or suicide
If someone you know is at immediate risk of harming themselves or others, or is experiencing thoughts of suicide:
- Ask the question, “Are you considering suicide?” even if it is tough.
- Listen without judgment.
- Call 911 or your local emergency number.
- Stay with the person until emergency services arrive.
- Try to remove weapons, medications, or other potentially harmful items.
If you or someone you know is experiencing suicidal thoughts, contact the National Suicide Prevention Lifeline:
- Call 800-273-8255 (or 988 after July 16, 2022).
- Chat with the lifeline.
This service is available 24/7.
Doctors classify bipolar disorder as three primary types. These are based on the symptoms and episodes that a person experiences:
- Bipolar I disorder: A person with bipolar I disorder experiences at least one manic episode that lasts at least 1 week. Many people with bipolar I disorder experience periods of neutral mood. Others can have depressive or hypomanic episodes.
- Bipolar II disorder: A person with bipolar II disorder experiences at least one major depressive episode and one hypomanic episode. People with bipolar II disorder often experience additional conditions, such as anxiety or substance misuse. These conditions can intensify the symptoms of depressive or hypomanic episodes.
- Cyclothymic disorder: This is a milder form of bipolar disorder in which a person experiences frequent emotional swings and changes in mood. However, these changes are not severe enough to warrant a diagnosis of bipolar I or bipolar II disorder. Doctors typically diagnose cyclothymic disorder if someone experiences symptoms for at least half of a 2-year period. In addition, symptoms cannot be absent for more than 2 months at a time.
The exact cause of bipolar disorder is not known, but it is possible that there is a genetic link. According to the American Psychiatric Association, 80–90% of people with bipolar disorder have a close relative with bipolar disorder or depression. It is also possible that an imbalance of chemicals in the brain or hormonal deficiencies cause bipolar disorder.
In some cases, the following may set off symptoms similar to those of bipolar disorder:
- sleep deprivation
- thyroid disease
- the use of certain drugs, including antidepressants, methamphetamines, and steroids
In these cases, a doctor typically will not give a diagnosis of bipolar disorder unless symptoms persist after treatment.
Risk factors may include brain structure and functioning, and a family history of bipolar disorder or depression. Not all people who have these risk factors will develop bipolar disorder.
You cannot prevent bipolar disorder. However, if you develop it, you can work closely with your doctor or mental health professional to manage the episodes.
It is possible to experience more than one mental condition at a time. This is known as having co-occurring conditions.
Common conditions that co-occur with bipolar disorder include:
- attention deficit hyperactivity disorder
- post-traumatic stress disorder
- substance use disorder
- eating disorders
The primary symptoms of bipolar disorder are related to mood changes. Your doctor may first rule out other possible causes for your mood swings.
Imaging tests or brain scans cannot diagnose bipolar disorder. However, they may identify underlying conditions that can produce drastic disruptions in your mood. These conditions include a brain tumor or stroke.
To further evaluate your mood changes, your doctor or mental health professional may ask you these questions:
- When did you first notice your mood swings?
- What moods do you experience when you have mood swings?
- How long do your mood changes last?
- Does anything make the mood changes better or worse?
- Do you have other symptoms?
- Do you have other psychiatric or medical problems?
- What medications are you taking?
- Do you drink alcohol?
- Are you using illegal drugs?
If your doctor rules out other medical conditions, they will most likely refer you to a mental health professional. This specialist will further evaluate your symptoms to confirm a diagnosis of bipolar disorder. You can then work closely with your doctor and mental health professional to create a treatment plan.
There is no cure for bipolar disorder. Treatment generally needs to be lifelong to most effectively manage symptoms. Treatment for bipolar disorder typically includes a combination of the following:
- Psychotherapy: A psychotherapist builds a relationship of trust with a client and helps the client better cope with bipolar disorder. Psychotherapy methods include family therapy and behavior therapy, such as cognitive behavioral therapy. These therapies can help people recognize and work through the issues associated with bipolar disorder.
- Medications: A doctor may recommend medications to stabilize the extreme mood changes that occur with bipolar disorder. Medications may include mood stabilizers, antipsychotics, antidepressants, or a combination of these.
- Self-care management: This includes education about the disorder, recognition of early signs of episodes, and lifestyle changes, such as regular exercise.
- Other treatments: If psychotherapy and medications are not successful in managing symptoms, a doctor may recommend alternative treatments. These may include electroconvulsive therapy or transcranial magnetic stimulation.
Treatment for bipolar disorder varies from person to person. Work closely with your doctor and mental health professional to find the right treatment plan for you.
Here are questions people also ask about bipolar disorder.
How does bipolar disorder affect quality of life?
Even with effective treatment, bipolar disorder is a challenging diagnosis that can alter day-to-day life.
Taking medication as prescribed is an essential part of a bipolar disorder treatment plan. The medications may result in side effects that are sometimes difficult to manage. If that is the case, talk with your doctor about alternative treatment options or medication changes. Do not stop taking medications on your own.
People around you may not understand bipolar disorder. They may feel discomfort or uncertainty. This can place an added burden on you. It is important to communicate with the people close to you. Explain to them what bipolar disorder is, what helps you manage symptoms, and the best ways for them to help.
Does bipolar disorder shorten life expectancy?
A 2015 study shows that the average life expectancy of an adult with bipolar disorder may decrease by 8–12 years.
How do you know if someone has bipolar disorder?
The only way to know if someone has bipolar disorder is for a health professional to give that diagnosis. If someone you are close to shows signs of bipolar disorder, encourage them to contact their doctor or mental health professional.
Bipolar disorder is a mental condition that affects all aspects of daily life. The symptoms include episodes of mania and depression. Most people experience these episodes interchangeably with periods of neutral mood in between.
Bipolar disorder is a lifelong condition. However, a treatment plan can help manage the symptoms.
If you are experiencing symptoms of bipolar disorder, contact your doctor or mental health professional.