Bipolar Disorder

What bipolar disorder is

Everyone has ups and downs. In bipolar disorder, mood episodes are more extreme, last days to weeks or longer, and change sleep, energy, thinking and behavior enough to disrupt life. Between episodes, many people feel well.

Manic episode

Mania lasts at least 1 week (or any duration if hospitalization is needed) and involves elevated, expansive or irritable mood with increased energy, plus symptoms such as:

• greatly reduced need for sleep (feeling rested after 3 hours)
• racing thoughts and rapid, pressured speech
• inflated self-esteem or grandiose beliefs
• distractibility and jumping between ideas
• increased goal-directed activity or agitation
• risky behavior: spending sprees, sexual risk-taking, reckless driving, impulsive business decisions

Severe mania can include psychosis: hallucinations or delusions.

Hypomanic episode

Hypomania has the same features but is milder, lasts at least 4 days, does not cause major impairment or need hospitalization, and has no psychosis. People may feel unusually productive or confident, and others notice the change more than they do.

Depressive episode

Depression lasts at least 2 weeks with low mood or loss of interest, plus changes in sleep, appetite, energy, concentration, feelings of guilt or worthlessness, slowed or restless movements, and thoughts of death. In bipolar disorder, depressive episodes are often longer and more frequent than manic ones.

Mixed features

Some episodes combine symptoms of both poles, such as depressed mood with racing thoughts and agitation. Mixed states carry a higher risk of suicide.

Types of bipolar disorder

Bipolar II is not a milder illness. Its depressive episodes can be long and disabling.

Rapid cycling means 4 or more mood episodes in a year.

Causes and risk factors

• Genetics: having a parent or sibling with bipolar disorder raises risk substantially. It is one of the most heritable mental health conditions.
• Brain biology: differences in mood-regulating circuits and neurotransmitters.
• Triggers: sleep disruption (shift work, jet lag, new parenthood), stressful life events, alcohol and drug use (especially stimulants and cannabis), and childbirth.
• Medicines: antidepressants without a mood stabilizer, steroids and stimulants can trigger mania in susceptible people.

Diagnosis

There is no blood test or scan for bipolar disorder. A psychiatrist or other mental health professional diagnoses it by:

• taking a detailed history of mood episodes, sleep, energy and behavior over years
• asking family members, who often recall hypomanic periods the person did not notice
• using mood charts and screening questionnaires
• ruling out medical causes such as thyroid disease, brain injury and substance effects with blood tests and sometimes imaging

Bipolar disorder is often first diagnosed as major depression, because people seek help when depressed. On average, years can pass before the correct diagnosis. It frequently coexists with anxiety disorders, ADHD and substance use disorders.

Treatment

Medicines

• Lithium: the longest-established mood stabilizer. It prevents both mania and depression and lowers suicide risk. It needs regular blood tests for levels, kidney and thyroid function.
• Anticonvulsant mood stabilizers: valproate (for mania; avoided in women who could become pregnant because of serious birth defect risks), lamotrigine (mainly prevents depression), and carbamazepine.
• Antipsychotics: quetiapine, olanzapine, aripiprazole, lurasidone, cariprazine and others treat mania, some treat bipolar depression, and many are used for maintenance.
• Antidepressants: used cautiously, only with a mood stabilizer, because alone they can trigger mania or rapid cycling.

Finding the right medicine can take time. Stopping suddenly, especially lithium, raises the risk of relapse.

Psychotherapy

• Psychoeducation: learning about the illness, early warning signs and triggers.
• Cognitive behavioral therapy (CBT).
• Interpersonal and social rhythm therapy: stabilizing daily routines and sleep.
• Family-focused therapy: improves communication and relapse planning.

Other treatments

Electroconvulsive therapy (ECT) is highly effective for severe mania or depression, psychosis, or when medicines have not worked. Hospital care keeps people safe during severe episodes.

Living with bipolar disorder

• Protect sleep: keep regular bed and wake times; sleep loss is a powerful trigger for mania.
• Track mood: apps or diaries help spot early warning signs.
• Make a relapse plan with your care team and family, including what to do if warning signs appear.
• Limit alcohol and avoid recreational drugs.
• Exercise regularly and keep a structured daily routine.
• Plan pregnancy with your psychiatrist, as some medicines need changing and the postpartum period carries a high risk of relapse and postpartum psychosis.

Outlook

Bipolar disorder is a lifelong condition, but many people have long periods of stability and lead full lives with work, relationships and families. Untreated, it carries risks of relationship and job loss, substance problems and suicide. The risk of suicide is substantially higher than in the general population, which is why ongoing treatment and support matter.

Frequently asked questions

What are the early signs of bipolar disorder?

Early signs include periods of unusually high energy, little need for sleep, racing thoughts, talkativeness and risky behavior, alternating with periods of depression. Many people first seek help for depression. A family history of bipolar disorder makes these signs more significant.

What is the difference between bipolar I and bipolar II?

Bipolar I involves at least one full manic episode, which can be severe and may require hospitalization or include psychosis. Bipolar II involves hypomania, a milder high without psychosis, and at least one major depressive episode. Depression in bipolar II is often prolonged.

Can bipolar disorder be cured?

There is no cure, but it is very treatable. Most people need long-term treatment with mood-stabilizing medicine and therapy. With good management, many people have few or no episodes for long periods and live full, productive lives.

What triggers a manic episode?

Common triggers include sleep loss, major stress, alcohol and drugs (especially stimulants and cannabis), stopping mood stabilizers, taking antidepressants without a mood stabilizer, steroids and the period after childbirth. Seasonal changes, especially spring, can also play a role.

Is bipolar disorder genetic?

Genetics play a large role. Having a parent or sibling with bipolar disorder increases risk several times over, and twin studies show high heritability. However, no single gene causes it, and many people with a family history never develop it.

How do you help someone with bipolar disorder?

Learn about the condition, encourage them to keep up treatment and regular sleep, watch for early warning signs together, and agree on a plan for relapses. During a crisis, do not leave them alone if they are at risk; call or text 988 in the US or call 911.