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Definition

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Do you go through intense moods?

Do you feel very happy and energized some days, and very sad and depressed on other days? Do these moods last for a week or more? Do your mood changes make it hard to sleep, stay focused, or go to work?

Some people with these symptoms have bipolar disorder, a serious mental illness. This brochure will give you more information.

What is bipolar disorder?

Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic depression. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and "up," and are much more energetic and active than usual. This is called a manic episode. Sometimes people with bipolar disorder feel very sad and "down," have low energy, and are much less active. This is called depression or a depressive episode.

Bipolar disorder is not the same as the normal ups and downs everyone goes through. The mood swings are more extreme than that and are accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong that they can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.

People with bipolar disorder can get treatment. With help, they can get better and lead successful lives.

Who develops bipolar disorder?

Anyone can develop bipolar disorder. It often starts in a person's late teen or early adult years. But children and older adults can have bipolar disorder too. The illness usually lasts a lifetime.

Why does someone develop bipolar disorder?

Doctors do not know what causes bipolar disorder, but several things may contribute to the illness. Family genes may be one factor because bipolar disorder sometimes runs in families. However, it is important to know that just because someone in your family has bipolar disorder, it does not mean other members of the family will have it as well. Another factor that may lead to bipolar disorder is the brain structure or the brain function of the person with the disorder. Scientists are finding out more about the disorder by studying it. This research may help doctors do a better job of treating people. Also, this research may help doctors to predict whether a person will get bipolar disorder. One day, doctors may be able to prevent the illness in some people.

What are the symptoms of bipolar disorder?

Bipolar "mood episodes" include unusual mood changes along with unusual sleep habits, activity levels, thoughts, or behavior. People may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day.

Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.

People having a manic episode may:

Feel very "up" or "high"

Feel "jumpy" or "wired"

Have trouble sleeping

Become more active than usual

Talk really fast about a lot of different things

Be agitated, irritable, or "touchy"

Feel like their thoughts are going very fast

Think they can do a lot of things at once

Do risky things, like spend a lot of money or have reckless sex

People having a depressive episode may:

Feel very "down" or sad

Sleep too much or too little

Feel like they can't enjoy anything

Feel worried and empty

Have trouble concentrating

Forget things a lot

Eat too much or too little

Feel tired or "slowed down"

Have trouble sleeping

Think about death or suicide

Can someone have bipolar disorder along with other problems?

Yes. Sometimes people having very strong mood episodes may have psychotic symptoms. Psychosis affects thoughts and emotions as well as a person's ability to know what is real and what is not. People with mania and psychotic symptoms may believe they are rich and famous, or have special powers. People with depression and psychotic symptoms may believe they have committed a crime, they have lost all of their money, or that their lives are ruined in some other way.

Sometimes behavior problems go along with mood episodes. A person may drink too much or take drugs. Some people take a lot of risks, like spending too much money or having reckless sex. These problems can damage lives and hurt relationships. Some people with bipolar disorder have trouble keeping a job or doing well in school.

Is bipolar disorder easy to diagnose?

No. Some people have bipolar disorder for years before the illness is diagnosed. This is because bipolar symptoms may seem like several different problems. Family and friends may notice the symptoms but not realize they are part of a bigger problem. A doctor may think the person has a different illness, like schizophrenia or depression.

People with bipolar disorder often have other health problems as well. This may make it hard for doctors to recognize the bipolar disorder. Examples of other illnesses include substance abuse, anxiety disorders, thyroid disease, heart disease, and obesity.

How is bipolar disorder treated?

Right now, there is no cure for bipolar disorder, but treatment can help control symptoms. Most people can get help for mood changes and behavior problems. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include:

1. Medication. There are several types of medication that can help. People respond to medications in different ways, so the type of medication depends on the patient. Sometimes a person needs to try different medications to see which works best.

Medications can cause side effects. Patients should always tell their doctors about these problems. Also, patients should not stop taking a medication without a doctor's help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse.

2. Therapy. Different kinds of psychotherapy, or "talk" therapy, can help people with bipolar disorder. Therapy can help them change their behavior and manage their lives. It can also help patients get along better with family and friends. Sometimes therapy includes family members.

3. Other treatments. Some people do not get better with medication and therapy. These people may try electroconvulsive therapy, or ECT. This is sometimes called "shock" therapy. ECT provides a quick electric current that can sometimes correct problems in the brain.

Sometimes people take herbal and natural supplements, such as St. John's wort or omega-3 fatty acids. Talk to your doctor before taking any supplement. Scientists aren't sure how these products affect people with bipolar disorder. Some people may also need sleep medications during treatment.

Personal Story

James has bipolar disorder.
Here's his story.
Four months ago, James found out he has bipolar disorder. He knows it's a serious illness, but he was relieved when he found out. That's because he had symptoms for years, but no one knew what was wrong. Now he's getting treatment and feeling better.

James often felt really sad. As a kid, he skipped school or stayed in bed when he was down. At other times, he felt really happy. He talked fast and felt like he could do anything. James lived like this for a long time, but things changed last year. His job got very stressful. He felt like he was having more "up" and "down" times. His wife and friends wanted to know what was wrong. He told them to leave him alone and said everything was fine.

A few weeks later, James couldn't get out of bed. He felt awful, and the bad feelings went on for days. Then, his wife took him to the family doctor, who sent James to a psychiatrist. He talked to this doctor about how he was feeling. Soon James could see that his ups and downs were serious. He was diagnosed with bipolar disorder, and he started treatment.

These days, James takes medicine and goes to talk therapy. Treatment was hard at first, and recovery took some time, but now he's back at work. His mood changes are easier to handle, and he's having fun again with his wife and friends.

Getting Help

If you're not sure where to get help, call your family doctor. You can also check the phone book for mental health professionals. Hospital doctors can help in an emergency. Finally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area. You can find it here: https://findtreatment.samhsa.gov.

How can I help myself if I have bipolar disorder?

You can help yourself by getting treatment and sticking with it. Recovery takes time, and it's not easy. But treatment is the best way to start feeling better. Here are some tips:

Talk with your doctor about your treatment.

Stay on your medication.

Keep a routine for eating and sleeping.

Make sure you get enough sleep.

Learn to recognize your mood swings.

Ask a friend or relative to help you stick with your treatment.

Be patient with yourself. Improvement takes time.

How can I help someone I know with bipolar disorder?

Help your friend or relative see a doctor to get the right diagnosis and treatment. You may need to make the appointment and go to the doctor together. Here are some helpful things you can do:

Be patient.

Encourage your friend or relative to talk, and listen carefully.

Be understanding about mood swings.

Include your friend or relative in fun activities.

Remind the person that getting better is possible with the right treatment.

I know someone who is in crisis. What do I do?

If you know someone who might hurt himself or herself, or if you're thinking about hurting yourself, get help quickly. Here are some things you can do:

Do not leave the person alone.

Call your doctor.

Call 911 or go to the emergency room.

Call the National Suicide Prevention Lifeline, toll-free:
1-800-273-TALK (8255). The TTY number is 1-800-799-4TTY (4889).

How does bipolar disorder affect friends and family?

When a friend or relative has bipolar disorder, it affects you too. Taking care of someone with bipolar disorder can be stressful. You have to cope with the mood swings and sometimes other problems, such as drinking too much. Sometimes the stress can strain your relationships with other people. Caregivers can miss work or lose free time.

If you are taking care of someone with bipolar disorder, take care of yourself too. Find someone you can talk to about your feelings. Talk with the doctor about support groups for caregivers. If you keep your stress level down, you will do a better job, and it might help your loved one stick to his or her treatment.

For More Information

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

U.S. Department of Health and Human Services
National Institutes of Health
National Institute of Mental Health

November 2015
NIH Publication Number TR 15-3679

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This brochure describes the signs and symptoms, risk factors, and treatment options for bipolar disorder (also known as manic-depressive illness), a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

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Symptoms

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The primary symptoms of bipolar disorder are periods of elevated or irritable mood accompanied by dramatic increases in energy, activity, and fast thinking. The illness has two (bi) strongly contrasting phases (polar): 1) bipolar mania or hypo- mania and 2) depression.

1) Bipolar mania or hypo-mania symptoms include:

Euphoria or irritability

Increased energy and activity

Excessive talk; racing thoughts

Inflated self-esteem

Unusual energy; less need for sleep

Impulsiveness, a reckless pursuit of gratification (shopping sprees, impetuous travel, more and sometimes promiscuous sex, high-risk business investments, fast driving)

2) Bipolar depression/major depression symptoms include:

Depressed mood and low self-esteem

Low energy levels and apathy

Sadness, loneliness, helplessness, guilt

Slow speech, fatigue, and poor coordination

Insomnia or oversleeping

Suicidal thoughts and feelings

Poor concentration

Lack of interest or pleasure in usual activities

Sources

SOURCES:

American Psychiatry Association: Diagnostic and Statistical Manual of Mental Disorders.

Kupfer, J. (editor). Bipolar Depression The Clinician's Reference Guide., Current Psychiatry, 2004.

Geddes, JR. Long Term Lithium Therapy for Bipolar Disorder, American Journal of Psychiatry, 2004.

McElroy SL. A 52 Week Continuation Study of Lamotrigine In the Treatment of Bipolar Depression, Journal of Clinical Psychiatry; 2004.

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The primary symptoms of bipolar disorder are periods of elevated or irritable mood accompanied by dramatic increases in energy, activity, and fast thinking. The illness has two (bi) strongly contrasting phases (polar): 1) bipolar mania or hypo- mania and 2) depression.

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Causes

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Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Bipolar disorder care at Mayo Clinic
Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

Marked loss of interest or feeling no pleasure in all - or almost all - activities

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number - in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

Take your medications exactly as directed. You may be tempted to stop treatment - but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

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Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities.

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Prevalence

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Bipolar Disorder Statistics - Depression and Bipolar Support Alliance

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Treatment

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Bipolar disorder - Diagnosis and treatment - Mayo Clinic

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Bipolar disorder causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

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Interesting Facts

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Explore common myths and facts about bipolar disorder.