Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a mental health condition that causes marked shifts in mood, energy, activity levels and the ability to carry out daily tasks. People experience episodes of mania or hypomania and, in most cases, episodes of depression, with periods of more stable mood in between.

Symptoms

During manic or hypomanic episodes, a person may have an elevated or irritable mood, much more energy, reduced need for sleep, racing thoughts, rapid speech, inflated self-confidence, and engage in risky activities. Depressive episodes involve symptoms similar to depression.

These symptoms can occur with bipolar disorder, but only a qualified professional can provide a diagnosis.

Types

• Bipolar I disorder: at least one manic episode, often with depressive episodes.
• Bipolar II disorder: at least one hypomanic episode and at least one major depressive episode, without full mania.
• Cyclothymic disorder: ongoing periods of hypomanic and depressive symptoms that don’t meet full criteria for an episode.

Causes and risk factors

Bipolar disorder has a strong genetic component and tends to run in families. Brain structure and function, stressful life events and disrupted sleep may also play a role.

Diagnosis

A psychiatrist or other qualified clinician makes the diagnosis based on a detailed history, often including input from family, and a review of physical health.

Treatment

• Medication: mood stabilizers and certain antipsychotics are commonly used. Treatment is typically long-term and monitored by a prescriber.
• Psychotherapy: psychoeducation, CBT, family-focused therapy and interpersonal and social rhythm therapy can help people manage symptoms and spot early warning signs.
• Routine: regular sleep and daily rhythms are an important part of staying well.

Bipolar disorder usually needs ongoing care from a psychiatric prescriber. Some online services, such as Sesame, list bipolar disorder among the conditions their psychiatric clinicians treat and prescribe mood stabilizers such as lithium and lamotrigine, while others, such as Lemonaid Health, advise in-person care instead.

What a manic or hypomanic episode can feel like

Mania is a period of unusually elevated, expansive or irritable mood together with a marked increase in energy or activity. It can last at least a week, or any length if hospitalization is needed. Hypomania is similar but less severe and shorter, and does not usually cause major impairment. Signs can include:

• Needing much less sleep without feeling tired
• Racing thoughts and rapid, pressured speech
• Inflated self-confidence or grandiose ideas
• Being easily distracted
• Increased goal-directed activity, or restlessness
• Risky behavior such as spending sprees, unsafe sex or reckless driving

Some people experience irritability and agitation more than euphoria. In severe episodes, psychosis, such as delusions or hallucinations, may occur. These signs can occur with bipolar disorder, but only a qualified healthcare professional can provide a diagnosis.

What bipolar depression can feel like

Depressive episodes in bipolar disorder can look like other forms of depression: persistent low mood, loss of interest, changes in sleep and appetite, fatigue, guilt, difficulty concentrating and thoughts of death or suicide. People spend more time in depressive than manic states, which is why bipolar disorder is often first diagnosed as depression. The difference matters because treatment differs.

Why it can be hard to diagnose

Bipolar disorder is frequently misdiagnosed or recognized years after symptoms begin. Reasons include:

• People usually seek help during a depressed phase rather than when elevated.
• Hypomania can feel good and may not be reported.
• Symptoms overlap with ADHD, anxiety, substance use and borderline personality disorder.
• Mood changes may be attributed to personality or circumstances.

If you’ve had depression that doesn’t respond to treatment, a family history of bipolar disorder, or episodes of unusual energy, mention them to your clinician. Information from a family member who has seen your episodes can also help.

Long-term management

Bipolar disorder is a lifelong condition for most people, but with consistent treatment many live full and stable lives. The main elements of management are:

• Medication. Mood stabilizers and some antipsychotics help prevent and treat episodes; see mood stabilizers and antipsychotics. Antidepressants are used cautiously and generally with a mood stabilizer. Taking medication as prescribed, even when feeling well, is important, and changes should always be discussed with a prescriber.
• Psychoeducation and therapy. Learning about the condition, identifying early warning signs and building coping strategies, using approaches such as CBT, family-focused therapy and interpersonal and social rhythm therapy.
• Routine. Regular sleep and daily rhythms are among the most important protective factors. Disrupted sleep can trigger episodes; see sleep and mental health.
• Avoiding triggers. Alcohol, drugs and extreme stress can destabilize mood.
• A relapse plan. Many people write a plan, with trusted people, that notes early warning signs and what to do.

Supporting someone with bipolar disorder

• Learn about the condition and the person’s own warning signs.
• Encourage regular treatment, sleep and routine.
• During a manic episode, stay calm, avoid arguments and help limit access to large financial decisions where possible, if the person has agreed to this plan in advance.
• Take talk of suicide seriously, and call emergency services if there is immediate danger.
• Take care of your own needs, and consider family support groups.

When to seek urgent help

Seek emergency help if someone has thoughts of suicide, is a danger to themselves or others, or is experiencing psychosis. See Get Help Now for crisis lines and emergency numbers. If you notice early signs of an episode, such as a few nights of reduced sleep with rising energy, contact your clinician promptly, because early adjustment can often prevent a full episode.

Living well with bipolar disorder

With the right treatment and support, people with bipolar disorder work, study, have relationships and raise families. Setbacks happen, and recovery isn’t linear, but learning your patterns and building supports makes episodes shorter and less disruptive. Speak with a psychiatrist or primary care clinician who can coordinate a plan, and see our guide to finding care for ways to start.