Bipolar disorder is a complex mental health condition that can impact a person’s mood and energy. During a manic episode, the person may feel full of energy and as if they can do anything. But a depressive episode may follow.
When a person has bipolar disorder, their mood can range from feelings of elation and high energy to depression. The condition can also cause disruptions in sleep, thinking patterns, and other behavioral symptoms.
With bipolar disorder, the periods of time when a person’s mood is impacted are known as manic episodes and depressive episodes. Hypomanic episodes involve less severe symptoms of a manic episode.
According to the American Psychiatric Association, people receive a diagnosis, on average, at age 25 years. But symptoms can appear during the teenage years and less commonly during childhood.
There are several forms of bipolar disorder, each with slightly different symptoms.
For a diagnosis of bipolar I disorder, a person only needs to have a manic episode. In fact, a person with bipolar I disorder may never experience a major depressive disorder.
Mania
When someone has mania, they do not just feel very happy. They feel euphoric.
A person with mania may:
- have a lot of energy
- feel able to do and achieve anything
- have difficulty sleeping
- use rapid speech that jumps between topics and ideas
- feel agitated, jumpy, or “wired”
- engage in potentially harmful behaviors, such as sex without condoms or other barrier methods, spending a lot of money, dangerous driving, or unwise consumption of alcohol and other substances
- believe that they are more important than others or have important connections
- show anger or aggression if others challenge their views or behavior
- experience episodes of psychosis with hallucinations or delusions
A person in a manic state may not realize their behavior is atypical, but others may notice a change in behavior. Some may see the person’s outlook as sociable and fun-loving, while others may find it unusual or bizarre.
The individual may not realize that they are acting inappropriately or be aware of the potential consequences of their behavior.
They may need help staying safe.
Hypomania
Not everyone will have a severe manic episode. Less severe mania is known as hypomania. Symptoms are similar to those of mania, but the behaviors are less extreme, and people can often function well in their daily life.
Depression
Signs of a depressive episode are the same as the symptoms of a major depressive episode.
They may include:
- feeling down or sad
- having very little energy
- having trouble sleeping or sleeping a lot more than usual
- thinking of death or suicide
- forgetting things
- feeling tired
- losing enjoyment in daily activities
- having a “flatness” of emotion that may show in the person’s facial expression
In severe cases, a person may experience psychosis or catatonic depression. With catatonic depression, they are unable to move, talk, or take any action.
Psychosis
Psychosis is a collection of symptoms that cause people to experience a loss of contact with reality. During an episode of psychosis, a person may have trouble distinguishing between what is real and what is not.
People experiencing psychosis may experience delusions and distorted thinking that cause them to believe that certain things are true when they are not.
For example, they may believe that they have important friends, such as the president of the United States or a celebrity, or that they descend from royalty.
People experiencing psychosis may also experience hallucinations. Hallucinations can cause a person to see, hear, or feel things that are not there.
In children and teens
Bipolar disorder is a lifelong condition. It can be present in young children, but this is very uncommon. Bipolar disorder often does not emerge until a person’s late teens or early adulthood.
It is important that any young person showing symptoms of bipolar disorder sees a mental health professional.
Learn more here about how bipolar disorder can affect teens.
Causes
Doctors do not know exactly what causes bipolar disorder, but the following things play a role:
- Genetic factors: A person with bipolar disorder may have a parent with the condition. However, having a parent or even a twin with bipolar disorder does not mean a person will develop it.
- Brain structure and function: Research
suggests that the brains of people with some mental health conditions, like bipolar disorder, are different than the brains of others. - Stressful triggers: For a person who is already susceptible to developing bipolar disorder, stressful life events such as experiencing abuse, the end of an important relationship or job, or significant sleep disturbances, may trigger the appearance of symptoms.
It is always a good idea to speak with a doctor when there is concern about frequent changes in mood. It is especially important to speak with a doctor if these changes in mood make it difficult to work or otherwise complete daily tasks.
Talking with a primary care physician or family doctor may be a good place to start. However, they will likely refer someone with these symptoms to a psychiatrist, or a specialist who cares for people with mental health conditions.
Someone who notices these symptoms in a friend or loved one can also speak with a doctor about their concerns. The doctor can help find local support groups or other mental health resources.
Suicide risk
Engaging in potentially harmful behavior and thinking about suicide can pose serious concerns for a person with bipolar disorder.
Whenever there is a possibility of harm or suicide, it is important to address the concern quickly and directly.
If there is a concern about imminent potential harm, a person or another person aware of the situation should contact emergency services or a suicide crisis hotline immediately.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) describes four types of bipolar disorder.
1. Bipolar I disorder
This involves periods of mania that last at least 7 days or any duration if the person is hospitalized.
If a person experiences severe manic or depressive episodes, they may need emergency treatment in the hospital to prevent harm to themselves or others, for example, through reckless behavior.
2. Bipolar II disorder
A person with bipolar II disorder has episodes of depression and hypomania. Hypomania has less extreme symptoms than a full manic episode.
People with bipolar II disorder tend not to have full mania.
Learn more here about the differences between type I and II bipolar disorder.
3. Cyclothymic disorder
Someone with cyclothymic disorder will also have alternating periods of hypomania-like symptoms and depression-like symptoms lasting for at least 2 years, but their symptoms do not meet the full criteria for bipolar II disorder.
The main difference between cyclothymic disorder and bipolar II is that the symptoms of a person with cyclothymia tend to be less severe and do not meet the criteria for hypomania and depression.
4. Not otherwise specified and unspecified bipolar disorders
A person may have bipolar disorder that does not fit within the above patterns. They may receive a diagnosis of either “not otherwise specified bipolar disorder” or “unspecified bipolar disorder,” depending on their symptoms.
Related conditions
Bipolar disorder has a number of comorbidities, or conditions that often occur alongside it.
Other mental health conditions that people might experience include:
- anxiety
- posttraumatic stress disorder (PTSD)
- ADHD
- misuse of alcohol and other substances
These can complicate the diagnosis.
It can take time to receive a correct diagnosis of bipolar disorder. A doctor may identify one of bipolar disorder’s comorbidities or a personality disorder instead.
If the person experiences psychosis, this can sometimes lead to a misdiagnosis of schizophrenia, a mental health disorder marked by persistent hallucinations and delusions.
Treating these conditions may make it more difficult to diagnose or treat bipolar disorder. It can also take time to find a suitable medication and the correct dose for the individual.
However, once a person receives a correct diagnosis and appropriate treatment, medication can help manage the symptoms of bipolar disorder, and these related conditions usually improve as well.
To diagnose bipolar disorder, a healthcare professional should begin with a complete medical interview and a physical exam to rule out a physical cause for the person’s behaviors.
There is currently no blood test or imaging to diagnose the condition, but a doctor may suggest tests to rule out other medical conditions with similar symptoms.
If no medical conditions or medications are causing the symptoms, the healthcare professional will consider bipolar disorder. They may refer the person to a mental health specialist.
The best person to diagnose bipolar disorder is a psychiatrist or psychiatric nurse practitioner who specializes in caring for people with mental health disorders.
Prescribers usually treat bipolar disorder with a combination of medications and talk therapy, or psychotherapy.
Because bipolar disorder is a lifelong disease, treatment should also be long term.
Medications
Medications for treating bipolar disorder
- mood stabilizers, such as lithium and some antiseizure medications
- antipsychotics, which help manage mania and symptoms of psychosis
- antidepressants may be used in some cases, depending on the person’s symptoms and other considerations
It can take time to find a suitable medication and dose for the individual.
Some people discontinue their medication because it has adverse effects. If adverse effects occur, it is essential to speak with the prescriber. They may be able to change the dose or treatment. Discontinuing medications for bipolar disorder can result in a return of symptoms.
Some people discontinue medication because they miss the “high energy feeling” that bipolar disorder brings. They may feel they are no longer “themselves” and may miss certain aspects of their personality.
People with bipolar disorder may be more likely to approach a doctor while experiencing depressive symptoms than manic symptoms.
A review of literature published in 2021
Some other research analyzed in another 2021 research review suggests that treatments like selective serotonin reuptake inhibitors (SSRIs), which treat depression and other mental health conditions like obsessive compulsive personality disorder (OCPD), can trigger an initial manic episode in a person who has bipolar disorder. This first manic episode may be the first sign that a person has bipolar disorder.
Talk therapy
Counseling or cognitive behavioral therapy (CBT) can help a person with bipolar disorder, as it can help them increase their awareness of the negative aspects of their behaviors and triggers that could affect their treatment, such as substance use.
Learning tips for getting enough sleep, dealing with stress, and establishing a steady work-life balance may all help manage mood changes. Using these tips to help manage symptoms is called social rhythm therapy, and it is often used to help people with bipolar disorder.
Electroconvulsive therapy
If medication and talk therapy are not effective in managing symptoms of bipolar disorder, a psychiatrist may consider electroconvulsive therapy (ECT).
In ECT, a doctor applies a controlled electric shock to certain areas of the brain to cause a seizure. Although ECT cannot cure bipolar disorder, there is
A doctor will only recommend ECT if symptoms are severe, medication and counseling do not work, or the person cannot take or tolerate medication.
Bipolar disorder is a complex but treatable mental health condition. It can have different symptoms depending on which form of the condition a person has, their age, and whether a person has a family history of the condition or other risk factors.
If a person believes that they may have bipolar disorder, they should consider talking with a primary care physician or another healthcare professional.