Bipolar Disorder: Symptoms, Causes, Treatments, and MoreBipolar disorder is a mental illness that is often misunderstood and even mistaken for other illnesses. Here’s what you need to know about bipolar disorder.
What is Bipolar Disorder?
According to the American Psychiatric Association, bipolar disorder is a brain disorder that causes changes in a person’s mood, energy, and ability to function. People who have bipolar disorder experience intense emotional states. They typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are specified as:
- Manic/Hypomanic (abnormally happy or irritable mood)
- Depressive (sad mood)
Bipolar disorder is a serious mental illness (SMI). It can disrupt a person’s relationships with loved ones. It can also make it difficult to work or go to school. People who have bipolar disorder may have periods of neutral mood as well. When individuals get the treatment they need, they can lead full and productive lives.
Data shows that an estimated 2.8% of Americans have bipolar disorder.1,2 Many people who have bipolar disorder also develop substance use disorders. This may be as high as 30-50%.
The history of bipolar disorder dates back to Hippocrates in Ancient Greece.4 He noted the distinction between two moods at either extreme: feeling low or feeling energized and excited. Today, we know these two moods as depression and mania, respectively.
These two “moods” were thought of as separate conditions with wholly different symptoms until the mid-19th century. In 1854, French psychiatrist Jean-Pierre Falret coined a specific disorder that encompassed the two moods: folie circulaire.4
In 1968, bipolar disorder was called manic depressive illness in the DSM-II (Diagnostic and Statistical Manual of Mental Disorders).5 When the DSM-III was published in 1980, it had the first mention of the term “bipolar disorder.”5 It also adopted the criteria we know today for bipolar disorder.
What are the Risk Factors for Bipolar Disorder?
Bipolar disorder cannot be linked to one single cause. Instead, there are a few risk factors that scientists believe contribute to bipolar disorder. In most cases, these risk factors are believed to work in some combination to contribute to the onset of the illness.
- Genetics – Bipolar disorder can run in families. The chances that a child will develop bipolar disorder are higher if their parents or siblings have it. Yet at the same time, a child may never develop bipolar disorder even if they are from a family that has a history of it. Studies of identical twins find that even if one twin develops bipolar disorder, the other may not.
- Stress – Chronic or severe stress, and how a person handles that stress, can play a role in the onset of mood episodes. Stressful life events may include illness, divorce, birth of a child, moving, an accident, and more.
- Brain Structure –Research finds that the brains of people who have bipolar disorder show subtle differences when compared to those who do not have it.6 Functional magnetic resonance imaging (fMRI) and positron emission technology (PET) are the two primary brain scans used to examine these findings. However, more research is needed before brain imaging can be used to guide clinical care for this condition.
What are the Signs and Symptoms of Bipolar Disorder?
Diagnoses of bipolar disorder are based on mood episode type, length, and severity. Mood episodes have two groups:
- Manic symptoms
- Depressive symptoms
- Easily distracted
- Pressured speech or very talkative
- Flight of ideas or racing thoughts (jumping from topic to topic or many ideas on one topic)
- Decreased need for sleep (e.g., feeling rested after only a few hours)
- Feelings of inflated self-esteem or grandiosity (feeling overly important or talented)
- Increased goal-related activity or psychomotor agitation
- Engaging in activities that could have painful consequences (such as unrestrained buying sprees)
- Depressed mood on most days and/or nearly every day
- Diminished interest or pleasure in most activities, even those that previously brought enjoyment
- Increased appetite or weight gain, or the opposite, less interest in food or weight loss
- Marked slowing of thought or movement, or the opposite, feeling agitated and restless
- Lack of energy
- Insomnia, or the opposite, hypersomnia
- Trouble concentrating or very indecisive
- Feelings of worthlessness or excessive or inappropriate feelings of guilt
- Thoughts of being better off dead or that life isn’t worth living (suicidal with or without a plan)
Mood symptoms don’t always fit completely into one category or the other. In some cases, those who live with bipolar disorder experience manic and depressive symptoms within the same episode. This is known as an episode with mixed features. They may feel sad and hopeless while at the same time they feel an overwhelming surge of energy.
Types of Bipolar Disorder
Bipolar disorder is a category that includes three main diagnoses: bipolar I, bipolar II, and cyclothymic disorder. The distinctions between these diagnoses in DSM-5 are based, in large part, on the frequency and severity of the manic and depressive episodes.
The scale of moods includes “down” moods. They are known as depressive episodes. This means periods of feeling down or depressed. It also includes “up” moods. This involves feeling energetic, elated, or irritable. Up moods are known as manic or hypomanic episodes. Some people who have bipolar disorder experience psychotic features, such as delusions and hallucinations.
- Bipolar I Disorder – This is defined as having at least one manic episode that lasts at least 7 days. That episode causes significant functional impairment in role functioning. Those with Bipolar I Disorder may or may not have a history of a major depressive episode.
- Bipolar II Disorder – This is defined by having at least one hypomanic episode lasting at least 4 days. That episode causes a change in functioning observable by others. This diagnosis also requires a history of a major depressive episode that lasts at least 2 weeks and causes significant functional impairment.
- Cyclothymic Disorder (or Cyclothymia) – This is defined as at least a two-year period with the presence of both up (hypomania) and down (mild depression) moods. Neither of these moods meet the criteria for mania or major depression. Between mood episodes, a person may experience a stable mood and feel fine.
It is worth noting that a large number of people experience symptoms of bipolar disorder at a level of severity or length below what is required for any of these three diagnoses.
How Does a Person Get a Bipolar Disorder Diagnosis?
A person gets a diagnosis of bipolar disorder when a doctor performs a physical examination, conducts an interview, and orders lab tests. This could be done by a primary care physician or psychiatrist, for example. They typically make the diagnosis by assessing several factors. These include:
- Current symptoms
- Lifetime history of symptoms
- Psychiatric family history
Note that bipolar disorder cannot be seen on a blood test or body scan. Yet these tests can help rule out other illnesses that can resemble bipolar disorder, such as hyperthyroidism. If there are no other causes for the symptoms — such as illnesses or medicines — the doctor may recommend mental health care. This may include medications or psychotherapy.
The onset of bipolar disorder is usually in late teens and early 20s. Yet it does also occur in younger individuals. However, it can be challenging to identify mood symptoms that meet criteria in younger people. This is due to the fact that the signs can be dismissed as normal behavior during puberty. That is why it is critical to get a diagnostic assessment if anyone has the signs and symptoms of a mood disorder. Some of these signs include:
- Extreme high or low moods when compared to their peers
- Mood changes that affect behavior
- Extreme excitement or irritability when compared to their peers
Impacts of Untreated Bipolar Disorder
Bipolar disorder can have unwanted impacts if left untreated. This might include:
- Challenges with relationships
- Financial troubles
- Issues at work or school
- Legal problems
- Symptoms that get worse
- Substance misuse
- Suicidal thoughts, plans, or attempts
- Symptoms that get worse
It is critical to work with mental health professionals to get treatment. It also helps to have the support of your family and/or friends. When these are in place, it can help people avoid the negative impacts of bipolar disorder.
Bipolar Disorder Treatment
Once a person has a diagnosis, they can work with mental health professionals to develop a treatment plan. This is a process that individuals can do together with their treatment team. You can share details and questions about the treatment options you have and consider the choices.
Psychopharmacology is a treatment that involves the use of medications. It is considered a first-line treatment for bipolar disorder. Medications can help address the mood symptoms and the functional impact of those symptoms. The most common categories of medications that are used to treat bipolar disorder include:
- Lithium: Used to stabilize mood and prevent relapse in bipolar disorder. Lithium levels should be checked regularly to ensure that individuals are on the correct dose. Also monitor thyroid and kidney function for potential side effects.
- Second-generation antipsychotics: Commonly used to treat the symptoms of bipolar disorder, most notably manic or mixed episodes. They are often used in conjunction with other mood stabilizers such as anticonvulsants or lithium.
- Antidepressants: Often used to treat depressive episodes in bipolar disorder. Antidepressants can trigger mania in some people with bipolar disorder.7 That is why they are typically prescribed in conjunction with a mood stabilizer.
- Anticonvulsants: Some medications used to treat seizures, such as valproic acid and carbamazepine, are also used as mood stabilizers in bipolar disorder.
It is critical to talk with your health care team about the medications you are on and how effective they are. Make sure to mention any symptoms that remain and any side effects that emerge. Sometimes, it may take several trials to find a medication that works best for you.
Psychotherapy, or counseling, can be another key part of an effective treatment plan. It is an umbrella term for several treatment techniques. They help people identify and change unwanted emotions, behaviors, and thoughts. Psychotherapy can be delivered on an individual basis or as group therapy along with other people who have similar diagnoses. Couples or family therapy might also be useful.
Psychotherapy can help people:
- Avoid ineffective coping (such as alcohol, drugs, risky behavior)
- Flesh out a treatment plan and recovery goals
- Identify the early symptoms of a mood episode before they get worse
- Improve feelings of self-worth
- Improve relationships
- Seek effective help from family and other key supports
Key evidence-based therapies include:
- Cognitive Behavioral Therapy (CBT) — This focuses on a person’s thoughts and beliefs and how they influence their mood and actions. Cognitive Behavioral Therapy is typically used in conjunction with medication and involves problem-solving and stress minimization.
- Family-Focused Therapy (FFT) — This includes the person diagnosed with bipolar disorder and their caregivers/family members. The treatment consists of joint sessions that focus on psychoeducation, improving communication, and problem-solving skills training.
- Interpersonal and Social Rhythm Therapy (IPSRT) — This is a treatment developed specifically to target bipolar disorder. The focus is on relationships and building interpersonal effectiveness skills. It has an emphasis on how to set and maintain a regular schedule. This can have an effect on mood changes.
Psychoeducation involves education for people who have bipolar disorder on the most effective ways to treat symptoms and prevent relapse. It covers topics such as:
- The course of bipolar treatment
- The importance of treatment
- Benefits of various treatment options
- How to identify early warning signs of relapse
- Behavioral changes that can reduce the likelihood of relapse
Electroconvulsive Therapy (ECT)
ECT is a treatment that can help people who have symptoms of bipolar disorder. It is delivered under general anesthesia and involves a brief electrical stimulation of the brain. ECT is considered as an option for people who experience severe depression, psychosis, and chronic suicidality. It is commonly used for people who do not respond to other treatments. ECT is done in multiple sessions that spread out over several weeks.
It is possible that at some point during the course of bipolar disorder a person may need to be admitted to the hospital. This can stabilize symptoms or keep an individual safe from self-harm.
Diet and Exercise
Regular exercise and a healthy diet can help manage mood and address symptoms of bipolar disorder. Options for exercise includes things such as:
- Any other activity that elevates the heart rate
Anaerobic exercise can be helpful as well, such as weightlifting. However, you should always consult your doctor before starting a new exercise plan.
It is also important to eat well. There is no specific diet for bipolar disorder. Yet any person who has bipolar disorder should make wise choices on what foods to eat. This can help maintain a healthy weight and support overall wellness. It is a good idea to talk with your health care team about a plan for your diet. They can assist with a referral to a dietician or provide guidance on how to eat healthy.
What Does Recovery from Bipolar Disorder Mean?
The course of mental illness, including bipolar disorder, does not look the same for every person. It is not inevitable that mental illness simply gets worse with time. In fact, there are many examples in the literature and many first-person stories of recovery. Recovery is a process or journey through which individuals improve their health and wellness. People can lead self-directed lives and strive to live to their full potential. For some, this may include an absence from symptoms. For others, it might mean they find success living and coping with symptoms.
A key aspect of the recovery journey is hope. Hope is the belief that a person can overcome challenges and conditions and that living a full life is possible even with symptoms.
Another aspect of recovery is finding purpose. Purpose is to have meaningful daily activities. This may include a paying job, a volunteer position, a spiritual connection, or a role with family or friends. The key is to participate in society in a meaningful way, as defined by the individual.
A person’s loved ones and health care team are key partners in the recovery journey. They can help to set goals and support the steps towards those goals.
Everyone can support recovery when they use compassionate, stigma-free, person-first words. This can help each person on their road to improved health and functioning from SMI. When you choose person-first language, you support their pursuit of healing, progress, and goals.
Questions About Bipolar Disorder?
If you are an individual or family member and want more information about bipolar disorder, you can find many resources in our Individuals and Families section. You can also use the SMI Adviser Knowledge Base to browse hundreds of evidence-based answers and resources.
If you are a mental health clinician and have a question about evidence-based treatments, research, or where to find resources for individuals, submit a question to get a free clinician-to-clinician consultation from SMI Adviser’s national experts.
- National Comorbidity Survey Replication (NCS-R)
- Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative – JAMA Psychiatry
- An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders – Substance Abuse and Mental Health Services Administration
- A Short History of Bipolar Disorder – Psychology Today
- Historical Underpinnings of Bipolar Disorder Diagnostic Criteria – Behavioral Sciences
- Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group – Molecular Psychiatry
- Mental Health Medications – National Alliance on Mental Illness