What Is Bipolar Disorder? Symptoms, Diagnosis, Causes, Treatment, and Prevention

Bipolar disorder is a mood disorder that causes extreme shifts in a person's mood and energy level. A person with bipolar disorder may experience periods with an extremely elevated or irritable mood (called manic episodes, or mania) as well as episodes of depression.

These shifts are more severe than the normal changes in mood that affect everyone. They can involve impaired thinking and behavior, and can affect your ability to function day to day.

The symptoms and severity of bipolar disorder can vary based on the type of bipolar disorder someone has.

Types of Bipolar Disorder

A hallmark of every type of bipolar disorder is discrete mood episodes that are interspersed with periods of normal mood and function, according to the American Psychiatric Association (APA). Your doctor will diagnose your condition on the basis of the length, frequency, and pattern of episodes of your mania and depression.

• Bipolar 1 is marked by manic episodes, and some people with bipolar 1 also experience major depressive episodes, along with periods of neutral mood.
• Bipolar 2 is characterized by major depressive episodes as well as episodes of hypomania (a less severe form of mania) and in-between periods of a neutral mood.
• Cyclothymia is a milder form of bipolar disorder involving less severe hypomanic and depressive episodes that alternate for at least two years in adults and at least one year in children and teens, according to Mayo Clinic.
• Other specified and unspecified bipolar and related disorders is a diagnosis given when a person doesn’t meet the criteria for any of the other types of bipolar disorder but still experiences periods of a significant, abnormal elevation in mood, according to the National Alliance on Mental Illness (NAMI).

Learn More About the Types of Bipolar Disorder

Manic or Hypomanic Episodes

Manic episodes involve a distinct and observable change in mood and functioning, and are severe enough to result in problems in your daily activities or to require hospitalization to prevent harm to yourself or others, according to the APA.

A manic episode consists of at least one week of abnormally and persistently elevated or irritable mood, with increased energy. A manic episode may also trigger a break from reality (psychosis), including hallucinations or delusions, per the APA. In addition, three of the following symptoms must also be present:

• Talking rapidly or more often than usual
• Decreased need for sleep and feeling energetic despite getting less sleep than usual
• Feeling easily distracted
• Racing thoughts that are hard to control
• Increased goal-directed activity, such as starting several projects at a time
• Increased risky behaviors, such as heavy spending, reckless driving, or reckless sex

A hypomanic episode is similar but not as intense or disabling. It’s shorter in duration, lasting at least four days, according to the APA.

Major Depressive Episodes

Having five or more of the following symptoms every day over a two-week period (including one or both of the first two symptoms) is considered a major depressive episode, per the APA:

• Deep sadness or depressed mood
• Loss of interest in regular activities you normally enjoy
• Significant changes in weight or appetite
• Changes in sleep
• Restlessness or fatigue
• Slowed movements or speech
• Feelings of emptiness, guilt, or worthlessness
• Trouble concentrating
• Thoughts of suicide

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Researchers aren't sure what exactly causes bipolar disorder, but there appears to be an association between the condition and genetics, brain structure, and brain function.

Bipolar disorder often runs in families. Approximately 80 to 90 percent of people with the condition have a relative who has bipolar disorder or depression, according to the APA. But a family history of bipolar disorder doesn't mean that you'll definitely be diagnosed with it. In fact, most people with a family history of bipolar disorder don't develop the condition, according to research.

The genetic components thought to be at work are complicated, but certain gene mutations appear to be involved in the development of the condition. In a study published in May 2019 in Nature Genetics, researchers found 30 gene mutations that could contribute to bipolar disorder.

Epigenetics — how your behaviors and environment affect how your genes work, according to the Centers for Disease Control and Prevention — may also play a role. But more research is still needed to determine its role, according to a review published in 2018 in Clinical Practice and Epidemiology in Mental Health.

Studies using brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), have attempted to reveal how the brains of people with bipolar disorder differ from the brains of healthy people or those with other mental disorders.

In neuroimaging studies, researchers have identified changes in cortical thickness as well as changes in the connectivity of brain regions responsible for emotional processing, emotional regulation, and reward processing among people with bipolar disorder. One MRI study published in Dialogues of Clinical Neuroscience found that the brains of adults with bipolar disorder have a prefrontal cortex that's smaller than — and doesn't function as well as — the prefrontal cortex of adults who don't have bipolar disorder.

The prefrontal cortex governs the brain's executive functions, such as problem-solving and decision-making. Other studies using neuroimaging, such as one published in the Journal of Affective Disorders, have found brain differences between those with bipolar 1 and bipolar 2.

People with a history of other mental health disorders — including anxiety, attention deficit hyperactivity disorder (ADHD), and borderline personality disorder — appear to be at an increased risk of developing bipolar disorder, though these links are still being studied.

A number of symptoms or situations that result from bipolar disorder can also be triggers for the disorder. Changes in sleep patterns, blowout arguments with coworkers or loved ones, high stress or traumatic events, alcohol abuse, certain medication interactions, shifts in season, and the hormonal changes of pregnancy can all put you at a greater risk of a manic or depressive episode.

It can be difficult to recognize the extent to which mood swings are affecting your quality of life.

The Mayo Clinic notes that some people with manic symptoms may enjoy the euphoric feelings and highs of productivity. But the fallout is often an emotional crash that may have financial, legal, or relationship consequences.

Bipolar disorder is a lifelong condition that won’t go away on its own, but getting the right diagnosis is the first step to managing your symptoms. Diagnosis typically involves these components, according to Mayo Clinic:

• A physical exam
• A psychiatric evaluation
• Mood charting, or keeping daily records of your moods and sleep patterns
• Comparing your symptoms with the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) — the guide that mental health professionals use to assist in diagnosis

There is no single bipolar disorder test, but blood tests and neuroimaging may be used to rule out other conditions, according to the NIMH. Bipolar symptoms can sometimes resemble those of other disorders, which can make it challenging to properly diagnose the condition, per the NIMH.

Diagnosing Bipolar Disorder in Kids and Teens

In children and teens, symptoms of bipolar disorder may be especially hard to distinguish from normal mood changes and behaviors.

Children and teens in a manic episode may be irritable and short-tempered, have trouble sleeping and staying focused, and engage in risky behaviors, the NIMH states. Those experiencing a depressive episode may have stomachaches and headaches, experience changes in eating habits, have little energy and interest in activities they usually enjoy, or have thoughts about death and suicide, per the NIMH.

Check in with your doctor if your child is having mood swings that seem more severe or significantly different from their usual ups and downs.

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While symptoms can intensify and subside, bipolar disorder is a lifelong condition that typically doesn’t go away on its own. But with consistent treatment, it can be managed.

Learn More About Bipolar Disorder and Sex Drive

Treatment may involve a combination of mood-balancing medication, psychotherapy, brain stimulation therapies, and certain lifestyle changes and complementary health approaches, according to Mayo Clinic.

In some instances, hospitalization may be necessary. But in many cases, outpatient treatment of bipolar disorder is successful, per Mayo Clinic.

If you’re afraid you or a loved one might hurt themselves or attempt suicide, it’s important to seek emergency medical help by dialing 911 for emergency medical services or 988 to reach the 988 Suicide and Crisis Lifeline.

Medication

Commonly prescribed medications for bipolar disorder, according to Mayo Clinic, are:

• Mood Stabilizers These medications are prescribed to help manage manic symptoms. Medicines like lithium (Lithobid), divalproex sodium (Depakote), valproic acid (Depakene), and lamotrigine (Lamictal) fall under this category.
• Antipsychotics Your doctor may add an antipsychotic drug to your treatment regimen if your manic or depressive symptoms persist, despite treatment with other medications. This class of medications includes risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and lurasidone (Latuda).
• Antidepressants These medicines are sometimes prescribed to help manage depressive episodes. But they’re usually prescribed alongside a mood stabilizer or an antipsychotic because taking antidepressants alone could potentially trigger manic episodes for some people with bipolar disorder.
• Anti-Anxiety Medication If you’re struggling with anxiety or sleep, your doctor may prescribe you a short-term course of anti-anxiety drugs called benzodiazepines to help you feel better.

These drugs can have a variety of side effects, and finding the right drug therapy can be challenging and take some time. It’s important, though, not to stop taking your medication without talking to your doctor, even if you’re feeling better. Doing so can cause withdrawal symptoms, or your symptoms may worsen or come back, per Mayo Clinic.

Psychotherapy

In conjunction with medication, your doctor will likely recommend some form of psychotherapy or counseling. Some common options for bipolar disorder, per Mayo Clinic, are:

• Cognitive Behavioral Therapy (CBT) During CBT sessions, a therapist will help you identify your triggers for mood episodes and develop behavioral strategies for managing them.
• Interpersonal and Social Rhythm Therapy (IPSRT) This form of therapy is focused on stabilizing your daily rhythms, including wake times, bedtimes, and mealtimes. Consistent routines are thought to help balance moods in people with bipolar disorder.
• Family Therapy In this form of therapy, you and your family members can learn to develop healthy communication strategies, which can help with managing your condition. Through family therapy, your loved ones can also learn about your triggers and how to recognize the warning signs of a mood episode.

Brain Stimulation Therapies

In instances where medication and psychotherapy aren’t enough to manage bipolar symptoms, your doctor might recommend you try brain stimulation therapies, such as electroconvulsive therapy or deep brain stimulation, according to NAMI.

During brain stimulation therapies, doctors directly and safely stimulate the brain via electricity, magnets, or implants, per NAMI.

Lifestyle Changes and Complementary Therapies

Making certain lifestyle changes may also be necessary, such as staying away from drugs and alcohol, avoiding certain foods like those containing caffeine, or making sure you’re exercising regularly, per Mayo Clinic.

Seeking out educational resources and a community of support can help you understand how to live with the condition and cope with symptoms. Joining a support group is one way to do this. The Depression and Bipolar Support Alliance, for instance, offers in-person and online support groups for people with bipolar disorder and their loved ones to share what they’re going through.

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Prevention of Bipolar Disorder

Although there’s no way to prevent bipolar disorder, seeking treatment at the earliest sign of this condition — and sticking to that treatment in the long term — can help you manage the symptoms and improve your prognosis, according to Mayo Clinic.

Bipolar disorder can increase your risk for other health and life issues, according to Mayo Clinic, such as:

• Drug and alcohol problems
• Financial or legal issues
• Headache
• Heart disease
• Obesity
• Problems at work or school
• Psychosis, or a detachment from reality
• Relationship issues
• Suicidal thoughts or behaviors
• Thyroid issues

The National Institute of Mental Health (NIMH) estimates that 2.8 percent of U.S. adults had bipolar disorder in the past year. The average age of onset is 25, though it can happen in teens and, less commonly, in children, according to NAMI.

Gender Differences in Bipolar Disorder

Although bipolar disorder is equally prevalent in men and women, the disorder appears to have some gender-related differences. Research suggests that women have an increased risk of bipolar 2, rapid cycling, and mixed episodes. Perhaps the most significant distinction involves reproductive health and choices, as treatment for pregnant women with bipolar disorder can be challenging.

What Is the Difference Between Bipolar Disorder and Manic Depression?

You may have heard the term “manic depression” used to describe a mental health disorder with similar symptoms as bipolar disorder.

In fact, bipolar disorder was officially known as manic depression until the 1980s, when mental health professionals decided to change the name of the illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the guide that mental health professionals use to assist in diagnosis.

They felt the term “bipolar disorder” more accurately described the condition and its symptoms, according to research. It's also been argued that the older term carries a stigma in popular culture and that both “manic” and “depression” are now used to describe everyday feelings and emotions.

As a result, bipolar disorder is now the preferred term and the one that healthcare professionals use in diagnosis.

Research has shown several differences in the diagnosis and treatment of bipolar disorder between Black people and white people.

For instance, bipolar disorder is more likely to be misdiagnosed as schizophrenia among Black people than white people, according to research published in September 2018 in Bipolar Disorders. As a result, Black people are also less likely to be treated for bipolar disorder than white people.

Other reasons Black people with bipolar disorder are less likely to be diagnosed and treated, according to Mental Health America, include:

• Mistrust of the U.S. medical system due to previous mistreatment, such as in the 40-year U.S. Public Health Service Syphilis Study at Tuskegee, during which nearly 400 Black men with syphilis were intentionally denied treatment
• Stigma around mental illness in Black communities
• Underrepresentation of providers who share the cultural same backgrounds of Black patients or are able to provide culturally competent care (meaning care that meets the needs of patients with diverse cultural values, behaviors, and beliefs)
• Greater likelihood of relying on family or religious communities for help rather than mental health professionals
• Lack of health insurance and, in turn, decreased access to care. Approximately 25 percent of Black Americans don’t have health insurance.
• Tendency to talk about physical health issues rather than mental health symptoms

Learn More About Racial Disparities in Bipolar Disorder

Many people with bipolar disorder also have other mental health conditions, according to NIMH, such as:

• Anxiety disorders
• ADHD
• Borderline personality disorder
• Eating disorders
• Substance use disorders