Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.
People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.
The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there).
"Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.
The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes.
Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.
There are a few types of bipolar disorder, including:
Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks.
Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.
Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.
With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues.
In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.
How severe it gets differs from person to person and can also change over time, becoming more or less severe.
Symptoms of mania ("the highs"):
During depressive periods ("the lows"), a person with bipolar disorder may have:
There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.
For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.
When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.
Men and women are equally likely to get it. Women are somewhat more likely than men to go through "rapid cycling," which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.
Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes.
A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders.
Some things that make you more likely to have bipolar disorder include:
Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.
If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.
Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?
The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.
Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.
Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.
If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.
Bipolar disorder can be treated. It's a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.
Medication is the main treatment, usually involving the following:
It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.
Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take.
Psychotherapy, or "talk therapy," is often recommended, too. There are several different types. Options can include:
Other treatment options for bipolar disorder can include:
Lifestyle changes may also help:
For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.
Ongoing treatment is more effective than dealing with problems as they come up.
The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.
Some people who have bipolar disorder may become suicidal.
Learn the warning signs and seek immediate medical help for them: