Bipolar Disorder

(Manic-Depressive Illness; Manic Depression; Manic Disorder; Manic Affective Disorder)


Bipolar disorder is a mental health condition marked by extreme swings in mood and energy. It can affect the ability to function normally. The mood changes of bipolar disorder are more severe than normal ups and downs. They can hurt relationships and cause poor job or school performance.

The two mood extremes of bipolar disorder are mania and depression. Mania is an increase in energy and a decreased need for sleep. The mood may be overly happy or irritable. In depression, a down mood with heavy fatigue takes over. Irritability is common with depression too.

There are 4 forms of bipolar disorder:

  • Bipolar I disorder—Repeated episodes of mania often immediately followed by depression These episodes can be severe.
  • Bipolar II disorder—Episodes of less severe mania (called hypomania) that rotate with episodes of major depression.
  • Bipolar disorder not otherwise specified (BP-NOS)—bipolar disorder that does not fit the description of bipolar I or bipolar II disorder.
  • Cyclothymia—Episodes of hypomania that alternate with episodes of mild depression that lasts for at least 2 years.

Causes    TOP

The cause of bipolar disorder is unknown. Specific genes may play a role, though it is most likely many different genes that act together.

The Brain

Color coded brain
Bipolar disorder may be a result of genetic influences on the brain.
Copyright © Nucleus Medical Media, Inc.

Risk Factors    TOP

A family history of the disorder increases your chance of developing it. Tell your doctor if you have a family member with bipolar disorder.

Symptoms    TOP

Symptoms include:

  • Dramatic mood swings—This can range from elated excitability, unrealistic goal setting, and an exaggerated sense of self-importance to feelings of hopelessness.
  • Periods of normal mood in between ups and downs.
  • Extreme changes in energy and behavior.

Mania may cause:

  • A mood that is extremely high or overly good
  • Increased energy and effort toward goal-directed activities
  • Restlessness and agitation
  • Racing thoughts, jumping from one idea to another
  • Rapid speech or pressure to keep talking
  • Trouble concentrating
  • Decreased need for sleep
  • Overconfidence or inflated self-esteem
  • Poor judgment, often involving spending sprees and sexual indiscretions

Depression may cause:

  • Prolonged sad, hopeless, or empty mood
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy or fatigue
  • Trouble concentrating, remembering, and/or making decisions
  • Restlessness or diminished movements
  • Agitation
  • Sleeping too much or too little
  • Unintended weight loss or gain
  • Thoughts of death or suicide with or without suicide attempts

Severe episodes of mania or depression may sometimes be associated with psychotic symptoms, such as:

  • Hallucinations
  • Delusions
  • Disorders of thought

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. In some cases, lab tests are ordered to rule out other causes of your symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on:

  • Presence of certain symptoms over time
  • Absence of other causes such as some medications, hormone imbalances, and certain neurologic conditions
  • Family history of bipolar disorder

Mania is diagnosed if:

  • Mood is elevated and there are 3 or more manic symptoms (listed above)
    • If the mood is irritable, not elevated, 4 symptoms must be present for a diagnosis of mania
  • Symptoms last for most of the day, nearly every day, for one week or longer
  • Symptoms cause problems in day-to-day duties

A depressive episode is diagnosed if:

  • There are 5 or more of the depressive symptoms (listed above)
  • Symptoms last for most of the day, nearly every day, for a period of 2 weeks or longer
  • Symptoms cause problems in day-to-day duties

Treatment    TOP

Talk with your medical team about the best plan for you. Options may include one or more of the following:


The primary treatment is medication called mood stabilizers. There are many different types and combinations of medications. Your medical team will work to find the best combination for you and your pattern. Examples of common medications used to treat bipolar disorder include:

  • Mood stabilizers
  • Antipsychotics
  • Antidepressants—only during depressive episodes
  • Antiseizure medications

Treatment should prevent significant mood swings. It may take some time to find the best combination.


Psychotherapy is often an important part of the treatment plan. It can give patients and their families support and guidance. Therapy may include:

Taking your daily medications and following your treatment plan can help prevent future mood swings.

Electroconvulsive Therapy    TOP

Electroconvulsive therapy (ECT) may be considered if medication and psychotherapy have not helped. It can be used for both mania and depression.

Prevention    TOP

There is nothing that has been shown to prevent bipolar disorder.


Depression and Bipolar Support Alliance


Canadian Mental Health Association
Canadian Psychiatric Association


Bipolar disorder. EBSCO DynaMed Plus website. Available at: Updated September 27, 2017. Accessed October 3, 2017.
Bipolar disorder. National Alliance on Mental Illness website. Available at: Updated August 2017. Accessed October 3, 2017.
Bipolar disorder in adults. National Institute of Mental Health website. Available at: Updated November 2015. Accessed October 3, 2017.
4/29/2011 DynaMed Plus Systematic Literature Surveillance Nivoli AM, Colom F, Murru A, et al. New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord. 2011;129(1-3):14-26.
Last reviewed January 2018 by EBSCO Medical Review Board Adrian Preda, MD
Last Updated: 2/6/2018

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