Bipolar (by-POLE-ar) disorder is a condition in which periods of extreme euphoria * , called mania (MAY-nee-uh), alternate with periods of severe depression * . Bipolar disorder is sometimes called manic (MAN-ik) depression.
Bipolar disorder is a type of mental disorder * . People with bipolar disorder experience two extremes in mood; they have periods of highly elevated mood and boundless energy that are followed by periods of depression. Bipolar disorder can range from severe to mild. Different forms of bipolar disorder are distinguished from one another by the severity of extremes in mood and activity or energy.
For example, bipolar I disorder involves at least one distinct manic episode or at least one episode of mania mixed with depression. People with this form of bipolar disorder often experience trouble sleeping, changes in appetite, psychosis * , and thoughts of suicide.
In bipolar II, a person has at least one episode of major depression and one episode that is considered hypomania * . Some people also experience mixed states in which symptoms of mania and depression exist at the same time; this form may be more common in younger individuals and children. Other people might experience a milder form of bipolar disorder in which there is a rapid cycling between “up” and “down” moods with few, if any, normal moods in between. Cyclothymia (sy-CLUH- thime-ah) is a condition in which there are mood swings but with milder highs and lows.
Finally, psychologists have added a new category for people who show symptoms of bipolar disorder but do not meet set criteria for diagnosis of bipolar disorder I or II. The new category is called “other specified bipolar and related disorder.”
Ernest Hemingway, winner of the Nobel Prize in Literature, showed signs of having bipolar disorder. So did presidents Abraham Lincoln and Theodore Roosevelt and the composer Ludwig von Beethoven. All of these men were intelligent, creative, successful individuals, but they all fought the two faces of bipolar disorder. Modern ideas about the disorder began taking shape in the 19th century.
Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6 percent of the U.S. population age 18 and older every year. It affects people of all races, cultures, professions, and income levels. Men and women are affected at equal rates. Bipolar disorder tends to run in families and is believed to have an inherited genetic component. Studies of twins show that if one member of a pair of identical twins (twins who have identical genes * ) has bipolar disorder, the other twin has about a 70 percent chance of also having the disorder. If one of a pair of fraternal twins (twins who do not have identical genes but do have many of the same genes) has bipolar disorder, the risk of the other twin having it is only 15 to 25 percent.
Bipolar disorder has two distinctive sets of symptoms.
During the depression phase, a person may experience:
During the manic or euphoric stage, a person may experience:
Bipolar disorder usually begins in early adulthood, around the age of 25, although experts believe that younger children and teens may also have the disorder. Some children who are diagnosed with attention deficit hyperactivity disorder * (ADHD) might actually have bipolar disorder or might have both disorders. These children have symptoms of ADHD along with symptoms such as significant and sustained tantrums, periods of anxiety * (including separation anxiety * ), periods of irritability, and mood changes. With many children, mood states change rapidly and without warning. Children with bipolar disorder are studied by psychologists * and psychiatrists * .
Doctors often ask family members about the person's symptoms because people with bipolar disorder are often not aware of the changes they are experiencing. To be diagnosed with bipolar disorder, the person must have had at least one period of mania. The diagnosis can easily be missed, and it often takes a long time before bipolar disorder is correctly diagnosed. Mental health professionals use tools to help them diagnose bipolar disorder earlier. An example is a checklist that helps the patient and therapist identify hypomanic symptoms. Five or more years can pass between a first episode of mania or depression and the next manic or depressive period. Despite the stretches with no episodes, bipolar disorder does not go away on its own. Instead, the time between mania and depression gets shorter, and the symptoms may become more severe. Not infrequently, bipolar disorder can lead to psychosis or suicide. About 20 percent of people who have required hospitalization for bipolar disorder commit suicide.
Many people with severe mood swings can be helped by treatment. The drug lithium has been one of the medications of choice for treating bipolar disorder; it is in a class of drugs called mood stabilizers. Other medications are also helpful in controlling mood swings. These include various antiseizure medications (such as valproate and carbamazepine) and anti psychotic or antidepressant medications (aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone). People with bipolar disorder need to continue to take their medications even when they feel normal to prevent mood and energy swings from reoccurring. Psychotherapy often is combined with medication to help people with bipolar disorder.
Living with bipolar disorder means remaining aware of the signs and symptoms, and keeping a steady routine for sleeping and eating. Taking medications as directed and talking with a doctor about treatment options can help improve symptoms.
Bipolar disorder can be difficult for the loved ones of those affected as well. Family members can help the person with the disorder get treatment and encourage him or her to stick with the treatment. Family members can also learn more about the warning signs that suggest a new mood episode may be approaching and encourage the person to seek medical care to try to prevent increasingly worse symptoms. Many family members find joining a support group or participating in family therapy is helpful in understanding and managing the effects of this difficult problem. People who are talking about suicide need emergency help. Many telephone directories list suicide and mental health crisis hotlines in their Community Service sections, and help can be obtained by calling emergency services (911 in most communities).
See also Anxiety and Anxiety Disorders: Overview • Attention Deficit Hyperactivity Disorder (ADHD) • Depressive Disorders: Overview • Psychopharmacology • Psychosis • Suicide
Hellier, Jennifer L., ed., The Brain, the Nervous System, and Their Diseases. Santa Barbara, CA: Greenwood, 2015.
American Psychiatric Association. “What Are Bipolar Disorders?” http://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders (accessed March 14, 2016).
Depression and Bipolar Support Alliance. “Bipolar Disorder Statistics.” (accessed March 11, 2016).
National Institute of Mental Health. “Bipolar Disorder in Children and Teens.” http://www.nimh.nih.gov/health/publications/bipolardisorder-in-children-and-adolescents/index.shtml (accessed March 14, 2016).
Depression and Bipolar Support Alliance (DBSA). 55 E Jackson Blvd., Suite 490, Chicago, IL 60604. Telephone: 312-642-0049. Website: http://www.dbsalliance.org (accessed March 11, 2016).
Mental Health America. 2000 N. Beauregard St., 6th Fl., Alexandria, VA 22311. Toll-free: 800-969-6642. Website: http://www.mentalhealthamerica.net/ (accessed March 14, 2016).
National Institute of Mental Health. 6001 Executive Blvd., Room 6200, MSC 9663, Bethesda, MD 20892-9663. Toll-free: 866-615-6464. Website: http://www.nimh.nih.gov (accessed March 14, 2016).
* euphoria (yoo-FOR-ee-uh) is an abnormally high mood with the tendency to be overactive and overtalkative, and to have racing thoughts and overinflated self-confidence.
* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
* mental disorder is a range of conditions that affect a person's thinking, feeling, or mood, including depression, bipolar disorder, personality disorders, and anxiety disorders.
* psychosis (sy-KO-sis) refers to mental disorders in which the sense of reality is so impaired that a patient cannot function normally. People with psychotic disorders may experience delusions (exaggerated beliefs that are contrary to fact), hallucinations (something that a person perceives as real but that is not actually caused by an outside event), incoherent speech, and agitated behavior, but they are usually not aware of their altered mental state.
* hypomania (hy-po-MAIN-e-uh) is a manic episode that is less severe than typical, and only lasts about four days.
* genes (JEENS) are chemical structures composed of deoxyribonucleic acid (DNA) that help determine a person's body structure and physical characteristics. Inherited from a person's parents, genes are contained in the chromosomes found in the body's cells.
* attention deficit hyperactivity disorder, or ADHD, is a condition that makes it hard for a person to pay attention, sit still, or think before acting.
* anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
* separation anxiety is the normal fear that babies and young children feel when they are separated from their parents or approached by strangers.
* psychologists (sy-KOL-o-jists) are mental health professionals who treat mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth. Psychologists also study the brain, behavior, emotions, and learning.
* psychiatrists (sy-KY-uh-trist) are medical doctors who have completed specialized training in the diagnosis and treatment of mental disorders. Psychiatrists can diagnose mental disorders, provide mental health counseling, and prescribe medications.