⚠️ Crisis Resources
If you or someone you know is in crisis, contact the 988 Suicide & Crisis Lifeline by calling or texting 988. For emergencies, call 911 or go to your nearest emergency room. You are not alone—help is available 24/7.
What is Bipolar Disorder?
Bipolar disorder (formerly called manic-depressive illness) is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. These shifts are far more severe than the normal ups and downs everyone experiences.
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called "mood episodes."
Mood episodes are drastically different from the moods and behaviors typical for the person. During an episode, symptoms last most of the day, nearly every day, for at least several days or weeks. Symptoms can also sometimes occur together in "mixed features" episodes.
💡 Key Distinction
Bipolar disorder is not the same as having mood swings. Everyone has ups and downs, but bipolar episodes are severe, prolonged, and significantly impair daily functioning or require hospitalization.
Types of Bipolar Disorder
There are three main types of bipolar disorder. All involve clear changes in mood, energy, and activity levels that differ from the person's usual behavior.
| Type | Manic Episodes | Depressive Episodes | Key Features |
|---|---|---|---|
| Bipolar I | Full mania (≥7 days or hospitalization) | Common but not required | Most severe manic symptoms; may include psychosis |
| Bipolar II | Hypomania only (≥4 days) | Required (≥2 weeks) | Milder highs, but depression often more severe and frequent |
| Cyclothymia | Hypomanic symptoms | Depressive symptoms | Chronic (≥2 years), less severe but persistent mood cycling |
Based on DSM-5 diagnostic criteria. A qualified mental health professional is required for accurate diagnosis.
Recognizing Mood Episodes
Bipolar disorder is characterized by two main types of mood episodes: manic (or hypomanic) episodes and depressive episodes. Recognizing the symptoms of each is crucial for early intervention.
🔥 Manic Episode Symptoms
- Feeling unusually "high," elated, or irritable
- Decreased need for sleep (feeling rested after 3 hours)
- Racing thoughts, rapid speech
- Being easily distracted
- Increased goal-directed activity
- Risky behavior (spending sprees, risky sex, impulsive decisions)
- Inflated self-esteem or grandiosity
🌧️ Depressive Episode Symptoms
- Feeling sad, empty, hopeless, or tearful
- Loss of interest in almost all activities
- Significant weight loss/gain or appetite changes
- Sleeping too much or too little
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide
Hypomania vs. Mania
Hypomania involves the same symptoms as mania but is less severe and shorter in duration (at least 4 days vs. 7 days). While hypomanic episodes don't cause the severe impairment that mania does, they are still a significant change from normal behavior and noticeable to others.
People experiencing hypomania may feel great and highly productive. However, without proper treatment, hypomanic episodes can develop into full mania or severe depression.
Mixed Features
Some people experience "mixed features"—having symptoms of mania and depression at the same time. For example, feeling very energized while also feeling hopeless. Mixed episodes can be particularly dangerous because the combination of high energy and depressive thoughts increases suicide risk.
Treatment Options
Bipolar disorder is a lifelong condition, but symptoms can be managed effectively with the right treatment plan. Treatment typically involves a combination of medication, psychotherapy, and lifestyle modifications.
Medications
Medications are the cornerstone of bipolar treatment. The main categories include:
| Medication Class | Examples | Primary Use |
|---|---|---|
| Mood Stabilizers | Lithium, Valproate, Carbamazepine | Prevent mood episodes, treat mania |
| Atypical Antipsychotics | Quetiapine, Olanzapine, Aripiprazole, Lurasidone | Mania, depression, maintenance |
| Anticonvulsants | Lamotrigine | Depression prevention, maintenance |
| Antidepressants | SSRIs, SNRIs (used cautiously) | Depressive episodes (with mood stabilizer) |
⚠️ Antidepressant Caution
Antidepressants used alone can trigger manic episodes in people with bipolar disorder. They should only be prescribed alongside a mood stabilizer or antipsychotic, and under close medical supervision.
Psychotherapy
Therapy, in combination with medication, is highly effective for bipolar disorder:
- Cognitive Behavioral Therapy (CBT): Helps identify and change negative thought patterns and behaviors
- Interpersonal and Social Rhythm Therapy (IPSRT): Focuses on stabilizing daily routines and sleep patterns
- Family-Focused Therapy: Involves family members in treatment to improve communication and support
- Psychoeducation: Learning about the illness to recognize warning signs and develop coping strategies
Other Treatments
Electroconvulsive Therapy (ECT) may be recommended for severe depression or mania that doesn't respond to medications, or when rapid response is needed. Despite its portrayal in media, modern ECT is safe and highly effective.
Living with Bipolar Disorder
With proper treatment and self-management strategies, people with bipolar disorder can lead full, productive lives. Here are evidence-based strategies for maintaining stability:
Lifestyle Strategies
- Maintain regular sleep schedules: Go to bed and wake up at consistent times, even on weekends
- Track your moods: Use apps or journals to identify patterns and early warning signs
- Avoid alcohol and drugs: Substances can trigger episodes and interfere with medications
- Exercise regularly: Physical activity helps regulate mood and improve sleep
- Build a support network: Stay connected with family, friends, and support groups
- Reduce stress: Practice mindfulness, set realistic goals, and learn to say no
Recognizing Early Warning Signs
Learning to recognize your personal warning signs of an impending episode is one of the most valuable skills you can develop:
- For mania: Decreased need for sleep, increased energy, racing thoughts, talking more than usual
- For depression: Social withdrawal, loss of interest, sleep changes, low energy
When you notice warning signs, contact your treatment team immediately. Early intervention can prevent a full episode.
📱 Mood Tracking Apps
Apps like Daylio, eMoods, and Bearable can help you track mood patterns, sleep, medication adherence, and potential triggers—making it easier to share information with your care team.
What Causes Bipolar Disorder?
The exact cause of bipolar disorder is unknown, but research suggests it results from a combination of factors:
Genetics
Bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, you have a higher risk (about 10%) of developing it, compared to 2-3% in the general population. However, most people with a family history never develop the condition.
Brain Structure and Function
Research using brain imaging shows subtle differences in brain structure and activity in people with bipolar disorder. These differences may help explain why treatments work and guide future research.
Environmental Triggers
While genetics create vulnerability, environmental factors can trigger episodes:
- High stress or major life changes
- Sleep disruption
- Substance abuse
- Traumatic experiences
- Seasonal changes
Getting Diagnosed
There is no blood test or brain scan for bipolar disorder. Diagnosis is based on a comprehensive evaluation by a mental health professional, which typically includes:
- Psychiatric assessment: Detailed interview about symptoms, history, and family mental health
- Mood charting: Tracking daily moods, sleep, and behaviors
- Physical exam: To rule out medical conditions that can mimic bipolar symptoms
- DSM-5 criteria: Symptoms must meet specific diagnostic criteria
Challenges in Diagnosis
Bipolar disorder is often misdiagnosed, particularly as unipolar depression (because people often seek help during depressive episodes, not manic ones). On average, it takes 10 years from symptom onset to receive a correct diagnosis.
Be sure to tell your doctor about any past episodes of elevated mood, increased energy, or uncharacteristic behavior—even if they felt good at the time.
Ongoing Research
Scientists are actively researching bipolar disorder to improve diagnosis and treatment:
- Biomarker research: Identifying biological markers that could aid in diagnosis
- Genetics studies: Mapping genes associated with bipolar disorder
- New treatments: Investigating novel medications and brain stimulation therapies
- Personalized medicine: Matching treatments to individual patient characteristics
To find clinical trials, visit ClinicalTrials.gov and search for "bipolar disorder."
Resources & Support
Living with bipolar disorder is easier with the right support. Here are trusted resources:
Crisis Support
- 988 Suicide & Crisis Lifeline: Call or text 988 (24/7)
- Crisis Text Line: Text HOME to 741741
- SAMHSA Helpline: 1-800-662-4357
Organizations
- National Institute of Mental Health (NIMH)
- Depression and Bipolar Support Alliance (DBSA)
- National Alliance on Mental Illness (NAMI)
- Mental Health America
For Family & Caregivers
Supporting someone with bipolar disorder can be challenging. NAMI offers Family Support Groups and the Family-to-Family education program.
Last reviewed: February 2026 | Medical review by thrive.md Clinical Advisory Team