Bipolar Disorder
This mental disorder causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.
There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels.
These moods range from periods of extremely “up”, elated, irritable, or energized behavior (known as manic episodes) to very “down”, sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
- Bipolar I Disorder– defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
- Bipolar II Disorder– defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
- Cyclothymic Disorder (also called Cyclothymia)– defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.”
Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.
Signs and Symptoms
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 very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.
People having a manic episode may:
- Feel very “up”, “high”, elated, or irritable or touchy
- Feel “jumpy” or “wired”
- Have a decreased need for sleep
- Have a loss of appetite
- Talk very fast about a lot of different things
- Feel like their thoughts are racing
- Think they can do a lot of things at once
- Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex
- Feel like they are unusually important, talented, or powerful
People having a depressive episode may:
- Feel very sad, “down”, empty, worried, or hopeless
- Feel slowed down or restless
- Have trouble falling asleep, wake up too early, or sleep too much
- Experience increased appetite and weight gain
- Talk very slowly, feel like they have nothing to say, forget a lot
- Have trouble concentrating or making decisions
- Feel unable to do even simple things
- Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”)
- Feel hopeless or worthless, think about death or suicide
Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features.
People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same time, feeling extremely energized.
A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life.
The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.
Diagnosis
Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions.
The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.
Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important. You can find tips for talking with your health care provider in the NIMH fact sheet “Taking Control of Your Mental Health: Tips for Talking with Your Health Care Provider”
National Institute of Mental Health (2020). Bipolar Disorder. Retrieved February 10, 2020
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