Bipolar Disorder - NIMH

Overview. Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in mood, energy, ... Skiptomaincontent Mainnavigation MentalHealthInformation GetInvolved Research Funding News&Events AboutUs HealthTopics NIMHoffersexpert-reviewedinformationonmentaldisordersandarangeoftopics. Statistics NIMHstatisticspagesincludestatisticsontheprevalence,treatment,andcostsofmentalillnessforthepopulationoftheUnitedStates. BrochuresandFactSheets Download,read,andorderfreeNIMHbrochuresandfactsheetsaboutmentaldisordersandrelatedtopics. HelpforMentalIllnesses Ifyouorsomeoneyouknowhasamentalillness,therearewaystogethelp.Usetheseresourcestofindhelpforyourself,afriend,orafamilymember. ClinicalTrials Ifyouorafriendorfamilymemberarethinkingabouttakingpartinclinicalresearch,thispagecontainsbasicinformationaboutclinicaltrials. 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QuickLinks ContributetoMentalHealthResearch Mobilenavigation MentalHealthInformation MentalHealthInformationHome HealthTopics Statistics BrochuresandFactSheets HelpforMentalIllnesses ClinicalTrials GetInvolved GetInvolvedHome StakeholderEngagement ConnectwithNIMH DigitalShareables ScienceEducation UpcomingObservancesandRelatedEvents Research ResearchHome ResearchFundedbyNIMH ResearchConductedatNIMH(IntramuralResearchProgram) Funding FundingHome Opportunities&Announcements StrategyforResearchGrants GrantWriting&ApprovalProcess ManagingGrants ClinicalResearch ResearchTrainingandCareerDevelopmentOpportunities SmallBusinessResearch News&Events News&EventsHome ScienceNews ResearchHighlights MeetingsandEvents Multimedia SocialMedia PressResources EmailUpdates InnovationSpeakerSeries AboutUs AboutUsHome AbouttheDirector AdvisoryBoardsandGroups StrategicPlan OfficesandDivisions Budget CareersatNIMH StaffDirectories GettingtoNIMH HealthTopics Statistics BrochuresandFactSheets HelpforMentalIllnesses ClinicalTrials Home > MentalHealthInformation > HealthTopics SharePage         Menu Overview SignsandSymptoms RiskFactors TreatmentsandTherapies JoinaStudy LearnMore BipolarDisorder Overview Bipolardisorder(formerlycalledmanic-depressiveillnessormanicdepression)isamentalillnessthatcausesunusualshiftsinmood,energy,activitylevels,concentration,andtheabilitytocarryoutday-to-daytasks. Therearethreetypesofbipolardisorder.Allthreetypesinvolveclearchangesinmood,energy,andactivitylevels.Thesemoodsrangefromperiodsofextremely“up,”elated,irritable,orenergizedbehavior(knownasmanicepisodes)tovery“down,”sad,indifferent,orhopelessperiods(knownasdepressiveepisodes).Lessseveremanicperiodsareknownashypomanicepisodes. BipolarIdisorderisdefinedbymanicepisodesthatlastatleast7days(mostoftheday,nearlyeveryday)orbymanicsymptomsthataresoseverethatthepersonneedsimmediatehospitalcare.Usually,depressiveepisodesoccuraswell,typicallylastingatleast2weeks.Episodesofdepressionwithmixedfeatures(havingdepressivesymptomsandmanicsymptomsatthesametime)arealsopossible.Theexperienceoffourormoreepisodesofmaniaordepressionwithinayearistermed“rapidcycling.” BipolarIIdisorderisdefinedbyapatternofdepressiveepisodesandhypomanicepisodes,buttheepisodesarelessseverethanthemanicepisodesinbipolarIdisorder. Cyclothymicdisorder(alsocalledcyclothymia)isdefinedbyrecurrenthypomanicanddepressivesymptomsthatarenotintenseenoughordonotlastlongenoughtoqualifyashypomanicordepressiveepisodes. Sometimesapersonmightexperiencesymptomsofbipolardisorderthatdonotmatchthethreecategorieslistedabove,andthisisreferredtoas“otherspecifiedandunspecifiedbipolarandrelateddisorders.” Bipolardisorderistypicallydiagnosedduringlateadolescence(teenyears)orearlyadulthood.Occasionally,bipolarsymptomscanappearinchildren.Althoughthesymptomsmayvaryovertime,bipolardisorderusuallyrequireslifelongtreatment.Followingaprescribedtreatmentplancanhelppeoplemanagetheirsymptomsandimprovetheirqualityoflife. SignsandSymptoms Peoplewithbipolardisorderexperienceperiodsofunusuallyintenseemotion,changesinsleeppatternsandactivitylevels,anduncharacteristicbehaviors—oftenwithoutrecognizingtheirlikelyharmfulorundesirableeffects.Thesedistinctperiodsarecalled“moodepisodes.”Moodepisodesareverydifferentfromthemoodsandbehaviorsthataretypicalfortheperson.Duringanepisode,thesymptomslasteverydayformostoftheday.Episodesmayalsolastforlongerperiods,suchasseveraldaysorweeks. SymptomsofaManicEpisode SymptomsofaDepressiveEpisode Feelingveryup,high,elated,orextremelyirritableortouchy Feelingverydownorsad,oranxious Feelingjumpyorwired,moreactivethanusual Feelingsloweddownorrestless Decreasedneedforsleep Troublefallingasleep,wakinguptooearly,orsleepingtoomuch Talkingfastaboutalotofdifferentthings(“flightofideas”) Talkingveryslowly,feelingunabletofindanythingtosay,orforgettingalot Racingthoughts Troubleconcentratingormakingdecisions Feelingabletodomanythingsatoncewithoutgettingtired Feelingunabletodoevensimplethings Excessiveappetiteforfood,drinking,sex,orotherpleasurableactivities Lackofinterestinalmostallactivities Feelingunusuallyimportant,talented,orpowerful Feelinghopelessorworthless,orthinkingaboutdeathorsuicide Sometimespeopleexperiencebothmanicanddepressivesymptomsinthesameepisode,andthisiscalledanepisodewithmixedfeatures.Peopleexperiencinganepisodewithmixedfeaturesmayfeelverysad,empty,orhopelesswhileatthesametimefeelingextremelyenergized. Apersonmayhavebipolardisordereveniftheirsymptomsarelessextreme.Forexample,somepeoplewithbipolarIIdisorderexperiencehypomania,alesssevereformofmania.Duringahypomanicepisode,apersonmayfeelverygood,beabletogetthingsdone,andkeepupwithday-to-daylife.Thepersonmaynotfeelthatanythingiswrong,butfamilyandfriendsmayrecognizethechangesinmoodoractivitylevelsaspossiblebipolardisorder.Withoutpropertreatment,peoplewithhypomaniacandevelopseveremaniaordepression. Diagnosis Properdiagnosisandtreatmentcanhelppeoplewithbipolardisorderleadhealthyandactivelives.Talkingwithadoctororotherlicensedhealthcareprovideristhefirststep.Thehealthcareprovidercancompleteaphysicalexamandordernecessarymedicalteststoruleoutotherconditions.Thehealthcareprovidermaythenconductamentalhealthevaluationorprovideareferraltoatrainedmentalhealthcareprovider,suchasapsychiatrist,psychologist,orclinicalsocialworkerwhohasexperienceindiagnosingandtreatingbipolardisorder. Mentalhealthcareprovidersusuallydiagnosebipolardisorderbasedonaperson’ssymptoms,lifetimehistory,experiences,and,insomecases,familyhistory.Accuratediagnosisinyouthisparticularlyimportant.Youcanfindtipsfortalkingwithyourhealthcareproviderin  NIMH'sTipsforTalkingWithaHealthCareProviderAboutYourMentalHealthfactsheet. BipolarDisorderandOtherConditions Manypeoplewithbipolardisorderalsohaveothermentaldisordersorconditionssuchasanxietydisorders,attention-deficit/hyperactivitydisorder(ADHD),misuseofdrugsoralcohol,oreatingdisorders.Sometimespeoplewhohaveseveremanicordepressiveepisodesalsohavesymptomsofpsychosis,suchashallucinationsordelusions.Thepsychoticsymptomstendtomatchtheperson’sextrememood.Forexample,someonehavingpsychoticsymptomsduringadepressiveepisodemayfalselybelievetheyarefinanciallyruined,whilesomeonehavingpsychoticsymptomsduringamanicepisodemayfalselybelievetheyarefamousorhavespecialpowers. Lookingatsymptomsoverthecourseoftheillnessandtheperson’sfamilyhistorycanhelpdeterminewhetherapersonhasbipolardisorderalongwithanotherdisorder. RiskFactors Researchersarestudyingthepossiblecausesofbipolardisorder.Mostagreethatthereisnosinglecauseanditislikelythatmanyfactorscontributetoaperson’schanceofhavingtheillness. BrainStructureandFunctioning:Somestudiesindicatethatthebrainsofpeoplewithbipolardisordermaydifferfromthebrainsofpeoplewhodonothavebipolardisorderoranyothermentaldisorder.Learningmoreaboutthesedifferencesmayhelpscientistsunderstandbipolardisorderanddeterminewhichtreatmentswillworkbest.Atthistime,healthcareprovidersbasethediagnosisandtreatmentplanonaperson’ssymptomsandhistory,ratherthanbrainimagingorotherdiagnostictests. Genetics:Someresearchsuggeststhatpeoplewithcertaingenesaremorelikelytodevelopbipolardisorder.Researchalsoshowsthatpeoplewhohaveaparentorsiblingwithbipolardisorderhaveanincreasedchanceofhavingthedisorderthemselves.Manygenesareinvolved,andnoonegenecancausethedisorder.Learningmoreabouthowgenesplayaroleinbipolardisordermayhelpresearchersdevelopnewtreatments. TreatmentsandTherapies Treatmentcanhelpmanypeople,includingthosewiththemostsevereformsofbipolardisorder.Aneffectivetreatmentplanusuallyincludesacombinationofmedicationandpsychotherapy,alsocalledtalktherapy. Bipolardisorderisalifelongillness.Episodesofmaniaanddepressiontypicallycomebackovertime.Betweenepisodes,manypeoplewithbipolardisorderarefreeofmoodchanges,butsomepeoplemayhavelingeringsymptoms.Long-term,continuoustreatmentcanhelppeoplemanagethesesymptoms. Medications Certainmedicationscanhelpmanagesymptomsofbipolardisorder.Somepeoplemayneedtotryseveraldifferentmedicationsandworkwiththeirhealthcareproviderbeforefindingmedicationsthatworkbest. Themostcommontypesofmedicationsthatdoctorsprescribeincludemoodstabilizersandatypicalantipsychotics.Moodstabilizerssuchaslithiumorvalproatecanhelppreventmoodepisodesorreducetheirseverity.Lithiumalsocandecreasetheriskofsuicide.Medicationsthattargetsleeporanxietyaresometimesaddedtomoodstabilizersaspartofatreatmentplan. Whilebipolardepressionisoftentreatedwithantidepressantmedication,amoodstabilizermustbetakenaswell,asanantidepressantalonecantriggeramanicepisodeorrapidcyclinginapersonwithbipolardisorder.Becausepeoplewithbipolardisorderaremorelikelytoseekhelpwhentheyaredepressedthanwhentheyareexperiencingmaniaorhypomania,takingacarefulmedicalhistoryisessentialtoensurethatbipolardisorderisnotmistakenfordepression. Peopletakingmedicationshould: Talkwiththeirhealthcareprovidertounderstandtherisksandbenefitsofthemedication. Telltheirhealthcareprovideraboutanyprescriptiondrugs,over-the-countermedications,orsupplementstheyarealreadytaking. Reportanyconcernsaboutsideeffectstoahealthcareproviderrightaway.Thehealthcareprovidermayneedtochangethedoseortryadifferentmedication. Rememberthatmedicationforbipolardisordermustbetakenconsistently,asprescribed,evenwhenoneisfeelingwell. Avoidstoppingamedicationwithouttalkingtoahealthcareproviderfirst.Suddenlystoppingamedicationmayleadtoa“rebound”orworseningofbipolardisordersymptoms.Forbasicinformationaboutmedications,visitNIMH'sMentalHealthMedicationswebpage.Readthelatestmedicationwarnings,patientmedicationguides,andinformationonnewlyapprovedmedicationsonthe FoodandDrugAdministration(FDA)website. Psychotherapy Psychotherapy,alsocalledtalktherapy,canbeaneffectivepartofthetreatmentplanforpeoplewithbipolardisorder.Psychotherapyisatermforavarietyoftreatmenttechniquesthataimtohelpapersonidentifyandchangetroublingemotions,thoughts,andbehaviors.Itcanprovidesupport,education,andguidancetopeoplewithbipolardisorderandtheirfamilies. Cognitivebehavioraltherapy(CBT)isanimportanttreatmentfordepression,andCBTadaptedforthetreatmentofinsomniacanbeespeciallyhelpfulasacomponentofthetreatmentofbipolardepression. Treatmentmayalsoincludenewertherapiesdesignedspecificallyforthetreatmentofbipolardisorder,includinginterpersonalandsocialrhythmtherapy(IPSRT)andfamily-focusedtherapy.Determiningwhetherintensivepsychotherapeuticinterventionattheearlieststagesofbipolardisordercanpreventorlimititsfull-blownonsetisanimportantareaofongoingresearch. VisitNIMH'sPsychotherapieswebpagetolearnaboutthevarioustypesofpsychotherapies. OtherTreatmentOptions Somepeoplemayfindothertreatmentshelpfulinmanagingtheirbipolarsymptoms,including: Electroconvulsivetherapy(ECT)isabrainstimulationprocedurethatcanhelprelieveseveresymptomsofbipolardisorder.ECTisusuallyonlyconsideredifanindividual’sillnesshasnotimprovedafterothertreatmentssuchasmedicationorpsychotherapy,orincasesthatrequirerapidresponse,suchaswithsuicideriskorcatatonia(astateofunresponsiveness). Transcranialmagneticstimulation(TMS)isatypeofbrainstimulationthatusesmagneticwaves,ratherthantheelectricalstimulusofECT,torelievedepressionoveraseriesoftreatmentsessions.AlthoughnotaspowerfulasECT,TMSdoesnotrequiregeneralanesthesiaandpresentslittleriskofmemoryoradversecognitiveeffects. Lighttherapyisthebestevidence-basedtreatmentforseasonalaffectivedisorder(SAD),andmanypeoplewithbipolardisorderexperienceseasonalworseningofdepressioninthewinter,insomecasestothepointofSAD.Lighttherapycouldalsobeconsideredforlesserformsofseasonalworseningofbipolardepression. Unlikespecificpsychotherapyandmedicationtreatmentsthatarescientificallyproventoimprovebipolardisordersymptoms,complementaryhealthapproachesforbipolardisorder,suchasnaturalproducts,arenotbasedoncurrentknowledgeorevidence.Formoreinformation,visittheNationalCenterforComplementaryandIntegrativeHealthwebsite. FindingTreatment Afamilyhealthcareproviderordoctorisagoodresourceandcanbethefirststopinsearchingforhelp.Fortipsfortalkingwithyourhealthcareprovider,seeNIMH’sTipsforTalkingWithaHealthCareProviderAboutYourMentalHealthfactsheet. Forgeneralinformationonmentalhealthandtofindlocaltreatmentservices,calltheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)TreatmentReferralHelplineat1-800-662-HELP(4357). TheSAMHSAwebsitehasaBehavioralHealthTreatmentServicesLocatorthatcansearchfortreatmentinformationbyaddress,city,orZIPcode. VisitNIMH’sHelpforMentalIllnesseswebpageformoreinformationandresources. Ifyouorsomeoneyouknowisinimmediatedistressoristhinkingabouthurtingthemselves,callortextthe988Suicide&CrisisLifelineat988orchatat988lifeline.org.YoucanalsocontacttheCrisisTextLine(textHELLOto741741).Formedicalemergencies,call911. CopingwithBipolarDisorder Livingwithbipolardisordercanbechallenging,buttherearewaystohelpmakeiteasierforyourself,afriend,oralovedone. Gettreatmentandstickwithit.Treatmentisthebestwaytostartfeelingbetter. Keepmedicalandtherapyappointmentsandtalkwithyourhealthcareproviderabouttreatmentoptions. Takemedicationasdirected. Structureactivities.Keeparoutineforeating,sleeping,andexercising. Tryregular,vigorousexerciselikejogging,swimming,orbicycling,whichcanhelpwithdepressionandanxiety,promotebettersleep,andishealthyforyourheartandbrain. Keepalifecharttohelprecognizeyourmoodswings. Askforhelpwhentryingtostickwithyourtreatment. Bepatient.Improvementtakestime.Socialsupporthelps. Remember,bipolardisorderisalifelongillness,butlong-term,ongoingtreatmentcanhelpcontrolsymptomsandenableyoutoliveahealthylife. JoinaStudy Clinicaltrialsareresearchstudiesthatlookatnewwaystoprevent,detect,ortreatdiseasesandconditions.Thegoalofclinicaltrialsistodetermineifanewtestortreatmentworksandissafe.Althoughindividualsmaybenefitfrombeingpartofaclinicaltrial,participantsshouldbeawarethattheprimarypurposeofaclinicaltrialistogainnewscientificknowledgesothatothersmaybebetterhelpedinthefuture. ResearchersatNIMHandaroundthecountryconductmanystudieswithpatientsandhealthyvolunteers.Wehavenewandbettertreatmentoptionstodaybecauseofwhatclinicaltrialsuncoveredyearsago.Bepartoftomorrow’smedicalbreakthroughs.Talktoyourhealthcareprovideraboutclinicaltrials,theirbenefitsandrisks,andwhetheroneisrightforyou. Tolearnmoreorfindastudy,visit: NIMH’sClinicalTrialswebpage:Informationaboutparticipatinginclinicaltrials Clinicaltrials.gov:CurrentStudiesonBipolarDisorder:ListofclinicaltrialsfundedbytheNationalInstitutesofHealth(NIH)beingconductedacrossthecountry JoinaStudy:BipolarDisorder–Adults:ListofstudiesbeingconductedontheNIHCampusinBethesda,MD LearnMore FreeBrochuresandShareableResources BipolarDisorder:Abrochureonbipolardisorderthatoffersbasicinformationonsignsandsymptoms,treatment,andfindinghelp.Alsoavailableenespañol. BipolarDisorderinChildrenandTeens:Abrochureonbipolardisorderinchildrenandteensthatoffersbasicinformationonsignsandsymptoms,treatment,andfindinghelp.Alsoavailableenespañol. BipolarDisorderinTeensandYoungAdults:KnowtheSigns:Aninfographicpresentingcommonsignsandsymptomsofbipolardisorderinteensandyoungadults.Alsoavailable enespañol. ShareableResourcesonBipolarDisorder:Helpsupportbipolardisorderawarenessandeducationinyourcommunity.Usethesedigitalresources,includinggraphicsandmessages,tospreadthewordaboutbipolardisorder. Multimedia MentalHealthMinute:BipolarDisorderinAdults:Takeamentalhealthminutetolearnaboutbipolardisorderinadults. NIMHExpertDiscussesBipolarDisorderinAdolescentsandYoungAdults:Learnthesigns,symptoms,andtreatmentsofbipolardisorder. ResearchandStatistics JournalArticles:ThiswebpageprovidesinformationonreferencesandabstractsfromMEDLINE/PubMed(NationalLibraryofMedicine). TreatmentforBipolarDisorderinAdults:ASystematicReview:AreviewfromtheAgencyforHealthcareResearchandQualitythatassessestheeffectivenessofmedicationsandothertherapiesfortreatingmaniaordepressionsymptomsandpreventingrelapseinadultswithbipolardisorderdiagnoses. BipolarDisorderStatistics:AnNIMHwebpagethatprovidesinformationontheprevalenceofbipolardisorderamongadultsandadolescents. LastReviewed:September2022 Unlessotherwisespecified,NIMHinformationandpublicationsareinthepublicdomainandavailableforusefreeofcharge.CitationofNIMHisappreciated.PleaseseeourCitingNIMHInformationandPublicationspageformoreinformation. ScienceNewsAboutBipolarDisorder ClinicalDecisionSupportSystemReducesCardiovascularRiskinPatientsWithSeriousMentalIllness GeneReadoutsContributeToDistinctnessofMentalDisorders Dr.CarlosZarateElectedtoNationalAcademyofMedicine More JoinAStudy BipolarDisorderStudiesforAdults FeaturedPublicationsAboutBipolarDisorder BipolarDisorder Thisbrochurepresentsinformationonbipolardisorderincludingsymptoms,causes,diagnosis,treatmentoptions,andresourcestofindhelpforyourselforothers. More ResearchResults SystematicTreatmentEnhancementProgramforBipolarDisorder(STEP-BD) PubMed:JournalArticlesaboutBipolarDisorder