Bipolar disorder, previously called manic depression, is a mental health condition that involves fluctuations in thinking, mood, and behavior. If you have bipolar disorder, you may experience periods of depression or mania.

There are different types of bipolar disorder, and it affects everyone differently. The main types are bipolar I disorder and bipolar II disorder.

Bipolar I involves depression and mania, an extremely high mood. Bipolar II is more likely to involve depression and hypomania. Hypomania is similar to mania but less extreme.

For some people, depression is the dominant mood. Some people find they often fluctuate between high and low moods or have long periods when their moods are stable.

For a diagnosis of bipolar I disorder, a person will experience mania at some point. People who receive a diagnosis of bipolar II will have at least one episode of hypomania.

Find out more about the differences between bipolar I and bipolar II disorder.

Experts do not know exactly why bipolar disorder happens, but it probably results from a combination of factors.

Brain structures

Features relating to specific areas of the brain may play a role, as well as the action and regulation of chemicals such as neurotransmitters and hormones.

Genetic factors

People with certain genetic factors may have a higher chance of developing bipolar disorder, and it appears to be more common in those who have a close relative with the disorder.

Psychosocial factors

In some cases, a stressful life event can trigger a person’s first episode of bipolar disorder. This usually happens if the person already has a genetic predisposition or other features that make it more likely.

Other mental health conditions

Bipolar depression may be more likely if a person has another mental health condition, such as obsessive-compulsive disorder (OCD) or traits of borderline personality disorder (BPD).

Bipolar disorder usually appears during adolescence or early adulthood, but it can occur at any age, including childhood.

Some statistics show that, on average, it starts between ages 18 and 20. Other research suggests it’s more likely to occur after the age of 25. One large study found evidence that higher numbers of first episodes appear in people ages 15 to 24 and in those ages 45 to 54.

Global statistics suggest bipolar I disorder affects around 1 percent of the general population, but the numbers may be higher. A survey looking at data for 11 countries found that bipolar II disorder could affect 0.4 percent of the general population.

The symptoms of bipolar disorder include changes in mood and:

  • energy and activity levels
  • sleep patterns
  • emotions
  • behavior

People with bipolar disorder often experience extreme highs and lows in their moods. The mood changes caused by bipolar disorder are very different from the highs and lows that are familiar to most people.

Bipolar disorder can affect work, studies, and relationships. In some cases, it can be life threatening, as there is a higher risk of suicide and risky behavior than in the general population.

Symptoms of a depressive mood episode may include:

  • feeling very low
  • feelings of emptiness or worthlessness
  • loss of interest in activities previously enjoyed
  • behavioral changes
  • fatigue or low energy
  • problems with concentration, decision making, or forgetfulness
  • restlessness or irritability
  • changes in eating or sleeping habits
  • finding it hard to carry out even simple tasks
  • thinking about suicide or a suicide attempt

In rare cases, a person with bipolar disorder may experience catatonia. This is a very severe form of depression. A person may be unable to get up, speak, carry out simple tasks, or even move.

A person with bipolar disorder can also experience manic or hypomanic episodes.

Symptoms of mania may include:

  • long periods of intense joy, excitement, or euphoria
  • extreme irritability, agitation, or a feeling of being “wired” (jumpiness)
  • being easily distracted or restless
  • having racing thoughts
  • speaking very quickly and possibly jumping quickly between topics
  • having little need for sleep
  • having unrealistic beliefs about your abilities
  • participating in impulsive or high-risk behaviors such as gambling or spending sprees, unprotected sex, or making unwise investments
  • feeling exceptionally talented or powerful

Hypomania involves symptoms similar to mania but less severe. The biggest difference between the two is that symptoms of hypomania have a less significant effect on your life and your ability to work, study, and carry out daily tasks.

In addition, for a diagnosis of mania for bipolar I, the episode must last at least 7 days. For a diagnosis of bipolar II hypomania, an episode must last at least 4 days.

Manic episodes can involve psychosis and may lead to hospitalization, but this is unlikely to happen with hypomania.

Some people with bipolar disorder experience “mixed mood states” in which depressive and manic symptoms coexist. In a mixed state, a person will often have symptoms that include:

  • agitation
  • insomnia
  • extreme changes in appetite
  • suicidal ideation

People may feel energized while experiencing the above symptoms.

Is it bipolar disorder? Here are 14 signs and symptoms to look out for.

There are several diagnoses of bipolar disorder, depending on how the features and symptoms appear.

Bipolar I

Bipolar I features manic episodes that last at least 1 week or are so severe that the person needs urgent hospital care. Depressive episodes can also occur, usually lasting at least 2 weeks.

The symptoms of both depression and mania must indicate a shift in the person’s behavior or mood. There should also be no other reasons that can explain the extreme changes in mood, such as drug use or a hormone imbalance.

A doctor may also diagnose bipolar I disorder if a person’s past behavior includes symptoms that meet the criteria, or in other words, if a person has previously had an episode that meets the criteria.

Bipolar II

A person with bipolar II disorder experiences depressive episodes mixed with hypomanic episodes. A hypomanic episode involves a high mood that lasts at least 4 days, but the manic symptoms will be less severe than in bipolar I.

Cyclothymic disorder (cyclothymia)

Cyclothymic disorder is another type of bipolar disorder. With cyclothymic disorder, a person will have periods of depression and hypomanic episodes that last at least 2 years or 1 year in children and adolescents. However, the symptoms do not meet the criteria for a diagnosis of bipolar I or bipolar II disorder.

Rapid cycling bipolar disorder

A person with rapid cycling bipolar disorder will have four or more episodes of depression and mania within one year.

Other specified and unspecified bipolar and related disorders

If a person experiences some features of bipolar disorder but these do not meet the criteria for a specific type, the doctor may diagnose their condition as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder usually appears during the teenage years or early adulthood, but it can start at any age, including childhood.

Most people are more likely to seek help from a doctor when they’re experiencing depression rather than a high mood. However, if a loved one notices an unusually high mood, they may encourage them to see a doctor.

To initially assess the person’s mood, a doctor may consider:

  • a person’s appearance, as some people wear unusual clothes during a manic mood
  • signs of excessively outgoing behavior or lack of awareness of the bounds of appropriate behavior, as can happen with mania
  • how talkative they are and whether they speak in a pressurized way or if they find it hard to speak
  • if their thoughts and speech appear to lack focus, for example, if they rapidly move to other topics in conversation
  • any signs of grandiosity, which could include talking about being very important or having important contacts
  • if they speak slowly or very little, or they have trouble concentrating or remembering things, these could be signs of bipolar depression
  • if impaired judgment suggests they lack understanding of reality, as can happen with mania
  • if they overemphasize any physical symptoms, which can be a feature of bipolar depression
  • aggressive or overassertive tendencies can affect people with mania, but a person with depression may be unable to make a decision
  • if they are showing unusual or excessive behaviors, such as spending a lot of money, gambling, high-risk sexual behavior, and so on, which can have undesirable consequences

The doctor will also:

  • ask about any personal or family history of mental health conditions, including other conditions such as OCD
  • ask about any history of prescription drug use, other drug use, or alcohol use
  • perform tests to rule out other conditions

People with bipolar disorder are more likely to receive a diagnosis for various other conditions, including:

It can take time to get a correct diagnosis of bipolar disorder. Doctors often misdiagnose it as either depression or attribute it to another condition the person may have, such as drug use. This can lead to inappropriate treatment.

There is currently no cure for bipolar disorder. However, treatment is available.

Bipolar disorder is a long-term condition that will need lifelong management. Treatment aims to prevent relapses of high or low episodes and maximize a person’s quality of life and ability to function.

Treatment usually includes both medication and talk therapy, such as cognitive behavioral therapy (CBT).

Medications

The first-line treatment for bipolar disorder is medications. Drugs for treating bipolar disorders include:

Drug treatment for bipolar depression is different from treatment for other types of depression, as some antidepressant drugs can trigger a manic episode in some people. The person may need to use a mood stabilizer as part of their treatment for depression.

Other treatment

Counseling can help people manage bipolar disorder. Here are some examples:

  • CBT can help a person manage the challenges they face and may help prevent disruption to work, study, relationships, and so on.
  • Learning about bipolar disorder can help the person understand why mood changes occur and may help prevent episodes.
  • Family-focused therapy can help loved ones learn about how bipolar disorder affects someone and how to help them manage it

Electroconvulsive therapy

Electroconvulsive therapy can help manage some severe cases of bipolar disorder. A doctor may recommend it for someone who is spending time in the hospital due to severe or life threatening mania or depression. They may also recommend it if other treatments have not helped.

Bipolar disorder is a treatable condition, but it is a lifelong condition. Research suggests that 50 percent of people with bipolar I disorder who have their first episode experience another within 2 years.

It is essential to work with a doctor to reach a correct diagnosis and establish a treatment plan. Over time, it may be necessary for a doctor to monitor the person’s progress and adjust their treatment plan. For example, it may be necessary to manage any side effects of drugs or address any changes in mood patterns over the person’s lifespan.

There is a risk that a person with bipolar disorder will consider or attempt suicide, or that they may harm themselves or others due to risky behavior. Family, friends, and others in the community can provide essential support.

Experts suggests that bipolar disorder can be more difficult to manage if:

  • you have a substance use disorder
  • you experience psychotic features as a symptom
  • depression plays a major part in your symptoms
  • you are male

How can racial disparities affect the outlook for someone with bipolar disorder?

Bipolar disorder is a lifelong mental health condition that involves episodes of high and low moods. There are different types, and each type can affect people in different ways.

A person who is experiencing a high or manic mood may feel high and as if they’re all-powerful. A person with hypomania will have similar symptoms, but they will be less severe and last shorter. Depression is also common with bipolar disorder.

It’s essential to get a correct diagnosis for bipolar disorder, but this can take time. A person is more likely to see a doctor with depression, and it can be hard to know if mood changes and other symptoms are part of another disorder.

If you think you or a loved one has bipolar disorder, you can help a doctor reach a correct diagnosis by providing as much information as possible about the person’s family history, what they’re experiencing now, and any unusual mood changes in the past.

If you or someone you know is considering suicide or self-harm, please seek support:

While you wait for help to arrive, stay with someone and remove any weapons or substances that can cause harm. You are not alone.