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TheNationalInstituteofMentalHealth:www.nimh.nih.gov

BipolarDisorder
Definition
Bipolardisorder,alsoknownasmanicdepressiveillness,isabraindisorderthatcausesunusualshiftsinmood,
energy,activitylevels,andtheabilitytocarryoutdaytodaytasks.
Therearefourbasictypesofbipolardisorderalloftheminvolveclearchangesinmood,energy,andactivity
levels.Thesemoodsrangefromperiodsofextremelyup,elated,andenergizedbehavior(knownasmanic
episodes)toverysad,down,orhopelessperiods(knownasdepressiveepisodes).Lessseveremanicperiodsare
knownashypomanicepisodes.
BipolarIDisorderdefinedbymanicepisodesthatlastatleast7days,orbymanicsymptomsthatareso
severethatthepersonneedsimmediatehospitalcare.Usually,depressiveepisodesoccuraswell,typically
lastingatleast2weeks.Episodesofdepressionwithmixedfeatures(havingdepressionandmanicsymptoms
atthesametime)arealsopossible.
BipolarIIDisorderdefinedbyapatternofdepressiveepisodesandhypomanicepisodes,butnotthefull
blownmanicepisodesdescribedabove.
CyclothymicDisorder(alsocalledcyclothymia)definedbynumerousperiodsofhypomanicsymptoms
aswellnumerousperiodsofdepressivesymptomslastingforatleast2years(1yearinchildrenand
adolescents).However,thesymptomsdonotmeetthediagnosticrequirementsforahypomanicepisodeand
adepressiveepisode.
OtherSpecifiedandUnspecifiedBipolarandRelatedDisordersdefinedbybipolardisordersymptoms
thatdonotmatchthethreecategorieslistedabove.

SignsandSymptoms
Peoplewithbipolardisorderexperienceperiodsofunusuallyintenseemotion,changesinsleeppatternsandactivity
levels,andunusualbehaviors.Thesedistinctperiodsarecalledmoodepisodes.Moodepisodesaredrastically
differentfromthemoodsandbehaviorsthataretypicalfortheperson.Extremechangesinenergy,activity,and
sleepgoalongwithmoodepisodes.

Thistableisscrollablebytouchonmobiledevices.
Peoplehavingamanicepisodemay:
Feelveryup,high,orelated
Havealotofenergy
Haveincreasedactivitylevels
Feeljumpyorwired
Havetroublesleeping
Becomemoreactivethanusual
Talkreallyfastaboutalotofdifferentthings
Beagitated,irritable,ortouchy
Feelliketheirthoughtsaregoingveryfast
Thinktheycandoalotofthingsatonce
Doriskythings,likespendalotofmoneyorhave
http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

Peoplehavingadepressiveepisodemay:
Feelverysad,down,empty,orhopeless
Haveverylittleenergy
Havedecreasedactivitylevels
Havetroublesleeping,theymaysleeptoolittleor
toomuch
Feelliketheycantenjoyanything
Feelworriedandempty
Havetroubleconcentrating
Forgetthingsalot
Eattoomuchortoolittle
Feeltiredorsloweddown
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recklesssex

Thinkaboutdeathorsuicide

Sometimesamoodepisodeincludessymptomsofbothmanicanddepressivesymptoms.Thisiscalledanepisode
withmixedfeatures.Peopleexperiencinganepisodewithmixedfeaturesmayfeelverysad,empty,orhopeless,
whileatthesametimefeelingextremelyenergized.
Bipolardisordercanbepresentevenwhenmoodswingsarelessextreme.Forexample,somepeoplewithbipolar
disorderexperiencehypomania,alesssevereformofmania.Duringahypomanicepisode,anindividualmayfeel
verygood,behighlyproductive,andfunctionwell.Thepersonmaynotfeelthatanythingiswrong,butfamilyand
friendsmayrecognizethemoodswingsand/orchangesinactivitylevelsaspossiblebipolardisorder.Without
propertreatment,peoplewithhypomaniamaydevelopseveremaniaordepression.

Diagnosis
Properdiagnosisandtreatmenthelppeoplewithbipolardisorderleadhealthyandproductivelives.Talkingwitha
doctororotherlicensedmentalhealthprofessionalisthefirststepforanyonewhothinksheorshemayhave
bipolardisorder.Thedoctorcancompleteaphysicalexamtoruleoutotherconditions.Iftheproblemsarenot
causedbyotherillnesses,thedoctormayconductamentalhealthevaluationorprovideareferraltoatrained
mentalhealthprofessional,suchasapsychiatrist,whoisexperiencedindiagnosingandtreatingbipolardisorder.
NoteforHealthCareProviders:Peoplewithbipolardisorderaremorelikelytoseekhelpwhentheyare
depressedthanwhenexperiencingmaniaorhypomania.Therefore,acarefulmedicalhistoryisneededtoensure
thatbipolardisorderisnotmistakenlydiagnosedasmajordepression.Unlikepeoplewithbipolardisorder,people
whohavedepressiononly(alsocalledunipolardepression)donotexperiencemania.Theymay,however,
experiencesomemanicsymptomsatthesametime,whichisalsoknownasmajordepressivedisorderwithmixed
features.

BipolarDisorderandOtherIllnesses
Somebipolardisordersymptomsaresimilartootherillnesses,whichcanmakeithardforadoctortomakea
diagnosis.Inaddition,manypeoplehavebipolardisorderalongwithanotherillnesssuchasanxietydisorder,
substanceabuse,oraneatingdisorder.Peoplewithbipolardisorderarealsoathigherriskforthyroiddisease,
migraineheadaches,heartdisease,diabetes,obesity,andotherphysicalillnesses.
Psychosis:Sometimes,apersonwithsevereepisodesofmaniaordepressionalsohaspsychoticsymptoms
(www.nimh.nih.gov//health/topics/schizophrenia/raise/whatispsychosis.shtml),suchashallucinationsordelusions.Thepsychotic
symptomstendtomatchthepersonsextrememood.Forexample:
Someonehavingpsychoticsymptomsduringamanicepisodemaybelievesheisfamous,hasalotofmoney,
orhasspecialpowers.
Someonehavingpsychoticsymptomsduringadepressiveepisodemaybelieveheisruinedandpenniless,or
thathehascommittedacrime.
Asaresult,peoplewithbipolardisorderwhoalsohavepsychoticsymptomsaresometimesmisdiagnosedwith
schizophrenia.(www.nimh.nih.gov//health/topics/schizophrenia/index.shtml)
AnxietyandADHD:Anxietydisordersandattentiondeficithyperactivitydisorder(ADHD)areoftendiagnosed
amongpeoplewithbipolardisorder.
SubstanceAbuse:Peoplewithbipolardisordermayalsomisusealcoholordrugs,haverelationshipproblems,or
performpoorlyinschooloratwork.Family,friendsandpeopleexperiencingsymptomsmaynotrecognizethese
problemsassignsofamajormentalillnesssuchasbipolardisorder.
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RiskFactors
Scientistsarestudyingthepossiblecausesofbipolardisorder.Mostagreethatthereisnosinglecause.Instead,itis
likelythatmanyfactorscontributetotheillnessorincreaserisk.
BrainStructureandFunctioning:Somestudiesshowhowthebrainsofpeoplewithbipolardisordermaydiffer
fromthebrainsofhealthypeopleorpeoplewithothermentaldisorders.Learningmoreaboutthesedifferences,
alongwithnewinformationfromgeneticstudies,helpsscientistsbetterunderstandbipolardisorderandpredict
whichtypesoftreatmentwillworkmosteffectively.
Genetics:Someresearchsuggeststhatpeoplewithcertaingenesaremorelikelytodevelopbipolardisorderthan
others.Butgenesarenottheonlyriskfactorforbipolardisorder.Studiesofidenticaltwinshaveshownthatevenif
onetwindevelopsbipolardisorder,theothertwindoesnotalwaysdevelopthedisorder,despitethefactthat
identicaltwinsshareallofthesamegenes.
FamilyHistory:Bipolardisordertendstoruninfamilies.Childrenwithaparentorsiblingwhohasbipolar
disorderaremuchmorelikelytodeveloptheillness,comparedwithchildrenwhodonothaveafamilyhistoryof
thedisorder.However,itisimportanttonotethatmostpeoplewithafamilyhistoryofbipolardisorderwillnot
developtheillness.

TreatmentsandTherapies
Treatmenthelpsmanypeopleeventhosewiththemostsevereformsofbipolardisordergainbettercontrolof
theirmoodswingsandotherbipolarsymptoms.Aneffectivetreatmentplanusuallyincludesacombinationof
medicationandpsychotherapy(alsocalledtalktherapy).Bipolardisorderisalifelongillness.Episodesofmania
anddepressiontypicallycomebackovertime.Betweenepisodes,manypeoplewithbipolardisorderarefreeof
moodchanges,butsomepeoplemayhavelingeringsymptoms.Longterm,continuoustreatmenthelpstocontrol
thesesymptoms.

Medications
Differenttypesofmedicationscanhelpcontrolsymptomsofbipolardisorder.Anindividualmayneedtotry
severaldifferentmedicationsbeforefindingonesthatworkbest.
Medicationsgenerallyusedtotreatbipolardisorderinclude:
Moodstabilizers
Atypicalantipsychotics
Antidepressants
Anyonetakingamedicationshould:
Talkwithadoctororapharmacisttounderstandtherisksandbenefitsofthemedication
Reportanyconcernsaboutsideeffectstoadoctorrightaway.Thedoctormayneedtochangethedoseortry
adifferentmedication.
Avoidstoppingamedicationwithouttalkingtoadoctorfirst.Suddenlystoppingamedicationmayleadto
reboundorworseningofbipolardisordersymptoms.Otheruncomfortableorpotentiallydangerous
withdrawaleffectsarealsopossible.
ReportserioussideeffectstotheU.S.FoodandDrugAdministration(FDA)MedWatchAdverseEvent
Reportingprogramonlineathttp://www.fda.gov/Safety/MedWatchorbyphoneat18003321088.Clients
anddoctorsmaysendreports.
Forbasicinformationaboutmedications,visittheNIMHMentalHealthMedications
http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

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(www.nimh.nih.gov//health/topics/mentalhealthmedications/index.shtml)webpage.Forthemostuptodateinformationon

medications,sideeffects,andwarnings,visittheFDAwebsite.

Psychotherapy
Whendoneincombinationwithmedication,psychotherapy(alsocalledtalktherapy)canbeaneffective
treatmentforbipolardisorder.Itcanprovidesupport,education,andguidancetopeoplewithbipolardisorderand
theirfamilies.Somepsychotherapytreatmentsusedtotreatbipolardisorderinclude:
Cognitivebehavioraltherapy(CBT)
Familyfocusedtherapy
Interpersonalandsocialrhythmtherapy
Psychoeducation
VisittheNIMHPsychotherapieswebpage(www.nimh.nih.gov//health/topics/psychotherapies/index.shtml)tolearnaboutthe
varioustypesofpsychotherapies.

OtherTreatmentOptions
ElectroconvulsiveTherapy(ECT)(www.nimh.nih.gov//health/topics/brainstimulationtherapies/brainstimulation
therapies.shtml):ECTcanprovidereliefforpeoplewithseverebipolardisorderwhohavenotbeenabletorecover
withothertreatments.SometimesECTisusedforbipolarsymptomswhenothermedicalconditions,including
pregnancy,maketakingmedicationstoorisky.ECTmaycausesomeshorttermsideeffects,includingconfusion,
disorientation,andmemoryloss.PeoplewithbipolardisordershoulddiscusspossiblebenefitsandrisksofECT
withaqualifiedhealthprofessional.
SleepMedications:Peoplewithbipolardisorderwhohavetroublesleepingusuallyfindthattreatmentishelpful.
However,ifsleeplessnessdoesnotimprove,adoctormaysuggestachangeinmedications.Iftheproblem
continues,thedoctormayprescribesedativesorothersleepmedications.
Supplements:Notmuchresearchhasbeenconductedonherbalornaturalsupplementsandhowtheymayaffect
bipolardisorder.
Itisimportantforadoctortoknowaboutallprescriptiondrugs,overthecountermedications,andsupplementsa
clientistaking.Certainmedicationsandsupplementstakentogethermaycauseunwantedordangerouseffects.
KeepingaLifeChart:Evenwithpropertreatment,moodchangescanoccur.Treatmentismoreeffectivewhena
clientanddoctorworkcloselytogetherandtalkopenlyaboutconcernsandchoices.Keepingalifechartthat
recordsdailymoodsymptoms,treatments,sleeppatterns,andlifeeventscanhelpclientsanddoctorstrackandtreat
bipolardisordermosteffectively.

FindingTreatment
Afamilydoctorisagoodresourceandcanbethefirststopinsearchingforhelp.
Forgeneralinformationonmentalhealthandtofindlocaltreatmentservices,calltheSubstanceAbuseand
MentalHealthServicesAdministration(SAMHSA)TreatmentReferralHelplineat1800662HELP(4357).
TheSAMHSAwebsitehasaBehavioralHealthTreatmentServicesLocatorthatcansearchfortreatment
informationbyaddress,city,orZIPcode.
VisittheNIMHsHelpforMentalIllnesses(www.nimh.nih.gov//health/findhelp/index.shtml)webpageformore
informationandresources.

ForImmediateHelp
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IfYouAreinCrisis:CallthetollfreeNationalSuicidePreventionLifelineat1800273TALK(8255),available
24hoursaday,7daysaweek.Theserviceisavailabletoanyone.Allcallsareconfidential.
Ifyouarethinkingaboutharmingyourselforthinkingaboutsuicide:
Tellsomeonewhocanhelprightaway
Callyourlicensedmentalhealthprofessionalifyouarealreadyworkingwithone
Callyourdoctor
Gotothenearesthospitalemergencydepartment
Ifalovedoneisconsideringsuicide:
Donotleavehimorheralone
Trytogetyourlovedonetoseekimmediatehelpfromadoctororthenearesthospitalemergencyroom,or
call911
Removeaccesstofirearmsorotherpotentialtoolsforsuicide,includingmedications

JoinaStudy
Clinicaltrialsareresearchstudiesthatlookatnewwaystoprevent,detect,ortreatdiseasesandconditions,
includingbipolardisorder.Duringclinicaltrials,treatmentsmightbenewdrugsornewcombinationsofdrugs,new
surgicalproceduresordevices,ornewwaystouseexistingtreatments.Thegoalofclinicaltrialsistodetermineif
anewtestortreatmentworksandissafe.Althoughindividualparticipantsmaybenefitfrombeingpartofaclinical
trial,participantsshouldbeawarethattheprimarypurposeofaclinicaltrialistogainnewscientificknowledgeso
thatothersmaybebetterhelpedinthefuture.
PleaseNote:Decisionsaboutwhethertoparticipateinaclinicaltrial,andwhichonesarebestsuitedforagiven
individual,arebestmadeincollaborationwithyourlicensedhealthprofessional.

HowDoIFindClinicalTrialsatNIMH/NIH?
ScientistsatNIMHstudymanysubjectsincludingcognition,genetics,epidemiology,andpsychiatry.Thestudies
takeplaceattheNationalInstitutesofHealth(NIH)ClinicalCenterinBethesda,Maryland,andrequireregular
visits.Aftertheinitialphoneinterview,participantscometoanappointmentattheclinicandmeetwithaclinician.
VisitJoinaStudy:BipolarDisorderAdults(www.nimh.nih.gov//labsatnimh/joinastudy/adults/adultsbipolardisorder.shtml)or
JoinaStudy:BipolarDisorderChildren(www.nimh.nih.gov//labsatnimh/joinastudy/children/index.shtml)formore
information.

HowDoIFindaClinicalTrialNearMe?
Tofindaclinicaltrialanywhereintheworld,visitClinicalTrials.gov.Thisisasearchabledatabaseoffederally
andprivatelysupportedclinicaltrialsconductedintheUnitedStatesandaroundtheglobe.ClinicalTrials.govhas
informationaboutatrialspurpose,whomayparticipate,locations,andphonenumbersformoredetails.Anyone
interestedinjoiningaclinicaltrialshouldconsultahealthprofessionalbeforemakingacommitment.

LearnMore
FreeBookletsandBrochures
BipolarDisorder:Abrochureonbipolardisorderthatoffersbasicinformationonsignsandsymptoms,
treatment,andfindinghelp.AlsoavailableenEspaol(www.nimh.nih.gov//health/publications/espanol/trastornobipolar
facildeleer/index.shtml).
http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

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BipolarDisorderinChildrenandTeens:(www.nimh.nih.gov//health/publications/bipolardisorderinchildrenandteensqf
156380/index.shtml)Abrochureonbipolardisorderinchildrenandteensthatoffersbasicinformationonsigns
andsymptoms,treatment,andfindinghelp.AlsoavailableenEspaol
(www.nimh.nih.gov//health/publications/espanol/trastornobipolarenninosyadolescentesfacildeleer/index.shtml).

ResearchandClinicalTrials
AntipsychoticMedicinesforTreatingSchizophreniaandBipolarDisorderAReviewoftheResearch
forAdultsandCaregivers:Thissummarytalksaboutonetypeofmedicineantipsychoticsusedtotreat
schizophreniaandbipolardisorder.
BipolarDisorderStatisticsAdults:(www.nimh.nih.gov//health/statistics/prevalence/bipolardisorderamongadults.shtml)
Thiswebpageprovidesinformationontrendsinprevalenceofanduseoftreatments/servicesbyadultswith
bipolardisorder.
BipolarDisorderStatisticsChildren:(www.nimh.nih.gov//health/statistics/prevalence/bipolardisorderamong
children.shtml)Thiswebpageprovidesinformationontrendsinprevalenceofanduseoftreatments/servicesby
childrenwithbipolardisorder.
JoinaStudy:BipolarDisorderAdults:(www.nimh.nih.gov//labsatnimh/joinastudy/adults/adultsbipolar
disorder.shtml)ThiswebpagelistsNIMHbipolardisorderclinicaltrialsthatarerecruitingadults.
JoinaStudy:BipolarDisorderChildren:(www.nimh.nih.gov//labsatnimh/joinastudy/children/childrenbipolar
disorder.shtml)ThiswebpagelistsNIMHbipolardisorderclinicaltrialsthatarerecruitingchildren.
LastRevised:April2016
Unlessotherwisespecified,NIMHinformationandpublicationsareinthepublicdomainandavailableforusefree
ofcharge.CitationoftheNIMHisappreciated.PleaseseeourCitingNIMHInformationandPublications
(www.nimh.nih.gov//siteinfo/citingnimhinformationandpublications.shtml)pageformoreinformation.

ScienceNewsAboutBipolarDisorder

AnAsianAmericanFamilysStoryofResilience(www.nimh.nih.gov//news/sciencenews/2016/copingwith
familialmentalillnessinstressfultimes.shtml)

PredictingBipolarDisorderinAtRiskYouth(www.nimh.nih.gov//news/sciencenews/2016/symptomsoutdo
diagnosesinpredictingbipolardisorderinatriskyouth.shtml)

GenomeWideStudyYieldsMarkersofLithiumResponse(www.nimh.nih.gov//news/science
news/2016/genomewidestudyyieldsmarkersoflithiumresponse.shtml)

More(www.nimh.nih.gov//news/sciencenews/sciencenewsaboutbipolardisorder.shtml)

BlogPostsAboutBipolarDisorder
CelebratingScience(www.nimh.nih.gov//about/director/2014/celebratingscience.shtml)March21,2014
Antipsychotics:TakingtheLongView(www.nimh.nih.gov//about/director/2013/antipsychoticstakingthelong
view.shtml)August28,2013
GettingSeriousAboutMentalIllnesses(www.nimh.nih.gov//about/director/2013/gettingseriousaboutmental
illnesses.shtml)July31,2013
http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

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More(www.nimh.nih.gov//about/director/indexbipolardisorder.shtml)

JoinAStudy
BipolarDisorderStudiesforAdults(www.nimh.nih.gov//labsatnimh/joinastudy/adults/adultsbipolardisorder.shtml)
BipolarDisorderStudiesforChildren(www.nimh.nih.gov//labsatnimh/joinastudy/children/childrenbipolardisorder.shtml)

FeaturedPublicationsAboutBipolarDisorder
MorePublicationsAboutBipolarDisorder(www.nimh.nih.gov//health/publications/bipolardisorderlisting.shtml)

ResearchResults
SystematicTreatmentEnhancementProgramforBipolarDisorder(STEPBD)(www.nimh.nih.gov//funding/clinical
research/practical/stepbd/index.shtml)

PubMed:JournalArticlesaboutBipolarDisorder
Top

http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

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