treatment bipolar disorder essay

Understanding Bipolar Disorder: An In-Depth Essay

From euphoric highs to crushing lows, the human mind can orchestrate a symphony of emotions that leaves both sufferers and observers in awe of its raw, uncontrollable power. This emotional rollercoaster is a hallmark of bipolar disorder, a complex mental health condition that affects millions of people worldwide. As we delve into the intricacies of this disorder, we’ll explore its various facets, from its definition and types to its impact on individuals and society at large.

What is Bipolar Disorder?

Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood episodes can last for days, weeks, or even months, significantly impacting a person’s energy levels, activity, behavior, and ability to function in daily life.

The concept of bipolar disorder has evolved over time, with researchers and mental health professionals gaining a deeper Understanding the Concept of Mundo Bipolar – a term that encapsulates the unique world experienced by those living with this condition. This perspective acknowledges the multifaceted nature of bipolar disorder and its profound impact on an individual’s perception of reality.

Types of Bipolar Disorder

Bipolar disorder is not a one-size-fits-all condition. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes several types of bipolar and related disorders:

1. Bipolar I Disorder: Characterized by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.

2. Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic episodes.

3. Cyclothymic Disorder: A milder form of bipolar disorder, involving numerous periods of hypomanic and depressive symptoms lasting for at least two years.

4. Other Specified and Unspecified Bipolar and Related Disorders: These categories include bipolar-like disorders that don’t meet the criteria for the aforementioned diagnoses.

Understanding these distinctions is crucial for accurate diagnosis and effective treatment planning.

Causes and Risk Factors

The exact cause of bipolar disorder remains unknown, but research suggests that a combination of factors contributes to its development:

1. Genetics: Bipolar disorder tends to run in families, indicating a strong genetic component. However, having a family history doesn’t guarantee that an individual will develop the condition.

2. Brain Structure and Function: Studies have shown differences in brain structure and function between people with bipolar disorder and those without. These differences may contribute to the disorder’s symptoms.

3. Environmental Factors: Stressful life events, trauma, or significant life changes may trigger the onset of bipolar disorder in susceptible individuals.

4. Neurotransmitter Imbalances: Abnormalities in neurotransmitter systems, particularly those involving serotonin, norepinephrine, and dopamine, may play a role in bipolar disorder.

5. Circadian Rhythm Disruptions: Disturbances in the body’s natural daily rhythms, such as sleep-wake cycles, have been linked to bipolar disorder.

Common Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can vary widely between individuals and even within the same person over time. However, the core features involve distinct episodes of mania (or hypomania) and depression.

Manic Episode Symptoms: – Elevated mood or euphoria – Increased energy and activity – Decreased need for sleep – Racing thoughts and rapid speech – Impulsivity and risk-taking behavior – Grandiose beliefs or inflated self-esteem – Distractibility and difficulty concentrating

Depressive Episode Symptoms: – Persistent sadness or emptiness – Loss of interest in previously enjoyed activities – Fatigue and decreased energy – Changes in appetite and weight – Sleep disturbances (insomnia or excessive sleeping) – Difficulty concentrating and making decisions – Feelings of worthlessness or guilt – Thoughts of death or suicide

It’s important to note that some individuals may experience mixed episodes, where symptoms of both mania and depression occur simultaneously.

Diagnostic Criteria for Bipolar Disorder

Diagnosing bipolar disorder can be challenging, as its symptoms can overlap with other mental health conditions. Mental health professionals use the criteria outlined in the DSM-5 to make an accurate diagnosis. These criteria include:

1. The presence of at least one manic or hypomanic episode (for Bipolar I and II, respectively) 2. The occurrence of at least one major depressive episode (for Bipolar II) 3. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning 4. The symptoms are not better explained by another mental disorder or medical condition

A comprehensive evaluation typically involves a detailed medical history, physical examination, and sometimes laboratory tests to rule out other potential causes of symptoms.

Distinguishing Bipolar Disorder from other Mental Health Conditions

Bipolar disorder shares symptoms with several other mental health conditions, which can complicate diagnosis. Some conditions that may be mistaken for bipolar disorder include:

1. Major Depressive Disorder: While both conditions involve depressive episodes, bipolar disorder is distinguished by the presence of manic or hypomanic episodes.

2. Borderline Personality Disorder: This condition can involve rapid mood swings, but they are typically triggered by interpersonal events and last for shorter periods than bipolar mood episodes.

3. Attention-Deficit/Hyperactivity Disorder (ADHD): The hyperactivity and impulsivity seen in ADHD can resemble manic symptoms, but ADHD symptoms are typically chronic rather than episodic.

4. Schizophrenia: While both conditions can involve psychotic symptoms, schizophrenia is characterized by persistent delusions and hallucinations rather than mood episodes.

Accurate differentiation is crucial for appropriate treatment, as the management strategies for these conditions can differ significantly.

Effects of Bipolar Disorder on Personal Relationships

Bipolar disorder can have profound effects on personal relationships. The unpredictable nature of mood swings can strain even the strongest bonds between partners, family members, and friends. During manic episodes, individuals may engage in risky or hurtful behaviors that damage trust. Conversely, depressive episodes can lead to withdrawal and emotional unavailability, leaving loved ones feeling helpless and frustrated.

Communication often becomes a significant challenge, as the person with bipolar disorder may struggle to express their needs or understand the impact of their behavior on others. Moreover, the caregiver burden on partners or family members can be substantial, leading to stress, burnout, and sometimes resentment.

However, with proper treatment, education, and support, many individuals with bipolar disorder maintain healthy, fulfilling relationships. Open communication, boundary-setting, and mutual understanding are key components of navigating relationships affected by bipolar disorder.

Challenges Faced by Individuals with Bipolar Disorder

Living with bipolar disorder presents numerous challenges that extend beyond managing mood symptoms. Some of the most common difficulties include:

1. Employment Issues: The episodic nature of bipolar disorder can lead to inconsistent job performance, difficulties maintaining employment, and career setbacks.

2. Financial Instability: Impulsive spending during manic episodes and inability to work during severe depressive episodes can result in significant financial problems.

3. Academic Struggles: For students, bipolar disorder can interfere with concentration, attendance, and overall academic performance.

4. Substance Abuse: Many individuals with bipolar disorder turn to drugs or alcohol as a form of self-medication, leading to co-occurring substance use disorders.

5. Physical Health Complications: Bipolar disorder is associated with an increased risk of various physical health problems, including cardiovascular disease, diabetes, and obesity.

6. Legal Issues: Manic episodes can sometimes lead to legal troubles due to reckless behavior or poor judgment.

7. Self-Esteem and Identity Concerns: The cyclical nature of bipolar disorder can leave individuals questioning their sense of self and struggling with self-esteem.

Societal Stigma and Misunderstandings

Despite increased awareness of mental health issues in recent years, bipolar disorder continues to be surrounded by stigma and misconceptions. Common misunderstandings include:

1. Bipolar disorder is just mood swings: This trivializes the severity and impact of the condition.

2. People with bipolar disorder are always either manic or depressed: In reality, many individuals experience periods of stable mood between episodes.

3. Bipolar disorder makes people violent or dangerous: While manic episodes can lead to agitation, most individuals with bipolar disorder are not violent.

4. Bipolar disorder is a character flaw or weakness: It’s a legitimate medical condition, not a personal failing.

These misconceptions can lead to discrimination in various aspects of life, including employment, housing, and social interactions. They can also prevent individuals from seeking help due to fear of judgment or rejection.

Combating stigma requires ongoing education, open dialogue, and representation of accurate portrayals of bipolar disorder in media and public discourse.

Medication Options for Bipolar Disorder

Medication is a cornerstone of bipolar disorder treatment. The primary goals of pharmacological interventions are to stabilize mood, prevent relapses, and manage acute episodes. Common medications used in bipolar disorder treatment include:

1. Mood Stabilizers: These are the foundation of bipolar disorder treatment. Examples include: – Lithium: One of the oldest and most effective treatments for bipolar disorder – Valproic acid (Depakene) and divalproex sodium (Depakote) – Carbamazepine (Tegretol, Carbatrol) – Lamotrigine (Lamictal)

2. Antipsychotics: These can help manage manic or mixed episodes. Some commonly prescribed antipsychotics include: – Olanzapine (Zyprexa) – Risperidone (Risperdal) – Quetiapine (Seroquel) – Aripiprazole (Abilify)

3. Antidepressants: These may be prescribed cautiously to manage depressive episodes, always in combination with a mood stabilizer to prevent triggering mania. Examples include: – Fluoxetine (Prozac) – Sertraline (Zoloft) – Bupropion (Wellbutrin)

4. Anti-anxiety Medications: These may be used short-term to help with anxiety symptoms or sleep disturbances.

It’s crucial to note that medication regimens are highly individualized. What works for one person may not work for another, and it often takes time and patience to find the right combination and dosage.

Therapeutic Approaches for Bipolar Disorder

While medication is essential, psychotherapy plays a vital role in the comprehensive treatment of bipolar disorder. Several evidence-based therapeutic approaches have shown effectiveness:

1. Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviors associated with mood episodes. It can improve coping skills, reduce symptoms, and prevent relapse.

2. Interpersonal and Social Rhythm Therapy (IPSRT): This therapy focuses on stabilizing daily routines and improving interpersonal relationships. It’s particularly effective in managing the disruptions to circadian rhythms often seen in bipolar disorder.

3. Family-Focused Therapy: This approach involves family members in treatment, educating them about the disorder and improving family communication and problem-solving skills.

4. Psychoeducation: Education about bipolar disorder, its symptoms, and management strategies can empower individuals to take an active role in their treatment.

5. Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT can be helpful for individuals with bipolar disorder in managing emotions and improving interpersonal effectiveness.

6. Mindfulness-Based Cognitive Therapy: This combines elements of CBT with mindfulness techniques to help prevent depressive relapse.

These therapies can be delivered individually, in groups, or even online, providing flexibility to meet diverse needs and preferences.

Lifestyle Changes to Support Mental Health

In addition to medication and therapy, certain lifestyle modifications can significantly support the management of bipolar disorder:

1. Establishing a Consistent Sleep Schedule: Regular sleep patterns can help stabilize mood and prevent episodes.

2. Stress Management: Techniques such as meditation, deep breathing exercises, or yoga can help manage stress, a common trigger for mood episodes.

3. Regular Exercise: Physical activity has been shown to have mood-stabilizing effects and can improve overall well-being.

4. Healthy Diet: A balanced diet can support overall health and may help stabilize mood.

5. Avoiding Alcohol and Drugs: Substance use can interfere with medication effectiveness and trigger mood episodes.

6. Maintaining a Mood Chart: Tracking daily moods, sleep patterns, and life events can help identify triggers and early warning signs of episodes.

7. Building a Support Network: Having a strong support system of friends, family, or support groups can provide crucial emotional support.

8. Developing a Crisis Plan: Creating a plan for what to do during severe mood episodes can provide a sense of control and ensure quick access to help when needed.

Choosing a Focus for the Essay

When writing an essay on bipolar disorder, it’s important to choose a specific focus or angle. Some potential topics could include:

1. The historical evolution of bipolar disorder diagnosis and treatment 2. The impact of bipolar disorder on creativity and artistic expression 3. Challenges in diagnosing bipolar disorder in children and adolescents 4. The role of genetics in bipolar disorder 5. Bipolar disorder and its relationship to other mental health conditions 6. The economic impact of bipolar disorder on individuals and society 7. Cultural variations in the presentation and treatment of bipolar disorder 8. Emerging treatments and future directions in bipolar disorder research

Choosing a focused topic allows for a more in-depth exploration and can make the essay more engaging and informative.

Structuring the Essay

A well-structured essay on bipolar disorder should include:

1. Introduction: Provide a brief overview of bipolar disorder and state the essay’s main focus or thesis.

2. Background Information: Offer essential context about bipolar disorder, including its definition, types, and prevalence.

3. Main Body: Divide the main content into logical sections, each addressing a specific aspect of the chosen topic. Use subheadings to improve readability.

4. Discussion: Analyze the information presented, discussing implications, controversies, or areas for further research.

5. Conclusion: Summarize the main points and restate the thesis in light of the evidence presented. Consider ending with thoughts on future directions or a call to action.

Remember to use transitions between sections to ensure a smooth flow of ideas.

Addressing Controversial Topics

When writing about bipolar disorder, you may encounter controversial or sensitive topics. These might include:

1. The overdiagnosis or underdiagnosis of bipolar disorder 2. The role of pharmaceutical companies in shaping bipolar disorder treatment 3. The use of electroconvulsive therapy (ECT) in treatment-resistant cases 4. The potential link between creativity and bipolar disorder 5. The ethics of genetic testing for bipolar disorder susceptibility

When addressing these topics:

– Present balanced viewpoints, acknowledging different perspectives – Rely on credible, peer-reviewed sources rather than anecdotal evidence – Avoid sensationalism or stigmatizing language – Clearly distinguish between established facts and areas of ongoing debate or uncertainty

Providing Reliable Sources

Using reliable sources is crucial when writing about a complex medical condition like bipolar disorder. Some reputable sources include:

1. Peer-reviewed academic journals (e.g., Journal of Affective Disorders, Bipolar Disorders) 2. Professional organizations (e.g., American Psychiatric Association, National Institute of Mental Health) 3. Reputable mental health websites (e.g., National Alliance on Mental Illness, Mental Health America) 4. Government health agencies (e.g., Centers for Disease Control and Prevention, World Health Organization)

When citing sources:

– Use the most recent information available, as understanding of bipolar disorder is continually evolving – Properly attribute all information to its original source – Consider including a mix of primary research articles and review papers for a comprehensive perspective

Bipolar disorder is a complex and challenging mental health condition that affects millions of individuals worldwide. Its impact extends far beyond mood swings, touching every aspect of a person’s life from relationships and career to physical health and self-identity. While the road to managing bipolar disorder can be difficult, advances in understanding and treatment offer hope for improved outcomes.

As our knowledge of bipolar disorder continues to grow, so does our ability to provide effective support and treatment. By combining medication, psychotherapy, lifestyle modifications, and a strong support system, many individuals with bipolar disorder lead fulfilling, productive lives. However, challenges remain, particularly in areas of early diagnosis

Similar Posts

The Goldberg Test for Bipolar Disorder: A Comprehensive Guide

Mood swings may be more than just a quirk—they could be the whispers of a hidden mental health condition that the Goldberg Test aims to unveil. Bipolar disorder, a complex and often misunderstood mental health condition, affects millions of people worldwide. Its impact on individuals, families, and society as a whole is significant, making early…

Understanding the Average Age of Death in Bipolar Disorder

Life’s pendulum swings with precarious force for those grappling with the invisible yet potent grip of bipolar disorder, where each day can be a battle not just for stability, but for survival itself. This complex mental health condition, characterized by extreme mood swings, can have far-reaching implications on an individual’s quality of life and, more…

Understanding Bipolar Dual Diagnosis: Causes, Symptoms, and Treatment

Minds entwined in a complex dance of emotions and substances, bipolar dual diagnosis challenges both patients and clinicians alike, demanding a nuanced approach to unravel its intricate web of symptoms and treatments. This complex condition, where bipolar disorder coexists with substance use disorders or other mental health conditions, presents a unique set of challenges for…

Understanding Bipolar Seizure Symptoms: A Comprehensive Guide

Delving into the complex interplay between bipolar disorder and epilepsy, this comprehensive guide unravels the mystery of bipolar seizure symptoms and their far-reaching impact on patients’ lives. The relationship between these two neurological conditions has long intrigued medical professionals and researchers alike, as they share several commonalities and often coexist in patients. This article aims…

10 Interesting Facts About Bipolar Disorder

From the soaring highs of mania to the crushing lows of depression, bipolar disorder is a mental health rollercoaster that affects millions worldwide, yet remains shrouded in mystery and misconception. This complex condition, characterized by extreme mood swings, can have a profound impact on an individual’s life, relationships, and overall well-being. Despite its prevalence, many…

Understanding the Abbreviations and Acronyms for Bipolar Disorder

From cryptic letters to powerful shorthand, the world of bipolar disorder abbreviations and acronyms unlocks a language that bridges patients, doctors, and researchers alike. This specialized vocabulary not only streamlines communication but also plays a crucial role in destigmatizing mental health conditions and facilitating research. In this comprehensive guide, we’ll delve into the intricate world…

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• Diagnosis and...

Diagnosis and management of bipolar disorders

• Related content
• Peer review
• 1 Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
• 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
• Correspondence to: F S Goes fgoes1{at}jhmi.edu

Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world’s population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.

Introduction

Abnormal states of mood, ranging from excesses of despondency, psychic slowness, diminished motivation, and impaired cognitive functioning on the one hand, and exhilaration, heightened energy, and increased cognitive and motoric activity on the other, have been described since antiquity. 1 However, the syndrome in which both these pathological states occur in a single individual was first described in the medical literature in 1854, 2 although its fullest description was made by the German psychiatrist Emil Kraepelin at the turn of the 19th century. 3 Kraepelin emphasized the periodicity of the illness and proposed an underlying trivariate model of mood, thought (cognition), and volition (activity) to account for the classic forms of mania and depression and the various admixed presentations subsequently know as mixed states. 3 These initial descriptions of manic depressive illness encompassed most recurrent mood syndromes with relapsing remitting course, minimal interepisode morbidity, and a wide spectrum of “colorings of mood” that pass “without a sharp boundary” from the “rudiment of more severe disorders…into the domain of personal predisposition.” 3 Although Kraepelin’s clinical description of bipolar disorder (BD) remains the cornerstone of today’s clinical description, more modern conceptions of bipolar disorder have differentiated manic depressive illness from recurrent depression, 4 partly based on differences in family history and the relative specificity of lithium carbonate and mood stabilizing anticonvulsants as anti-manic and prophylactic agents in bipolar disorder. While the boundaries of bipolar disorder remain a matter of controversy, 5 this review will focus on modern clinical conceptions of bipolar disorder, highlighting what is known about its causes, prognosis, and treatments, while also exploring novel areas of inquiry.

Sources and selection criteria

PubMed and Embase were searched for articles published from January 2000 to February 2023 using the search terms “bipolar disorder”, “bipolar type I”, “bipolar type II”, and “bipolar spectrum”, each with an additional search term related to each major section of the review article (“definition”, “diagnosis”, “nosology”, “prevalence”, “epidemiology”, “comorbid”, “precursor”, “prodrome”, “treatment”, “screening”, “disparity/ies”, “outcome”, “course”, “genetics”, “imaging”, “treatment”, “pharmacotherapy”, “psychotherapy”, “neurostimulation”, “convulsive therapy”, “transmagnetic”, “direct current stimulation”, “suicide/suicidal”, and “precision”). Searches were prioritized for systematic reviews and meta-analyses, followed by randomized controlled trials. For topics where randomized trials were not relevant, searches also included narrative reviews and key observational studies. Case reports and small observations studies or randomized controlled trials of fewer than 50 patients were excluded.

Modern definitions of bipolar disorder

In the 1970s, the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders reflected the prototypes of mania initially described by Kraepelin, following the “neo-Kraepelinian” model in psychiatric nosology. To meet the primary requirement for a manic episode, an individual must experience elevated or excessively irritable mood for at least a week, accompanied by at least three other typical syndromic features of mania, such as increased activity, increased speed of thoughts, rapid speech, changes in esteem, decreased need for sleep, or excessive engagement in impulsive or pleasurable activities. Psychotic symptoms and admission to hospital can be part of the diagnostic picture but are not essential to the diagnosis. In 1994, Diagnostic and Statistical Manual of Mental Disorders , fourth edition (DSM-IV) carved out bipolar disorder type II (BD-II) as a separate diagnosis comprising milder presentations of mania called hypomania. The diagnostic criteria for BD-II are similar to those for bipolar disorder type I (BD-I), except for a shorter minimal duration of symptoms (four days) and the lack of need for significant role impairment during hypomania, which might be associated with enhanced functioning in some individuals. While the duration criteria for hypomania remain controversial, BD-II has been widely accepted and shown to be as common as (if not more common than) BD-I. 6 The ICD-11 (international classification of diseases, 11th revision) included BD-II as a diagnostic category in 2019, allowing greater flexibility in its requirement of hypomania needing to last several days.

The other significant difference between the two major diagnostic systems has been their consideration of mixed symptoms. Mixed states, initially described by Kraepelin as many potential concurrent combinations of manic and depressive symptoms, were more strictly defined by DSM as a week or more with full syndromic criteria for both manic and depressive episodes. In DSM-5, this highly restrictive criterion was changed to encompass a broader conception of subsyndromal mixed symptoms (consisting of at least three contrapolar symptoms) in either manic, hypomanic, or depressive episodes. In ICD-11, mixed symptoms are still considered to be an episode, with the requirement of several prominent symptoms of the countervailing mood state, a less stringent requirement that more closely aligns with Kraepelin's broader conception of mixed states. 7

Epidemiology

Using DSM-IV criteria, the National Comorbidity Study replication 6 found similar lifetime prevalence rates for BD-I (1.0%) and BD-II (1.1%) among men and women. Subthreshold symptoms of hypomania (bipolar spectrum disorder) were more common, with prevalence rate estimates of 2.4%. 6 Incidence rates, which largely focus on BD-I, have been estimated at approximately 6.1 per 100 000 person years (95% confidence interval 4.7 to 8.1). 8 Estimates of the incidence and lifetime prevalence of bipolar disorder show moderate variations according to the method of diagnosis (performed by lay interviewers in a research context v clinically trained interviews) and the racial, ethnic, and demographic context. 9 Higher income, westernized countries have slightly higher rates of bipolar disorder, 10 which might reflect a combination of westernized centricity in the specific idioms used to understand and elicit symptoms, as well as a greater knowledge, acceptance, and conceptualization of emotional symptoms as psychiatric disorders.

Causes of bipolar disorder

Like other common psychiatric disorders, bipolar disorder is likely caused by a complex interplay of multiple factors, both at the population level and within individuals, 11 which can be best conceptualized at various levels of analysis, including genetics, brain networks, psychological functioning, social support, and other biological and environmental factors. Because knowledge about the causes of bipolar disorder remains in its infancy, for pragmatic purposes, most research has followed a reductionistic model that will ultimately need to be synthesized for a more coherent view of the pathophysiology that underlies the condition.

Insights from genetics

From its earliest descriptions, bipolar disorder has been observed to run in families. Indeed, family history is the strongest individual risk factor for developing the disorder, with first degree relatives having an approximately eightfold higher risk of developing bipolar disorder compared with the baseline population rates of ~1%. 12 While family studies cannot separate the effects of genetics from behavioral or cultural transmission, twin and adoption studies have been used to confirm that the majority of the familial risk is genetic in origin, with heritability estimates of approximately 60-80%. 13 14 There have been fewer studies of BD-II, but its heritability has been found to be smaller (~46%) 15 and closer to that of more common disorders such as major depressive disorder or generalized anxiety. 15 16 Nevertheless, significant heritability does not necessarily imply the presence of genes of large effect, since the genetic risk for bipolar disorder appears likely to be spread across many common variants of small effect sizes. 16 17 Ongoing studies of rare variations have found preliminary evidence for variants of slightly higher effect sizes, with initial evidence of convergence with common variations in genes associated with the synapse and the postsynaptic density. 18 19

While the likelihood that the testing of single variants or genes will be useful for diagnostic purposes is low, analyses known as polygenic risk studies can sum across all the risk loci and have some ability to discriminate cases from controls, albeit at the group level rather than the individual level. 20 These polygenic risk scores can also be used to identify shared genetic risk factors across other medical and psychiatric disorders. Bipolar disorder has strong evidence for common variant based coheritability with schizophrenia (genetic correlation (r g ) 0.69) and major depressive disorder (r g 0.48). BD-I has stronger coheritability with schizophrenia compared with BD-II, which is more strongly genetically correlated with major depressive disorder (r g 0.66). 16 Lower coheritability was observed with attention deficit hyperactivity disorder (r g 0.21), anorexia nervosa (0.20), and autism spectrum disorder (r g 0.21). 16 These correlations provide evidence for shared genetic risk factors between bipolar disorder and other major psychiatric syndromes, a pattern also corroborated by recent nationwide registry based family studies. 12 14 Nevertheless, despite their potential usefulness, polygenic risk scores must currently be interpreted with caution given their lack of populational representation and lingering concerns of residual confounds such as gene-environment correlations. 21

Insights from neuroimaging

Similarly to the early genetic studies, small initial studies had limited replication, leading to the formation of large worldwide consortiums such as ENIGMA (enhancing neuroimaging genetics through meta-analysis) which led to substantially larger sample sizes and improved reproducibility. In its volumetric analyses of subcortical structures from MRI (magnetic resonance imaging) of patients with bipolar disorder, the ENIGMA consortium found modest decreases in the volume of the thalamus (Cohen’s d −0.15), the hippocampus (−0.23), and the amygdala (−0.11), with an increased volume seen only in the lateral ventricles (+0.26). 22 Meta-analyses of cortical regions similarly found small reductions in cortical thickness broadly across the parietal, temporal, and frontal cortices (Cohen’s d −0.11 to −0.29) but no changes in cortical surface area. 23 In more recent meta-analyses of white matter tracts using diffuse tension imaging, widespread but modest decreases in white matter integrity were found throughout the brain in bipolar disorder, most notably in the corpus callosum and bilateral cinguli (Cohen’s d −0.39 to −0.46). 24 While these findings are likely to be highly replicable, they do not, as yet, have clinical application. This is because they reflect differences at a group level rather than an individual level, 25 and because many of these patterns are also seen across other psychiatric disorders 26 and could be either shared risk factors or the effects of confounding factors such as medical comorbidities, medications, co-occurring substance misuse, or the consequences (rather than causes) of living with mental illness. 27 Efforts to collate and meta-analyze large samples utilizing longitudinal designs 28 task based, resting state functional MRI measurents, 29 as well as other measures of molecular imaging (magnetic resonance spectroscopy and positron emission tomography) are ongoing but not as yet synthesized in large scale meta-analyses.

Environmental risk factors

Because of the difficulty in measuring and studying the relevant and often common environmental risk factors for a complex illness like bipolar disorder, there has been less research on how environmental risk factors could cause or modify bipolar disorder. Evidence for intrauterine risk factors is mixed and less compelling than such evidence in disorders like schizophrenia. 30 Preliminary evidence suggests that prominent seasonal changes in solar radiation, potentially through its effects on circadian rhythm, can be associated with an earlier onset of bipolar disorder 31 and a higher likelihood of experiencing a depressive episode at onset. 31 However, the major focus of environmental studies in bipolar disorder has been on traumatic and stressful life events in early childhood 32 and in adulthood. 33 The effects of such adverse events are complex, but on a broad level have been associated with earlier onset of bipolar disorder, a worse illness course, greater prevalence of psychotic symptoms, 34 substance misuse and psychiatric comorbidities, and a higher risk of suicide attempts. 32 35 Perhaps uniquely in bipolar disorder, evidence also indicates that positive life events associated with goal attainment can also increase the risk of developing elevated states. 36

Comorbidity

Bipolar disorder rarely manifests in isolation, with comorbidity rates indicating elevated lifetime risk of several co-occurring symptoms and comorbid disorders, particularly anxiety, attentional disorders, substance misuse disorders, and personality disorders. 37 38 The causes of such comorbidity can be varied and complex: they could reflect a mixed presentation artifactually separated by current diagnostic criteria; they might also reflect independent illnesses; or they might represent the downstream effects of one disorder increasing the risk of developing another disorder. 39 Anxiety disorders tend to occur before the frank onset of manic or hypomanic symptoms, suggesting that they could in part reflect prodromal symptoms that manifest early in the lifespan. 37 Similarly, subthreshold and syndromic symptoms of attention deficit/hyperactivity disorder are also observed across the lifespan of people with bipolar disorder, but particularly in early onset bipolar disorder. 40 On the other hand, alcohol and substance misuse disorders occur more evenly before and after the onset of bipolar disorder, consistent with a more bidirectional causal association. 41

The association between bipolar disorder and comorbid personality disorders is similarly complex. Milder manifestations of persistent mood instability (cyclothymia) or low mood (dysthymia) have previously been considered to be temperamental variants of bipolar disorder, 42 but are now classified as related but separate disorders. In people with persistent emotional dysregulation, making the diagnosis of bipolar disorder can be particularly challenging, 43 since the boundaries between longstanding mood instability and phasic changes in mood state can be difficult to distinguish. While symptom overlap can lead to artificially inflated prevalence rates of personality disorders in bipolar disorder, 44 the elevated rates of most personality disorders in bipolar disorder, particularly those related to emotional instability, are likely reflective of an important clinical phenomenon that is understudied, particularly with regard to treatment implications. 45 In general, people with comorbidities tend to have greater symptom burden and functional impairment and have lower response rates to treatment. 46 47 Data on approaches to treat specific comorbid disorders in bipolar disorder are limited, 48 49 and clinicians are often left to rely on their clinical judgment. The most parsimonious approach is to treat primary illness as fully as possible before considering additional treatment options for remaining comorbid symptoms. For certain comorbidities, such as anxiety symptoms and disorders of attention, first line pharmacological treatment—namely, antidepressants and stimulants, should be used with caution, since they might increase the long term risks of mood switching or overall mood instability. 50 51

Like other major mental illnesses, bipolar disorder is also associated with an increased prevalence of common medical disorders such as obesity, hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, and thyroid dysfunction. 52 These have been attributed to increase risk factors such as physical inactivity, poor nutrition, smoking, and increased use of addictive substances, 53 but some could also be consequences of specific treatments, such as the atypical antipsychotics and mood stabilizers. 54 Along with poor access to care, this medical burden likely accounts for much of the increased standardized mortality (approximately 2.6 times higher) in people with bipolar disorder, 55 highlighting the need to utilize treatments with better long term side effect profiles, and the need for better integration with medical care.

Precursors and prodromes: who develops bipolar disorder?

While more widespread screening and better accessibility to mental health providers should in principle shorten the time to diagnosis and treatment, early manifestation of symptoms in those who ultimately go on to be diagnosed with bipolar disorder is generally non-specific. 56 In particular, high risk offspring studies of adolescents with a parent with bipolar disorder have found symptoms of anxiety and attentional/disruptive disorders to be frequent in early adolescence, followed by higher rates of depression and sleep disturbance in later teenage years. 56 57 Subthreshold symptoms of mania, such as prolonged increases in energy, elated mood, racing thoughts, and mood lability are also more commonly found in children with prodromal symptoms (meta-analytic prevalence estimates ranging from 30-50%). 58 59 Still, when considered individually, none of these symptoms or disorders are sensitive or specific enough to accurately identify individuals who will transition to bipolar disorder. Ongoing approaches to consider these clinical factors together to improve accuracy have a promising but modest ability to identify people who will develop bipolar disorder, 60 emphasizing the need for further studies before implementation.

Screening for bipolar disorder

Manic episodes can vary from easily identifiable prototypical presentations to milder or less typical symptoms that can be challenging to diagnose. Ideally, a full diagnostic evaluation with access to close informants is performed on patients presenting to clinical care; however, evaluations can be hurried in routine clinical care, and the ability to recall previous episodes might be limited. In this context, the use of screening scales can be a helpful addition to clinical care, although screening scales must be regarded as an impetus for a confirmatory clinical interview rather than a diagnostic instrument by themselves. The two most widely used and openly available screening scales are the mood disorders questionnaire (based on the DSM-IV criteria for hypomania) 61 and the hypomania check list (HCL-32), 62 that represent a broader overview of symptoms proposed to be part of a broader bipolar spectrum.

Racial/ethnic disparities

Although community surveys using structured or semi-structured diagnostic instruments, have provided little evidence for variation across ethnic groups, 63 64 observational studies based on clinical diagnoses in healthcare settings have found a disproportionately higher rate of diagnosis of schizophrenia relative to bipolar disorder in black people. 65 Consistent with similar disparities seen across medicine, these differences in clinical diagnoses are likely influenced by a complex mix of varying clinical presentations, differing rates of comorbid conditions, poorer access to care, greater social and economic burden, as well as the potential effect of subtle biases of healthcare professionals. 65 While further research is necessary to identify driving factors responsible for diagnostic disparities, clinicians should be wary of making a rudimentary diagnosis in patients from marginalized backgrounds, ensuring comprehensive data gathering and a careful diagnostic formulation that incorporates shared decision making between patient and provider.

Bipolar disorder is a recurrent illness, but its longitudinal course is heterogeneous and difficult to predict. 46 66 The few available long term studies of BD-I and BD-II have found a consistent average rate of recurrence of 0.40 mood episodes per year in historical studies 67 and 0.44 mood episodes per year in more recent studies. 68 The median time to relapse is estimated to be 1.44 years, with higher relapse rates seen in BD-I (0.81 years) than in BD-II (1.63 years) and no differences observed with respect to age or sex. 1 2 In addition to focusing on episodes, an important development in research and clinical care of bipolar disorder has been the recognition of the burden of subsyndromal symptoms. Although milder in severity, these symptoms can be long lasting, functionally impairing, and can themselves be a risk factor for episode relapse. 69 Recent cohort studies have also found that a substantial proportion of patients with bipolar disorder (20-30%) continue to have poor outcomes even after receiving guideline based care. 46 70 Risk factors that contribute to this poor outcome include transdiagnostic indicators of adversity such as substance misuse, low educational attainment, socioeconomic hardship, and comorbid disorders. As expected, those with more severe past illness activity, including those with rapid cycling, were also more likely to remain symptomatically and psychosocially impaired. 46 71 72

The primary focus of treating bipolar disorder has been to manage the manic, mixed, or depressive episodes that present to clinical care and to subsequently prevent recurrence of future episodes. Owing to the relapse remitting nature of the illness, randomized controlled trials are essential to determine treatment efficacy, as the observation of clinical improvement could just represent the ebbs and flows of the natural history of the illness. In the United States, the FDA (Food and Drug Administration) requires at least two large scale placebo controlled trials (phase 3) to show significant evidence of efficacy before approving a treatment. Phase 3 studies of bipolar disorder are generally separated into short term studies of mania (3-4 weeks), short term studies for bipolar depression (4-6 weeks), and longer term maintenance studies to evaluate prophylactic activity against future mood episodes (usually lasting one year). Although the most rigorous evaluation of phase 3 studies would be to require two broadly representative and independent randomized controlled trials, the FDA permits consideration of so called enriched design trials that follow participants after an initial response and tolerability has been shown to an investigational drug. Because of this initial selection, such trials can be biased against comparator agents, and could be less generalizable to patients seen in clinical practice.

A summary of the agents approved by the FDA for treatment of bipolar disorder is in table 1 , which references the key clinical trials demonstrating efficacy. Figure 1 and supplementary table 1 are a comparison of treatments for mania, depression, and maintenance. Effect sizes reflect the odds ratios or relative risks of obtaining response (defined as ≥50% improvement from baseline) in cases versus controls and were extracted from meta-analyses of randomized controlled trials for bipolar depression 86 and maintenance, 94 as well as a network meta-analysis of randomized controlled trials in bipolar mania. 73 Effect sizes are likely to be comparable for each phase of treatment, but not across the different phases, since methodological differences exist between the three meta-analytic studies.

FDA approved medications for bipolar disorder

• View inline

Summary of treatment response rates (defined as ≥50% improvement from baseline) of modern clinical trials for acute mania, acute bipolar depression, and long term recurrence. Meta-analytic estimates were extracted from recent meta-analyses or network meta-analyses of acute mania, 73 acute bipolar depression, 86 and bipolar maintenance studies 94

• Download figure
• Open in new tab
• Download powerpoint

Acute treatment of mania

As mania is characterized by impaired judgment, individuals can be at risk for engaging in high risk, potentially dangerous behaviors that can have substantial personal, occupational, and financial consequences. Therefore, treatment of mania is often considered a psychiatric emergency and is, when possible, best performed in the safety of an inpatient unit. While the primary treatment for mania is pharmacological, diminished insight can impede patients' willingness to accept treatment, emphasizing the significance of a balanced therapeutic approach that incorporates shared decision making frameworks as much as possible to promote treatment adherence.

The three main classes of anti-manic treatments are lithium, mood stabilizing anticonvulsants (divalproate and carbamazepine), and antipsychotic medications. Almost all antipsychotics are effective in treating mania, with the more potent dopamine D2 receptor antagonists such as risperidone and haloperidol demonstrating slightly higher efficacy ( fig 1 ). 73 In the United States, the FDA has approved the use of all second generation antipsychotics for treating mania except for lurasidone and brexpriprazole. Compared with mood stabilizing medications, second generation antipsychotics have a faster onset of action, making them a first line treatment for more severe manic symptoms that require rapid treatment. 99 The choice of which specific second generation antipsychotic to use depends on a balance of efficacy, tolerability concerns, and cost considerations (see table 1 ). Notably, the FDA has placed a black box warning on all antipsychotics for increasing the risk of cerebral vascular accidents in the elderly. 100 While this was primarily focused on the use of antipsychotics in dementia, this likely class effect should be taken into account when considering the use of antipsychotics in the elderly.

Traditional mood stabilizers, such as lithium, divalproate, and carbamazepine are also effective in the treatment of active mania ( fig 1 ). Since lithium also has a robust prophylactic effect (see section on prevention of mood episodes below) it is often recommended as first line treatment and can be considered as monotherapy when rapid symptom reduction is not clinically indicated. On the other hand, other anticonvulsants such as lamotrigine, gabapentin, topiramate, and oxcarbazepine have not been found to be effective for the treatment of mania or mixed episodes. 101 Although the empirical evidence for polypharmacy is limited, 102 combination treatment in acute mania, usually consisting of a mood stabilizer and a second generation antipsychotic, is commonly used in clinical practice despite the higher burden of side effects. Following resolution of an acute mania, consideration should be given to transitioning to monotherapy with an agent with proven prophylactic activity.

Pharmacological approaches to bipolar depression

Depressed episodes are usually more common than mania or hypomania, 103 104 and often represent the primary reason for individuals with bipolar disorder to seek treatment. Nevertheless, because early antidepressant randomized controlled trials did not distinguish between unipolar and bipolar depressive episodes, it has only been in the past two decades that large scale randomized controlled trials have been conducted specifically for bipolar depression. As such trials are almost exclusively funded by pharmaceutical companies, they have focused on the second generation antipsychotics and newer anticonvulsants still under patent. These trials have shown moderate but robust effects for most recent second generation antipsychotics, five of which have received FDA approval for treating bipolar depression ( table 1 ). No head-to-head trials have been conducted among these agents, so the choice of medication depends on expected side effects and cost considerations. For example, quetiapine has robust antidepressant efficacy data but is associated with sedation, weight gain, and adverse cardiovascular outcomes. 105 Other recently approved medications such as lurasidone, cariprazine, and lumateperone have better side effect profiles but show more modest antidepressant activity. 106

Among the mood stabilizing anticonvulsants, lamotrigine has limited evidence for acute antidepressant activity, 107 possibly owing to the need for an 8 week titration to reach the full dose of 200 mg. However, as discussed below, lamotrigine can still be considered for mild to moderate acute symptoms owing to its generally tolerable side effect profile and proven effectiveness in preventing the recurrence of depressive episodes. Divalproate and carbamazepine have some evidence of being effective antidepressants in small studies, but as there has been no large scale confirmatory study, they should be considered second or third line options. 86 Lithium has been studied for the treatment of bipolar depression as a comparator to quetiapine and was not found to have a significant acute antidepressant effect. 88

Antidepressants

Owing to the limited options of FDA approved medications for bipolar depression and concerns of metabolic side effects from long term second generation antipsychotic use, clinicians often resort to the use of traditional antidepressants for the treatment of bipolar depression 108 despite the lack of FDA approval for such agents. Indeed, recent randomized clinical trials of antidepressants in bipolar depression have not shown an effect for paroxetine, 89 109 bupropion, 109 or agomelatine. 110 Beyond the question of efficacy, another concern regarding antidepressants in bipolar disorder is their potential to worsen the course of illness by either promoting mixed or manic symptoms or inducing more subtle degrees of mood instability and cycle acceleration. 111 However, the risk of switching to full mania while being treated with mood stabilizers appears to be modest, with a meta-analysis of randomized clinical trials and clinical cohort studies showing the rates of mood switching over an average follow-up of five months to be approximately 15.3% in people with bipolar disorder treated on antidepressants compared with 13.8% in those without antidepressant treatment. 111 The risk of switching appears to be higher in the first 1-2 years of treatment in people with BD-I, and in those treated with a tricyclic antidepressant 112 or the dual reuptake inhibitor venlafaxine. 113 Overall, while the available data have methodological limitations, most guidelines do not recommend the use of antidepressants in bipolar disorder, or recommend them only after agents with more robust evidence have been tried. That they remain so widely used despite the equivocal evidence base reflects the unmet need for treatment of depression, concerns about the long term side effects of second generation antipsychotics, and the challenges of changing longstanding prescribing patterns.

Pharmacological approaches to prevention of recurrent episodes

Following treatment of the acute depressive or manic syndrome, the major focus of treatment is to prevent future episodes and minimize interepisodic subsyndromal symptoms. Most often, the medication that has been helpful in controlling the acute episode can be continued for prevention, particularly if clinical trial evidence exists for a maintenance effect. To show efficacy for prevention, studies must be sufficiently long to allow the accumulation of future episodes to occur and be potentially prevented by a therapeutic intervention. However, few long term treatment studies exist and most have utilized enriched designs that likely favor the drug seeking regulatory approval. As shown in figure 1 , meta-analyses 94 show prophylactic effect for most (olanzapine, risperidone, quetiapine, aripiprazole, asenapine) but not all (lurasidone, paliperidone) recently approved second generation antipsychotics. The effect sizes are generally comparable with monotherapy (odds ratio 0.42, 95% confidence interval 0.34 to 0.5) or as adjunctive therapy (odds ratio 0.37, 95% confidence interval 0.25 to 0.55). 94 Recent studies of lithium, which have generally used it as a (non-enriched) comparator drug, show a comparable protective effect (odds ratio 0.46, 95% confidence interval 0.28 to 0.75). 94 Among the mood stabilizing anticonvulsant drugs, a prophylactic effect has also been found for both divalproate and lamotrigine ( fig 1 and supplementary table 1), although only the latter has been granted regulatory approval for maintenance treatment. While there are subtle differences in effect sizes in drugs approved for maintenance ( fig 1 and table 1 ), the overlapping confidence intervals and methodological differences between studies prevent a strict comparison of the effect measures.

Guidelines often recommend lithium as a first line agent given its consistent evidence of prophylaxis, even when tested as the disadvantaged comparator drug in enriched drug designs. Like other medications, lithium has a unique set of side effects and ultimately the decision about which drug to use among those which are efficacious should be a decision carefully weighed and shared between patient and provider. The decision might be re-evaluated after substantial experience with the medication or at different stages in the long term treatment of bipolar disorder (see table 1 ).

Psychotherapeutic approaches

The frequent presence of residual symptoms, often associated with psychosocial and occupational dysfunction, has led to renewed interest in psychotherapeutic and psychosocial approaches to bipolar disorder. Given the impairment of judgment seen in mania, psychotherapy has more of a supportive and educational role in the treatment of mania, whereas it can be more of a primary focus in the treatment of depressive states. On a broad level, psychotherapeutic approaches effective for acute depression, such as cognitive behavioral therapy, interpersonal therapy, behavioral activation, and mindfulness based strategies, can also be recommended for acute depressive states in individuals with bipolar disorder. 114 Evidence for more targeted psychotherapy trials for bipolar disorder is more limited, but meta-analyses have found evidence for decreased recurrence (odds ratio 0.56; 95% confidence interval 0.43 to 0.74) 115 and improvement of subthreshold interepisodic depressive and manic symptoms with cognitive behavioral therapy, family based therapy, interpersonal and social rhythm therapy, and psychoeducation. 115 Recent investigations have also focused on targeted forms of psychotherapy to improve cognition 116 117 118 as well as psychosocial and occupational functioning. 119 120 Although these studies show evidence of a moderate effect, they remain preliminary, methodologically diverse, and require replication on a larger scale. 121

The implementation of evidence based psychotherapy as a treatment faces several challenges, including clinical training, fidelity monitoring, and adequate reimbursement. Novel approaches, leveraging the greater tractability of digital tools 122 and allied healthcare workers, 123 are promising means of lessening the implementation gap; however, these approaches require validation and evidence of clinical utility similar to traditional methods.

Neurostimulation approaches

For individuals with bipolar disorder who cannot tolerate or do not respond well to standard pharmacotherapy or psychotherapeutic approaches, neurostimulation techniques such as repetitive transcranial magnetic stimulation or electric convulsive therapy should be considered as second or third line treatments. Electric convulsive therapy has shown response rates of approximately 60-80% in severe acute depressions 124 125 and 50-60% in cases with treatment resistant depression. 126 These response rates compare favorably with those of pharmacological treatment, which are likely to be closer to ~50% and ~30% in subjects with moderate to severe depression and treatment resistant depression, respectively. 127 Although the safety of electric convulsive therapy is well established, relatively few medical centers have it available, and its acceptability is limited by cognitive side effects, which are usually short term, but which can be more significant with longer courses and with bilateral electrode placement. 128 While there have been fewer studies of electric convulsive therapy for bipolar depression compared with major depressive disorder, it appears to be similarly effective and might show earlier response. 129 Anecdotal evidence also suggests electric convulsive therapy that is useful in refractory mania. 130

Compared with electric convulsive therapy, repetitive transcranial magnetic stimulation has no cognitive side effects and is generally well tolerated. Repetitive transcranial magnetic stimulation acts by generating a magnetic field to depolarize local neural tissue and induce excitatory or inhibitory effects depending on the frequency of stimulation. The most studied FDA approved form of repetitive transcranial magnetic stimulation applies high frequency (10 Hz) excitatory pulses to the left prefrontal cortex for 30-40 minutes a day for six weeks. 131 Like electric convulsive therapy, repetitive transcranial magnetic stimulation has been primarily studied in treatment resistant depression and has been found to have moderate effect, with about one third of patients having a significant treatment response compared with those treated with pharmacotherapy. 131 Recent innovations in transcranial magnetic stimulation have included the use of a novel, larger coil to stimulate a larger degree of the prefrontal cortex (deep transcranial magnetic stimulation), 132 and a shortened (three minutes), higher frequency intermittent means of stimulation known as theta burst stimulation that appears to be comparable to conventional (10 Hz) repetitive transcranial magnetic stimulation. 133 A preliminary trial has recently assessed a new accelerated protocol of theta burst stimulation marked by 10 sessions a day for five days. It found that theta burst stimulation had a greater effect on people with treatment resistant depression compared with treatment as usual, although larger studies are needed to confirm these findings. 134

Conventional repetitive transcranial magnetic stimulation (10 Hz) studies in bipolar disorder have been limited by small sample sizes but have generally shown similar effects compared with major depressive disorder. 135 However, a proof of concept study of single session theta burst stimulation did not show efficacy in bipolar depression, 136 reiterating the need for specific trials for bipolar depression. Given the lack of such trials in bipolar disorder, repetitive transcranial magnetic stimulation should be considered a potentially promising but as yet unproven treatment for bipolar depression.

The other major form of neurostimulation studied in both unipolar and bipolar depression is transcranial direct current stimulation, an easily implemented method of delivering a low amplitude electrical current to the prefrontal area of the brain that could lead to local changes in neuronal excitability. 137 Like repetitive transcranial magnetic stimulation, transcranial direct current stimulation is well tolerated and has been mostly studied in unipolar depression, but has not yet generated sufficient evidence to be approved by a regulatory agency. 138 Small studies have been performed in bipolar depression, but the results have been mixed and require further research before use in clinical settings. 137 138 139 Finally, the evidence for more invasive neurostimulation studies such as vagal nerve stimulation and deep brain stimulation remains extremely limited and is currently insufficient for clinical use. 140 141

Treatment resistance in bipolar disorder

As in major depressive disorder, the use of term treatment resistance in bipolar disorder is controversial since differentiating whether persistent symptoms are caused by low treatment adherence, poor tolerability, the presence of comorbid disorders, or are the result of true treatment resistance, is an essential but often challenging clinical task. Treatment resistance should only be considered after two or three trials of evidence based monotherapy, adjunctive therapy, or both. 142 In difficult-to-treat mania, two or more medications from different mechanistic classes are typically used, with electric convulsive therapy 143 and clozapine 144 being considered if more conventional anti-manic treatments fail. In bipolar depression, it is common to combine antidepressants with anti-manic agents, despite limited evidence for efficacy. 145 Adjunctive therapies such as bright light therapy, 146 the dopamine D2/3 receptor agonist pramipexole, 147 and ketamine 148 149 have shown promising results in small open label trials that require further study.

Treatment considerations to reduce suicide in bipolar disorder

The risk of completed suicide is high across the subtypes of bipolar disorder, with estimated rates of 10-15% across the lifespan. 150 151 152 Lifetime rates of suicide attempts are much higher, with almost half of all individuals with bipolar disorder reporting at least one attempt. 153 Across a population and, often within individuals, the causes of suicide attempts and completed suicides are likely to be multifactorial, 154 affected by various risk factors, such as symptomatic illness, environmental stressors, comorbidities (particularly substance misuse), trait impulsivity, interpersonal conflict, loneliness, or socioeconomic distress. 155 156 Risk is highest in depressive and dysphoric/mixed episodes 157 158 and is particularly high in the transitional period following an acute admission to hospital. 159 Among the available treatments, lithium has potential antisuicidal properties. 160 However, since suicide is a rare event, with very few to zero suicides within a typical clinical trial, moderate evidence for this effect emerges only in the setting of meta-analyses of clinical trials. 160 Several observational studies have shown lower mortality in patients on lithium treatment, 161 but such associations might not be causal, since lithium is potentially fatal in overdose and is often avoided by clinicians in patients at high risk of suicide.

The challenge of studying scarce events has led most studies to focus on the reduction of the more common phenomena of suicidal ideation and behavior as a proxy for actual suicides. A recent such multisite study of the Veterans Affairs medical system included a mixture of unipolar and bipolar disorder and was stopped prematurely for futility, indicating no overall effect of moderate dose lithium. 162 Appropriate limitations of this study have been noted, 163 164 including difficulties in recruitment, few patients with bipolar disorder (rather than major depressive disorder), low levels of compliance with lithium therapy, high rates of comorbidity, and a follow-up of only one year. Nevertheless, while the body of evidence suggests that lithium has a modest antisuicidal effect, its degree of protection and utility in complex patients with comorbidities and multiple risk factors remain matters for further study. Treatment of specific suicidal risk in patients with bipolar disorder must therefore also incorporate broader interventions based on the individual’s specific risk factors. 165 Such an approach would include societal interventions like means restriction 166 and a number of empirically tested suicide focused psychotherapy treatments. 167 168 Unfortunately, the availability of appropriate training, expertise, and care models for such treatments remains limited, even in higher income countries. 169

More scalable solutions, such as the deployment of shortened interventions via digital means could help to overcome this implementation gap; however, the effectiveness of such approaches cannot be assumed and requires empirical testing. For example, a recent large scale randomized controlled trial of an abbreviated online dialectical behavioral therapy skills training program was paradoxically associated with slightly increased risk of self-harm. 170

Treatment consideration in BD-II and bipolar spectrum conditions

Because people with BD-II primarily experience depressive symptoms and appear less likely to switch mood states compared with individuals with BD-I, 50 171 there has been a greater acceptance of the use of antidepressants in BD-II depression, including as monotherapy. 172 However, caution should be exercised when considering the use of antidepressants without a mood stabilizer in patients with BD-II who might also experience high rates of mood instability and rapid cycling. Such individuals can instead respond better to newer second generation antipsychotic agents such as quetiapine 173 and lumateperone, 93 which are supported by post hoc analyses of these more recent clinical trials with more BD-II patients. In addition, despite the absence of randomized controlled trials, open label studies have suggested that lithium and other mood stabilizers can have similar efficacy in BD-II, especially in the case of lamotrigine. 174

Psychotherapeutic approaches such as psychoeducation, cognitive behavioral therapy, and interpersonal and social rhythm therapy have been found to be helpful 115 and can be considered as the primary form of treatment for BD-II in some patients, although in most clinical scenarios BD-II is likely to occur in conjunction with psychopharmacology. While it can be tempting to consider BD-II a milder variant of BD-I, high rates of comorbid disorders, rapid cycling, and adverse consequences such as suicide attempts 175 176 highlight the need for clinical caution and the provision of multimodal treatment, focusing on mood improvement, emotional regulation, and better psychosocial functioning.

Precision medicine: can it be applied to improve the care of bipolar disorder?

The recent focus on precision medicine approaches to psychiatric disorders seeks to identify clinically relevant heterogeneity and identify characteristics at the level of the individual or subgroup that can be leveraged to identify and target more efficacious treatments. 1 177 178

The utility of such an approach was originally shown in oncology, where a subset of tumors had gene expression or DNA mutation signatures that could predict response to treatments specifically designed to target the aberrant molecular pathway. 179 While much of the emphasis of precision medicine has been on the eventual identification of biomarkers utilizing high throughput approaches (genetics and other “omics” based measurements), the concept of precision medicine is arguably much broader, encompassing improvements in measurement, potentially through the deployment of digital tools, as well as better conceptualization of contextual, cultural, and socioeconomic mechanisms associated with psychopathology. 180 181 Ultimately, the goal of precision psychiatry is to identify and target driving mechanisms, be they molecular, physiological, or psychosocial in nature. As such, precision psychiatry seeks what researchers and clinicians have often sought: to identify clinically relevant heterogeneity to improve prediction of outcomes and increase the likelihood of therapeutic success. The novelty being not so much the goals of the overarching approach, but the increasing availability of large samples, novel digital tools, analytical advances, and an increasing armamentarium of biological measurements that can be deployed at scale. 177

Although not unique to bipolar disorder, several clinical decision points along the life course of bipolar disorder would benefit from a precision medicine approach. For example, making an early diagnosis is often not possible based on clinical symptoms alone, since such symptoms are usually non-specific. A precision medicine approach could also be particularly relevant in helping to identify subsets of patients for whom the use of antidepressants could be beneficial or harmful. Admittedly, precision medicine approaches to bipolar disorder are still in their infancy, and larger, clinically relevant, longitudinal, and reliable phenotypes are needed to provide the infrastructure for precision medicine approaches. Such data remain challenging to obtain at scale, leading to renewed efforts to utilize the extant clinical infrastructure and electronic medical records to help emulate traditional longitudinal analyses. Electronic medical records can help provide such data, but challenges such as missingness, limited quality control, and potential biases in care 182 need to be resolved with carefully considered analytical designs. 183

Emerging treatments

Two novel atypical antipsychotics, amilsupride and bifeprunox, are currently being tested in phase 3 trials ( NCT05169710 and NCT00134459 ) and could gain approval for bipolar depression in the near future if these pivotal trials show a significant antidepressant effect. These drugs could offer advantages such as greater antidepressant effects, fewer side effects, and better long term tolerability, but these assumptions must be tested empirically. Other near term possibilities include novel rapid antidepressant treatments, such as (es)ketamine that putatively targets the glutamatergic system, and has been recently approved for treatment resistant depression, but which have not yet been tested in phase 3 studies in bipolar depression. Small studies have shown comparable effects of intravenous ketamine, 149 184 in bipolar depression with no short term evidence of increased mood switching or mood instability. Larger phase 2 studies ( NCT05004896 ) are being conducted which will need to be followed by larger phase 3 studies. Other therapies targeting the glutamatergic system have generally failed phase 3 trials in treatment resistant depression, making them unlikely to be tested in bipolar depression. One exception could be the combination of dextromethorphan and its pharmacokinetic (CYP2D6) inhibitor bupropion, which was recently approved for treatment resistant depression but has yet to be tested in bipolar depression. Similarly, the novel GABAergic compound zuranolone is currently being evaluated by the FDA for the treatment of major depressive disorder and could also be subsequently studied in bipolar depression.

Unfortunately, given the general efficacy for most patients of available treatments, few scientific and financial incentives exist to perform large scale studies of novel treatment in mania. Encouraging results have been seen in small studies of mania with the selective estrogen receptor modulator 185 tamoxifen and its active metabolite endoxifen, both of which are hypothesized to inhibit protein kinase C, a potential mechanistic target of lithium treatment. These studies remain small, however, and anti-estrogenic side effects have potentially dulled interest in performing larger studies.

Finally, several compounds targeting alternative pathophysiological mechanisms implicated in bipolar disorder have been trialed in phase 2 academic studies. The most studied has been N -acetylcysteine, a putative mitochondrial modulator, which initially showed promising results only to be followed by null findings in larger more recent studies. 186 Similarly, although small initial studies of anti-inflammatory agents provided impetus for further study, subsequent phase 2 studies of the non-steroidal agent celecoxib, 187 the anti-inflammatory antibiotic minocycline, 187 and the antibody infliximab (a tumor necrosis factor antagonist) 188 have not shown efficacy for bipolar depression. Secondary analyses have suggested that specific anti-inflammatory agents might be effective only for a subset of patients, such as those with elevated markers of inflammation or a history of childhood adversity 189 ; however, such hypotheses must be confirmed in adequately powered independent studies.

Several international guidelines for the treatment of bipolar disorder have been published in the past decade, 102 190 191 192 providing a list of recommended treatments with efficacy in at least one large randomized controlled trial. Since effect sizes tend to be moderate and broadly comparable across classes, all guidelines allow for significant choice among first line agents, acknowledging that clinical characteristics, such as history of response or tolerability, severity of symptoms, presence of mixed features, or rapid cycling can sometimes over-ride guideline recommendations. For acute mania requiring rapid treatment, all guidelines prioritize the use of second generation antipsychotics such as aripiprazole, quetiapine, risperidone, asenapine, and cariprazine. 102 192 193 Combination treatment is considered based on symptom severity, tolerability, and patient choice, with most guidelines recommending lithium or divalproate along with a second generation antipsychotic for mania with psychosis, severe agitation, or prominent mixed symptoms. While effective, haloperidol is usually considered a second choice option owing to its propensity to cause extrapyramidal symptoms. 102 192 193 Uniformly, all guidelines agree on the need to taper antidepressants in manic or mixed episodes.

For maintenance treatment, guidelines are generally consistent in recommending lithium if tolerated and without relative contraindications, such as baseline renal disease. 194 The second most recommended maintenance treatment is quetiapine, followed by aripiprazole for patients with prominent manic episodes and lamotrigine for patients with predominant depressive episodes. 194 Most guidelines recommend considering prophylactic properties when initially choosing treatment for acute manic episodes, although others suggests that acute maintenance treatments can be cross tapered with maintenance medications after several months of full reponse. 193

For bipolar depression, recent guidelines recommend specific second generation antipsychotics such as quetiapine, lurasidone, and cariprazine 102 192 193 For more moderate symptoms, consideration is given to first using lamotrigine and lithium. Guidelines remain cautious about the use of antidepressants (selective serotonin reuptake inhibitors, venlafaxine, or bupropion) in patients with BP-I, restricting them to second or third line treatments and always in the context of an anti-manic agent. However, for patients with BP-II and no rapid cycling, several guidelines allow for the use of carefully monitored antidepressant monotherapy.

Bipolar disorder is a highly recognizable syndrome with many effective treatment options, including the longstanding gold standard therapy lithium. However, a significant proportion of patients do not respond well to current treatments, leading to negative consequences, poor quality of life, and potentially shortened lifespan. Several novel treatments are being developed but limited knowledge of the biology of bipolar disorder remains a major challenge for novel drug discovery. Hope remains that the insights of genetics, neuroimaging, and other investigative modalities could soon be able to inform the development of rational treatments aimed to mitigate the underlying pathophysiology associated with bipolar disorder. At the same time, however, efforts are needed to bridge the implementation gap and provide truly innovative and integrative care for patients with bipolar disorder. 195 Owing to the complexity of bipolar disorder, few patients can be said to be receiving optimized care across the various domains of mental health that are affected in those with bipolar disorder. Fortunately, the need for improvement is now well documented, 196 and concerted efforts at the scale necessary to be truly innovative and integrative are now on the horizon.

Questions for future research

Among adolescents and young adults who manifest common mental disorders such as anxiety or depressive or attentional disorders, who will be at high risk for developing bipolar disorder?

Can we predict the outcomes for patients following a first manic or hypomanic episode? This will help to inform who will require lifelong treatment and who can be tapered off medications after sustained recovery.

Are there reliable clinical features and biomarkers that can sufficiently predict response to specific medications or classes of medication?

What are the long term consequences of lifelong treatments with the major classes of medications used in bipolar disorder? Can we predict and prevent medical morbidity caused by medications?

Can we understand in a mechanistic manner the pathophysiological processes that lead to abnormal mood states in bipolar disorder?

Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

Contributors: FSG performed the planning, conduct, and reporting of the work described in the article. FSG accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Competing interests: I have read and understood the BMJ policy on declaration of interests and declare no conflicts of interest.

Patient involvement: FSG discussed of the manuscript, its main points, and potential missing points with three patients in his practice who have lived with longstanding bipolar disorder. These additional viewpoints were incorporated during the drafting of the manuscript.

Provenance and peer review: Commissioned; externally peer reviewed.

• ↵ . Falret’s discovery: the origin of the concept of bipolar affective illness. Translated by M. J. Sedler and Eric C. Dessain. Am J Psychiatry 1983;140:1127-33. doi: 10.1176/ajp.140.9.1127 OpenUrl CrossRef PubMed Web of Science
• ↵ Kraepelin E. Manic-depressive Insanity and Paranoia. Translated by R. Mary Barclay from the Eighth German. Edition of the ‘Textbook of Psychiatry.’ 1921.
• Merikangas KR ,
• Akiskal HS ,
• Koukopoulos A ,
• Jongsma HE ,
• Kirkbride JB ,
• Rowland TA ,
• Kessler RC ,
• Kazdin AE ,
• Aguilar-Gaxiola S ,
• WHO World Mental Health Survey collaborators
• Bergen SE ,
• Kuja-Halkola R ,
• Larsson H ,
• Lichtenstein P
• Smoller JW ,
• Lichtenstein P ,
• Sjölander A ,
• Mullins N ,
• Forstner AJ ,
• O’Connell KS ,
• Palmer DS ,
• Howrigan DP ,
• Chapman SB ,
• Pirooznia M ,
• Murray GK ,
• McGrath JJ ,
• Hickie IB ,
• ↵ Mostafavi H, Harpak A, Agarwal I, Conley D, Pritchard JK, Przeworski M. Variable prediction accuracy of polygenic scores within an ancestry group. Loos R, Eisen MB, O’Reilly P, eds. eLife 2020;9:e48376. doi: 10.7554/eLife.48376 OpenUrl CrossRef PubMed
• Westlye LT ,
• van Erp TGM ,
• Costa Rica/Colombia Consortium for Genetic Investigation of Bipolar Endophenotypes
• Pauling M ,
• ENIGMA Bipolar Disorder Working Group
• Schnack HG ,
• Ching CRK ,
• ENIGMA Bipolar Disorders Working Group
• Goltermann J ,
• Hermesdorf M ,
• Dannlowski U
• Gurholt TP ,
• Suckling J ,
• Lennox BR ,
• Bullmore ET
• Marangoni C ,
• Hernandez M ,
• Achtyes ED ,
• Agnew-Blais J ,
• Gilman SE ,
• Upthegrove R ,
• ↵ Etain B, Aas M. Childhood Maltreatment in Bipolar Disorders. In: Young AH, Juruena MF, eds. Bipolar Disorder: From Neuroscience to Treatment . Vol 48. Current Topics in Behavioral Neurosciences. Springer International Publishing; 2020:277-301. doi: 10.1007/7854_2020_149
• Johnson SL ,
• Weinberg BZS
• Stinson FS ,
• Costello CG
• Klein & Riso LP DN
• Sandstrom A ,
• Perroud N ,
• de Jonge P ,
• Bunting B ,
• Nierenberg AA
• Hantouche E ,
• Vannucchi G
• Zimmerman M ,
• Ruggero CJ ,
• Chelminski I ,
• Leverich GS ,
• McElroy S ,
• Mignogna KM ,
• Balling C ,
• Dalrymple K
• Kappelmann N ,
• Stokes PRA ,
• Jokinen T ,
• Baldessarini RJ ,
• Faedda GL ,
• Offidani E ,
• Viktorin A ,
• Launders N ,
• Osborn DPJ ,
• Roshanaei-Moghaddam B ,
• De Hert M ,
• Detraux J ,
• van Winkel R ,
• Lomholt LH ,
• Andersen DV ,
• Sejrsgaard-Jacobsen C ,
• Skjelstad DV ,
• Gregersen M ,
• Søndergaard A ,
• Brandt JM ,
• Van Meter AR ,
• Youngstrom EA ,
• Taylor RH ,
• Ulrichsen A ,
• Strawbridge R
• Hafeman DM ,
• Merranko J ,
• Hirschfeld RM ,
• Williams JB ,
• Spitzer RL ,
• Adolfsson R ,
• Benazzi F ,
• Regier DA ,
• Johnson KR ,
• Akinhanmi MO ,
• Biernacka JM ,
• Strakowski SM ,
• Goldberg JF ,
• Schettler PJ ,
• Coryell W ,
• Scheftner W ,
• Endicott J ,
• Zarate CA Jr . ,
• Matsuda Y ,
• Fountoulakis KN ,
• Zarate CA Jr .
• Bowden CL ,
• Brugger AM ,
• The Depakote Mania Study Group
• Calabrese JR ,
• Depakote ER Mania Study Group
• Weisler RH ,
• Kalali AH ,
• Ketter TA ,
• SPD417 Study Group
• Keck PE Jr . ,
• Cutler AJ ,
• Caffey EM Jr . ,
• Grossman F ,
• Eerdekens M ,
• Jacobs TG ,
• Grundy SL ,
• The Olanzipine HGGW Study Group
• Versiani M ,
• Ziprasidone in Mania Study Group
• Sanchez R ,
• Aripiprazole Study Group
• McIntyre RS ,
• Panagides J
• Calabrese J ,
• McElroy SL ,
• EMBOLDEN I (Trial 001) Investigators
• EMBOLDEN II (Trial D1447C00134) Investigators
• Lamictal 606 Study Group
• Lamictal 605 Study Group
• Keramatian K ,
• Chakrabarty T ,
• Nestsiarovich A ,
• Gaudiot CES ,
• Neijber A ,
• Hellqvist A ,
• Paulsson B ,
• Trial 144 Study Investigators
• Schwartz JH ,
• Szegedi A ,
• Cipriani A ,
• Salanti G ,
• Dorsey ER ,
• Rabbani A ,
• Gallagher SA ,
• Alexander GC
• Cerqueira RO ,
• Yatham LN ,
• Kennedy SH ,
• Parikh SV ,
• Højlund M ,
• Andersen K ,
• Correll CU ,
• Ostacher M ,
• Schlueter M ,
• Geddes JR ,
• Mojtabai R ,
• Nierenberg AA ,
• Goodwin GM ,
• Agomelatine Study Group
• Vázquez G ,
• Baldessarini RJ
• Altshuler LL ,
• Cuijpers P ,
• Miklowitz DJ ,
• Efthimiou O ,
• Furukawa TA ,
• Strawbridge R ,
• Tsapekos D ,
• Hodsoll J ,
• Vinberg M ,
• Kessing LV ,
• Forman JL ,
• Miskowiak KW
• Lewandowski KE ,
• Sperry SH ,
• Torrent C ,
• Bonnin C del M ,
• Martínez-Arán A ,
• Bonnín CM ,
• Tamura JK ,
• Carvalho IP ,
• Leanna LMW ,
• Karyotaki E ,
• Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration
• Vipulananthan V ,
• Hurlemann R ,
• UK ECT Review Group
• Haskett RF ,
• Mulsant B ,
• Trivedi MH ,
• Wisniewski SR ,
• Espinoza RT ,
• Vazquez GH ,
• McClintock SM ,
• Carpenter LL ,
• National Network of Depression Centers rTMS Task Group ,
• American Psychiatric Association Council on Research Task Force on Novel Biomarkers and Treatments
• Levkovitz Y ,
• Isserles M ,
• Padberg F ,
• Blumberger DM ,
• Vila-Rodriguez F ,
• Thorpe KE ,
• Williams NR ,
• Sudheimer KD ,
• Bentzley BS ,
• Konstantinou G ,
• Toscano E ,
• Husain MM ,
• McDonald WM ,
• International Consortium of Research in tDCS (ICRT)
• Sampaio-Junior B ,
• Tortella G ,
• Borrione L ,
• McAllister-Williams RH ,
• Gippert SM ,
• Switala C ,
• Bewernick BH ,
• Hidalgo-Mazzei D ,
• Mariani MG ,
• Fagiolini A ,
• Swartz HA ,
• Benedetti F ,
• Barbini B ,
• Fulgosi MC ,
• Burdick KE ,
• Diazgranados N ,
• Ibrahim L ,
• Brutsche NE ,
• Sinclair J ,
• Gerber-Werder R ,
• Miller JN ,
• Vázquez GH ,
• Franklin JC ,
• Ribeiro JD ,
• Turecki G ,
• Gunnell D ,
• Hansson C ,
• Pålsson E ,
• Runeson B ,
• Pallaskorpi S ,
• Suominen K ,
• Ketokivi M ,
• Hadzi-Pavlovic D ,
• Stanton C ,
• Lewitzka U ,
• Severus E ,
• Müller-Oerlinghausen B ,
• Rogers MP ,
• Li+ plus Investigators
• Manchia M ,
• Michel CA ,
• Auerbach RP
• Altavini CS ,
• Asciutti APR ,
• Solis ACO ,
• Casañas I Comabella C ,
• Riblet NBV ,
• Young-Xu Y ,
• Shortreed SM ,
• Rossom RC ,
• Amsterdam JD ,
• Brunswick DJ
• Gustafsson U ,
• Marangell LB ,
• Bernstein IH ,
• Karanti A ,
• Kardell M ,
• Collins FS ,
• Armstrong K ,
• Concato J ,
• Singer BH ,
• Ziegelstein RC
• ↵ Holmes JH, Beinlich J, Boland MR, et al. Why Is the Electronic Health Record So Challenging for Research and Clinical Care? Methods Inf Med 2021;60(1-02):32-48. doi: 10.1055/s-0041-1731784
• García Rodríguez LA ,
• Cantero OF ,
• Martinotti G ,
• Dell’Osso B ,
• Di Lorenzo G ,
• REAL-ESK Study Group
• Palacios J ,
• DelBello MP ,
• Husain MI ,
• Chaudhry IB ,
• Subramaniapillai M ,
• Jones BDM ,
• Daskalakis ZJ ,
• Carvalho AF ,
• ↵ Goodwin GM, Haddad PM, Ferrier IN, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016;30:495-553. doi: 10.1177/0269881116636545 OpenUrl CrossRef PubMed
• Verdolini N ,
• Del Matto L ,
• Regeer EJ ,
• Hoogendoorn AW ,
• Harris MG ,
• WHO World Mental Health Survey Collaborators

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  
• Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a mood disorder. It causes you to have cycles of extreme mood changes that go beyond normal ups and downs. You will have periods of feeling joyful, energized, and excited (called mania). These are followed by periods of feeling sad and depressed. For this reason, it’s also called manic depression.

Depression affects your body, mood, and thoughts. It also affects how you eat and sleep, think about things, and feel about yourself. It’s not the same as being unhappy or in a blue mood. It’s not a sign of weakness or a condition that can be willed away. Treatment is often needed and is key to recovery.

Bipolar disorder affects equal numbers of men and women. But women tend to have more symptoms of depression than of mania. This disorder often starts in the teens or early adulthood.

What causes bipolar disorder?

Experts don't know what causes bipolar disorder. They agree that many factors seem to play a role. This includes environmental, mental health, and genetic factors.

Bipolar disorder tends to run in families. Researchers are still trying to find genes that may be linked to it.

What are the symptoms of bipolar disorder?

Symptoms may occur a bit differently in each person. The following are the most common symptoms:

Depressive  symptoms may include:

Constant sad, anxious, or empty mood

Loss of interest in things that you once enjoyed, including sex

Feeling restless or irritable

Inability to focus, think, or make decisions

Low energy, tiredness (fatigue), or being slowed down

Having thoughts of death or suicide, wishing to die, or attempting suicide (People with this symptom should get treatment right away.)

Feeling worthless or hopeless

Feeling undue guilt

Changes in eating habits, or eating too much or not enough

Changes in sleep patterns, such as fitful sleep, inability to sleep, waking up very early, or sleeping too much

Headaches, digestive problems, or chronic pain

Manic  symptoms may include:

Very inflated self-esteem

Need for less rest and sleep

Easily distracted or irritable

Racing thoughts

Physical agitation

Risky, aggressive, or destructive behavior

Talking a lot and talking fast

Very high or euphoric feelings (feeling overly happy)

Increased sex drive

Increased energy

Unusual poor judgment. For instance, buying sprees, drug or alcohol abuse, or risky sexual behavior.

Increased denial

Cultural background influences how people understand and react to the symptoms and diagnosis of bipolar disorder. It’s important to remember that when interacting with people and families who are managing this serious mental illness.

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, your healthcare provider will ask about your health history, your symptom history, and your current symptoms. You may have both depressive and manic symptoms to a varying degree.

A diagnosis is made after a careful medical evaluation (to make certain there are no physical problems) and a mental health exam by an experienced mental health provider.

The symptoms of bipolar disorder may look like other mental health conditions.

Always see a healthcare provider for a diagnosis.

How is bipolar disorder treated?

There is no cure for bipolar disorder, but treatment works well for many people. Treatment may include 1 or a combination of the following:

Medicine.  Many different medicines are available for bipolar disorder. But it often takes 4 to 6 weeks for antidepressants to work their best. So it’s important to keep taking the medicine even if it doesn’t seem to be working at first. It’s also important to talk with your healthcare provider before stopping or changing the medicine dose. Some people have to switch medicines or add medicines to get results.

Therapy.  This treatment is most often cognitive-behavioral or interpersonal therapy. It focuses on changing the distorted views you have of yourself and your environment. It works to improve your interpersonal relationship skills. It also helps you find out what your stressors are and how to manage them.

Electroconvulsive therapy (ECT).  This treatment may be used in people with severe, life-threatening depression that has not responded to medicines. A brief electrical current is passed through the brain, triggering a mild seizure. For unknown reasons, this treatment helps restore the normal balance of chemicals in the brain and ease symptoms.

In most cases, you will need consistent, long-term treatment to stabilize the mood swings and provide the support needed to manage bipolar disorder. Life charts can be very helpful to manage the condition. In a life chart, you record daily mood, symptoms, treatments, sleep patterns, and life events. You can share this life chart information with your healthcare provider. The chart can help your healthcare provider see patterns and figure out the best treatment. Family therapy can also be very helpful.

You can also take steps to help yourself. During periods of depression, consider the following:

Get help. If you think you may be depressed, see a healthcare provider right away.

Set realistic goals and don’t take on too much at a time.

Break large tasks into small ones. Set priorities and do what you can as you can.

Try to be with other people and confide in someone. It's usually better than being alone and secretive.

Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.

Get regular exercise.

Expect your mood to get better slowly, not right away. Feeling better takes time.

Eat healthy, well-balanced meals.

Don't drink alcohol or use illegal drugs. These can make depression worse.

It’s best to postpone big decisions until the depression has lifted. Before making big decisions, such as changing jobs or getting married or divorced, discuss it with others who know you well and have a more objective view of your situation.

People don’t snap out of a depression. But with treatment they can feel a little better day by day.

Try to be patient and focus on the positives. It may help replace the negative thinking that is part of the depression, and the negative thoughts will disappear as your depression responds to treatment.

As difficult as it may be, tell your family and friends that you are not feeling well and let them help you.

Key points about bipolar disorder

Bipolar disorder causes cycles of extreme mood changes that go beyond life's regular ups and downs. Treatment is key to recovery.

There is no clear cause of bipolar disorder. Mental health experts think it’s a result of chemical imbalances in the brain. It seems to run in families, but no genes have yet been linked to it.

It causes unusual mood swings. A person will have periods of extreme joy, elevated mood, or irritability (called mania). This switches with periods of depression.

Bipolar disorder may be diagnosed after a careful mental health exam by a mental health provider.

It's most often treated with medicine, therapy, or a combination of both.

You can lead a productive life with ongoing medical care, medicine management, psychological support, family and social support, and a plan for self-care.

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Find a Doctor

Specializing In:

Find a Treatment Center

• Psychiatry and Behavioral Sciences

Find Additional Treatment Centers at:

• Howard County Medical Center
• Sibley Memorial Hospital
• Suburban Hospital

Request an Appointment

Bipolar Relationships: What to Expect

• Patient Care & Health Information
• Diseases & Conditions
• Bipolar disorder

To find out if you have bipolar disorder, your evaluation may include:

• Physical exam. Your healthcare professional may do a physical exam and lab tests to find any medical problems that could be causing your symptoms.
• Mental health assessment. Your healthcare professional may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You also may answer a series of questions. With your permission, family members or close friends may be asked to provide information about your symptoms.
• Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help make the right diagnosis and get you the right treatment.

Diagnosis in children

Although children and teenagers with bipolar disorder are diagnosed with bipolar disorder based on the same criteria used for adults, symptoms in children and teens often have different patterns. These patterns may not fit neatly into diagnostic categories.

Also, children who have bipolar disorder are often diagnosed with other mental health conditions, such as ADHD or behavior problems. This can complicate a diagnosis. These children may need to see a child psychiatrist with experience in bipolar disorder.

• Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your bipolar disorder-related health concerns Start Here

More Information

Bipolar disorder care at Mayo Clinic

• Bipolar disorder in children: Is it possible?

Treatment is best guided by a medical doctor who diagnoses and treats mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. Your care team also may include a psychologist, social worker or psychiatric nurse.

Bipolar disorder is a lifelong condition, with treatment directed to manage symptoms.

Depending on your needs, treatment may include:

• Medicines. Often, you'll need to start taking medicines right away to balance your moods.
• Ongoing treatment. You need to take your medicine for the rest of your life — even when you feel better. If you don't keep taking your medicine, your symptoms could come back, or minor mood changes could turn into full-blown mania or depression.
• Intensive outpatient programs or a program involving a partial stay in a hospital. These programs provide intensive support and counseling that lasts a few hours per day for several weeks to help you get symptoms under control.
• Treatment for alcohol or drug misuse. If you have problems with alcohol or drugs, you'll also need treatment for this misuse. Without this treatment, it can be very hard to manage bipolar disorder.
• A hospital stay. Your healthcare professional may recommend that you stay in a hospital if you're behaving dangerously or thinking about suicide, or you've become detached from reality. Getting mental health treatment at a hospital can keep you calm and safe and stabilize your mood. This is true whether you're having a manic or major depressive episode.

The main treatments for bipolar disorder include medicines and talk therapy, also known as psychotherapy, to control symptoms. Treatment also may include education and support groups.

Several medicines are used to treat bipolar disorder. The types and doses of medicines prescribed are based on your symptoms. Usually you'll need a mood stabilizer or an antipsychotic medicine that functions as a mood stabilizer.

Medicines may include:

• Mood stabilizers. Mood-stabilizing medicines help control manic or hypomanic episodes. They also may help depressive bouts. Examples include lithium (Lithobid), valproic acid, divalproex sodium (Depakote, Depakote ER), carbamazepine (Tegretol, Tegretol XR, Equetro, others) and lamotrigine (Lamictal).
• Antipsychotics. Antipsychotic medicines have mood-stabilizing properties, and many have been approved by the U.S. Food and Drug Administration for manic or hypomanic episodes or maintenance treatment. Antipsychotics may be used by themselves or with mood stabilizers. Examples of antipsychotic drugs are olanzapine (Zyprexa, Lybalvi, others), risperidone (Risperdal), quetiapine (Seroquel, Seroquel XR), aripiprazole (Abilify, Aristada, others), ziprasidone (Geodon), lurasidone (Latuda), asenapine (Saphris), lumateperone (Caplyta) and cariprazine (Vraylar).
• Antidepressants. Your healthcare professional may cautiously add an antidepressant to manage depression. But an antidepressant sometimes can cause a manic or hypomanic episode. Antidepressants should be prescribed along with a mood stabilizer or antipsychotic medicine.
• Antidepressant-antipsychotic combination. The medicine Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It's approved to treat bipolar depression.
• Antianxiety medicines. Benzodiazepines may ease anxiety and make you sleep better. But they're usually used on a short-term basis as they can be misused when taken for a long time.

Finding the right medicine

Finding the right medicine for you likely will take some trial and error. If one doesn't work well for you, there may be others to try. Sometimes, two or three medicines are used at the same time. This process requires patience, as some medicines need weeks to months to take full effect. Periodic or routine blood monitoring may be needed for certain medicines.

Generally, your healthcare professional changes only one medicine at a time. This is done to find out which medicines make your symptoms better with the least bothersome side effects. Your healthcare professional also may need to change your medicines as your symptoms change.

Side effects

You may have side effects with medicines. Some side effects may get better as your healthcare professional adjusts the dose and your body gets used to the medicines. Talk to your healthcare professional or mental health professional to find a medication that can be effective and has minimal side effects.

Don't make changes or stop taking your medicines. If you stop your medicine, you may have withdrawal effects or your symptoms may get worse or return. You may become very depressed, think about suicide, or go into a manic or hypomanic episode. If you think you need to make a change, call your healthcare professional.

Medicines and pregnancy

A few medicines for bipolar disorder can be linked to birth defects. These medicines may pass through breast milk to the baby. Every medicine is different, so you should talk with your prescriber. Valproic acid and divalproex sodium have a specific warning that they are to be avoided when pregnant. Carbamazepine, a mood stabilizer, may make certain birth control medicines less effective.

If possible, talk with your healthcare professional about treatment options before you become pregnant. If you're taking medicine to treat your bipolar disorder and think you may be pregnant, talk to your healthcare professional right away.

Talk therapy

Talk therapy, also called psychotherapy, is a vital part of bipolar disorder treatment. This treatment can be provided in individual, family or group settings.

Several types of therapy may help, including:

• Interpersonal and social rhythm therapy. This therapy focuses on stabilizing daily rhythms, including sleeping, waking and eating. A consistent routine helps manage moods. A daily routine for sleep, diet and exercise may help people with bipolar disorder.
• Cognitive behavioral therapy (CBT). This therapy focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive beliefs and behaviors. CBT can help find what triggers your bipolar episodes. You also learn effective ways to manage stress and cope with upsetting situations.
• Psychoeducation. Learning about bipolar disorder, also known as psychoeducation, can help you and your loved ones know more about the condition. Knowing what's going on can help you get the best support, find issues, make a plan to stop symptoms from returning and stick with treatment.
• Family-focused therapy. Family support and communication can help you stay with your treatment plan. It also can help you and your loved ones see and manage warning signs of mood swings.

Other treatment options

Depending on your needs, your health professional may add other treatments to your depression therapy, such as:

• Electroconvulsive therapy, also known as ECT. During ECT , electrical currents pass through the brain, causing a brief seizure. ECT seems to change brain chemistry, which can reverse symptoms of certain mental illnesses. ECT may be an option to treat bipolar disorder if you don't get better with medicines, can't take antidepressants for health reasons such as pregnancy or are at high risk of attempting suicide.
• Repetitive transcranial magnetic stimulation, also known as rTMS. During a series of rTMS treatment sessions, magnetic waves stimulate the brain to reduce depression. This treatment is being studied as an option for people with bipolar disorder who haven't responded to antidepressants. It is not as powerful as ECT .
• Ketamine. Ketamine also is being studied as a possible treatment for bipolar depression. Limited research suggests that ketamine could be a promising short-term treatment that's generally well tolerated. It's been shown to ease symptoms of depression and reduce thoughts of suicide — all within two weeks. But the effects of ketamine include dissociative symptoms during the treatment. Patients may feel groggy, spacey, out of it, or disconnected with reality and surroundings. But some patients also report thinking more clearly and feeling more connected with others. More studies are needed to determine the role of ketamine in the long-term treatment of bipolar disorder and create guidelines for its use.

Treatment in children and teenagers

Generally, healthcare professionals decide on treatments for children and teenagers on a case-by-case basis, depending on symptoms, medicine side effects and other issues.

Generally, treatment includes:

• Medicines. There's less research on the safety and effectiveness of bipolar medicines in children than in adults, so healthcare professionals often decide on treatment based on adult research. Children and teens with bipolar disorder often are prescribed the same types of medicines as adults. That's because children have taken part in fewer studies. But children can respond differently to medicines than adults. Some children may need to try more than one medicine for the best results.
• Talk therapy. Initial and long-term therapy can help keep symptoms from returning. Talk therapy, also known as psychotherapy, can help children and teens manage their routines, cope better, handle learning difficulties, make social problems better, and make family bonds and communication stronger. If needed, talk therapy can treat alcohol or drug misuse problems common in older children and teens with bipolar disorder.
• Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's age, the situation and appropriate cultural behavior. Knowing more about bipolar disorder also can help you support your child.
• Support. Teachers and school counselors can help find services. They and family and friends can encourage success.
• Bipolar medications and weight gain
• Bipolar treatment: I vs. II
• Cognitive behavioral therapy
• Electroconvulsive therapy (ECT)
• Psychotherapy
• Transcranial magnetic stimulation

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

You'll probably need to make lifestyle changes to stop cycles of behavior that make your bipolar disorder worse. Here are some steps to take:

• Quit drinking or using street drugs. One of the biggest concerns with bipolar disorder is the negative results of risk-taking behavior and drug or alcohol misuse. Get help if you have trouble quitting on your own.
• Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.
• Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Eat a healthy diet. If you take lithium, talk with your healthcare professional about how much fluid and salt you should take in. If you have trouble sleeping, talk to your healthcare professional or mental health professional about what you can do.
• Check first before taking other medicines. Call your healthcare professional or mental health professional before you take medicines that another health professional prescribes or any supplements or medicines available without a prescription. For example, when taking lithium (Lithobid), you should avoid regularly using ibuprofen (Advil, Motrin IB, others). Sometimes other medicines cause depression or mania. Or these medicines may not work well with the medicines you take for bipolar disorder.
• Think about keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be changed.

Alternative medicine

There isn't much research on alternative or complementary medicine — sometimes called integrative medicine — and bipolar disorder. Most studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder.

If you choose to use alternative or complementary medicine in addition to the treatment your healthcare professional recommends, take some precautions first:

• Don't stop taking your prescribed medicines or skip therapy sessions. Alternative or complementary medicine does not replace regular medical care to treat bipolar disorder.
• Be honest with your healthcare professional and mental health professional. Tell them which alternative or complementary treatments you use or would like to try.
• Beware of potential dangers. Alternative and complementary products aren't regulated like prescription drugs. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your healthcare professional or mental health professional about the risks, including how these treatments might cause problems with the medicines you already take.

Coping and support

Coping with bipolar disorder can be hard. Here are some ways to help:

• Learn about bipolar disorder. Learning about your condition can motivate you to stick to your treatment plan and know when your mood changes. Help your family and friends learn about what you're going through.
• Focus on your goals. Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind and reminding yourself that you can work to fix damaged relationships and other problems your mood swings cause.
• Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share what's going on with you.
• Find healthy outlets. Explore healthy ways to focus your energy, such as hobbies, exercise and recreational activities.
• Learn ways to relax and manage stress. Yoga, massage, deep breathing, meditation or other relaxation techniques can help.

Preparing for your appointment

You may start by seeing your primary care professional or a psychiatrist. You may want to take a family member or friend along to your appointment, if possible, for support and to help remember information.

What you can do

Before your appointment, make a list of:

• Any symptoms you've had, including any that may seem unrelated to the appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbs or other supplements you're taking, and the doses.
• Questions to ask your healthcare professional.

Questions to ask your healthcare professional may include:

• Do I have bipolar disorder?
• Are there any other possible causes for my symptoms?
• What kinds of tests will I need?
• Which treatments do you recommend?
• What side effects can treatment cause?
• What are the alternatives to the treatment that you suggest?
• I have other health conditions. How can I best manage these conditions together?
• Should I see a psychiatrist or another mental health professional?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional likely will ask you several questions:

• When did you or your loved ones first begin noticing your symptoms?
• How often do your moods change?
• Do you think about suicide when you're feeling down?
• Do your symptoms get in the way of daily life or how well you get along with others?
• Do you have any blood relatives with bipolar disorder or depression?
• What other mental or physical health conditions do you have?
• Do you drink alcohol, smoke or chew tobacco, or use street drugs?
• How much do you sleep at night? Does the amount of sleep you get change over time?
• Do you sometimes take risks that you wouldn't usually take, such as take part in unsafe sex or make financial decisions that are unwise or impulsive?
• What, if anything, seems to make your symptoms better or worse?

Your healthcare professional or mental health professional will ask more questions based on your responses, symptoms and needs. Getting ready for these questions will help you make the most of your time at your appointment.

• Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Jan. 15, 2024.
• Bipolar disorder. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/mental-health/bipolar. Accessed Jan. 15, 2024.
• Roberts LW, et al. Bipolar and related disorders. In: The American Psychiatric Association Publishing Textbook of Psychiatry. 7th ed. American Psychiatric Publishing; 2019. https://psychiatryonline.org. Accessed Jan. 15, 2024.
• Kellerman RD, et al. Depressive, bipolar, and related mood disorders. In: Conn's Current Therapy 2024. Elsevier; 2024. https://clinicalkey.com. Accessed Jan. 15, 2024.
• Suppes T. Bipolar disorder in adults: Clinical features. https://www.uptodate.com/contents/search. Accessed Jan. 15, 2024.
• Miklowitz DJ, et al. Adjunctive psychotherapy for bipolar disorder: A systemic review and component network meta-analysis. JAMA Psychiatry. 2020; doi:10.1001/jamapsychiatry.2020.2993.
• Bipolar disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder. Accessed Jan. 15, 2024.
• Bipolar disorder in children and teens. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens. Accessed Jan. 15, 2024.
• Bipolar disorder. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder. Accessed Jan. 15, 2024.
• Yalin N, et al. Pharmacological treatment of bipolar depression: What are the current and emerging options? Neuropsychiatric Disease and Treatment. 2020; doi:10.2147/NDT.S245166.
• Suppes T. Bipolar disorder in adults: Assessment and diagnosis. https://www.uptodate.com/contents/search. Accessed Jan. 15, 2024.
• Shelton RC, et al. Bipolar major depression in adults: Choosing treatment. Accessed Jan. 15, 2024.
• 988 Suicide & Crisis Lifeline. Substance Abuse and Mental Health Services Administration. https://988lifeline.org/. Accessed Jan. 15, 2024.
• Managing stress. National Alliance on Mental Illness. https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress. Accessed Jan. 15, 2024.
• Axelson D. Pediatric bipolar disorder: Overview of choosing treatment. https://www.uptodate.com/contents/search. Accessed Jan. 15, 2024.
• Markdante KJ, et al., eds. Depression and bipolar disorders. In: Nelson Essentials of Pediatrics. 9th ed. Elsevier; 2023. https://www.clinicalkey.com/. Accessed Jan. 15, 2024.
• Kung S (expert opinion). Mayo Clinic. April 8, 2024.
• Jawad MY, et al. The role of ketamine in the treatment of bipolar depression: A scoping review. Brain Sciences. 2023; doi:10.3390/brainsci13060909.
• Dissociative disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Jan. 17, 2024.
• Leung JG (expert opinion). Mayo Clinic. June 18, 2024.
• Bipolar disorder and alcoholism: Are they related?

Associated Procedures

News from mayo clinic.

• Science Saturday: Could antidepressants cause treatment-emergent mania? Feb. 25, 2023, 12:00 p.m. CDT

Products & Services

• A Book: Mayo Clinic Family Health Book
• Newsletter: Mayo Clinic Health Letter — Digital Edition

Mayo Clinic in Rochester, Minnesota, has been recognized as a highly performing Psychiatry hospital for 2024-2025 by U.S. News & World Report.

• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Help transform healthcare

Your donation can make a difference in the future of healthcare. Give now to support Mayo Clinic's research.

Home — Essay Samples — Nursing & Health — Bipolar Disorder — Treatment, Symptoms, and Prevention Strategies for Bipolar Disorder

Treatment, Symptoms, and Prevention Strategies for Bipolar Disorder

• Categories: Bipolar Disorder

About this sample

Words: 585 |

Published: Jan 30, 2024

Words: 585 | Page: 1 | 3 min read

Table of contents

Introduction, treatment options, medication management, psychotherapy, manic episodes, depressive episodes, prevention strategies, early identification and intervention, lifestyle changes, education and awareness.

• “Bipolar Disorder”. National Institute of Mental Health , 2021, https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
• “Bipolar Disorder”. Mayo Clinic, 2021, https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.
• McIntyre, Roger S., et al. “The Effectiveness and Safety of Long-term Medications for Bipolar Disorder: A Systematic Review and Meta-Analysis for the UK National Institute for Health and Care Excellence.” The Lancet Psychiatry, vol. 3, no. 5, 2016, pp. 405-415., doi:10.1016/s2215-0366(15)00597-5.
• “Bipolar Disorder and Therapy”. GoodTherapy, 2018, https://www.goodtherapy.org/learn-about-therapy/issues/bipolar-disorder.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

• Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

1 pages / 482 words

1 pages / 614 words

3 pages / 2970 words

3 pages / 1358 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Bipolar Disorder

Ian Gallagher, a central character in the hit TV show Shameless, is known for his complex personality traits, including mania and manmas. These aspects of Ian's character have garnered significant attention from viewers and [...]

Bipolar disorder, also known as 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. This essay will explore various aspects of [...]

Psychological disorders, also known as mental disorders, are conditions that affect a person's thinking, feeling, behavior, or mood. These disorders can be debilitating and have a significant impact on an individual's life. In [...]

Bipolar disorder, also known as manic-depressive disorder, is a mental illness that affects an individual's mood, behavior, thoughts, and perceptions, leading to abnormal shifts in energy, mood, and functioning (Huxley, 2002). [...]

Mood is the changing expression of emotion and can be described as a spectrum describing how the various expressions of human happiness and sadness may be experienced. The outermost ends of this spectrum highlight two states, [...]

Stress is the unpleasant feedback people have to extreme pressure or other types of order placed on them. Stress as a result of work is not an illness but when it is extended, or its intensity prolonged; it can lead to some [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Transforming the understanding and treatment of mental illnesses.

Información en español

Celebrating 75 Years! Learn More >>

• Health Topics
• Brochures and Fact Sheets
• Help for Mental Illnesses
• Clinical Trials

Bipolar Disorder

What is bipolar disorder.

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult 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  is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical 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. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
• Bipolar II disorder  is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
• Cyclothymic disorder  (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. 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.

What are the signs and symptoms of bipolar disorder?

People with bipolar disorder experience periods of unusually intense emotion and changes in sleep patterns and activity levels, and engage in behaviors that are out of character for them—often without recognizing their likely harmful or undesirable effects. These distinct periods are called mood episodes. Mood episodes are very different from the person’s usual moods and behaviors. 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.

Sometimes people have both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. During an episode with mixed features, people 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 II disorder 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 changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Receiving the right diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a health care provider is the first step. The health care provider can complete a physical exam and other necessary medical tests to rule out other possible causes. 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.

Find  tips to help prepare for and get the most out of your visit with your health care provider.

Bipolar disorder and other conditions

Many people with bipolar disorder also have other mental disorders or conditions such as  anxiety disorders ,  attention-deficit/hyperactivity disorder (ADHD) ,  misuse of drugs or alcohol , or  eating disorders.  Sometimes people who have severe manic or depressive episodes also have symptoms of  psychosis , which may include hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example, someone having psychotic symptoms during a depressive episode may falsely believe they are financially ruined, while someone having psychotic symptoms during a manic episode may falsely believe they are famous or have special powers.

Looking at a person’s symptoms over the course of the illness and examining their family history can help a health care provider determine whether the person has bipolar disorder along with another disorder.

What are the risk factors for bipolar disorder?

Researchers are studying possible causes of bipolar disorder. Most agree that there are many factors that are likely to contribute to a person’s chance of having the disorder.

Brain structure and functioning:  Some studies show that the brains of people with bipolar disorder differ in certain ways from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these brain differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics:  Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene causes the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

How is bipolar disorder treated?

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called talk therapy.

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Certain medications can help manage symptoms of bipolar disorder. Some people may need to try different medications and work with their health care provider to find the medications that work best.

The most common types of medications that health care providers prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium or valproate can help prevent mood episodes or reduce their severity. Lithium also can decrease the risk of suicide. Health care providers may include medications that target sleep or anxiety as part of the treatment plan.

Although bipolar depression is often treated with antidepressant medication, a mood stabilizer must be taken as well—taking an antidepressant without a mood stabilizer can trigger a manic episode or rapid cycling in a person with bipolar disorder.

Because people with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania, it is important for health care providers to take a careful medical history to ensure that bipolar disorder is not mistaken for depression.

People taking medication should:

• Talk with their health care provider to understand the risks and benefits of the medication.
• Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
• Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
• Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

It is important to talk to a health care provider before stopping a prescribed medication. Stopping a medication suddenly may lead symptoms to worsen or come back. You can find basic information about medications on  NIMH's medications webpage . Read the latest medication warnings, patient medication guides, and information on newly approved medications on the  Food and Drug Administration (FDA) website. 

Psychotherapy

Psychotherapy, also called talk therapy, can be an effective part of treatment for people with bipolar disorder. Psychotherapy is a term for treatment techniques that aim to help people identify and change troubling emotions, thoughts, and behaviors. This type of therapy can provide support, education, and guidance to people with bipolar disorder and their families.

Cognitive behavioral therapy (CBT) is an important treatment for depression, and CBT adapted for the treatment of insomnia can be especially helpful as part of treatment for bipolar depression.

Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy.

Learn more about the  various types of psychotherapies .

Other treatment options

Some people may find other treatments helpful in managing their bipolar symptoms:

• Electroconvulsive therapy (ECT)  is a brain stimulation procedure that can help relieve severe symptoms of bipolar disorder. Health care providers may consider ECT when a person’s illness has not improved after other treatments, or in cases that require rapid response, such as with people who have a high suicide risk or catatonia (a state of unresponsiveness).
• Repetitive transcranial magnetic stimulation (rTMS)  is a type of brain stimulation that uses magnetic waves to relieve depression over a series of treatment sessions. Although not as powerful as ECT, rTMS does not require general anesthesia and has a low risk of negative effects on memory and thinking.
• Light therapy  is the best evidence-based treatment for  seasonal affective disorder (SAD) , and many people with bipolar disorder experience seasonal worsening of depression or SAD in the winter. Light therapy may also be used to treat lesser forms of seasonal worsening of bipolar depression.

Unlike specific psychotherapy and medication treatments that are scientifically proven to improve bipolar disorder symptoms, complementary health approaches for bipolar disorder, such as natural products, are not based on current knowledge or evidence. Learn more on the  National Center for Complementary and Integrative Health website  .

Finding treatment

• A family health care provider is a good resource and can be the first stop in searching for help. Find tips to help prepare for and get the most out of your visit .
• To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), visit the SAMHSA online treatment locator  , or text your ZIP code to 435748.
• Learn more about finding help on the NIMH website.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline   at 988 or chat at 988lifeline.org   . In life-threatening situations, call 911.

Coping with bipolar disorder

Living with bipolar disorder can be challenging, but there are ways to help make it easier.

• Work with a health care provider to develop a treatment plan and stick with it. Treatment is the best way to start feeling better.
• Follow the treatment plan as directed. Work with a health care provider to adjust the plan, as needed.
• Structure your activities. Try to have a routine for eating, sleeping, and exercising.
• Try regular, vigorous exercise like jogging, swimming, or bicycling, which can help with depression and anxiety, promote better sleep, and support your heart and brain health.
• Track your moods, activities, and overall health and well-being to help recognize your mood swings.
• Ask trusted friends and family members for help in keeping up with your treatment plan.
• Be patient. Improvement takes time. Staying connected with sources of social support can help.

Long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

How can I find a clinical trial for bipolar disorder?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage : Information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on Bipolar Disorder  : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
• Join a Study: Bipolar Disorder – Adults : List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about bipolar disorder?

Free brochures and shareable resources.

• Bipolar Disorder : A brochure on bipolar disorder that offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Bipolar Disorder in Children and Teens : A brochure on bipolar disorder in children and teens that offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Bipolar Disorder in Teens and Young Adults: Know the Signs : An infographic presenting common signs and symptoms of bipolar disorder in teens and young adults. Also available  en español .
• Shareable Resources on Bipolar Disorder :  Digital resources, including graphics and messages, to help support bipolar disorder awareness and education.
• NIMH Experts Discuss Bipolar Disorder in Adults : Learn the signs and symptoms, risk factors, treatments of bipolar disorder, and the latest NIMH-supported research in this area.
• Mental Health Minute: Bipolar Disorder in Adults : A minute-long video to learn about bipolar disorder in adults.
• NIMH Expert Discusses Bipolar Disorder in Adolescents and Young Adults :  A video with an expert who explains the signs, symptoms, and treatments of bipolar disorder.

Research and Statistics

• Journal Articles   : This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Bipolar Disorder Statistics : An NIMH webpage that provides information on the prevalence of bipolar disorder among adults and adolescents.

Last Reviewed: February 2024

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

Evidence-Based Psychotherapies for Bipolar Disorder

Information & authors, metrics & citations, view options, clinical context, rationale for adjunctive psychotherapy in bipolar disorder, treatment strategies and evidence, psychoeducation.

Peer Support

Questions and controversy, recommendations, unmet needs and future directions, information, published in.

• Mood Disorders-Bipolar
• Psychotherapy
• cognitive-behavioral therapy
• interpersonal and social rhythm therapy
• psychoeducation

Funding Information

Export citations.

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu .

To download the citation to this article, select your reference manager software.

There are no citations for this item

View options

Login options.

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Purchase Options

Purchase this article to access the full text.

PPV Articles - Focus

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR ® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Share article link

Copying failed.

PREVIOUS ARTICLE

Next article, request username.

Can't sign in? Forgot your username? Enter your email address below and we will send you your username

If the address matches an existing account you will receive an email with instructions to retrieve your username

Create a new account

Change password, password changed successfully.

Your password has been changed

Reset password

Can't sign in? Forgot your password?

Enter your email address below and we will send you the reset instructions

If the address matches an existing account you will receive an email with instructions to reset your password.

Your Phone has been verified

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use , this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

• Undergraduate
• High School
• Architecture
• American History
• Asian History
• Antique Literature
• American Literature
• Asian Literature
• Classic English Literature
• World Literature
• Creative Writing
• Linguistics
• Criminal Justice
• Legal Issues
• Anthropology
• Archaeology
• Political Science
• World Affairs
• African-American Studies
• East European Studies
• Latin-American Studies
• Native-American Studies
• West European Studies
• Family and Consumer Science
• Social Issues
• Women and Gender Studies
• Social Work
• Natural Sciences
• Pharmacology
• Earth science
• Agriculture
• Agricultural Studies
• Computer Science
• IT Management
• Mathematics
• Investments
• Engineering and Technology
• Engineering
• Aeronautics
• Medicine and Health
• Alternative Medicine
• Communications and Media
• Advertising
• Communication Strategies
• Public Relations
• Educational Theories
• Teacher's Career
• Chicago/Turabian
• Company Analysis
• Education Theories
• Shakespeare
• Canadian Studies
• Food Safety
• Relation of Global Warming and Extreme Weather Condition
• Movie Review
• Admission Essay
• Annotated Bibliography
• Application Essay
• Article Critique
• Article Review
• Article Writing
• Book Review
• Business Plan
• Business Proposal
• Capstone Project
• Cover Letter
• Creative Essay
• Dissertation
• Dissertation - Abstract
• Dissertation - Conclusion
• Dissertation - Discussion
• Dissertation - Hypothesis
• Dissertation - Introduction
• Dissertation - Literature
• Dissertation - Methodology
• Dissertation - Results
• GCSE Coursework
• Grant Proposal
• Marketing Plan
• Multiple Choice Quiz
• Personal Statement
• Power Point Presentation
• Power Point Presentation With Speaker Notes
• Questionnaire
• Reaction Paper
• Research Paper
• Research Proposal
• SWOT analysis

Thesis Paper

• Online Quiz
• Literature Review
• Movie Analysis
• Statistics problem
• Math Problem
• All papers examples
• How It Works
• Money Back Policy
• Terms of Use
• Privacy Policy
• We Are Hiring

Bipolar Disorder: Causes, Symptoms, and Treatment, Essay Example

Pages: 6

Words: 1575

Hire a Writer for Custom Essay

Use 10% Off Discount: "custom10" in 1 Click 👇

You are free to use it as an inspiration or a source for your own work.

Bipolar Disorder is a mental disorder characterized by severe elevations of mood and fluctuations in activity and energy levels. Bipolar Disorder affects the ability of the victim to perform day-to-day activities. The mood swings caused by the disorder are classified by severity and the accompaniment of psychosis.  When the moods of the victim are incredibly high, the condition is classified as mania. During hypomania, the individual gets extremely happy and energetic. The effects mostly affect behavior, judgment, activity, sleep and the individual’s ability to think usually. During manic, the victim lacks sleep and may often avoid eye contact with other people. The victim may end up harming themselves and in some extreme cases, committing suicide. The causes of Bipolar Disorder have never been well understood. However, it is believed that social, genetic and environmental factors play a role. Substance abuse and anxiety disorders are commonly associated with the condition. This paper expounds on the causes, symptoms, risk factors and prevention techniques of the disorder.

Bipolar Disorder

There are three main categories of Bipolar Disorder. The first category is Bipolar I Disorder. Bipolar I Disorder is characterized by manic episodes that occur and cause severe symptoms to the victim. Manic episodes in Bipolar I Disorder last for a minimum of seven days. If the episode was depressive, it might last for a minimum of fourteen days. The severity of the conditions requires the victim to be hospitalized immediately. For Bipolar II Disorder, the individual may suffer more hypomanic episodes as opposed to the long manic episodes of Bipolar I Disorder. The third category is cyclothymia characterized by numerous periods of hypomania accompanied by depressive symptoms that last for a minimum of two years. When cyclothymia occurs in children and adolescents, the depressive symptoms may last for at most one year. Apart from the three main categories, there are other types of bipolar disorder whose symptoms which are not very common.

Possible causes of Bipolar Disorder

The main cause of Bipolar Disorder is still poorly understood. However, researchers have associated it with a combination of environmental, genetic and biochemical factors that affect either the norepinephrine, serotonin or dopamine which are the main neurotransmitters of the brain (Nordqvist, 2017).

Other researchers have associated Bipolar Disorder with genetic factors related to other disorders such as epilepsy and schizophrenia. Some chromosomes in the genes of the victims have also been associated with the disorder with no clarity whether the disorder is a variation another condition or independent. The condition is also triggered by social factors such as emotional trauma and stressful life events.

Risk Factors associated with Bipolar Disorder

There are several factors considered to trigger the occurrence of Bipolar Disorder in an individual. These factors include:

Age. Bipolar disorder commonly attacks people between the fifteen and thirty years of age. Although it may attack a person on any age, Bipolar Disorder is not as common in children and old people as it is in the people at the age of about twenty-five years. When it occurs to old people, the condition often accompanies neurological disorders such as stroke.

Gender. The cyclothymia type of Bipolar disorder has higher incidences in women than men. Cases of mixed states and rapid cycling associated with the disorder are also more common in women (Merikangas K.R, 2011) than in men. Similarly, men suffering from the condition tend to be victims of drug and substance abuse than it happens with women.

Family history. People from families with cases of Bipolar and psychiatric disorders such as major depression, ADHD, anxiety disorders, schizoaffective disorder, and schizophrenia tend to be more vulnerable to the condition than others.

Signs and symptoms of Bipolar Disorder

Unique symptoms characterize each of the three main categories of Bipolar Disorder. The symptoms, however, remain the same regardless of the intensity of the disorder as explained below.

Bipolar I disorder. For this category, the victim is subject to a manic episode commonly followed or preceded by a major depressive episode or hypomania. In extreme cases, the individual may experience psychosis as a result of prolonged episodes of mania. The individuals, therefore, may have abnormal behaviors such as speaking rapidly in uncontrollable tone, having no attention and racing thoughts. These behaviors can extend to hypersexuality, agitation and urge to perform activities that are goal oriented. The individual ends up not working or socializing as expected. If the condition is not noted early, it may last for periods not less than six months. Due to the changes in the conventional thinking of the victim, they may have a decrease in the need to sleep, excessive speaking and making judgments that are impaired. The victims may also express violent behaviors after they experienced some appetite changes, psychomotor, mood changes or sleep disturbances

Bipolar II disorder. For this category, the individual experiences a hypomanic episode accompanied by a depressive period. Individuals with Bipolar II Disorder do not encounter manic episodes. Individuals with hypomanic episodes suffer similar disabilities like those in manic episodes. However, a hypomanic person can still socialize and work but with reduced psychotic capabilities such as hallucinations and delusions. The victim, therefore, does not need hospitalization like it would be for one with a manic episode. The person with hypomania usually has increased functioning capabilities which at times are thought to be defensive mechanisms practiced by the victims in opposition to depression. The conditions hardly advance to full-fledged manic episodes. Visible signs of hypomania include poor judgment by some of the victims and increased activity.

Persons with hypomania may often feel good due to the forgetfulness of actions they do to those around them. Some explain the experience as stressing and painful and may deny any recognition of their mood swings by friend and family. The event is not problematic unless it is accompanied by depression. When the victim experiences mercurial, volatile or uncontrollable mood swings for a long time, hospitalization would be essential to avoid any effects that would be because of the activities governed by the condition.

Cyclothymic disorder. Individuals with cyclothymic experience less severe depressions accompanied by hypomania. Individuals with depressions portray hopelessness, too much sleep, excessive and unfit guilt, little or no interest in activities which they previously enjoyed, quick excitability or excessive sadness. The victims may also feel fatigued, worthless, self-loathed, with no appetite or have suicidal thoughts. If the victim is not hospitalized, they may develop severe bipolar disorder characterized by hallucinations and delusions. The condition commonly lasts for about two weeks and may lead to suicide if the individual is not carefully monitored.

Therapies and treatment

Bipolar disorder treatment involves administration of medicine and psychotherapy. Since the disorder is lifelong, the treatment may be continuous over a long period. The individual may at times need to try several medications before getting their most suitable one. The medications administered to Bipolar Disorder patients can be an antidepressant, atypical antipsychotic or a mood stabilizer. Typical examples include Lithium and Lamotrigine. Lithium is used to reduce the risk of the individual committing self-harm or suicide. Lamotrigine is used to treat bipolar depression especially when it is severe.

Psychotherapy is often done in combination with the administered medication. Psychotherapy is used to provide guidance, education, and support to the victim and their close associates who may monitor them. Some of the psychotherapy treatments include family-focused therapy, psychoeducation, cognitive behavioral therapy and interpersonal & social rhythm therapy (NIMH, 2017).

Prevention and Control

No way has been proved effective in the prevention of the bipolar disorder. However, it is essential to seek treatment and further guidance as soon as the disorder is suspected. When the condition is treated in its early stages, it is not common for it to get to critical stages (Kessler R.C., 2005). Even so, some strategies can help prevent the symptoms experienced from getting to their full-fledged levels.

Paying attention to suspected signs. If a pattern in the episodes or something triggering them is noticed, it is advisable to seek medical advice since the symptoms may be prevented from getting to full-blown levels.

Avoid drugs substance abuse. The abuse of drugs such as alcohol may impair the symptoms and at times even bring them back after they have been controlled.

Taking medications as directed. Individuals with Bipolar Disorder may be subjected to medication all they life. If they feel like the symptoms have disappeared, they may be tempted to stop the medication which may worsen effects or cause some seized symptoms to return.

Individuals suffering from any of the three main categories of Bipolar Disorder may experience declined cognitive functioning before the first hypomanic or manic episode, and the dysfunction may end up being permanent. During acute phases, the impairment may get more severe causing impaired psychosocial functioning when the episodes occur even with fully remitted moods. People with Bipolar I Disorder may have a higher degree of impairment compared to those with Bipolar II Disorder. The number of manic episodes experienced before proportional to the degree of impairment. It is therefore advisable to seek intervention as soon as an individual is suspected to have the disorder so that the cognitive impairment progression can be controlled. The overall effect of the condition will be easily managed when noted in its early stages.

(NIMH), T. N. (2017, October 12). Bipolar Disorder . Retrieved from Health and Education: https://www.nimh.nih.gov/index.shtml

Kessler R.C., D. O. (2005). Prevalence and treatment of mental disorders. N Engl J Med , 2516-2521.

Merikangas K.R, J. R.-M.-V. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 241-51 , 4-8.

Nordqvist, C. (2017, July 7). Bipolar disorder: Causes, symptoms, and treatment. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/37010.php

Stuck with your Essay?

Get in touch with one of our experts for instant help!

Henry V Movie Comparison, Thesis Paper Example

Fairness Criteria, Essay Example

Time is precious

don’t waste it!

Plagiarism-free guarantee

Privacy guarantee

Secure checkout

Money back guarantee

Related Essay Samples & Examples

Voting as a civic responsibility, essay example.

Pages: 1

Words: 287

Utilitarianism and Its Applications, Essay Example

Words: 356

The Age-Related Changes of the Older Person, Essay Example

Pages: 2

Words: 448

The Problems ESOL Teachers Face, Essay Example

Pages: 8

Words: 2293

Should English Be the Primary Language? Essay Example

Pages: 4

Words: 999

The Term “Social Construction of Reality”, Essay Example

Words: 371

• Bipolar Disorder

Could Your Depression Be Bipolar Disorder?

Bipolar ii disorder often goes undiagnosed for years..

Posted August 19, 2024 | Reviewed by Michelle Quirk

• What Is Bipolar Disorder?
• Take our Bipolar Disorder Test
• Find counselling to treat bipolar disorder
• Unlike bipolar I, bipolar II disorder presents with more subtle highs making it more tricky to identify.
• Delay in diagnosis can lead to time lost to depression and other symptoms.
• A significant portion of individuals with treatment-resistant depression may, in fact, have bipolar disorder.

Imagine wading through severe depression for years, taking medication after medication, with no relief. Now, envision discovering that what you were facing was not major depression but bipolar disorder . Sara Schley shares her journey through these woods in her book Brainstorm: From Broken to Blessed on the Bipolar Spectrum . Once given the correct diagnosis, Sara recovered. She shares her journey to raise awareness of bipolar II disorder, a sometimes unrecognized source of severe depression.

Is Bipolar II Disorder Underdiagnosed?

Bipolar disorder is a mood disorder associated with highs and lows. In the case of bipolar II disorder, those highs do not reach the " manic " level of bipolar I disorder. Still, the lows can be devastating. As this version of bipolar disorder is not usually associated with the soaring symptoms of bipolar I, the hypomanias in bipolar II are trickier to detect.

A meta-analysis found that bipolar disorder may be, on average, diagnosed five years after onset (Scott et al., 2022). For those living with bipolar II disorder, the delay is likely longer. The time between bipolar disorder's beginnings and recognition can potentially represent years of suffering and damage to one's life course.

In particular, a sizable proportion of those struggling against treatment-resistant depression are later diagnosed with bipolar disorder.

The marked depressions of bipolar II often spur individuals to reach out for help. Yet, the subtle highs usually feel similar to health with an improved mood and productivity . Hypomania can sometimes be a welcome respite after depression, and clients often are not aware that this could be part of an illness. Mental health professionals might also neglect to rule out hypomania adequately.

Treating Bipolar Disorder

Yet, the identification of bipolar disorder is critical. Medication and psychotherapy treatment for bipolar disorder differs quite a bit from major depression. Some medications utilized to treat major depression can trigger negative mood shifts in individuals with bipolar disorder (Gomes et al., 2022). In addition, many of the medications that can be effective in interrupting the bipolar cycle are not used for other kinds of depression.

Repeated trials of medications that are not effective are exhausting and can wear at a person's sense of hope.

From a psychotherapy standpoint, Interpersonal Social Rhythm Therapy (ISPRT) is a psychotherapy that has been shown to benefit individuals with bipolar disorder (Steardo et al., 2020). ISPRT focuses on regulating sleep patterns and improving relationships. This intervention is rarely offered to those with major depression.

It is essential that providers routinely rule out bipolar disorder when approached by clients presenting with depression. Utilizing instruments like the Bipolarity Index may also help predict individuals with depression who are at risk of developing bipolar disorder (Aiken et al., 2015).

With appropriate identification and intervention, many living with bipolar disorder recover.

Aiken, C. B., Weisler, R. H., & Sachs, G. S. (2015). The Bipolarity Index: a clinician-rated measure of diagnostic confidence. Journal of Affective Disorders , 177 , 59–64.

Gomes, F. A., Cerqueira, R. O., Lee, Y., Mansur, R. B., Kapczinski, F., McIntyre, R. S., ... & Brietzke, E. (2022). What not to use in bipolar disorders: A systematic review of non-recommended treatments in clinical practice guidelines. Journal of Affective Disorders , 298 , 565–576.

Schley, S. (2022). Brainstorm: From Broken to Blessed on the Bipolar Spectrum . Seed System

Scott, J., Graham, A., Yung, A., Morgan, C., Bellivier, F., & Etain, B. (2022). A systematic review and meta‐analysis of delayed help‐seeking, delayed diagnosis and duration of untreated illness in bipolar disorders. Acta Psychiatrica Scandinavica , 146 (5), 389–405.

Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F.,& Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial. Annals of General Psychiatry , 19 , 1–7.

Jennifer Gerlach, LCSW, is a psychotherapist based in Southern Illinois who specializes in psychosis, mood disorders, and young adult mental health.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• International
• New Zealand
• South Africa
• Switzerland
• Asperger's
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

Warning: The NCBI web site requires JavaScript to function. more...

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Bipolar disorder.

Ankit Jain ; Paroma Mitra .

Affiliations

Last Update: February 20, 2023 .

• Continuing Education Activity

Bipolar disorder, also known as bipolar affective disorder, is one of the top 10 leading causes of disability worldwide. Bipolar disorder is characterized by chronically occurring episodes of mania or hypomania alternating with depression and is often misdiagnosed initially. Treatment involves pharmacotherapy and psychosocial interventions, but mood relapse and incomplete response occur, particularly with depression. Continual reevaluation and treatment modification are commonly required during the long-term care of patients with bipolar disorder. Management of comorbid psychiatric and chronic medical conditions may also be necessary. This activity reviews the etiology, classification, evaluation, management, and prognosis of bipolar affective disorder, and it also highlights the role of the interprofessional team in managing and improving care for patients with this condition.

• Recognize patterns of symptoms suggestive of bipolar disorder, its various subtypes, and related disorders.
• Implement evidence-based management of bipolar disorder based on current published guidelines.
• Select individualized pharmacotherapy plans and adjunct therapies for bipolar disorder and comorbidities.
• Describe the necessity of an interprofessional holistic team approach that integrates psychiatric and medical healthcare in caring for patients with bipolar disorder to help achieve the best possible outcomes.
• Introduction

Bipolar disorder (BD) is characterized by chronically occurring episodes of mania or hypomania alternating with depression and is often misdiagnosed initially.

Bipolar and related disorders include bipolar I disorder (BD-I), bipolar II disorder (BD-II), cyclothymic disorder, other specified bipolar and related disorders, and bipolar or related disorders, unspecified. The diagnostic label of "bipolar affective disorders" in the International Classification of Diseases 10th Revision (ICD-10) was changed to "bipolar disorders" in the ICD-11. The section on bipolar disorders in the ICD-11 is labeled "bipolar and related disorders," which is consistent with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). [1]

A World Health Organization study showed "remarkably similar" international prevalence rates, severity, impact, and comorbidities of bipolar spectrum disorder, defined as BD-I, BD-II, and subthreshold bipolar. The aggregate lifetime prevalence of the bipolar spectrum was 2.4%. [2]

BD is often difficult to recognize because symptoms overlap with other psychiatric disorders, psychiatric and somatic comorbidity is common, and patients may lack insight into their conditions, particularly hypomania. Treatment involves pharmacotherapy and psychosocial interventions, but mood relapse and incomplete response occur, particularly with depression. Continual reevaluation and treatment modification are commonly required during the long-term care of these patients. Management of comorbid psychiatric and chronic medical conditions may also be necessary. This activity provides an overview of the etiology, classification, evaluation, and management of bipolar affective disorder.

Currently, the etiology of BD is unknown but appears to be due to an interaction of genetic, epigenetic, neurochemical, and environmental factors. Heritability is well established. [3] [4] [5]  Numerous genetic loci have been implicated as increasing the risk of BD; the first was noted in 1987 with "DNA markers" on the short arm of chromosome 11. Since then, an association has been made between at least 30 genes and an increased risk of the condition. [6]

Although it is difficult to establish causation between life events and the development of BD, childhood maltreatment, particularly emotional abuse or neglect, has been linked to the later development of the condition. Other stressful life events associated with developing BD include childbirth, divorce, unemployment, disability, and early parental loss. [7] In adulthood, more than 60% of patients with BD report at least one "stressful life event" before a manic or depressive episode in the preceding 6 months. [6]

The etiology of BD is thought to involve imbalances in systems associated with monoaminergic neurotransmitters, particularly dopamine and serotonin, and intracellular signaling systems that regulate mood. However, no singular dysfunction of these neurotransmitter systems has been identified. [8]

In a recent neuroimaging review article, the ENIGMA Bipolar Disorder Working Group stated, "Overall, these studies point to a diffuse pattern of brain alterations including smaller subcortical volumes, lower cortical thickness and altered white matter integrity in groups of individuals with bipolar disorder compared to healthy controls." [9]  Neuroimaging studies have also shown evidence of changes in functional connectivity. [10] [11]

• Epidemiology

In the World Mental Health Survey Initiative, the use of mental health services for the bipolar spectrum (BD-I, BD-II, and subthreshold BD) concluded, “Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally.” The aggregate lifetime prevalence of BD-I was 0.6%, BD-II 0.4%, subthreshold BD 1.4%, and bipolar spectrum 2.4%. [2]

There are two peaks in the age of onset: 15-24 years and 45-54 years, with more than 70% of individuals manifesting clinical characteristics of the condition before 25 years of age. [12] [13]  Bipolar disorder shows a relatively equal distribution across sex, ethnicity, and urban compared to rural areas. [7] [14]

Cyclothymia is associated with a lifetime prevalence of approximately 0.4-1% and a male-to-female ratio of 1:1. [15]

• Pathophysiology

As with the etiology, the pathophysiology of BD is unknown and is thought to involve interactions between multiple genetic, neurochemical, and environmental factors. A recent neurobiology review article discusses in detail the “genetic components, signaling pathways, biochemical changes, and neuroimaging findings” in BD. [10]

Evidence supports a strong genetic component and an epigenetic contribution. Human studies have shown changes in brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4) in patients with BD, indicating neurotrophic signaling is a molecular mechanism associated with decreased neuroplasticity. Other proposed mechanisms include mitochondrial dysfunction, oxidative stress, immune-inflammatory imbalance, and compromised hypothalamic-pituitary-adrenal axis. Additionally, neuroimaging studies have shown “evidence of change in regional activity, functional connectivity, neuronal activity, and bioenergetics associated with BD,” and anatomic studies have revealed dendritic spine loss in the dorsolateral prefrontal cortex in the post-mortem brain tissue of patients with BD. [10] [16]

As mentioned, imbalances in systems associated with monoaminergic neurotransmitters, particularly dopamine and serotonin, and intracellular signaling systems that regulate mood are thought to be involved. However, no singular dysfunction of these neurotransmitter systems has been identified. [8]

• History and Physical

Because bipolar disorder is a clinical diagnosis, making the correct diagnosis requires a comprehensive clinical assessment, including the directed patient interview, preferably supplemented by interviews of their relatives and the longitudinal course of their condition. Currently, there is no biomarker or neuroimaging study to aid in making the diagnosis.

Most patients with bipolar disorder are not correctly diagnosed until approximately 6 to 10 years after first contact with a healthcare provider, despite the presence of clinical characteristics of the condition. [17]  Notably, misdiagnosing BD after first contact differs from not recognizing the transition from major depressive disorder (MDD), the most common index presentation, to BD. Estimates of patients transitioning to BD within three years of an MDD diagnosis range from 20-30%; therefore, clinicians must maintain an awareness of the potential for this transition when caring for patients with MDD who initially screened negative for BD. [18] Also, subthreshold hypomanic symptoms can occur in as many as 40% of patients with MDD. [19]

Although not highly sensitive and specific, self-report screening tools for BD may aid clinicians in making an accurate diagnosis. The most studied screening tools are the Mood Disorders Questionnaire (sensitivity 80%, specificity 70%) and the Hypomania Checklist 32 (sensitivity 82%, specificity 57%). [20]  Positive results should motivate the clinician to conduct a thorough clinical assessment for bipolar disorder.

A significant diagnostic challenge is distinguishing between unipolar and bipolar depression because episodes of unipolar major depression and bipolar depression have the same general diagnostic criteria. Clinicians must inquire about past manic, hypomanic, and depressive episodes in patients presenting with symptoms of a depressive episode. Inquiry into past hypomanic or manic episodes is particularly important for patients with early onset of their first depressive episode (ie, in patients younger than 25 years), a high number of lifetime depressive episodes (5 or more episodes), and a family history of bipolar disorder. These findings in the patient’s history have been shown to increase the likelihood of a bipolar rather than a unipolar diagnosis. [21]  

Other factors increasing the likelihood of a diagnostic change from MDD to BD include the presence of psychosis, unresponsiveness to antidepressants, the induction of manic or hypomanic symptoms by antidepressant drug treatment, and polymorbidity, defined as 3 or more comorbid conditions. [18] [22]

General DSM-5 Diagnostic Criteria for Bipolar and Related Disorders (American Psychiatric Association. Diagnostic and StatisticalManual of Mental Disorders 5th edition (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013)

BD-I : Criteria met for at least one manic episode, which might have been preceded or followed by a hypomanic episode or major depressive episode (hypomanic or major depressive episodes are not required for the diagnosis).

BD-II : Criteria met for at least one current or past hypomanic episode and a major depressive episode; no manic episodes.

Cyclothymic disorder : Hypomanic symptoms that do not meet the criteria for hypomanic episodes and depressive symptoms that do not meet the criteria for major depressive episodes in numerousperiods (at least half the time) for at least 2 years (1 year in those aged ≤18 years); criteria for major depressive, manic, or hypomanic episodes have never been met.

Specified bipolar and related disorders : Bipolar-like phenomena that do not meet the criteria for BD-I, BD-II, or cyclothymic disorder due to insufficient duration or severity, ie, 1) short-duration hypomanic episodes and major depressive disorder, 2) hypomanic episodes with insufficient symptoms and major depressive episode, 3) hypomanic episode without a prior major depressive episode, and 4) short-duration cyclothymia.

Unspecified bipolar and related disorders : Characteristic symptoms of bipolar and related disorders that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any category previously mentioned.

The symptoms and episodes used to diagnose these disorders must not be related to the physiological effects of a substance or general medical condition.

BD-I and BD-II can be further specified as rapid cycling or seasonal patterns and whether the episodes have psychotic features, catatonia, anxious distress, melancholic features, or peripartum onset. Rapid cycling refers to 4 or more distinct mood episodes during a 12-month period. 

Mood-congruent delusions may be present in either a depressive or manic episode, including delusions of guilt or grandiose delusions of power and wealth. Psychotic features, by definition, are absent in hypomanic episodes. 

To better account for "mixed features," the current diagnostic criteria implements specifiers. Manic or hypomanic episodes with mixed features meet the full criteria for mania or hypomania and have at least 3 of the following signs or symptoms: depressed mood, anhedonia, psychomotor retardation, fatigue, excessive guilt, or recurrent thoughts of death. Major depressive episodes with mixed features meet the full criteria for a major depressive episode and have at least 3 of the following signs or symptoms: expansive mood, grandiosity, increased talkativeness, flight of ideas, increased goal-directed activity, indulgence in activities with a high potential for "painful consequences," and decreased need for sleep. The mixed features must be present during "most days."

DSM-5 Diagnostic Criteria for Bipolar I Disorder

For a diagnosis of BD-I, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes (hypomanic or major depressive episodes are not required for the diagnosis).

A manic episode is defined as a distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 7 consecutive days or requiring hospitalization. The presence of 3 or more of the following is required to qualify as a manic episode. If the mood is irritable, at least 4 of the following must be present:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• A compulsion to keep talking or being more talkative than usual
• Flight of ideas or racing thoughts
• High distractibility
• Increased goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation (non-goal-directed activity)
• Excessive involvement in activities that have a high potential for painful consequences, such as engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments

The episode is not attributable to the physiological effects of a substance or general medical condition.

The symptoms of a manic episode are markedly more severe than those of a hypomanic episode and result in impaired social or occupational functioning or require hospitalization.

DSM-5 Diagnostic Criteria for Bipolar II Disorder

For a diagnosis of BD-II, it is necessary to have met the criteria for at least one current or past hypomanic episode and a major depressive episode without a manic episode (see below for major depressive episode criteria).

A hypomanic episode is defined as a distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 4 consecutive days. The presence of 3 or more of the following is required to qualify as a hypomanic episode. If the mood is irritable, at least 4 of the following must be present:

The episode is an unequivocal change in functioning, uncharacteristic of the person and observable by others. Also, the episode is not severe enough to cause marked impairment, is not due to the physiological effects of a substance or general medical condition, and there is no psychosis (if present, this is mania by definition).

DSM-5 Diagnostic Criteria for a Major Depressive Episode

The presence of 5 or more of the following symptoms daily or nearly every day for a consecutive 2-week period that is a change from baseline or previous functioning:

• Subjective report of depressed mood most of the day (or depressed mood observed by others)
• Anhedonia most of the day
• Significant weight loss when not dieting or weight gain or decrease or increase in appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased concentration or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan

To meet the criteria, at least one of the symptoms must be depressed mood or anhedonia, the symptoms must not be attributable to a substance or general medical condition, and it causes functional impairment (eg, social or occupational).

Possible Secondary Cause of Bipolar Disorder

The following characteristics may heighten the clinical suspicion for a possible secondary cause in patients with signs and symptoms associated with bipolar disorder: older than 50 at the first onset of symptoms, abnormal vital signs or neurological examination, a recent change in health status or medications temporally associated with symptom onset, unusual response or unresponsiveness to appropriate treatments, and no personal or family history of a psychiatric disorder.

Recommended initial evaluation for a possible secondary cause includes a urine drug screen, complete blood count with blood smear, comprehensive metabolic panel, thyroid function tests, and vitamin B and folate levels.

• Treatment / Management

Although numerous clinical practice guidelines exist for the treatment and management of bipolar disorder, there is not enough consistency to generate a ‘meta-consensus’ model. [23]  Authors of a recent systematic review concluded, “The absence of a uniform language and recommendations in current guidelines may be an additional complicating factor in the implementation of evidence-based treatments in BD.” [24]  The following is an abbreviated synthesis of guidelines published by the National Institute for Health and Care Excellence (NICE), British Association for Psychopharmacology, International College of Neuro-Psychopharmacology (CINP), Canadian Network for Mood and Anxiety Treatments (CANMAT), International Society for Bipolar Disorders (ISBD), and Indian Psychiatric Society (IPS). [25] [26] [27] [28] [29]

Manic Episode

Mania is considered a medical emergency and often requires psychiatric hospitalization. Initial treatment is aimed at stabilization of the potentially or acutely agitated patient to help de-escalate distress, mitigate potentially dangerous behavior, and facilitate the patient assessment and evaluation. When possible, a calming environment with minimal stimuli should be provided. Adjunctive benzodiazepines may be used concomitantly with mood stabilizers and antipsychotic drugs to reduce agitation and promote sleep.

The patient’s current medications must be considered. For example, a second drug is recommended if the patient presents while the condition is already managed with lithium monotherapy. Also, antidepressants are usually tapered and discontinued in a manic phase. First-line monotherapy includes a mood stabilizer, such as lithium or valproate, or an antipsychotic, such as aripiprazole, asenapine, cariprazine, quetiapine, or risperidone.

Add another medication if symptoms are inadequately controlled, or the mania is very severe. Combination treatments include lithium or valproate with either aripiprazole, asenapine, olanzapine, quetiapine, or risperidone. Electroconvulsive therapy (ECT) may be considered as monotherapy or as part of combination therapy in patients whose mania is particularly severe or treatment-resistant and in women with severe mania who are pregnant. 

Valproate should not be used for women of childbearing potential due to the unacceptable risk to the fetus of teratogenesis and impaired intellectual development.

Hypomanic Episodes

By definition, hypomanic episodes are not severe enough to cause marked impairment, and there is no psychosis; therefore, these episodes can be managed in an ambulatory setting. Pharmacotherapy is similar to that for mania, but higher doses may be required for the latter.

Acute Bipolar Depression

Suicidal and self-harm risk has priority in managing patients with bipolar disorder who present with an acute depressive episode because most suicide deaths in patients with BD occur during this phase. Patients may or may not require hospitalization.

For patients not already taking long-term medication for BD, first-line monotherapy includes quetiapine, olanzapine, or lurasidone (has not been studied in acute bipolar mania). Combination treatment with olanzapine-fluoxetine, lithium plus lamotrigine, and lurasidone plus lithium or valproate may also be considered.

Consider cognitive behavioral therapy (CBT) as an add-on to pharmacotherapy. However, never consider CBT as monotherapy because there is minimal evidence to support psychological treatments without pharmacotherapy in treating acute bipolar depression.

Also, consider adding ECT for refractory bipolar depression or as a first-line treatment in the presence of psychotic features and a high risk of suicide.

For patients presenting with a depressive episode while taking long-term medication (breakthrough episode), make sure their current treatments are likely to protect them from a manic relapse (eg, mood stabilizer or antipsychotic). When applicable, check the medication dose, patient adherence, drug-drug interactions, and serum concentrations. Also, inquire about current stressors, alcohol or substance use, and psychosocial intervention adherence.

Generally, treatment options for BD-II depression are similar to those for BD-I depression.

Antidepressant medications should not be used as monotherapy in most patients with bipolar disorder, as available evidence does not support their efficacy, and there is a risk of a switch to mania or mood instability during an episode of bipolar depression. Antidepressants can be administered adjunctively to mood stabilizers (eg, lithium and lamotrigine) and second-generation antipsychotics.

Maintenance Treatment

Most patients with bipolar disorder will require maintenance treatment for many years, possibly lifelong, to prevent recurrent episodes and restore their pre-illness functioning. The current recommendation is for continuous rather than intermittent treatment, with treatments that were effective during the acute phase often continued initially to prevent early relapse. Mood stabilizers and atypical antipsychotics alone or in combination are the mainstays of maintenance pharmacotherapy.

There is substantial evidence showing lithium monotherapy’s effectiveness against manic, depressive, and mixed relapse. Additionally, lithium is associated with a decreased risk of suicide in patients with BD. Monitoring during treatment, including serum lithium concentrations, is a standard of care.

In addition to the individualized pharmacotherapy plan, essential components of maintenance treatment include medication adherence, primary prevention and treatment for psychiatric and medical comorbidities, and psychotherapy when appropriate. Suicidality surveillance is critical throughout the maintenance phase.

• Differential Diagnosis

The differential diagnosis of bipolar disorder includes other conditions characterized by depression, impulsivity, mood lability, anxiety, cognitive dysfunction, and psychosis. The most common differential diagnoses are MDD, schizophrenia, anxiety disorders, substance use disorders, borderline personality disorder, and in the pediatric age group, attention-deficit/hyperactivity disorder and oppositional defiant disorder. [18] [30]

Bipolar disorder is one of the top 10 leading causes of disability worldwide. [31]  A recent meta-analysis showed that patients with BD “experienced reduced life expectancy relative to the general population, with approximately 13 years of potential life lost.” Additionally, patients with bipolar disorder showed a greater reduction in lifespan relative to the general population than patients with common mental health disorders, including anxiety and depressive disorders, and life expectancy was significantly lower in men with BD than in women with BD. [32]  A different meta-analysis showed that all-cause mortality in patients with BD is double that expected in the general population. Natural deaths occurred over 1.5 times greater in BD, comprised of an “almost double risk of deaths from circulatory illnesses (heart attacks, strokes, etc) and 3 times the risk of deaths from respiratory illness (COPD, asthma, etc).” Unnatural deaths occurred approximately 7 times more often than in the general population, with an increased suicide risk of approximately 14 times and an increased risk of other violent deaths of almost 4 times. Deaths by all causes studied were similarly increased in men and women. [33]  A more recent systematic review of the association between completed suicide and bipolar disorder showed an approximately 20- to 30-fold greater suicide rate in bipolar disorder than in the general population. [34]

• Complications

Individuals with bipolar disorder show a markedly increased risk of premature death due to the increased risk of suicide and medical comorbidities, including cardiovascular, respiratory, and endocrine causes. [35]  More than half of patients are overweight or obese, which appears to be independent of treatment with weight-promoting psychotropic medications. [36]  One-third of patients with bipolar disorder also meet the criteria for metabolic syndrome, which increases the risks of heart disease and stroke. [37]  Additionally, attempted suicides are more common among patients with concurrent metabolic syndrome. [37]  Comorbid overweight and obesity are associated with a more severe course, an increased lifetime number of depressive and manic episodes, poorer response to pharmacotherapy, and heightened suicide risk. [22] [38]  Migraine is also associated with bipolar disorder. [39]

Psychiatric comorbidity is present in 50 to 70% of patients with BD. Of those diagnosed with the condition, 70% to 90% meet the criteria for generalized anxiety disorder, social anxiety disorder, or panic disorder, and 30 to 50% for alcohol and other substance use disorders. [40] [41] [42]  Psychiatric comorbidities in patients with bipolar disorder are associated with a more severe course, more frequent depressive and manic episodes, and reduced quality of life. [22]  Up to half of patients with BD have a comorbid personality disorder, particularly borderline personality disorder, and 10 to 20% have a binge eating disorder, leading to more frequent mood episodes and higher rates of suicidality and alcohol and substance use disorders. [43] [44]

• Deterrence and Patient Education

Psychoeducation delivered individually or in a group setting is recommended for patients and family members and may include teaching to detect and manage prodromes of depression and mania, enhance medication adherence, and improve lifestyle choices. Patients are encouraged to avoid stimulants like caffeine, minimize alcohol consumption, exercise regularly, and practice appropriate sleep hygiene. [28]  Providers are encouraged to maximize the therapeutic alliance, convey empathy, allow patients to participate in treatment decisions, and consistently monitor symptoms, which have been shown to reduce suicidal ideation, improve treatment outcomes, and increase patient satisfaction with care. [28] [45]  Patients may also benefit from case management or care coordination services to help connect them to community-based resources, such as support groups, mental health centers, and substance use treatment programs.

• Enhancing Healthcare Team Outcomes

The goal of treatment for patients with bipolar disorder is a full functional recovery (a return to pre-illness baseline functioning). This goal can best be achieved by integrating psychiatric and medical healthcare using an interprofessional team approach to manage BD and comorbid psychiatric and medical conditions. [46]  Interprofessional healthcare teams may consist of any combination of the following: case manager, primary care clinician, psychiatrist, psychiatric nurse practitioner, psychiatric physician assistant, psychiatric nurse specialist, social worker, psychologist, and pharmacist.

Ideally, a consistent long-term alliance will form between the patient, their family, and healthcare team members to provide pharmacotherapy management, psychoeducation, ongoing monitoring, and psychosocial support. [26]  Also, patients with bipolar disorder and co-occurring alcohol or substance use disorders may benefit from the involvement of an addiction specialist, as there is evidence that effective treatment can improve outcomes. [47]  Pharmacists must perform medication reconciliation to ensure there are no drug-drug interactions that could inhibit effective care and report any concerns they have to the prescriber or their nursing staff. Furthermore, collaborative care models have shown efficacy in improving outcomes when used to treat patients with BD. Key elements include patient psychoeducation, using evidence-based treatment guidelines; collaborative decision-making by patients and their healthcare provider(s); and supportive technology to support monitoring and patient follow-up. [46] [48] [49]

An interprofessional approach is a mainstay in treating patients with bipolar disorder. An interprofessional team that provides a holistic and integrated approach to patient care can help achieve the best possible outcomes with the fewest adverse events. [Level 5]

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Disclosure: Ankit Jain declares no relevant financial relationships with ineligible companies.

Disclosure: Paroma Mitra declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Jain A, Mitra P. Bipolar Disorder. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

• Bulk download StatPearls data from FTP

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Mood Disorder. [StatPearls. 2024] Mood Disorder. Sekhon S, Gupta V. StatPearls. 2024 Jan
• Letter to the Editor: CONVERGENCES AND DIVERGENCES IN THE ICD-11 VS. DSM-5 CLASSIFICATION OF MOOD DISORDERS. [Turk Psikiyatri Derg. 2021] Letter to the Editor: CONVERGENCES AND DIVERGENCES IN THE ICD-11 VS. DSM-5 CLASSIFICATION OF MOOD DISORDERS. Cerbo AD. Turk Psikiyatri Derg. 2021; 32(4):293-295.
• Review Bipolar II disorder : epidemiology, diagnosis and management. [CNS Drugs. 2007] Review Bipolar II disorder : epidemiology, diagnosis and management. Benazzi F. CNS Drugs. 2007; 21(9):727-40.
• Demographic and Clinical Characteristics, Including Subsyndromal Symptoms Across Bipolar-Spectrum Disorders in Adolescents. [J Child Adolesc Psychopharmaco...] Demographic and Clinical Characteristics, Including Subsyndromal Symptoms Across Bipolar-Spectrum Disorders in Adolescents. Salazar de Pablo G, Guinart D, Cornblatt BA, Auther AM, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, et al. J Child Adolesc Psychopharmacol. 2020 May; 30(4):222-234. Epub 2020 Feb 21.
• Review The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. [Psychiatr Clin North Am. 2002] Review The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Perugi G, Akiskal HS. Psychiatr Clin North Am. 2002 Dec; 25(4):713-37.

Recent Activity

• Bipolar Disorder - StatPearls Bipolar Disorder - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Back to The Library

How A Person Living With Bipolar Disorder Thinks, According to Experts

August 9, 2024

Experts share what a person living with bipolar disorder might be thinking as they experience the condition — from thoughts focused on overconfidence to negative self-perception and more.

By: Sarah Fielding

Clinically Reviewed By: Clary Figueroa

Learn more about our Clinical Review Process

Table of Contents

Each person’s experience with mental health is unique, but there are patterns individuals with the same condition might exhibit. These similarities can also extend to how they think and respond to anything from triggers to day-to-day experiences. So, how does a person living with bipolar disorder think? 

That’s a large group to speak for, as the National Alliance on Mental Illness (NAMI) reports that about 2.3% of people in the US receive a bipolar disorder diagnosis, with 83% of cases classified as severe. On average, it first presents in people at 25 years of age, but it can also occur in younger people. However, understanding the condition and its impact can paint a better picture of how people living with bipolar disorder might think and the ways their loved ones can support them. Below, experts share what a person living with bipolar disorder might be thinking as they experience the condition and what they can do to manage those thoughts. 

We can help your loved one manage bipolar disorder

Virtual intensive therapy for serious mental health issues.

What is bipolar disorder?

Bipolar disorder is a mental health condition that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. It can have overlapping symptoms with other mental health conditions (like an anxiety disorder or a depressive disorder), and it is sometimes mistakenly thought of as a personality disorder, but it is actually a type of mood disorder. There are two primary forms of bipolar disorder: type I and type II. 

What is bipolar disorder I?

Bipolar I disorder is marked by manic episodes, which are periods of “abnormally elevated, expansive, or irritable mood lasting at least one week for most of the day,” according to Charlie Health Primary Therapist Meghan Jensen, LPC. A manic episode can include increased energy, activity, or restlessness, but in some instances, it may include risky behaviors that are severe enough to warrant medical attention or hospitalization, explains Clinical Supervisor Tracye Freeman Valentine, LPC-MHSP. A person living with bipolar I disorder might also experience depressive episodes that can last at least two weeks and include symptoms like fatigue, eating more or less, sleep disturbances, and more.

Bipolar disorder symptoms can change back and forth throughout the year. “A person may experience both manic and depressive episodes and rapid mood cycling, which is defined as four or more of the episodes in a year,” says Freeman Valentine. “The symptoms have moderate to severe functional impairment in day-to-day activities.” 

Living with Bipolar Disorder

Amanda Lundberg

What is bipolar II disorder? 

Bipolar II disorder is a type of bipolar disorder that doesn’t include full-fledged mania episodes. Instead, it “consists of at least one depressive mood and one hypomania — a milder version of mania that lasts for a shorter time — episode,” says Freeman Valentine. “The symptoms are not full-blown and have less impairment with day-to-day activities.” Hypomanic symptoms include talkativeness, racing thoughts, increased energy, and more. 

The depressive symptoms will present similarly to those experienced in bipolar I disorder, but the person might feel a persistent low mood and associated symptoms during a depressive episode, says Jensen. Hypomanic episodes last at least four days and, as explained, are less severe than their manic counterpart — though some symptoms are the same. 

Potential thought patterns while living with bipolar disorder

It’s impossible to detail exactly what each person who lives with bipolar thinks. “People with bipolar disorder usually experience both depressive moods and times of excitement of high energy, reduced inhibitions, and less sleep. The range of experiences is vast,” explains Freeman Valentine. Personal experience, the current impact of the disorder, the help available, and more all impact how an individual living with bipolar thinks. 

However, some general thought patterns can be associated with bipolar disorder, which can be beneficial to know for both people who experience it (no one wants to feel alone in it or misunderstood) and those hoping to support them. “For example, a person may participate in activities to the extreme like eating, drinking, or spending too much money when experiencing a period of high energy and excitement, which may lead to depression and anxiety due to actions and feeling the loss of equilibrium in mood due to the cycling between the moods,” adds Freeman Valentine. “During the phases, a person may also experience suicidal ideations or thoughts of self-harm.”

Jensen elaborates on this, explaining that thoughts during a manic or hypomanic episode could involve:  

• Rapid and disjointed thoughts that make it difficult to focus
• Overconfidence and inflated self-esteem that leads to risky behaviors
• Irritability or agitation that can cause conflicts with others
• Perceived invincibility that might lead to unrealistic plans and goals

According to Jensen, depressive episodes, in contrast, can bring thoughts such as:

• Hopelessness and worthlessness
• Overall difficulty concentrating and making decisions
• Negative self-perception or guilt
• Suicidal ideation 

If you’re experiencing suicidal thoughts or are in danger of harming yourself, this is a mental health emergency. Contact The Suicide & Crisis Lifeline 24/7 by calling or texting 988.

Coping with bipolar disorder thoughts and symptoms

Bipolar disorder can be a lifelong experience that requires care, attention, and understanding. The general symptoms brought on by bipolar I and bipolar II disorders can require a range of coping mechanisms. There are steps and habits a person can implement to manage the thoughts and actions associated with them. Here are the coping mechanisms Jensen and Freeman Valentine recommend trying.

Implement a routine

Practice medication compliance

Try psychoeducation and psychotherapy

Get support from others

1. Implement a routine

The mental health professionals recommend that individuals create structure and routines in many areas of their lives. These routines could include exercise, meditation, and calming activities like reading. Keeping a consistent sleep schedule (going to bed and waking up at the same time) is among the most important routines for someone with bipolar disorder because sleep disturbances can be among the first signs of a manic or depressive episode. By maintaining a consistent sleep schedule people can speak to a doctor or therapist if they notice a disturbance in their sleep and are worried about their mental health, the experts say.

2. Practice medication compliance

Medical professionals often prescribe medication to help people manage bipolar disorder symptoms. A person should do their best to take the recommended quantity of medication at the necessary frequency. This compliance can go a long way toward keeping symptoms in check.

3. Try psychoeducation and psychotherapy

A person living with bipolar disorder might want to explore options like cognitive behavioral therapy to identify their triggers, manage symptoms, incorporate grounding techniques, and learn additional coping techniques. “With therapy and psychoeducation, the person will have tools to identify symptoms of mania and depression, watch for patterns of the behavior, and identify triggers that influence mood changes,” says Freeman Valentine. “Psychoeducation and therapy are vital to manage and identify warning signs of an episode, involve supportive friends/family, and implement an emergency action plan.”  

4. Get support from others

The people who love and support you should want to help you navigate bipolar disorder. “Having connections and a ‘circle of support’ is important and reduces isolation and increases interactions and feelings of support,” says Freeman Valentine. “It is important to understand that check-ins and a circle of support is not a weakness but a tool and a positive habit for managing the disorder.” It can be beneficial for individuals to involve their loved ones in any safety plan they create and make them aware of warning signs. 

On that note, there are many ways a person can support those in their life who live with bipolar disorder. Psychoeducation about bipolar disorder is a valuable tool for support from friends and family. They can also assist in creating that routine, maintain non-judgemental communication, and be patient. 

How Charlie Health can help 

If you or a loved one are struggling with bipolar disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including bipolar disorder and other mental disorders. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your well-being is possible. Fill out the form below or give us a call to start healing today.

https://www.nami.org/about-mental-illness/mental-health-conditions/bipolar-disorder/

Comprehensive mental health treatment from home

90% of Charlie Health clients and their families would recommend Charlie Health

More like this

5 Common Myths About Bipolar Disorder

Sarah Fielding

What Is the Best Therapy for Bipolar Disorder?

Get the mental health treatment you deserve

Need additional mental health support? Charlie Health can help. Get started with virtual intensive therapy now.

How can we help?

• Depression in Children
• Depression in Teens
• Depression in College
• Depression in Women
• Depression in Men
• Depression in Older People
• How Is Depression Diagnosed?
• Related Conditions
• What Are the Different Types of Depression?
• Mild Depression
• Major Depressive Disorder
• Overview of Treatment
• Psychotherapy
• Complementary & Alternative Therapy
• Overview of Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Tricyclic and Tetracyclic Antidepressants (TCAs)
• Side Effects
• Treatment-Resistant Depression (TRD)
• Family & Relationships
• Diet & Exercise
• Complications
• Support & Resources
• Appointment Prep
• View Full Guide

Treating Bipolar Depression Without Medication: What to Know

Aug. 14, 2024 – After receiving a bipolar depression diagnosis following a suicide  attempt in 2014, Tiffany Jean Taylor was prescribed antipsychotics and antidepressants for treatment, and talk therapy was recommended. But when she found herself at the same hospital 4 months later, Taylor had a “full-circle moment” when she realized she wasn’t getting any better. She knew she needed to try something different. 

“I went home, and I really started to embark on my holistic mental health journey, said Taylor, 38, who has now been off psychiatric medications for a decade. “At that very moment, I decided to start looking at different theories and different modalities for my healing.”

People with bipolar depression are often treated with antipsychotics  for mania and antidepressants  for depressive symptoms. But some patients like Taylor seek out alternative ways to treat this condition without the use of prescription drugs, according to Maria Ingalla, a psychiatric nurse practitioner and owner of Paperflower Psychiatry, which has multiple locations in Arizona. 

“I've had a lot of patients who are just not interested in medication or have tried medication before and had really intense side effects,” Ingalla said. “The medication is lifelong because it’s a chronic disease.”

While prescription medication is the primary form of treatment for bipolar disorder, “I think it's important to be clear: Medications are not the only treatment for bipolar disorder. There are so many other things that can be done to help modulate the problems that often come with both bipolar disorder, and more specifically, bipolar depression,” said John Leslie Beyer, MD, a psychiatry and behavioral sciences professor at Duke University School of Medicine. 

Chemical imbalance in the brain plays a role in bipolar disorder, and prescription medicine can help level out these brain chemicals. But psychiatric drugs do not “add or subtract” chemicals in your brain, said Ingalla. Rather, they may stabilize an overactive chemical that could be triggering certain bipolar symptoms. 

Historically, one of the hallmark signs of bipolar disorder has been severe and persistent disease, where a person has an episode of depression or mania that they feel unable to control, said Beyer. It’s also important to note that bipolar disorder is a recurring illness for 90% of patients, meaning they will have another episode at some point of their lives.

But in the last decade or so, the term “bipolar disorder” has been used more fluidly. As the condition is more understood as existing on a range, between normal emotions and impaired emotions, the term is often applied not only to full-syndrome bipolar disorder but also to a milder tendency for moods to become detached from a person's baseline, Beyer said. 

For the latter, nondrug treatments could be an option, particularly given certain side effects that come with prescription drugs, he said. Some of the most concerning side effects of psychiatric drugs include complications that can develop within the liver and the kidneys . And some medications could also affect your blood sugars , possibly increasing the risk of diabetes.

“I think it starts by recognizing what the impact of bipolar illness is on that person's life,” said Beyer. “If it is such that it has significantly caused functional problems, problems in relationships, problems in jobs, problems with divorce – which bipolar is known to do – then I would not in any way hesitate to say we need to think about medications.”

So, who might be a good candidate for a more holistic approach? If your mood is stable, but you were diagnosed with bipolar disorder during a traumatic phase of life where you struggled with emotional highs and lows, you could be a contender for exploring treatment options outside of medication. This is especially true if you are stable but were diagnosed between ages 16 and 24, when the brain is still developing.

“It’s possible that as we arrive at the maturation of the person's brain, they've settled down into their lives so much that they may be able to handle some of those challenges that happened earlier in a different way than when they seemed to have had a bipolar episode,” Beyer said. 

“For the people that don't have the high-risk bipolar disorder – meaning they are severely and persistently mentally ill – we probably need to have an open mind about something that happened during a person's adolescence.”

But keep in mind: It’s crucial that you speak to your psychiatrist before you stop taking bipolar depression medication, as many drugs require you to taper off slowly, as directed by your doctor. Use even more caution if you are having severe mental health challenges, such as destructive manic episodes , said Ingalla. 

“It is possible for a lot of people – but not all people – to find a good space to heal and to maintain good mental health while holding good lifestyle patterns," while trying to give up medication, she said.

After being diagnosed with bipolar disorder six times by six doctors, making multiple hospital visits, and having severe depression, Caitlin Pyle had been prescribed nearly a dozen antipsychotics and antidepressants at various times over several years. Pyle, 37, began to explore potential causes of her mental health struggles – such as mounting stress from a tumultuous divorce. Now, after 4 years of healing from bipolar depression without psychiatric drugs, the Florida-based transformational life coach said self-awareness is a major part of recovery, as well as refusing to accept the common narrative that you can’t heal bipolar disorder without prescription drugs. Taylor, who is now a mental wellness coach and practitioner in Ohio, echoes this sentiment. 

“I had to change my identity. I had to change the way that I acted. I had to change the way that I reacted. I had to get in touch with my feelings. I had to connect with myself. I had to be self-aware. I had to be self-responsible. I had to self-actualize,” she said. 

Possible Nondrug Treatments 

One form of nondrug treatment is social rhythm therapy, which has been shown to be a great alternative for managing unstable bipolar moods, according to Beyer. This type of psychotherapy centers on lifestyle management and following a daily routine that includes things like eating a healthy diet, regular exercise, self-care practices, and keeping a regular sleep-wake cycle . 

“It has some really good data about its efficacy both in treating patients with medications and those without medications,” Beyer said. “Those same ideas that support what social rhythm therapy is are also just good ideas about how to help people work to manage their own moods and take care of themselves far as noticing if they're having any mood problems and finding where stress impacts upon mood reactivity.”

Traveling, late nights, and certain stimulants – such as caffeine, alcohol, and drugs – can all trigger unstable moods when you have bipolar disorder, according to Ingalla. Being exposed to bright lights in the morning can help keep your mood regulated. If you are having a manic episode, try dark therapy, suggested Ingalla. Go into a pitch-dark room between 6 p.m. and 8 a.m. and do your best to relax. Getting a pair of blue light glasses could also help when practicing dark therapy. 

Don’t Let the Diagnosis Define You 

Not being limited by your diagnosis and believing that you can push through seemingly unbearable moments is paramount in recovery, said Taylor. She recalled a time when depression had left her bedridden for several years. 

“I had to be honest and say that nobody is going to come get me out of this bed,” she said. “I literally am the only person that can force myself to move my body and socialize and take a shower and eat.” 

Taylor also said that when she cut off relationships where she felt disrespected, or where certain boundaries were crossed, she had fewer mania symptoms. 

Remember that your doctor is going to play a key role in any plans to adjust, or even wean off of medications completely, Beyer said. 

“It’s important to have a working relationship with your doctor to discuss things like: ‘What should I look out for?’ or ‘What are the early signs that I really may have an underlying bipolar disorder?’” he said. 

If you and your doctor agree you should stop taking bipolar medication, connecting with a good therapist  will be critical for the next part of your healing journey, as they can also help keep you in check and monitor your emotions, Ingalla said. “Medication can do some things, but therapy does everything, in my opinion.” 

Top doctors in ,

Find more top doctors on, related links.

• Depression News
• Depression Reference
• Depression Slideshows
• Depression Quizzes
• Depression Blogs
• Depression Videos
• Depression Medications
• Find a Psychiatrist
• Anxiety & Panic Disorders
• Binge Eating Disorder
• Bipolar Disorder
• Crisis Assistance
• Mental Health
• Pain Management
• Pill Identifier
• Postpartum Depression
• Stress Management
• Substance Abuse & Addiction
• More Related Topics

Bipolar disorder: Symptoms, causes, diagnosis and treatment

Checked : Suzanne S. , Grayson N.

Latest Update 19 Jan, 2024

Table of content

Symptoms of bipolar disorder

What is the cause of this mood disorder, what are the consequences of bipolar disorder, how to recognize this disorder, how to diagnose bipolar disorder, how to treat bipolar disorder, cognitive-behavioral therapy for bipolar disorder, the main purposes of the treatment are the following:.

People with bipolar disorder continually see their lives switch between euphoria and depression. Bipolarity is the name we give today to manic depression. This mood disorder, which is diagnosed late, affects 1% of the population. Bipolar disorder, formerly called "manic depression" or wrongly bipolar, is a disease that affects mood regulation. The World Health Organization ranks it among the ten most disabling conditions. There are different types of bipolar illness, but it is generally characterized by the alternation of periods of depression and so-called “manic” or hypomanic periods, interspersed with free intervals (where the person is in a normal state).

• In the depressive phase,   the patient shows all the symptoms of major depression.
• In the manic phase,   he is in a euphoric, enthusiastic, and/or irritable state. His sleep needs are reduced. He is in physical, sexual, social hyperactivity. The individual is very confident; he is talkative and believes himself capable of succeeding in everything. When this last phase is less intense, we speak of hypomania.

Manic (or hypomanic) and depressive episodes follow one another in the course of life.

The disease most often begins at the end of adolescence, between 15 and 19 years of age. Some warning signs of bipolar disorder should lead to consultation.

This disorder caused by brain dysfunctions is said to have genetic origins. It is not necessarily hereditary, but there are family predispositions.

Painful life events, particularly the shock experienced in childhood, can trigger or worsen the disease in people who are predisposed.

• In the manic phase:   the individual can be led to adopt behaviors dangerous for his physical integrity (speeding driving, hazardous and unprotected sexual relations.), and socially problematic. Also with aggressiveness at work with a risk of job loss; compulsive and reckless spending; risky financial investments; gambling addiction.
• In the depressive phase:   we find all the symptoms of depressive suffering with a very marked risk of suicide. One in two patients will make at least one suicide attempt in their lifetime.

Finally, the disease is really trying for loved ones who must endure the phases of mania during which the individual refuses any advice of moderation (risks of over-indebtedness, etc.) Or even proves to be irritable or aggressive; then, the phases of depression are experienced in depression and inability to act on a daily basis.

Bipolar disorder is often associated with an anxiety disorder and sometimes leads to alcohol addiction (which can mask the disease and complicate the diagnosis).

While one in two patients will attempt suicide in their lifetime, it is essential that doctors be helped to diagnose this delicate disorder.

Here is the advice of the High Authority for   Health:

• You have to think about bipolar disorder in front of a depressive disorder and find out if there is mania that went unnoticed.
• In adolescents, we must be vigilant in the face of withdrawal, dropping out of school, risky behavior, taking psychoactive substances.
• Care should be taken if the patient has had more than three histories of depressive episodes if he has attempted suicide if he has reacted poorly to antidepressant treatment.
• The attending physician should not hesitate to consider hospitalization if he considers the manic episode or the risk of suicide high.
• Support by a psychiatrist for confirmation of the diagnosis is necessary, as is collaborative treatment with the attending physician.

The diagnosis is often made late (after nine years on average) because it takes several months, even several years, before the succession of cycles is noticeable.

It is often an acute manic episode (which requires temporary hospitalization), which allows it to be posed. The diagnosis is more difficult when the hypomanic phases are just signaled by a slight state of euphoria. In this case, the patient may be wrongly perceived as depressed or an alcoholic.

The attending physician who sees the patient only occasionally (and rather in the depressed phase) is not necessarily in a position to observe the variations in mood. The patient himself, when he is in the euphoric phase, does not perceive himself absolutely as such: he feels in great shape!

It is often the entourage that sounds the alarm. Relatives must be particularly attentive to changes in the behavior of an adolescent or a young adult, withdrawal, dropping out of school, risky behavior, etc.).

The hospitalization is often required in acute manic or depressive phase-in when the risk of suicide seems worrying. The purpose of these hospitalizations is to prevent the patient from being harmed, but also to allow the drugs to show their first effects.

The mood disorders should indeed be regulated by specific drugs,   the mood stabilizers, the oldest known (and always very helpful) are the lithium salts. Other psychotropic drugs can be prescribed more punctually in case of manic phase or depressive phase.

Life-long thermoregulatory drugs thymoregulators must be taken for life (which is not always well accepted by patients who tend to stop treatment as soon as they feel better). They have a preventive effect that prevents relapses and, in many cases, this allows patients to return to normal life.

Psycho educational measures that allow patients to control the disease (by avoiding fatigue, by learning to limit disruptive events, etc.) remain essential.

We Will Write an Essay for You Quickly

Numerous studies have shown, in recent years, the effectiveness of Cognitive Behavioral Therapy combined with pharmacotherapy in the treatment of the bipolar disorder. Cognitive Behavioral Therapy is very effective in increasing compliance. In particular, the work on compliance is based on three key interventions:

• Constantly develop and strengthen the therapeutic alliance throughout the psychotherapeutic process.
• Develop problem-solving strategies that help the patient solve practical problems related to the use of drugs.
• Develop strategies that help the patient to combat with dysfunctional beliefs underlying emotional stress and dysfunctional behaviors.
• Provide information to the patient and their family members about Bipolar Disorder, drug treatment, and difficulties with treatment compliance.
• Early warning signs, teaching preventive coping skills that can reduce the severity and duration of symptoms.
• Recognize the dysfunctional beliefs typical of Bipolar Disorder, particularly with respect to drug therapy in order to improve treatment compliance.
• Promote problem-solving skills, emotional regulation, and adaptive response in order to cope with psycho-social stressors.
• Promote a sense of personal power by improving the quality of life, in particular, reducing hospitalization and the risk of suicide.

Looking for a Skilled Essay Writer?

• University of California, Los Angeles (UCLA) Bachelor of Arts

No reviews yet, be the first to write your comment

Write your review

Thanks for review.

It will be published after moderation

Latest News

What happens in the brain when learning?

10 min read

20 Jan, 2024

How Relativism Promotes Pluralism and Tolerance

Everything you need to know about short-term memory

The Bipolar Disorder and Its Management Exploratory Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Signs and symptoms, causes of the disorder, diagnosis and treatment.

Bipolar disorder is a mental disorder characterized by intermittent moods and fitful energy levels thus affecting the ability of the patient to function normally. The disorder affects the neurons in the brain, hence causing uncoordinated functions of the brain. The functions of the brain rely upon the intermittent moods of depression and mania that characterize the disorder.

The National Institute of Mental Health (NIMH) observes that, “manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live … brings in its wake almost unendurable suffering and, not infrequently, suicide” (2002).

The disorder mostly affects adults although some cases in children occur due to the inheritable nature of the disorder. Prevalence studies by the American Psychiatric Association shows that, approximately 1.5% of the American adults suffer from bipolar disorder. Given the fact that the disorder is long-term, proper handling mechanisms is paramount to both the patients and health professionals. This essay explores the nature of the bipolar disorder and its management.

The bipolar disorder causes periodic episodes of depression and mania in patients. The intermittent depressive and manic episodes affect the physical and psychological functions of the patients causing them to have abnormal behaviors. During the depressive episode, the patient experiences low moods and loss of interests in the daily activities.

The signs and symptoms of depressive episode include anxiety, feeling of helplessness, loss of pleasure in activities, fatigue, petulance, sleep disturbance, suicidal feelings, and chronic pain amongst other clinical symptoms. “In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features such as delusions or, less commonly, hallucinations, usually unpleasant” (Grier, & Wilkins, 2007, p.2).

The state of severe bipolar depression may last for about two weeks to several months in adults but in children, it may take several hours to days. Patients at the depressive episode have low mood and energy to perform usual activities.

During the manic episode, the patient experiences high mood with high energy levels in the body that results into increased body activity. The signs and symptoms of the manic episode include increased activity, extreme irritability, high energy levels, little sleep, aggressive, poor judgment and distractibility amongst other symptoms. If these signs and symptoms occur daily for a period of two weeks, then the patient is in the manic episode. The activity of the patient is due to the high energy levels that the body generates.

At some instances, patient may experience moderate effects of mania referred to as hypomania ; “ Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity … ” (Simeonova, & Chang, 2005, p.5). Apart from depressive and manic episodes, a patient can also experience mixed episodes of the bipolar disorder and this complicates the symptoms, diagnosis, and treatment of the disorder.

Scientists have discovered that a bipolar disorder occurs due to the combination of different factors. Many scientific studies suggest that the possible causes of the bipolar disorder are genetic, environmental, and physiological conditions. Genetic studies indicate that, “children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder” (Simeonova, & Chang, 2005, p.624).

This implies that the bipolar disorder is genetic disease and that parents with the disorder predispose their kids to the same. Family history studies of the patients suffering from the bipolar disorder revealed that, at least one or more members of their families had suffered from some other psychiatric condition if not bipolar disorder. The prevalence of the disorder to certain families proves that it is a genetic disorder.

Further scientific studies have proved that environmental conditions also can cause bipolar disorder. Prospective and case studies reveal that the historical experiences of the patients determine their susceptibility to the bipolar disorder. “There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders” (Simeonova, & Chang, 2005, p. 625).

These findings affirmed that interaction of the genetic and environmental conditions influence the susceptibility to the bipolar disorder. Case studies of adult patients showed that they experienced harsh environmental conditions as compared with those having with the genetic predisposition.

Another cause of the bipolar disorder is the physiological condition of the brain due to its structure. The comparative examination of brains shows that bipolar patients have relatively abnormal brain structure. Imaging studies reveal, “…the pattern of brain development in children with bipolar disorder was similar to that in children with ‘multi-dimensional impairment,’ a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia” (NIMH, 2002).

The abnormal structure of the brain affects the physiological chemicals that are critical in normal functioning of the brain. For instance, insufficient neurotransmitters and neuron with defects contribute in causing the bipolar disorder.

The diagnosis and the treatment of the bipolar disorder require the concerted efforts of the family and psychiatrists. The family members should aid the psychiatrist by noting the clinical symptoms and providing the historical information for the psychiatrist to ascertain the cause of the disorder. “Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician …anyone who talks about suicide should be taken seriously” (NIMH, 2002).

Family members should note the conditions of the patient and report them to the psychiatrist who will conduct diagnostic procedures. For example, a psychiatrist may conduct brain scan and blood test to rule out complications of a tumor before considering the disorder as a bipolar disorder.

The psychiatrist will then evaluate the diagnostics tests and determine whether the condition is a bipolar disorder or not. Information concerning family history with regard to the disorder coupled with some clinical signs in most cases is enough to determine if the condition under investigation is bipolar disorder or not.

Since bipolar disorder is a long-term illness, the management of the disorder entails the use of chemotherapy and psychotherapy techniques.

Chemotherapy involves the use of medications that control and alleviates the devastating clinical symptoms. Usually, “…people with bipolar disorder continue treatment with mood stabilizers for extended periods of time and other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer” (Simeonova, & Chang, 2005, p.628).

These medications are very important in regulating and stabilizing intermittent moods that characterize the bipolar disorder. Lithium and valproate are very effective drugs in stabilizing the mood of the patients for they are mood stabilizers.

Psychotherapy is another method used in treating bipolar disorder. Many psychiatrists have found out that psychotherapy can be very effective in stabilizing the mood of the patient. “Cognitive behavioral therapy, family focused therapy and psycho-education have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear the most effective in regard to residual depressive symptoms” (Grier, & Wilkins, 2007, p.10).

Cognitive behavioral therapy and psycho-education helps the patient to recognize and control the negative moods. Focused family therapy encourages the family members to create a homely environment that will not trigger moods swings of the patient. For effective treatment, family environment and medication are essential in management of the bipolar disorder.

Bipolar disorder is a neurological and psychological disorder that affects the normal functioning of the brain. Periodic moods changes characterize the disorder in that the patients experience manic and depressive episodes depending on the psychological condition. The signs and symptoms vary from low moods through intermediate moods to high moods.

Varied studies have shown that physiological, environmental, and genetic factors predispose an individual to the bipolar disorder. Although the disorder is a long-term illness, chemotherapy and psychotherapy has proved to be the current effective ways of managing the disorder. In the view of the technological advancement, scientists are still designing effective chemotherapy methods coupled with other clinical interventions that would help in managing the disorder in a better way.

Grier, E., & Wilkins, A. (2007). Bipolar Disorder: Educational Implication for Secondary Students. National Associations of Psychologists, 1-12.

National Institute of Mental Health. (2002). Bipolar Disorder . Web.

Simeonova, D., & Chang, K. (2005). Creativity in Familial Bipolar Disorder. Journal of Psychiatric Research , 39 (7), 623-631.

• Agoraphobia's Impact on Health and Life
• Cognitive Behavioural Therapy in Schizophrenia
• Bipolar Disorder and Current Treatment Options
• Bipolar Disorder: Diagnostic Evaluation
• Cognitive-Behavioral Therapy for Bipolar Disorder
• Mental Health & Culture on Weight and Eating Disorders
• The Psychiatric Disorders and Their Treatment
• Psychological Behaviorism: Cassandra's Crisis
• Schizophrenia a Psychological Disorder
• Anxiety, Somatoform, and Dissociative Disorders
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, February 20). The Bipolar Disorder and Its Management. https://ivypanda.com/essays/bipolar-disorder-6/

"The Bipolar Disorder and Its Management." IvyPanda , 20 Feb. 2019, ivypanda.com/essays/bipolar-disorder-6/.

IvyPanda . (2019) 'The Bipolar Disorder and Its Management'. 20 February.

IvyPanda . 2019. "The Bipolar Disorder and Its Management." February 20, 2019. https://ivypanda.com/essays/bipolar-disorder-6/.

1. IvyPanda . "The Bipolar Disorder and Its Management." February 20, 2019. https://ivypanda.com/essays/bipolar-disorder-6/.

Bibliography

IvyPanda . "The Bipolar Disorder and Its Management." February 20, 2019. https://ivypanda.com/essays/bipolar-disorder-6/.

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

What It’s Like Living With a Spouse Who Is Bipolar

Relationship Tips for Married Couples

• Bipolar Disorder Basics
• Considerations
• Talking About Divorce

Bipolar disorder is a mental health condition that can cause significant mood changes. A person’s energy levels, thoughts, feelings, and behaviors may be affected.

When a partner with bipolar disorder is unstable, they may struggle to function as they would when they are stabke. This can create problems and impact the quality of life partners have established. These challenges can cause strain in a relationship for the person with the condition, as well as their spouse. It’s common for someone with bipolar disorder to hurt or offend their partner or be controlling.

Verywell / Julie Bang

When living with a spouse who has bipolar disorder, understanding the condition, recognizing and discussing the needs of both partners, and creating boundaries to care for each other can help manage a partner’s bipolar disorder.

Read on to learn about bipolar disorder, how it can affect a relationship, and ways to help a spouse living with the condition.

Bipolar Disorder at a Glance

Bipolar disorder is characterized by extreme mood fluctuations. Periods of mania (high energy, elevated moods), hypomania (elevated moods less severe than mania), and depression (states of sadness and hopelessness) can occur.

There are different types of bipolar disorder, including:

• Bipolar I : A person with bipolar I experiences at least one episode of mania or elevated mood for at least one week. They also usually experience depression for at least two weeks.
• Bipolar II : In bipolar II disorder, the person has at least one major depressive episode and at least one hypomanic episode (a less intense form of mania).
• Cyclothymic disorder : This is a milder form of bipolar disorder involving many "mood swings." It is diagnosed when symptoms of depression and hypomania persist for at least two years but do not meet the criteria for a diagnosis of bipolar I or bipolar II.
• Mixed states : Mania and depression symptoms occur within the same period of time that last a week or two, sometimes longer.
• Rapid cycling : Here, a person experiences at least four or more episodes of mania, hypomania, and depression within a single year.
• Unspecified : This is when the condition is characteristic of bipolar disorder, but does not meet the full criteria for any of the other specified bipolar spectrum disorders.

Treatment often includes a combination of medication and psychotherapy.

Every person with bipolar disorder has a unique experience of the condition. Being educated about symptoms and treatment options can provide insight into ways to better support a spouse with bipolar disorder.

Recognizing symptoms or patterns in their spouse’s behavior allows a partner to support their spouse, determine the ways they can take care of themselves, and tend to the things that need attention in the life they’ve built together.

If Your Spouse Has Undiagnosed Bipolar Disorder

It’s sometimes possible for a person to have bipolar disorder and be unaware of their condition, particularly during a manic episode. One reason is that symptoms may be confused with other conditions, such as ADHD, anxiety, substance use, and more.

If you believe your spouse might have undiagnosed bipolar disorder, you might notice the following behaviors.

• Elevated mood
• Inflated sense of self-esteem
• Easily distractible
• Agitation or irritability 
• Impulsiveness or engagement in risky behaviors (e.g., excessive spending)
• Lack of sleep
• Expressions of hopelessness 
• Periods of low mood or sadness
• Increased need for sleep
• Isolation and withdrawal
• Lack of interest in daily activities 
• Thoughts about death or suicidal ideation

If you observe some of these symptoms in your spouse, talk to them about what you’re seeing and ask if they would be willing to seek help.

If they are open to the conversation:

• Inform your spouse about what you’ve noticed without being judgmental.
• Let your partner know that your concern comes from a loving and caring place.
• Ask them about how they’ve been feeling and if they’ve noticed changes in their mood as well.
• Listen to what they think and what this might mean for them.
• Inquire about their thoughts on seeking help.

If your spouse is open to seeking treatment, let them know they have your support. If they are not open, you can let them know you want to support them and ask how you best do so.

If Your Spouse Has Diagnosed Bipolar Disorder

Recurrent or extreme changes in mood can have a significant impact on the spouses of people living with bipolar disorder. There can be a level of unpredictability in the relationship that causes distress.

On the one hand, the partner experiencing the mood episode is affected by their symptoms, leading to changes in behavior and level of functioning. On the other hand, their spouse may feel responsible for their partner and the family, and may begin to feel burnt out.

These dynamics create challenges in marriages that can be difficult to overcome. Research indicates divorce rates are higher in couples in which one partner has the condition.

How Bipolar Disorder Affects a Marriage

For many people, getting married is a positive experience and aspiration. Being married provides an emotional connection and partnership in life.

However, every relationship has its challenges. When one partner in a marriage has bipolar disorder, the relationship can become complicated when they are unwell.

Communication

Communication between partners may not be as fluid when a partner is going through a manic or depressive episode. However, communication is crucial for understanding between partners.

Research shows that communication between partners and members of a spouse who has bipolar disorder's care team can help manage their care and support the relationship. Additionally, research demonstrates that couples believe a level of emotional disclosure is vital to their relationships.

In a study where researchers interviewed the wives of patients with bipolar disorder, they uncovered that wives felt helpless, frustrated, and hypervigilant when their spouses were unwell.

Another study determined spouses have a hard time assessing the impact of bipolar disorder on their partners’ lives.

Ultimately, bipolar disorder and the emotional impact it has on partners can weaken their communication.

A spouse who has bipolar disorder's interest in sex can wax and wane depending on their mood and medication. Some medications can diminish a person’s interest in sex, while an episode of mania can lead to hypersexuality .

Additionally, research suggests that during mania, a person may participate in risky behavior, such as having unprotected sex or cheating on their spouse.

While being a parent can be rewarding yet taxing at times, for people with bipolar disorder, stressful situations can cause changes in mood. When they are unwell and unable to assist with family responsibilities, this can take a toll on the other partner.

Bipolar disorder is complex, and depending on a child’s age and level of understanding, explaining to them what their parent is going through might be challenging. 

Financial Responsibility

Mania and impulsivity can lead to behaviors that can jeopardize a couple’s financial health. Excessive spending, accumulation of credit and debt, and gambling have serious consequences for a couple’s financial standing, and it can be hard to recover. 

Considering Your Spouse’s Feelings

Compassion from both partners toward each other can go a long way in a marriage in which one spouse has bipolar disorder.

The partner with the condition may have feelings of guilt, shame, and fear because of the impact of a mood episode on the relationship. Meanwhile, the spouse’s partner may experience a range of emotions, including anxiety, resentment, loneliness, or feeling stuck.

Learning how to take care of themselves and support each other can strengthen the relationship.

How to Help

There are many ways you can help a spouse with bipolar disorder:

• Educate yourself about bipolar disorder. Understanding what you and your partner are dealing with can help you cope and strengthen your relationship.
• Recognize that your partner is separate from the disorder. If your partner does or says something hurtful, reminding yourself it's the disorder causing the behavior can help alleviate your confusion or frustration.
• Talk to your partner about their experience with the condition, and identify patterns to be aware of. This can help you anticipate changes in behavior and how to cope with them.
• Ask questions, actively listen, and communicate honestly. Having empathy and allowing your spouse to be heard can strengthen your relationship.
• Work together to create a plan to support your family and household when your partner is unwell.
• Develop a plan of action when symptoms worsen (e.g., contacting the care team or seeking emergency services).
• Support your partner in seeking treatment and staying consistent with medication and therapy. Proper treatment can stabilize moods and support a healthy relationship.
• Encourage healthy daily habits (e.g., exercise, balanced meals, and good sleep hygiene). Research shows that people with bipolar disorder who have an unhealthy lifestyle have a worse course of illness.
• Consider couple's therapy. Going to counseling together can support open communication, help work through upset and frustration, and provide professional guidance for dealing with challenges.
• Build a shared prevention and safety plan. Identify protective factors (e.g. eight hours of sleep per night), triggers (e.g. not getting enough sleep), warning signs (e.g. starting to stay up later) in addition to the plan of action when symptoms worsen.

Caring for Your Needs

You must also remember to take care of yourself:

• Cultivate self-care and coping skills. Self-care, such as exercising, healthy eating, good sleep habits, and spending time with friends and family members can help to manage stress and improve mental health.
• Set boundaries by expressing what is acceptable or unacceptable. Setting boundaries, such as not tolerating verbal abuse or participating in unhealthy behaviors can improve communication, support self-care, and potentially strengthen your relationship.
• Be clear about what will happen if a boundary is violated.
• Reach out for help if you need support or guidance. Individual therapy or support groups can be beneficial.
• Be gentle and compassionate toward yourself. Negative self-talk and blaming yourself are harmful to your self-esteem and mental health. Self-compassion has been shown to improve well-being.

When to Talk About Divorce

Sometimes a marriage doesn’t work, and partners exhaust options that might help them reconcile. In such cases, the partners may want to consider divorce as an option.

Due to stigma , people often associate violence with mental health conditions. The truth is that most people with a mental health diagnosis are not violent.

However, abuse can occur when there are extreme changes in mood or when drugs or alcohol are involved. Irritability and impulsiveness that accompany mania can lead to a dangerous situation. 

Abuse can appear in many forms, including emotional, physical, or financial, and determining the best course of action to protect oneself can be scary.

Leaving a dangerous situation cannot always happen immediately for safety or other reasons (e.g., finances, culture, religion). Once a person has resolved to leave a relationship, it can help to seek support about the safest way to exit.

Knowing When to Leave

Walking away from a marriage can be a difficult choice. It might feel like the time to leave if:

• The relationship feels consistently unhealthy.
• You are constantly taxed, burnt out, or unable to care for your own needs.
• You feel unsafe.

Alternately, the partner with bipolar disorder may be the one to decide the relationship is not beneficial for their well-being anymore. Some signs might be:

• They feel consistently judged or stigmatized by their partner.
• They feel their spouse doesn’t support them.
• The relationship feels unsafe (emotionally, physically, etc.).

Seeking psychotherapy to help clarify these issues can be important for both partners in the relationship.

Living with a spouse who has bipolar disorder can be challenging. Engage in honest conversations about how you are affected and how you need support. No one is to blame for bipolar disorder, and spouses can learn to care for themselves and each other.

Alternatively, the relationship may not feel safe. In those cases, you should prioritize your own mental health and well-being and seek help.

Frequently Asked Questions

The diagnosis of a mental health condition is not a red flag. Many people with various mental health conditions, including bipolar disorder, lead balanced and meaningful lives.

When dating someone with bipolar disorder, if it appears they are not managing their symptoms, this may be an indication that something deeper is going on and they need to seek help.

Rates of separation and divorce are higher in couples where one partner has bipolar disorder. Dating or being married to a person with bipolar disorder has challenges, and like any relationship, communication, understanding, and support can benefit the relationship.

Partners should be clear about when it feels like a relationship is or isn’t working for them. Strategies to enhance and improve the relationship are available through individual and couples counseling .

However, the emotional impact of recurrent mood swings on either party can lead partners to feel like a relationship isn’t healthy anymore. 

Whether your partner has bipolar disorder or not, learning how to clearly communicate thoughts and feelings in a nonjudgmental manner helps couples in a few ways. They can identify and address the root of concern, listen and validate each other, and determine a course of action to move forward together.

It can also be a good idea to decide whether or not it feels like the right time to have a conversation. If your partner is unwell or it doesn’t feel like either of you is ready to have a productive discussion, don’t proceed. Instead, take some time to process and cope individually, then come back together at a time that feels better for both partners.

Honesty and communication are foundational to establishing trust. People often feel more confident in trusting or relying on others when they can have an open dialogue about the concerns and issues that may be affecting the relationship and how to tackle them.

If you have concerns about trust, you might voice them and talk with your partner about how you can share responsibilities in your relationship. Set boundaries and ask for what you need. Hear your partner on this as well. Be clear about what you need to build trust between the two of you.

A person can sometimes have bipolar disorder and not recognize it. The best way to gauge your partner’s emotional state is to have an open and honest conversation about it. If you suspect that your spouse may be dealing with bipolar disorder, let them know your concerns and that you are there to help.

Asking them about what they’ve noticed about themselves and their thoughts can be a great way to get insight into how they’re feeling. Offer to help connect them with a mental health professional in order to take the next step.

National Institute of Mental Health. Bipolar disorder .

American Psychiatric Association. What are bipolar disorders?

Carvalho AF, Dimellis D, Gonda X, Vieta E, Mclntyre RS, Fountoulakis KN. Rapid cycling in bipolar disorder: a systematic review. J Clin Psychiatry . 2014 Jun;75(6):e578-86. doi: 10.4088/JCP.13r08905

Merck Manual. Bipolar disorders .

Grover S, Nehra R, Thakur A. Bipolar affective disorder and its impact on various aspects of marital relationship .  Ind Psychiatry J . 2017;26(2):114-120. doi:10.4103/ipj.ipj_15_16

Azorin J-M, Lefrere A, Belzeaux R. The impact of bipolar disorder on couple functioning: implications for care and treatment. A systematic review . Medicina . 2021;57(8):771. doi:10.3390/medicina57080771

Naqvi TF, Dasti R, Khan N. Emotional journey of wives of spouses diagnosed with bipolar I disorder: moving from vicissitude towards reconciliation . Int J Qual Stud Health Well-being . 2021;16(1):1946926. doi:10.1080/17482631.2021.1946926

Granek L, Danan D, Bersudsky Y, Osher Y. Living with bipolar disorder: the impact on patients, spouses, and their marital relationship .  Bipolar Disord . 2016;18(2):192-199. doi:10.1111/bdi.12370

Kopeykina I, Kim HJ, Khatun T, et al. Hypersexuality and couple relationships in bipolar disorder: a review .  J Affect Disord . 2016;195:1-14. doi:10.1016/j.jad.2016.01.035

Huang J, Yuan CM, Xu XR, et al. The relationship between lifestyle factors and clinical symptoms of bipolar disorder patients in a Chinese population . Psychiatry Res. 2018 Aug;266:97-102. doi: 10.1016/j.psychres

Zessin U, Dickhäuser O, Garbade S. The Relationship Between Self-Compassion and Well-Being: A Meta-Analysis . Appl Psychol Health Well Being. 2015 Nov;7(3):340-64. doi: 10.1111/aphw.12051

By Geralyn Dexter, PhD, LMHC Dexter has a doctorate in psychology and is a licensed mental health counselor with a focus on suicidal ideation, self-harm, and mood disorders.