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Bipolar DisorderNational Instituteof Mental Health

Do you feel very happy and outgoing—or very irritable—on somedays, but unusually sad or anxious on other days? Do the “up” periodsgo along with increased energy or activity? Do the “downs” go alongwith low energy, hopelessness, or inability to enjoy what youusually like to do, and sometimes suicidal thoughts? Do these moodswings make it hard to sleep, stay focused, or get things done?Some people with these symptoms have a lifelong but treatablemental disorder called bipolar disorder.What is bipolar disorder?Bipolar disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals)mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity,and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manicdepression, which are older terms.Everyone goes through normal ups and downs, but bipolar disorder is different. The range of moodchanges can be extreme. In manic episodes, someone might feel very happy, irritable, or “up,” andthere is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent,or hopeless, in combination with a very low activity level. Some people have hypomanic episodes,which are like manic episodes, but less severe and troublesome.Most of the time, bipolar disorder develops or starts during late adolescence (teen years) or earlyadulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come andgo, bipolar disorder usually requires lifetime treatment and does not go away on its own. Bipolardisorder can be an important factor in suicide, job loss, and family discord, but proper treatment leadsto better outcomes.What are the symptoms of bipolar disorder?The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes,depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms.These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode,the symptoms last every day for most of the day. Mood episodes are intense. The feelings are intenseand happen along with changes in behavior, energy levels, or activity levels that are noticeable to others.SYMPTOMS OF A MANIC EPISODESYMPTOMS OF A DEPRESSIVE EPISODEFeeling very up, high, elated, or extremely irritableor touchyFeeling very down or sad, or anxiousFeeling jumpy or wired, more active than usualFeeling slowed down or restlessRacing thoughtsTrouble concentrating or making decisionsDecreased need for sleepTrouble falling asleep, waking up too early, orsleeping too muchTalking fast about a lot of different things (“flightof ideas”)Talking very slowly, feeling like you have nothing tosay, or forgetting a lotExcessive appetite for food, drinking, sex, or otherpleasurable activitiesLack of interest in almost all activitiesThinking you can do a lot of things at once withoutgetting tiredUnable to do even simple thingsFeeling like you are unusually important, talented,or powerfulFeeling hopeless or worthless, or thinking aboutdeath or suicide

Some people with bipolar disorder may have milder symptoms than others with the disorder. Forexample, hypomanic episodes may make the individual feel very good and be very productive; theymay not feel like anything is wrong. However, family and friends may notice the mood swings andchanges in activity levels as behavior that is different from usual, and severe depression may followmild hypomanic episodes.Types of Bipolar DisorderThere are three basic types of bipolar disorder; all of them involve clear changes in mood, energy,and activity levels. These moods range from periods of extremely “up,” elated, and energizedbehavior or increased activity levels (manic episodes) to very sad, “down,” hopeless, or low activitylevel periods (depressive episodes). People with bipolar disorder also may have a normal (euthymic)mood alternating with depression. Four or more episodes of mania or depression in a year are termed“rapid cycling.” Bipolar I Disorder is defined by manic episodes that last at least seven days (most of the day,nearly every day) or when manic symptoms are so severe that hospital care is needed. Usually,separate depressive episodes occur as well, typically lasting at least two weeks. Episodes ofmood disturbance with mixed features (having depression and manic symptoms at the same time)are also possible. Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, butnot the full-blown manic episodes described above. Cyclothymic Disorder (also called cyclothymia) is defined by persistent hypomanic anddepressive symptoms that are not intense enough or do not last long enough to qualify ashypomanic or depressive episodes. The symptoms usually occur for at least two years in adultsand for one year in children and teenagers. Other Specified and Unspecified Bipolar and Related Disorders is a category that refers tobipolar disorder symptoms that do not match any of the recognized categories.Conditions That Can Co-Occur With Bipolar DisorderMany people with bipolar disorder also may have other mental health disorders or conditions such as: Psychosis. Sometimes people who have severe episodes of mania or depression also havepsychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to matchthe person’s extreme mood. For example: Someone having psychotic symptoms during a manic episode may falsely believe that he orshe is famous, has a lot of money, or has special powers. Someone having psychotic symptoms during a depressive episode may believe he or she isfinancially ruined and penniless or has committed a crime. Anxiety Disorders and Attention-Deficit/Hyperactivity Disorder (ADHD). Anxiety disorders andADHD often are diagnosed in people with bipolar disorder. Misuse of Drugs or Alcohol. People with bipolar disorder are more prone to misusing drugsor alcohol. Eating Disorders. People with bipolar disorder occasionally may have an eating disorder, such asbinge eating or bulimia.Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. Forexample, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosedwith schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moodsand other symptoms of bipolar disorder. Street drugs sometimes can mimic, provoke, or worsen moodsymptoms.Looking at symptoms over the course of the illness (longitudinal follow-up) and the person’s familyhistory can play a key role in determining whether the person has bipolar disorder with psychosisor schizophrenia.

What causes bipolar disorder?The exact cause of bipolar disorder is unknown. However, research suggests that there is no singlecause. Instead, a combination of factors may contribute to bipolar disorder.GenesBipolar disorder often runs in families, and research suggests that this is mostly explained byheredity—people with certain genes are more likely to develop bipolar disorder than others. Manygenes are involved, and no one gene can cause the disorder.But genes are not the only factor. Some studies of identical twins have found that even when one twindevelops bipolar disorder, the other twin may not. Although people with a parent or sibling withbipolar disorder are more likely to develop the disorder themselves, most people with a family historyof bipolar disorder will not develop the illness.Brain Structure and FunctionResearchers are learning that the brain structure and function of people with bipolar disorder may bedifferent from the brain structure and function of people who do not have bipolar disorder or otherpsychiatric disorders. Learning about the nature of these brain changes helps doctors betterunderstand bipolar disorder and may in the future help predict which types of treatment will workbest for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brainimaging or other diagnostic tests.How is bipolar disorder diagnosed?To diagnose bipolar disorder, a doctor or other health care provider may: Complete a full physical exam. Order medical testing to rule out other illnesses. Refer the person for an evaluation by a psychiatrist.A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms,lifetime course, and experiences of the individual. Some people have bipolar disorder for years beforeit is diagnosed. This may be because: Bipolar disorder has symptoms in common with several other mental health disorders. A doctormay think the person has a different disorder, such as schizophrenia or (unipolar) depression. Family and friends may notice the symptoms, but not realize that the symptoms are part of a moresignificant problem. People with bipolar disorder often have other health conditions, which can make it hard fordoctors to diagnose bipolar disorder.How is bipolar disorder treated?Treatment helps many people, even those with the most severe forms of bipolar disorder. Doctorstreat bipolar disorder with medications, psychotherapy, or a combination of treatments.MedicationsCertain medications can help control the symptoms of bipolar disorder. Some people may need to tryseveral different medications and work with their doctor before finding the ones that work best. Themost common types of medications that doctors prescribe include mood stabilizers and atypicalantipsychotics. Mood stabilizers such as lithium can help prevent mood episodes or reduce their

severity when they occur. Lithium also decreases the risk for suicide. Additional medications thattarget sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan.Talk with your doctor or a pharmacist to understand the risks and benefits of each medication. Reportany concerns about side effects to your doctor right away. Avoid stopping medication without talkingto your doctor first.PsychotherapyPsychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques thataim to help a person identify and change troubling emotions, thoughts, and behaviors. Psychotherapycan offer support, education, skills, and strategies to people with bipolar disorder and their families.Psychotherapy often is used in combination with medications; some types of psychotherapy(e.g., interpersonal, social rhythm therapy) can be an effective treatment for bipolar disorder whenused with medications.Learn more about psychotherapy at ex.shtml.Other TreatmentsSome people may find other treatments helpful in managing their bipolar symptoms, including: Electroconvulsive therapy is a brain stimulation procedure that can help people get relief fromsevere symptoms of bipolar disorder. This type of therapy is usually considered only if a patient’sillness has not improved after other treatments (such as medication or psychotherapy) are tried,or in cases where rapid response is needed, as in the case of suicide risk and catatonia (a state ofunresponsiveness), for example. Regular vigorous exercise, such as jogging, swimming, or bicycling, helps with depression andanxiety, promotes better sleep, and is healthy for your heart and brain. Check with your doctorbefore you start a new exercise regimen. Keeping a life chart, which records daily mood symptoms, treatments, sleep patterns, and lifeevents, can help people and their doctors track and treat bipolar disorder.Not much research has been conducted on herbal or natural supplements and how they may affectbipolar disorder. Talk to your doctor before taking any supplement. Certain medications andsupplements taken together can cause serious side effects or life-threatening drug reactions. Visit theNational Center for Complementary and Integrative Health for more information: TreatmentThe National Institute of Mental Health (NIMH) is a federal research agency and cannot providemedical advice or referrals to practitioners. However, there are tools and resources available that may help you find a provider or treatment. You can also: Call your doctor. Your doctor can be the first step in getting help. Call the Substance Abuse and Mental Health Services Administration (SAMHSA) TreatmentReferral Helpline at 800-662-HELP (4357) for general information on mental health and to findlocal treatment services. Visit the SAMHSA website, which has a Behavioral Health Treatment Services Locator that cansearch for treatment information by address, city, or ZIP code at Seek immediate help from a doctor or the nearest hospital emergency room, or call 911, if you orsomeone you know is in crisis or considering suicide.

Call the toll-free National Suicide Prevention Lifeline at 800-273-TALK (8255), available 24hours a day, seven days a week. This service is available to everyone. The deaf and hard ofhearing can contact the Lifeline via TTY at 800-799-4889. All calls are free and confidential.Contact social media outlets directly if you are concerned about a friend’s social mediaupdates, or dial 911 in an emergency. Learn more at With Bipolar DisorderLiving with bipolar disorder can be challenging, but there are ways to help make it easier for yourself,a friend, or a loved one. Get treatment and stick with it—recovery takes time and it’s not easy. But treatment is the bestway to start feeling better. Keep medical and therapy appointments, and talk with the provider about treatment options. Take all medicines as directed. Structure activities: keep a routine for eating and sleeping, and make sure to get enough sleepand exercise. Learn to recognize your mood swings. Ask for help when trying to stick with your treatment. Be patient; improvement takes time. Social support helps.Remember, bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help controlsymptoms and enable you to live a healthy life.How is NIMH addressing bipolar disorder?The National Institute of Mental Health (NIMH) conducts and supports research on bipolar disorderthat increases our understanding of its causes and helps develop new treatments. Researcherscontinue to study genetics and bipolar disorder, brain function, and symptoms in children and teenswho have bipolar disorder, as well as family history in health and behavior.Learn more about NIMH’s research priorities and current studies by visiting articipating in Clinical ResearchClinical research is medical research that involves people like you. People volunteer to participate incarefully conducted investigations that ultimately uncover better ways to treat, prevent, diagnose, andunderstand human disease. Clinical research includes trials that test new treatments and therapies aswell as long-term natural history studies, which provide valuable information about how disease andhealth progress.Please Note: Decisions about participating in a clinical trial and determining which ones arebest suited for you are best made in collaboration with your licensed health professional.Join a StudyNIMH researchers conduct studies in a wide range of areas related to the brain and mental disorders.The studies usually take place at the NIH Clinical Center in Bethesda, MD, and may require regularvisits. After the initial phone interview, you will come to an appointment at the clinic and meet with aclinician. Visit or formore information.

To find a clinical trial near you, you can visit This website is a searchableregistry and results database of federally and privately supported clinical trials conducted in theUnited States and around the world. gives you information about a trial’s purpose,who may participate, locations, and phone numbers for more details. This information should be usedin conjunction with advice from health professionals.Talk to your doctor about clinical trials, their benefits and risks, and whether one is right for you. Learnmore about clinical trials by visiting the following websites: NIMH’s Clinical Research Trials and You: Questions and Answers at tml (also availablein print) NIMH’s Join a Study webpage at The National Institutes of Health (NIH) Clinical Research Trials and You website at ch-trials-youThrough clinical trials, researchers are making discoveries that can be used in everyday practice tohelp people.Finding HelpMental Health Treatment LocatorThe Substance Abuse and Mental Health Services Administration provides this online resource forlocating mental health treatment facilities and programs. The Mental Health Treatment Locator sectionof the Behavioral Health Treatment Services Locator lists facilities providing mental health services topersons with mental illness. Find a facility in your state at Foradditional resources, visit to Ask Your DoctorAsking questions and providing information to your doctor or health care provider can improve your care.Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit theAgency for Healthcare Research and Quality website for tips at publication is in the public domain and may be reproduced or copied without permission fromNIMH. Citation of NIMH as a source is appreciated. We encourage you to reproduce this publicationand use it in your efforts to improve public health. However, using government materialsinappropriately can raise legal or ethical concerns, so we ask you to follow these guidelines: NIMH does not endorse or recommend any commercial products, processes, or services, and ourpublications may not be used for advertising or endorsement purposes. NIMH does not provide specific medical advice or treatment recommendations or referrals; ourmaterials may not be used in a manner that has the appearance of providing such information. NIMH requests that non-federal organizations do not alter our publications in ways that willjeopardize the integrity and “brand” when using the publication. The addition of non-federal government logos and website links may not have the appearanceof NIMH endorsement of any specific commercial products or services, or medical treatmentsor services. Images pictured in NIMH publications are of models and are used for illustrative purposes only.Use of some images is restricted.If you have questions regarding these guidelines and the use of NIMH publications, please contactthe NIMH Information Resource Center at 866-615-6464 or email [email protected]

For More InformationNIMH websitewww.nimh.nih.govMedlinePlus (National Library of Medicine) español: español: al Institute of Mental HealthOffice of Science Policy, Planning, and CommunicationsScience Writing, Press, and Dissemination Branch6001 Executive BoulevardRoom 6200, MSC 9663Bethesda, MD 20892-9663Phone: 301-443-4513 orToll-free: 866-615-NIMH (6464)TTY: 301-443-8431 orTTY Toll-free: 866-415-8051Fax: 301-443-4279Email: [email protected]: www.nimh.nih.govU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNIH Publication 19-MH-8088Revised October 2018

Bipolar disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals) mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manic