Bipolar Disorder Explained: Everything You Need to Know

Bipolar disorder refers to a group of mental health conditions characterized by sudden, dramatic changes in mood, energy, and behavior. Formerly known as manic depression, this condition causes mood episodes lasting days or weeks at a time and hinder day-to-day functioning, school or work performance, and relationships.

This article describes the symptoms, causes, and treatments for bipolar disorder and discusses how to cope if you’re diagnosed with this mental health condition.

What Is Bipolar Disorder?

Estimated to affect 4.4% of U.S. adults at some point in their lives, bipolar disorder causes distinct periods of extreme emotional states or episodes that can last for days or weeks. Episodes are characterized by manic or depressive behavior.

Manic Episodes

A manic episode is a phase of a week or more during which you have an elevated mood and energy most of the time for most days. In this phase, you may feel abnormally happy, agitated, restless, and don’t need much sleep.

In rare and severe cases, people experience hallucinations and delusions during manic episodes. In addition, some people experience hypomanic episodes—less severe manic episodes lasting four or more days.   

Major Depressive Episodes

A major depressive episode is a period of two or more weeks of depressive symptoms, such as sadness, hopelessness, lethargy (lack of energy), and apathy. These episodes can become severe, leading to suicidal thoughts. As with manic episodes, severe depressive episodes can lead to hallucinations or delusions.

What Are the Types of Bipolar Disorder?

Healthcare providers break down bipolar disorder into four primary types: bipolar 1, bipolar 2, cyclothymic disorder, and unspecified bipolar disorder.

Bipolar 1 Disorder

With bipolar 1 disorder, manic episodes last a week or become so severe that you require hospitalization. In most cases, bipolar 1 also causes depressive episodes. Some people have “mixed” episodes that feature both manic and depressive symptoms at the same time. Neutral periods—neither manic nor depressive—are also common with this type.

Bipolar 2 Disorder

Bipolar 2 disorder occurs when you experience one depressive episode and at least one hypomanic episode (milder manic episodes that last four or more days). In between these are symptom-free periods. Those with bipolar 2 disorder often have other mental health conditions, such as anxiety or depression.

Cyclothymic Disorder (Cyclothymia)

Cyclothymic disorder is a milder type of bipolar disorder that causes regular mood swings. Ranging between those of mild depression and hypomania, the symptoms aren’t severe enough to be considered clinically depressive or hypomanic episodes.

Unspecified Bipolar Disorder

Unspecified bipolar disorder is when you have extreme mood fluctuations, but the symptoms aren’t as bad as those of bipolar 1 or 2. Still, with this type, the symptoms are significant enough to affect daily functioning, relationships, and work or school.

Bipolar Disorder Symptoms

Dramatic and intense changes in your mood, emotions, behaviors, and activity level are the primary signs of bipolar disorder. These shifts tend to be noticeable to others and impact your relationships, performance at work or school, or daily functioning.

The symptoms you experience depend on whether you’re having a manic or depressive episode.

Manic Episode Symptoms

During manic episodes, emotion and activity levels are elevated. Manic episode symptoms include the following:

• Abnormal giddiness or happiness 
• Changing topics when speaking 
• Distractibility
• Feeling energetic despite insufficient sleep
• Increased irritability or agitation
  
• Racing, uncontrollable thoughts
• Recklessness or risky, impulsive behaviors
  
• Restlessness, increased activity
  
• Talking faster or more often
  

Major Depressive Episode Symptoms

In contrast to manic episodes, during a depressive episode, you feel “low” in terms of energy, mood, and emotion. Symptoms of this type include combinations of the following:

• Despair, thoughts about death or suicide
• Difficulty falling or staying asleep or sleeping excessively
• Difficulty with routine tasks
• Feeling sad, hopeless, or anxious
• Forgetfulness, slowed speech, not knowing what to say
  
• Loss of energy or motivation 
• Loss of interest in activities
  
• Restlessness
  

What Causes Bipolar Disorder?

Researchers don’t know what exactly causes bipolar disorder. The consensus is that genetic factors, brain chemistry and structure, and environmental factors all play a role in this condition.  

Genetic Factors

Though more work is needed, researchers have linked genetics with an increased risk of developing bipolar disorder. This condition is heritable, making family history a risk factor; people with a parent or sibling with the condition are more likely to have it.

Brain Chemistry and Structure

Using imaging techniques, researchers have found differences between the brains of those with and without bipolar disorder. Some research shows that people with bipolar disorder have smaller subcortical structures (associated with mood and cognition) and a thinner cortex (the outer layer of the brain).

In addition, researchers have linked imbalances in certain neurotransmitters (brain chemicals), particularly dopamine and serotonin, to bipolar disorder.

Environmental Factors

Stressful or traumatic life events and certain behaviors can also raise your risk of developing bipolar disorder. Examples of traumatic events found to trigger attacks include childbirth, losing a job or a loved one, divorce, misusing or overusing drugs or alcohol, or traumatic head injuries.

How Is Bipolar Disorder Diagnosed?

To diagnose bipolar disorder, a healthcare provider will ask about your medical history, current medications, symptoms, and your family’s mental health history. You’ll also undergo a physical exam and, in some cases, blood tests to rule out other potential causes of bipolar disorder symptoms, such as hypothyroidism, stroke, and substance use disorder. 

A healthcare provider or a mental health specialist, like a psychiatrist or psychologist, will perform a mental health evaluation. They will diagnose bipolar disorder and identify the type based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).     

Diagnosing Bipolar 1 Disorder

According to the DSM-5, to be diagnosed with bipolar 1 disorder, you must have had at least one manic episode. This may be followed or preceded by a hypomanic or major depressive episode. While hypomanic or major depressive episodes can occur in bipolar 1, they are not required for a diagnosis.

In bipolar 1 disorder, manic episodes last at least one week or are severe enough to require hospitalization. A healthcare provider will look for at least three (or four if you experience irritability) of the following to diagnose you with bipolar 1 disorder:

• An inflated self-esteem or sense of grandiosity
• Difficulty concentrating; being easily distracted
• Increased activities, agitation, toe-tapping, pacing, or other unnecessary movements
• Increased engagement in unusually risky or self-destructive activities    
• Racing thoughts; thoughts in flight
• Reduced need for sleep
  

Diagnosing Bipolar 2 Disorder

A diagnosis of bipolar 2 disorder is made based on four criteria:  

• A current or past episode of hypomania and at least one major depressive episode 
• Never having a manic episode 
• No other psychological or neurological issues can explain the symptoms
• The mood changes cause impairments in social, personal, and professional life and daily functioning

"Hypomania" is defined as at least four days of manic symptoms that aren’t as severe or numerous as with a full manic episode. Major depressive episodes are defined as having daily or nearly daily symptoms for at least two weeks. According to the DSM-5, these are diagnosed when you display five of the following criteria:

• Agitation, toe-tapping, or pacing
• A lack of interest or enjoyment in life
  
• Decreased ability to concentrate
• Depression, sadness
• Fatigue, insufficient energy
• Inappropriate guilt or lack of self-worth
• Thinking about suicide without making a concrete plan (suicidal ideation)
• Weight loss without dieting, weight gain, decrease or increase in appetite
  

Diagnostic Criteria for Cyclothymic Disorder

In the DSM-5, among the criteria for cyclothymic disorder are the following:

• You have neutral, asymptomatic periods for no more than three months at a time.
  
• Symptoms arise independent of substance use disorder. 
• Symptoms hinder your ability to function and impact your work, school, home, or social life.
• Symptoms are inconsistent with bipolar 1 or 2 or another mental health condition.
• You experience two or more years of hypomania and depressive episodes if an adult and at least one year of symptoms if a child.

Bipolar Disorder Treatment

Treating bipolar disorder typically involves adopting multiple strategies, including medications, counseling, and lifestyle changes.

Medications

Antidepressants, mood stabilizers, and atypical antipsychotics are medication types that healthcare providers consider. A healthcare provider may prescribe selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, for depression associated with bipolar disorder. However, these can cause what is known as cycling—rapid mood shifts—so healthcare providers prescribe them with caution.

Mood-stabilizing drugs, such as Eskalith (lithium) and Depacon (valproate), are indicated alongside SSRIs and help ease or shorten the length of mood episodes. A provider may also prescribe medications to address insomnia (sleep problems) and anxiety, which often accompany bipolar disorder.

Psychotherapy and Counseling

Psychotherapy and counseling involve talk therapy with a psychiatrist, therapist, or trained counselor. This work aims to identify and change problematic behaviors, thoughts, or emotions that set off episodes. Another alternative is cognitive behavioral therapy (CBT), which focuses on changing thought patterns.

Lifestyle Changes

Alongside medical treatments or therapy, lifestyle changes can help you manage bipolar disorder, including:

• Relax: Activities like yoga or meditation may help ease anxiety and help with symptoms.
• Stay active: Regular exercise improves sleep and helps with stress, among other benefits.
• Dietary changes: Poor diet is associated with an increased risk for bipolar disorder and a reduced risk of co-occurring conditions. 
• Avoid substances: Drinking alcohol, smoking tobacco, or using recreational drugs can all increase the risk of bipolar symptoms.
• Education: Understand the symptoms of bipolar disorder and keep track of events or things that trigger symptoms; know your medications and their side effects.

Living With Bipolar Disorder

Living with bipolar disorder means finding a support system, developing coping mechanisms, and managing the shifts in your mood and behaviors. Strategies that can help include:

• Adding structure to your daily activities
• Enlisting loved ones and/or family members in your care
• Ensuring you’re getting regular exercise and enough sleep
• Making sure to take part in enjoyable activities, staying connected to friends, family, and the local community
• Seeking out social support from online or in-person support groups, social media, or message boards
  
• Seeking treatment, developing a treatment plan with your healthcare provider
  
• Tracking and logging your symptoms, medications, and triggers
  

Summary

Bipolar disorder causes dramatic and lasting mood and behavior shifts. People with the condition go through high-energy manic episodes and often also experience depressive episodes. Because of its effects on behavior, bipolar disorder can significantly impact your professional, academic, and/or personal life. If you suspect you or someone you care for has this condition, talk to a healthcare provider for an accurate diagnosis and treatment.