Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.
Bipolar disorder is a mental health condition defined by periods (or episodes) of extreme mood disturbances that affect mood, thoughts, and behavior. There are two main types of bipolar disorders. Bipolar I disorder involves episodes of severe mania and often depression. Bipolar II disorder involves a less severe form of mania called hypomania. There is also a third type known as cyclothymic disorder.
Estimates suggest that around 4.4% of U.S. adults will have bipolar disorder at some point in their lives. Genetics are thought to play a significant role, although brain abnormalities and environmental factors also contribute as causes of bipolar disorder. Mood stabilizers are usually the first-line treatment, but electroconvulsive therapy (ECT) may be used to address severe symptoms.
The exact causes of bipolar disorder are not entirely understood. Research has shown that genetics play a significant role. Other causes include changes in the brain as well as environmental factors including childhood trauma or stress caused by major life changes. Understanding the causes may help scientists develop ways to prevent or treat the condition.
Research suggests there is a strong genetic component in bipolar disorder. Twin studies have found that when one identical twin has the condition, the likelihood that their twin sibling will also have it is around 40%. While there is a genetic vulnerability, inherited factors interact with environmental influences that can play a role in triggering the disorder’s onset.
Bipolar disorder is typically treated with medications and sometimes electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), therapy, and psychoeducation. Common medications include mood stabilizers or anticonvulsants, as well as second or third generation antipsychotics. Antidepressants are typically avoided if possible due to risks including mania and rapid cycling.
Your condition may be considered a disability that is protected by the Americans with Disabilities Act (ADA) or qualifies you for disability payments. If your disability substantially limits your work, you may be able to request reasonable accommodations from your employer. You may qualify for disability benefits if your condition makes it impossible for you to maintain employment.
Only a doctor or qualified mental health professional can diagnose you with bipolar disorder. You may want to see your doctor if you are experiencing symptoms of mania, depression, or both. Symptoms of mania can include talking excessively, racing thoughts, decreased sleep, and delusions. Symptoms of depression may include fatigue, prolonged sadness, and loss of interest in activities.
This type of bipolar disorder involves the presence of at least one manic episode. Manic episodes may last seven days or longer or be severe enough that a person requires acute care. People usually experience depressive episodes as well, but they may also have mixed episodes where they experience depression and mania at the same time.
This type of bipolar disorder is marked by periods of depressive and hypomanic episodes without periods of full-blown mania. It involves at least one episode of depression that lasts at least two weeks and one episode of hypomania that lasts for at least four days. During hypomanic episodes, people have symptoms of mania but are still able to function.
This condition, also known as cyclothymia, is marked by periods of cycling between hypomania and depressive symptoms. These symptoms are persistent and last for at least two years, but they do not meet the criteria to qualify for a diagnosis as a hypomanic or depressive episode. People who have cyclothymic disorder may have a higher risk for later developing bipolar disorder.
Mania is a phase of bipolar disorder that involves elevated periods of mood, energy, thoughts, and other behaviors. Common symptoms of mania include rapid and excessive talking, grandiose thoughts and beliefs, decreased sleep, flights of ideas or racing thoughts, an inability to keep still, and trouble concentrating.
Hypomania is a symptom of bipolar disorder that involves racing thoughts, impulsive and other out of character behaviors, and elevated moods. It is marked by increased excitability, irritability, and excess energy. People may seem restless, overly talkative, highly distracted, or overly focused on specific activities. A decreased need for sleep, engaging in risky behaviors, and inappropriate social behavior can also be symptoms.
Depression is characterized by a persistent low mood and loss of interest in activities that can have a significant impact on a person's ability to function in daily life. Bipolar depression typically presents with increased sleep, increased appetite (often with carbohydrate cravings), and increased rejection sensitivity.
Psychotherapy is an approach to the treatment of mental illness that focuses on thoughts, emotions, and behaviors. For bipolar disorder, psychotherapy often focuses on helping people identify and manage their moods and identify the triggers that contribute to depressive, manic, or hypomanic episodes.
Major depressive disorder involves persistently low mood and loss of interest in activities. These symptoms can lead to both physical and behavioral symptoms including poor concentration, low energy, changes in sleep, changes in appetite, poor self-esteem, and difficulty managing daily tasks. Treatment often involves medication, psychotherapy, or a combination of the two.
A psychiatric assessment involves gathering information about mental health symptoms in order to make a diagnosis. An assessment often involves getting a physical exam, providing a medical history, and answering questions about the nature, duration, and severity of your symptoms. A mental health professional can then use this information to make a diagnosis and recommend a treatment plan.
If you have bipolar disorder, charting your moods can be a useful way to look at symptom patterns over time. Monitoring your symptoms on an ongoing basis allows you to learn to recognize stressful life events that may trigger the onset of symptoms. Printable mood charts can be helpful, but there are also mobile apps available.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC. 2013.
National Institute of Mental Health. Bipolar disorder. Updated November 2017.
National Institute of Mental Health. Bipolar disorder. Updated January 2020.