Bipolar Disorder: Types, Symptoms and Treatment

Bipolar disorder — once called manic depression or manic-depressive disorder — is a mood disorder that causes intense mood swings, along with changes in behavior, energy and activity:

• a manic episode: feeling extremely "up," elated, irritable or energized;
• a depressive episode: feeling "down," sad, indifferent or hopeless;
• a mixed episode: manic and depressive symptoms at the same time.

Types

Having four or more episodes of mania or depression in a year is called rapid cycling.

Causes and risk

The exact cause is unknown; genetics, brain structure and function and environment likely all play a part. Having a close relative with bipolar disorder raises your risk, and trauma or stressful life events may raise it further.

Symptoms

Mania may include:

• feeling very up, high or elated;
• feeling jumpy or wired, more active than usual;
• a very short temper or extreme irritability;
• racing thoughts and fast talking;
• needing less sleep;
• feeling unusually important, talented or powerful;
• risky behavior — overeating or drinking, spending or giving away lots of money, reckless sex.

Depression may include:

• feeling very sad, hopeless or worthless;
• loneliness or isolating yourself;
• talking slowly, feeling you have nothing to say, forgetting a lot;
• little energy; sleeping too much; eating too much or too little;
• losing interest in usual activities, being unable to do even simple things;
• thinking about death or suicide.

Some people have milder symptoms. With hypomania you may feel very good and productive and not notice anything wrong — but family and friends may see unusual mood and activity changes, and severe depression can follow. Episodes may last a week or two or longer, with symptoms most of the day, nearly every day.

Diagnosis

A provider may use a physical exam, a medical history (symptoms, lifetime and family history), tests to rule out other conditions, and a mental health evaluation — or refer you to a specialist.

Treatment

Treatment helps many people, even with the most severe forms. The main treatments are medicines, psychotherapy or both.

• Medicines help control symptoms. You may need to try several, or take more than one. Take them consistently, don't stop without talking to your provider, and raise any concerns about side effects.
• Psychotherapy (talk therapy) helps you recognize and change troubling emotions, thoughts and behaviors, and gives you and your family support, education, skills and coping strategies.
• Electroconvulsive therapy (ECT) uses a mild electric current under general anesthesia. It's most often used for severe bipolar disorder that hasn't improved with other treatments, or when faster relief is needed — such as a high suicide risk or catatonia.
• Repetitive transcranial magnetic stimulation (rTMS) uses magnetic waves to relieve depression. It's less powerful than ECT but needs no anesthesia and has little effect on memory and thinking.
• Light therapy works for seasonal affective disorder and may help people whose depression worsens in certain seasons, usually fall and winter.
• Healthy habits — regular exercise, a steady sleep schedule and a mood journal — also help.

Bipolar disorder is lifelong, but ongoing treatment can manage symptoms and let people live healthy, successful lives.

If you or someone you know is struggling or in crisis, call or text 988, or chat at 988lifeline.org, to reach the 988 Suicide & Crisis Lifeline.

Sources

Based on "Bipolar Disorder," MedlinePlus, U.S. National Library of Medicine; summary text from the NIH's National Institute of Mental Health. A work of the United States government in the public domain.