Bipolar disorder: types, symptoms, causes, medications

Everybody has mood changes where they feel happy or depressed, depending on the day and circumstances. If your mood swings are extreme or last too long, you may have a mood disorder. A mood disorder is where your emotional state doesn’t match your circumstances and interferes with your daily life. 

One of the major mood disorders is bipolar disorder. Learn more about the types, causes, symptoms, and treatment of bipolar disorder below.

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Bipolar disorder is when a person has alternating periods of intense high and low moods that disturb their sleep, energy levels, and activities. These alternating changes can profoundly affect their relationships, work, and behavior (Jain, 2021).

You may feel “high” when having a manic episode or hypomanic episode. You may feel “low” when having a depressive episode. Some people have psychotic symptoms like hallucinating or feeling paranoid during a manic or depressive episode.

Before 1980, bipolar disorder was called manic-depression or manic-depressive illness. The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3) changed the diagnosis to bipolar disorder. The American Psychiatric Association made this change to reflect both the emotional and physical symptoms of the condition, providing better diagnoses to people with mood disorders.

In addition, the word “mania” was removed from the name, as it is stigmatizing. People with the disorder were called “maniacs,” a very judgmental term, and now they are said to have bipolar disorder (Mason, 2016).

The National Alliance on Mental Illness (NAMI) says that bipolar disorder affects about 2.8% of people in the U.S., with nearly 83% of those experiencing severe cases. It affects men and women equally. Bipolar disorder is usually diagnosed in a person’s mid-twenties, but some people can start having symptoms in their teenage years or later in life (NAMI, 2021).

Bipolar symptoms of manic, hypomanic, or depressive episodes can make it challenging to live your daily life the way you’d like. It can impact your relationships at home, work, or school.

Not everyone with bipolar disorder has the same symptoms, and episodes can last for varying amounts of time. One person may have an episode that lasts for several months. Another may have alternating episodes of “high” and “low” moods happening simultaneously. Some people have “rapid cycling” bipolar disorder with at least four episodes a year (Jain, 2021).

What is a manic or hypomanic episode?

Both of these words mean elevated moods, but hypomania is less intense than mania. Therefore, if you experience a hypomanic episode, you will have less extreme symptoms than in a manic episode.

If you or your loved one are having a manic or hypomanic episode, symptoms can include (Jain, 2021):

• Feeling better than you have before—including high levels of self-importance, exhilaration, euphoria, and feeling like you can do anything—even if your situation isn’t ideal

• Talking a lot more than usual and being extra sociable or aggressive in social situations

• Having racing thoughts and feeling hyper or wired

• Not being able to concentrate or focus, or feeling easily distracted

• Sleeping little or being unable to sleep, without feeling tired

• Feeling more irritable than usual

• Engaging in risky behaviors that may include spending a lot of money, acting out on bizarre thoughts, making poor decisions, gambling, taking drugs, drinking alcohol, or having impulsive sex with different people

• Not realizing anything you’re doing is wrong or actively denying that anything is wrong

What is a depressive episode?

If you or your loved one are having a depressive episode, symptoms can include (Jain, 2021):

• Feeling guilty, down, or despairing

• Feeling hopeless or worthless

• Low energy

• Not wanting to do things that bring you pleasure

• Feeling extremely tired but restless or irritable at the same time

• Sleeping too much or unable to sleep

• Unable to concentrate, make decisions, or keep forgetting things

• Not wanting to go to school or work

• Overeating or unable to eat at all

• Pain or other physical issues that don’t get better

• Weight gain or loss when you aren’t trying to do either

• Thinking about suicide

People with bipolar disorder are at an extremely high risk of suicide, especially if they go without treatment (Jain, 2021). It is essential to reach out to a loved one or a healthcare professional when you have these thoughts to get help. You can call the suicide hotline at any time, 24 hours a day, every single day at 800-273-8255.

What is psychosis?

Some people may have symptoms of psychosis when they have a severe episode of either mania or depression. These may include delusions, hallucinations, or paranoia. A delusion is where you may believe things that are not true, like you have special powers like making yourself invisible.A hallucination is where you see, hear, or feel things that are not there, like seeing a talking tiger. Paranoia is where you think someone is out to “get you” (Jain, 2021). If you have any of these symptoms, it’s especially important to seek help. 

There are four types of bipolar disorder (Sekhon, 2020).

1. Bipolar I disorder

Bipolar I disorder is where you or your loved one has had one or more episodes of mania. The manic episode needs to last at least one week or be so severe that you require hospitalization. Many people with bipolar I will have both mania and depression. Still, for a diagnosis of bipolar I, you don’t need to have a depressive episode to be diagnosed (Sekhon, 2020). 

 2. Bipolar II disorder

Bipolar II disorder is where you or your loved one have depressive episodes alternating with hypomanic episodes, but you never have a full manic episode (Sekohn, 2020). 

Some people are diagnosed with bipolar I or II with mixed features, also called mixed bipolar states. Mixed bipolar states mean you experience depression, mania, or hypomania at the same time. You may feel despairing and down, together with irritability and aggression (Jain, 2021).

Other people may be diagnosed with bipolar I or II disorder with rapid cycling. Rapid cycling is when you have at least four or more manic, depressive, or hypomanic episodes in a year (Jain, 2021).

Some people may also have depressive episodes of bipolar I or II that are affected by the weather. This is called bipolar I or II, with a seasonal pattern. This type is similar to seasonal affective disorder (SAD), but SAD does not have any manic or hypomanic episodes during other seasons (Jain, 2021).

3. Cyclothymia

The third type of bipolar disorder is cyclothymia or cyclothymic disorder. Cyclothymia is where you or your loved one have an unstable mood with hypomania and moderate depression for at least two years. You may have short periods of a normal mood, but those periods last for less than two months (Sekhon, 2020).

4. Bipolar disorder unspecified

Bipolar disorder unspecified or other unspecified is where you or your loved one do not meet the criteria for any other bipolar disorder, but still have times of recognized high moods that can’t be explained by anything else (Sekhon, 2020).

There isn’t one single cause of bipolar disorder, but several factors can make it more likely that you or your loved one develop bipolar disorder (Jain, 2021).

Family history

If you have one parent with bipolar disorder, you have a 10–25% chance of being diagnosed with the same condition. The risk is increased if both your parents or your identical twin have this diagnosis. At least two genetic factors have been linked to the development of this disorder (Jain, 2021). 

Brain chemicals and structure

Your body produces chemicals called neurotransmitters that affect the brain. An imbalance of these neurotransmitters or conditions that affect the way your brain is formed and functions may lead to bipolar disorder (Jain, 2021).

Environmental factors

Traumatic and stressful life events, including physical abuse, loss of a significant person in your life, or severe mental stress, can increase your chances of triggering a bipolar episode (Jain, 2021).

Other mental illnesses

If you have been diagnosed with another mental health disorder like borderline personality disorder (BPD) or obsessive-compulsive disorder (OCD), you may be more likely to have a bipolar depressive episode (Jain, 2021).

If you or your loved one’s behavior shows any of the symptoms of mania, hypomania, or depression, it’s best to seek medical advice. 

You will first have a complete physical examination to rule out any underlying medical conditions, such as a thyroid condition, and see if any of the symptoms are caused by medications, alcohol, or substance abuse (Jain, 2021). 

Many people will seek help when they feel low rather than when they’re feeling exhilarated. It can be challenging for your healthcare professional to distinguish your low mood from major depression, so it’s best to share all of your symptoms so that you can receive proper treatment.

After your physical exam, your healthcare professional will assess your symptoms to learn about the duration and impact of the symptoms and behaviors. Your healthcare provider will want to rule out other mental health conditions, like major depressive disorder, post-traumatic stress disorder (PTSD), attention-deficit hyperactivity disorder (ADHD), anxiety disorder, schizophrenia, and delusional disorder, all of which may have symptoms that are similar to bipolar disorder (Jain, 2021). 

Diagnosing the different types of bipolar disorder

To diagnose bipolar I disorder, you must have had at least one manic episode lasting at least seven days, or your symptoms were so severe that you needed to be hospitalized. You may or may not have had a depressive episode. If you did have a depressive episode, it had to last for at least two weeks (Jain, 2021).

To diagnose bipolar II disorder, you must have had one or more episodes of depression and at least one episode of hypomania. Some people with hypomania may be high-functioning and able to do well at home, work, or school, but their mood is not stable (Jain, 2021). 

Diagnosing cyclothymia may be challenging, since this disorder has similar features to bipolar disorder, with hypomanic and depressive episodes. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classifies this disorder separately because the intensity and severity of the symptoms are lower than those in either bipolar I or bipolar II disorders (Bielecki, 2020).

How do you treat bipolar disorder?

Bipolar disorder treatment focuses on stabilizing your mood and reducing the severity of your symptoms. The overall goal is to get you or your loved one back to daily life. However, it can take time to get the correct diagnosis and figure out what treatments work best for you or your loved one. Treatment options include medications, psychotherapy, and lifestyle changes. 

If this is an acute situation, it is crucial to keep you and your family safe. If this is the first time you or your loved one is in a manic episode, you may need to go to the nearest emergency room. Some people diagnosed with bipolar do require hospitalization if there is a risk of them harming themselves or others.

Medications work by managing levels of chemicals and hormones that affect the brain. Your psychiatrist and healthcare provider may prescribe a combination of medications that include mood stabilizers, antipsychotics, antidepressants, and anticonvulsants (Kato, 2019).  

The medications you will be prescribed depend on several factors, including your previous symptoms of depression or mania, your current symptoms, and how long these symptoms lasted. Your physical health will also play a role. For example, if you have diabetes, kidney issues, obesity, or are at risk for dementia, you may need a different medication.If you are pregnant, you will not be able to take certain anticonvulsants. Your healthcare professional will also check to see how well you have responded to certain medications in the past and how consistent you will be in taking your medicine (Kato, 2019).

If you’re on an antidepressant, your healthcare provider or psychiatrist may take you off it, especially if you are showing symptoms of mania. People with bipolar disorder usually do better with mood stabilizers (Kato, 2019). 

Mood stabilizers

Lithium is recognized as one of the best medications to help with mania and reduce the risk of suicide. If you are prescribed lithium, you will need to have frequent blood tests to make sure you are taking the best dose for you (Nath, 2020). 

Sometimes anti-seizure medications (called anticonvulsants) are used as mood stabilizers. People who are having an acute manic episode may receive carbamazepine (Tegretol) or valproic acid (Depakote). People who are on “maintenance” bipolar disorder therapy may be prescribed lamotrigine (Lamictal) (Nath, 2020).

Antipsychotics

Antipsychotics include atypical or second-generation antipsychotics like olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). These may be prescribed alone or together with a mood stabilizer (Kato, 2019).

Mood stabilizers combined with antipsychotics are best for managing mania, hypomania, and bipolar depression symptoms (Kato, 2019).

Depressive symptom treatment

The U.S. Food and Drug Administration (FDA) has approved four antipsychotics to treat major depressive episodes in bipolar disorder. They include quetiapine (Seroquel), cariprazine (Vraylar), olanzapine-fluoxetine (Symbax), and lurasidone (Latuda) (Jain, 2021). 

You may be prescribed different combinations or dosages of medications to make sure you receive the best treatment. You will need to monitor your health while receiving treatment for bipolar disorder. You should have a medical exam at least once a year to check your weight, blood pressure, heart rate and rhythm, liver, and kidneys, and to have blood and urine tests. This way, your treatment can be modified as needed so you can feel your best. 

All medications can have side effects. If you experience bothersome side effects, you may need to work with your healthcare provider to adjust your medications. If you have any questions about how you react to your prescribed medications, contact your healthcare provider. Do not stop taking any of your medicines without speaking to your provider, as your symptoms may worsen.

Electroconvulsive therapy (ECT)

You may be a candidate for electroconvulsive therapy (ECT) if (Salik, 2020): 

• Different combinations and dosages of the medications used to treat bipolar disorder haven’t helped

• You are currently pregnant and cannot take certain medicines

• You have life-threatening mania

Electroconvulsive therapy is one of the fastest ways to relieve severe symptoms of depression or mania. In addition, this type of therapy is considered very effective for people at risk for suicide (Salik, 2020).

If you are having this procedure done, you will have electrodes placed on your head and scalp. You will be given a muscle relaxant and oxygen and placed under general anesthesia. You will be carefully monitored during the entire procedure. A tiny electric current will pass through your scalp to create a brief seizure (lasting 15 to 70 seconds) in your brain. You will wake up a few minutes later. Many people do not remember the treatment at all (Salik, 2020). 

If you are a candidate for this treatment, you will typically have three treatments a week for two to four weeks. After that, you will go on “maintenance” and receive treatments once a week or once a month as needed (Salik, 2020).

A few types of psychotherapy help people with bipolar disorder and their loved ones manage manic and depressive symptoms. 

Cognitive-behavioral therapy (CBT) is a form of talking therapy that helps you identify triggers, thoughts, and behaviors that aggravate your bipolar disorder symptoms. CBT gives you tools and skills to help you manage these triggers and behaviors (Kato, 2019).

Interpersonal therapy is talk therapy that helps you manage your relationships with other people in your life. You may be able to engage the help and support of your family and friends while getting healthier (Kato, 2019).

Family therapy is talk therapy usually recommended for teens and children diagnosed with bipolar disorder. This type of therapy helps support the entire family (Miklowitz, 2016).

You can make some choices to help you or your loved ones manage symptoms and maintain a stable mood. 

These include eating a healthy diet with fruits and vegetables, eating at regular times, doing moderate exercise for at least 30 minutes a day at least five days a week, keeping a routine at work or school, and making sure you get enough sleep every night. You may want to add breathing exercises or a form of meditation to help reduce stress. It is important to stop drinking alcohol, as even small amounts of alcohol can interact with some medications you may be taking (NAMI, 2021a). 

If you are taking any supplements, please discuss them with your healthcare provider. Some supplements interact with prescription medications and may make your bipolar symptoms much worse.

Some people find joining a support group beneficial. A support group for people with bipolar disorder can help you share your experience, gain information, and receive support from others who have the same diagnosis (NAMI, 2021a).

Risks of untreated bipolar disorder

People with bipolar disorder can live happy and fulfilling lives with treatment. If you or your loved one decides to go without treatment for bipolar disorder, both manic and depressive symptoms may continue to worsen. Symptoms tend not to get better with time. Some people with bipolar disorder have higher rates of obesity, diabetes, and heart disease, so your healthcare provider will want to continue monitoring you. 

If you or your loved one has been diagnosed with bipolar disorder, it is essential to know that this is a lifelong diagnosis. Treatments for bipolar disorder stop the symptoms of either mania or depression, but consistent treatment is essential. You may want to stay as healthy as possible by understanding your disorder, monitoring your thoughts and behavior, and recognizing what might trigger a recurrence. You can create a plan to follow if you or your loved one starts showing symptoms again or stops taking their medication (Garcia, 2016). 

Treatment can help you live a productive and fulfilling life. By working together with your mental health professional, taking your medications as prescribed, going to therapy, living a healthy lifestyle, and engaging your friends and family to support you, you will be able to live well with your condition.

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Current version

June 21, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.