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What is bipolar disorder?

Bipolar disorder is a mood disorder that can cause intense mood swings:

• Sometimes you may feel extremely "up," elated, irritable, or energized. This is called a manic episode.
• Other times you may feel "down," sad, indifferent, or hopeless. This is called a depressive episode.
• You may have both manic and depressive symptoms together. This is called a mixed episode.

Along with mood swings, bipolar disorder causes changes in behavior, energy levels, and activity levels.

Bipolar disorder used to be called other names, including manic depression and manic-depressive disorder.

There are three main types of bipolar disorder:

• Bipolar I disorder involves manic episodes that last at least 7 days or manic symptoms so severe that you need immediate hospital care. Depressive episodes are also common. Those often last at least two weeks. This type of bipolar disorder can also involve mixed episodes.
• Bipolar II disorder involves depressive episodes. But instead of full-blown manic episodes, there are episodes of hypomania. Hypomania is a less severe version of mania.
• Cyclothymic disorder, or cyclothymia, also involves hypomanic and depressive symptoms. But they are not as intense or as long-lasting as hypomanic or depressive episodes. The symptoms usually last for at least two years in adults and for one year in children and teenagers.

With any of these types, having four or more episodes of mania or depression in a year is called "rapid cycling."

The exact cause of bipolar disorder is unknown. Several factors likely play a role in the disorder. They include genetics, brain structure and function, and your environment.

You are at higher risk for bipolar disorder if you have a close relative who has it. Going through trauma or stressful life events may raise this risk even more.

The symptoms of bipolar disorder can vary. But they involve mood swings known as mood episodes:

• The symptoms of a manic episode can include
  • Feeling very up, high, or elated
  • Feeling jumpy or wired, more active than usual
  • Having a very short temper or seeming extremely irritable
  • Having racing thoughts and talking very fast
  • Needing less sleep
  • Feeling like you are unusually important, talented, or powerful
  • Do risky things that show poor judgment, such as eating and drinking too much, spending or giving away a lot of money, or having reckless sex
• The symptoms of a depressive episode can include
  • Feeling very sad, hopeless, or worthless
  • Feeling lonely or isolating yourself from others
  • Talking very slowly, feeling like you have nothing to say, or forgetting a lot
  • Having little energy
  • Sleeping too much
  • Eating too much or too little
  • Lack of interest in your usual activities and being unable to do even simple things
  • Thinking about death or suicide
• The symptoms of a mixed episode include both manic and depressive symptoms together. For example, you may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Some people with bipolar disorder may have milder symptoms. For example, you may have hypomania instead of mania. With hypomania, you may feel very good and find that you can get a lot done. You may not feel like anything is wrong. But your family and friends may notice your mood swings and changes in activity levels. They may realize that your behavior is unusual for you. After the hypomania, you might have severe depression.

Your mood episodes may last a week or two or sometimes longer. During an episode, symptoms usually occur every day for most of the day.

To diagnose bipolar disorder, your health care provider may use many tools:

• A physical exam
• A medical history, which will include asking about your symptoms, lifetime history, experiences, and family history
• Medical tests to rule out other conditions
• A mental health evaluation. Your provider may do the evaluation or may refer you to a mental health specialist to get one.

Treatment can help many people, including those with the most severe forms of bipolar disorder. The main treatments for bipolar disorder include medicines, psychotherapy, or both:

• Medicines can help control the symptoms of bipolar disorder. You may need to try several different medicines to find which one works best for you. Some people need to take more than one medicine. It's important to take your medicine consistently. Don't stop taking it without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicines.
• Psychotherapy (talk therapy) can help you recognize and change troubling emotions, thoughts, and behaviors. It can give you and your family support, education, skills, and coping strategies. There are several different types of psychotherapy that may help with bipolar disorder.
• Other treatment options include:
  • Electroconvulsive therapy (ECT), a brain stimulation procedure that can help relieve symptoms. It uses a mild electric current and is done while you are under general anesthesia. ECT is most often used for severe bipolar disorder that is not getting better with other treatments. It may also be used when someone needs a treatment that will work more quickly than medicines. This might be when a person has a high risk of suicide or is catatonic (unresponsive).
  • Repetitive transcranial magnetic stimulation (rTMS), a brain stimulation procedure that uses magnetic waves to relieve depression. It is not as powerful as ECT, but with rTMS, you don't need general anesthesia. It also has a low risk of negative effects on your memory and thinking.
  • Light therapy has been shown to be effective for seasonal affective disorder (SAD). Many people with bipolar disorder also find that their depression gets worse during certain seasons, usually in the fall and winter. Light therapy may help with their symptoms.
  • Healthy lifestyle changes, such as getting regular exercise, having a consistent sleep schedule, and keeping a mood journal, can also help with your symptoms.

Bipolar disorder is a lifelong illness. But long-term, ongoing treatment can help manage your symptoms and enable you to live a healthy, successful life.

NIH: National Institute of Mental Health

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