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Everyone feels changes in their mood as they experience life’s ups and downs. Occasional periods of depression and extra energy are not unusual among these mood swings. However, if these episodes of depression and extra energy are more extreme and more long-lasting than your usual moods, they could be a symptom of a condition called bipolar disorder. According to data from the National Institute of Mental Health, nearly 3% of adolescents and more than 4% of adults are diagnosed with bipolar disorder at some point during their lives.

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What is bipolar disorder?

Bipolar disorder is a brain disorder that affects an individual’s moods, energy and activity levels, and ability to start and complete everyday responsibilities. Individuals with bipolar disorder experience mood swings that are more extreme than the person’s typical moods. Furthermore, those suffering from bipolar disorder experience two types of mood episodes: manic and depressive.

Manic episodes vary by individual, but can involve:

• Feeling elated
• Having a greater amount of energy than usual
• Trouble sleeping
• Irritability
• Engaging in risky behavior

Depressive episodes also vary by individual, but may involve:

• Hopelessness
• Lack of energy
• Feeling worried
• Trouble concentrating
• Forgetfulness
• Changes in appetite
• Thinking about death or suicide

Additionally, some people experience episodes of hypomania, which is a form of mania with less extreme symptoms. Whereas an individual in a true manic episode may have so much energy and motivation that they stay awake for 24 hours cleaning their house, an individual experiencing a hypomanic episode may just have a little more energy than usual (and complete a task like organizing a single room).

Does bipolar disorder affect some groups of people differently than others?

Bipolar disorder affects men and women in similar numbers. Furthermore, research shows that bipolar disorder presents with similar symptoms across racial and ethnic groups. Cases of bipolar disorder are most common in adolescents and young adults; the age group with the highest prevalence of symptoms of bipolar disorder in the past year is 18–29 year olds, at 4.7%. Prevalence of symptoms of bipolar disorder decreases with age: 30–44 year olds have a past-year prevalence of 3.5%, 45–59 year olds have a past-year prevalence of 2.2%, and those 60 or older have a past-year prevalence of less than 1%. The decrease in prevalence of bipolar disorder and related symptoms throughout an individual’s lifespan is likely related to multiple factors: older patients better managing their condition, the effect of bipolar disorder on an individual’s life expectancy, and increased rates of suicide in individuals suffering from bipolar disorder.

Are there different types of bipolar disorder?

Yes. Bipolar disorder can be broken into four distinct types which are differentiated by the extent and duration of changes in behavior.

• Bipolar I Disorder involves manic episodes that last at least seven days or that require immediate hospitalization due to their severity and intensity. Typically, individuals also experience depressive episodes that last at least two weeks. Episodes involving a mix of depressive and manic symptoms are also possible.
• Bipolar II Disorder involves depressive episodes and hypomanic episodes, but these episodes are less intense than those experience by people diagnosed with Bipolar I.
• Cyclothymic Disorder/Cyclothymia involves many depressive and hypomanic episodes across a minimum of two years. The highs and lows are milder than those seen in both Bipolar I and Bipolar II, and individuals often cycle between moods more frequently.
• Other Specified and Unspecified Bipolar and Related Disorders is a diagnosis for individuals who have symptoms of bipolar disorder that do not fit any of the other categories, but also cannot be attributed to any one other disease.

How do I know if what I’m feeling is depression or bipolar disorder?

Often, the first mood episode that occurs in patients with bipolar disorder is a depressive episode, but it can be difficult to differentiate between a depressive episode of bipolar disorder and major depressive disorder (the official name for depression). The symptoms of major depressive disorder are nearly identical to those of a depressive episode of bipolar disorder, and may include feelings of hopelessness, lack of energy, and/or thoughts of suicide. In both cases, the symptoms usually last at least two weeks.

Typically, if bipolar disorder is suspected, mental health professionals obtain a history of symptoms from the patient and look for signs of manic episodes. If patients haven’t had a manic episode yet, don’t recognize the manic episodes they have had, or choose not to disclose manic episodes, a wrong diagnosis may be made. Misdiagnosis is common with bipolar disorder. As many as 69% of cases are originally misdiagnosed. Women are more likely to be misdiagnosed with depression, whereas men are more likely to be misdiagnosed with schizophrenia.

How is bipolar disorder diagnosed?

Often, individuals with bipolar disorder do not seek help during episodes of mania or hypomania because they are full of energy, have lots of ideas, and can get by on less sleep than usual (so they don’t feel that anything is wrong). However, during depressive episodes they are more likely to seek help because symptoms such as anxiety, hopelessness, and a lack of energy are causing issues in their day-to-day life.

If you have a health concern, schedule an appointment with your primary care physician. A primary care physician can run tests to rule out physical causes of symptoms, but will need to make a referral to a licensed mental health professional (e.g., a psychiatrist) for a diagnosis of bipolar disorder. A mental health professional will need a full history (including both manic and depressive episodes) to rule out other disorders and make an accurate diagnosis.

How is bipolar disorder treated?

Bipolar disorder is most often treated with medications and/or psychotherapy, also known as talk therapy. There are many different forms of psychotherapy, the most popular of which are cognitive behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and psychoeducation. What all of these therapies have in common is that their goal is to help the individual who is suffering identify the emotions, thoughts, and behaviors that are troubling them and then work to change their response. Talk therapy involves working with a clinician trained in a specific type of therapy to achieve this change. The most effective treatment for bipolar disorder, and the type of therapy that a mental health professional might suggest, varies from person to person.

Medications used to treat bipolar disorder typically fall into a few main categories: mood stabilizers, antipsychotics, benzodiazepines, and antidepressants.

• Mood stabilizers treat episodes of mania or depression and stabilize overall mood, but do not totally prevent mood swings throughout the day.
• Antipsychotics can be used along with mood stabilizers to treat symptoms of mania.
• Benzodiazepines are typically used to help treat anxiety and sleep disorders, but may also be used to help treat sleeping problems associated with bipolar disorder.
• Antidepressants may help with depressive symptoms, but should be used cautiously because traditional antidepressants may trigger a manic episode in individuals with bipolar disorder. Certain antidepressants are less likely to trigger manic episodes, but individuals with bipolar disorder who are taking any antidepressant must be closely monitored by their psychiatrist.

What resources are available for people struggling with bipolar disorder?

For everyone:

• Crisis Text Line
  • Text "HOME" to 741741.
  • Text line is available 24 hours a day, seven days a week.
  • Texts are confidential.
• Depression and Bipolar Support Alliance
  • In-person support groups are available in every state and the District of Columbia.
• National Alliance on Mental Illness
  • Call 1-800-950-6264 to access the helpline.
  • Helpline is available Monday through Friday from 10:00 a.m. to 6:00 p.m. (EST).
• National Suicide Prevention Lifeline
  • Call 1-800-273-8255 toll-free or chat with an online representative.
  • Helpline is available 24 hours a day, seven days a week.
  • Calls are confidential.

For teens and adolescents:

• Your Life Your Voice
  • Call 1-800-448-3000 to access the helpline.
  • Helpline is available 24 hours a day, seven days a week.
  • Chat online Sunday through Thursday from 7:00 p.m. to 1:00 a.m. (EST).
  • Text “VOICE” to 20121 from 1:00 p.m. to 1:00 a.m. (EST) daily.
  • Email services are available 24 hours a day, seven days a week. Receive a response within 48 hours.

For Spanish Speakers:

• National Institute of Mental Health
  • Call 1-866-615-6464 toll-free.
  • Helpline is open Monday through Friday from 8:30 a.m. to 5:00 p.m. (EST).
  • Online chat is available Monday through Friday from 8:30 a.m. to 5:00 p.m. (EST).
• National Suicide Prevention Lifeline
  • Call 1-800-273-8255 toll-free.
  • Helpline is open 24 hours a day, seven days a week.
  • Calls are confidential.

For LGBT+ youth:

• The Trevor Project
  • Call 1-866-488-7386 toll-free.
  • Helpline is open 24 hours a day, seven days a week.
  • Chat with a counselor 24 hours a day, seven days a week.
  • Text "START" to 678678 to text with a counselor 24 hours a day, seven days a week.

Page last updated: 04/2019