Illness & Conditions - Health Conditions
Looks at illness that causes extreme mood swings, ranging from mania (feeling overly energetic) to depression. Also called manic-depressive disorder. Covers treatment with counseling and medicines like mood stabilizers, antipsychotics, and antidepressants.
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This topic discusses bipolar disorder in adults. If you are concerned that your child or teen may have bipolar disorder, see the topic Bipolar Disorder in Children and Teens.
What is bipolar disorder?
Bipolar disorder is an illness that causes extreme mood changes from manic episodes of very high energy to the extreme lows of depression . It is also called manic-depressive disorder.
This illness can cause behavior so extreme that you cannot function at work, in family or social situations, or in relationships with others. Some people with bipolar disorder become suicidal.
Over 3 million Americans—about 1% of the population, or 1 out of 100 people—have bipolar disorder, and rates are similar in other countries. 1
It's important to know that you're not alone. Talking with others who suffer from bipolar disorder may help you learn that there is hope for a better life. And treatment can help you get back in control.
What causes bipolar disorder?
The cause of bipolar disorder isn't completely understood. It tends to run in families. It may also be affected by your living environment or family situation. One possible cause is an imbalance of chemicals in the brain.
What are the symptoms?
The symptoms depend on your mood swings, or "highs" and "lows." During a manic high, you may feel:
Some people spend a lot of money or get involved in dangerous activities when they are manic. After a manic episode, you may return to normal. Or your mood may swing in the opposite direction to feelings of sadness, depression, and hopelessness. During a depressive episode, or low, you may have:
The mood swings of bipolar disorder can be mild or extreme. They may come on slowly over several days or weeks or suddenly over a few minutes or hours. These mood swings may last for a few hours or for several months.
How is bipolar disorder diagnosed?
Bipolar disorder is hard to diagnose. First, your doctor or therapist will ask detailed questions about what kind of symptoms you have and how long they last. Your urine and blood may be tested to rule out other problems that could be causing your symptoms.
There are two types of bipolar disorder: I and II.
To be diagnosed with bipolar I disorder, you must have had:
For bipolar II disorder, your doctor will look for the same symptoms, but the manic high may be less severe and shorter.
How is it treated?
Bipolar disorder is treatable. With treatment, which includes medicines and counseling, you can feel better.
You may need to try several medicines to find the combination that works for you.
Counseling for you and your family is also an important treatment. It can help you cope with some of the work and relationship issues that the illness may cause.
You can do a few things on your own to help deal with bipolar disorder. These include regular activity, getting enough sleep, and learning to recognize early signs of highs and lows.
People often stop taking their medicines during a manic phase because they feel good. But this is a mistake. You must take your medicines regularly, even if you are feeling better.
Frequently Asked Questions
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The cause of bipolar disorder is not well understood, but evidence suggests that it runs in families. 2 Your living environment and family situation may also play a role. Episodes of depression and mania may be caused by a problem with certain brain chemicals called neurotransmitters .
Antidepressant medicines can trigger a manic episode in a person who has bipolar disorder. But this may occur before the person is diagnosed, while he or she is seeking treatment for an episode of depression.
Sleep deprivation or substance abuse, including caffeine, can cause a person with bipolar disorder to have a manic episode.
Bipolar disorder causes extreme mood swings, from feeling overly energetic (mania) to feeling very sad or having low energy (depression). 2
Mania may make you:
Depression may make you:
Types of bipolar disorder
Some people may have bipolar disorder with mixed symptoms. Their highs and lows of mania and depression occur together. This makes the disorder challenging to treat and very frustrating for you and for those around you. It can also lead to hospitalization if your daily functioning becomes impaired.
If you have rapid-cycling bipolar disorder, you may have at least four episodes of depression, mania, or both within a 12-month period. You may go directly from a low to a high. Or you may have a short time lapse between the two extreme moods.
With bipolar disorder, you go back and forth between highs and lows of mania and depression . In between, you may return completely to normal or have some remaining symptoms. The extreme mood changes may come on suddenly or appear more slowly.
During a manic episode, you may go from feeling abnormally happy and productive to behaving irresponsibly and sleeping very little. After this manic high, your mood may return to normal. Or it may swing in the opposite direction. You may feel useless and extremely sad. And you may lose interest in things you've enjoyed in the past.
Men tend to have more manic highs, and women tend to have more lows of depression. 3
At first, stress may trigger depression or mania. But as the illness progresses, mood swings may not be caused by any specific event. Without treatment, your bipolar disorder may get worse. This can cause you to move more often between mania and depression.
Other health problems
People with bipolar disorder—men more often than women—may have substance abuse problems, especially during manic episodes. 4 Abusing alcohol or drugs may affect treatment and interfere with taking medicines as prescribed. Other disorders that may occur along with this disorder include: 5
These illnesses need to be treated along with bipolar disorder.
What Increases Your Risk
Bipolar disorder can be passed down through families. If anyone in your family has been diagnosed with bipolar disorder, your risk of having it is higher.
Some things can increase your risk of a manic episode or depression. These include:
Alcohol or drug use or abuse puts you at a high risk for having a relapse of mood disturbances. 5
When To Call a Doctor
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
Who to see
Bipolar disorder is complex and hard to diagnose, because it has many phases and symptoms. Sometimes it is misdiagnosed as only depression, because people are more likely to seek treatment during a period of depression.
After you are diagnosed with bipolar disorder, you'll need to keep a long-term relationship with your doctor or therapist. It can help you make sure that your treatment is consistent and that your medicines can be adjusted as needed.
Although other health professionals can diagnose bipolar disorder, you will probably be referred to a psychiatrist who specializes in treating such disorders. He or she can prescribe medicines and provide counseling. Other health professionals who can diagnose bipolar disorder include:
Counseling can help you deal with mood changes and the impact bipolar disorder can have on your work and family relationships. In addition to psychiatrists, others who can provide counseling include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
To find out if you have bipolar disorder, your doctor will ask detailed questions about your symptoms. You will be asked how long your symptoms last and how often you have them. Your doctor will ask about your family history and may do a mental health assessment.
Blood and urine tests, such as a test of your thyroid, may be done to make sure another problem isn't causing your symptoms. A toxicology screen looks at blood, urine, or hair for the presence of drugs.
The earlier the disease is confirmed, the sooner you can get treatment, feel better, and improve the quality of your life. This can also reduce your risk of other health problems, such as alcohol and drug abuse.
Bipolar disorder is treated with a combination of medicines and counseling. It's important to take your medicines exactly as prescribed, even when you feel well. Your doctor may have you try different combinations of medicines to find what's right for you.
Your family doctor can prescribe medicines to treat bipolar disorder. But you will probably be referred to a psychiatrist , who is trained specifically to treat mental disorders.
Many people don't get help for bipolar disorder. You may not seek treatment because you think the symptoms aren't bad enough or that you can work things out on your own. But treatment can help you manage the highs and lows.
If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.
Your treatment plan
Treatment often starts with helping you through an "acute" phase or manic episode. You may be suicidal or psychotic or using such poor judgment that you are in danger of harming yourself. Your doctor may decide that you should be hospitalized for your own safety, especially if he or she thinks you are suicidal.
Medicines that may be used include mood stabilizers and antipsychotics. Over time, these medicines will be adjusted with the goal of preventing manic and depressive episodes. It may take months for your symptoms to go away and for you to be able to maintain a normal routine of work and activity. To learn more, see Medications.
Counseling is also an important part of treatment. It can help you cope with problems that may come up in your work or relationships because of bipolar disorder. To learn more, see Other Treatment.
You can also do some things on your own to help manage your symptoms and maintain a normal routine. Joining a support group to talk with others who have bipolar disorder can help. To learn more, see Home Treatment.
Bipolar disorder cannot be prevented. But often the mood swings can be controlled with medicines. And there are many things you can do for yourself to help manage highs and lows. To learn more, see Home Treatment.
Home treatment is important in bipolar disorder. There are many things you can do to help control mood swings. You don't have to do them all at once. Try to do one thing, such as eating a healthy diet, then add another when you can.
Watch what you eat
Try to eat a healthy, balanced diet. A balanced diet includes foods from different food groups , such as whole grains, dairy, fruits and vegetables, and protein. Eat a variety of foods from each group. (For example, eat different fruits from the fruit group instead of only apples.) A varied diet helps you get all the nutrients you need. No single food provides every nutrient.
Keep good habits
Reduce stress, get rest
Ask for help
How family and friends can help
Family members often feel helpless when a loved one is depressed or manic. But you can help.
Know the signs
Get help for you
If a loved one has bipolar disorder, it may be helpful for you to get counseling to deal with its impact on your own life. Manic episodes can be particularly hard. Talk with a psychiatrist, a psychologist, a social worker, or a licensed professional counselor for your own therapy.
Counseling can also be helpful for a child who has a bipolar parent. The parent's mood swings may negatively affect the child. This can cause tearfulness, anger, depression, or rebellious behavior.
Find out how to help a person during a manic episode.
To learn more about how you can help your loved one with depression, see:
Medicines, when taken as prescribed, can help control bipolar mood swings. Your doctor will vary the amounts and combinations of your medicines according to your symptoms, which type of bipolar disorder you have, and how you respond to the medicines.
Taking medicines during pregnancy for bipolar disorder may increase the risk of birth defects. If you are pregnant or thinking of becoming pregnant, talk to your doctor. You may need to keep taking medicine if your bipolar disorder is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.
Several medicines are used to treat bipolar disorder. It may take time to find the treatment that works best for you. The most common medicines used are:
Medicines and your lifestyle
When you and your doctor are discussing your medicines, think about whether your lifestyle allows you to take medicines on time every day. A medicine you only take once a day may work best for you if you have a hard time remembering to take your medicines.
During your doctor's appointment, ask about:
You'll need to check in with your doctor regularly when taking medicines for bipolar disorder.
If you are prescribed carbamazepine, lithium, or valproate, you will need regular blood tests to monitor the amount of medicine in your blood. Too much lithium in your bloodstream may lead to serious side effects. Blood tests can also help show how medicines are affecting your liver, kidneys, and thyroid gland or to measure the number of blood cells in your body.
The use of antidepressants alone has been linked to an increase in manic episodes. Antidepressant treatment needs to be monitored closely to avoid causing a manic episode.
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant and anticonvulsant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide, such as threatening to harm himself or herself and being preoccupied with death or suicide. This is especially important at the beginning of treatment or when doses are changed.
Almost all people who have bipolar disorder need medicine. But counseling is also important to help you cope with work and relationship struggles related to your illness.
No matter which type of counseling you choose, establish a long-term relationship with a counselor you like. The counselor will help you recognize personality changes that show when you are moving into a mood swing. Getting early treatment can reduce the length of the high or low. See some tips for finding a counselor or therapist.
In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
A few studies suggest that adding omega-3 fatty acids to medicine (such as lithium) can help reduce the depressive symptoms of bipolar disorder in some people. Omega-3 fatty acids don't seem to have an effect on the manic symptoms of bipolar disorder. And omega-3 fatty acids alone are not a good treatment for bipolar disorder. They are not a replacement for medicine or other therapy used to treat bipolar disorder. 6, 7
Other Places To Get Help
Last Revised: April 3, 2013
Brent DA, Pan RJ (2008). Bipolar disorders. In MH Ebert et al., eds., Current Diagnosis and Treatment in Psychiatry, 2nd ed., pp. 607–611. New York: McGraw-Hill.
American Psychiatric Association (2000). Bipolar disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 382–397. Washington, DC: American Psychiatric Association.
Akiskal HS (2009). Mood disorders: Clinical features. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1693–1733. Philadelphia: Lippincott Williams and Wilkins.
American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159(4, Suppl):1–50.
Keck PE, et al. (2004). Expert consensus guideline series: Treatment of bipolar disorder 2004. Postgraduate Medicine Special Report. Available online: http://www.psychguides.com/content/treatment-bipolar-disorder-2004.
Sarris J, et al. (2012). Omega-3 for bipolar disorder: Meta-analyses of use in mania and bipolar depression. Journal of Clinical Psychiatry, 73(1): 81–86.
Montgomery P, Richardson AJ (2009). Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews (1).
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