Bipolar Disorder

Bipolar affective disorder is a mood disorder characterized by extreme mood swings. These moods include both manic or depressive episodes where deep depressive symptoms are followed by intense feelings of euphoria that are often referred to as manic episodes.

Sometimes people with bipolar disorder will experience quick changes from one extreme manic or depressive episode to the other. Different kinds of bipolar disorder involve different levels of mania, but all bipolar disorders involve periods of clinical depression. People with bipolar disorder can also experience extreme changes in energy levels or thought processes.

Feelings of great happiness or a depressed mood are a normal part of life, and it’s also normal to experience distinct mood episodes sometimes. However, if your mood changes are frequent and extreme enough to interfere with your day-to-day life on a regular basis, you may be dealing with a form of bipolar disorder.


Prevalence of bipolar disorder

Bipolar disorder is relatively common in the United States.

  • About 2.8% of Americans experience bipolar disorder
  • Among that population, almost 83% has severe symptoms [1]
  • Symptoms commonly set in around the age of 25 (but can start earlier)
  • Bipolar disorder is about equally common for men and women
  • Developing bipolar disorder, particularly type I, is highly influenced by genetics. It is the psychiatric disorder most likely to be inherited from family members. If one parent has bipolar disorder, there is an increased chance that their child will also develop the illness [2]

Symptoms of bipolar disorder

Bipolar disorder symptoms have a broad range, and not everyone experiences every symptom. Some of the most common ones include:

  • Depressive episodes: All people diagnosed with bipolar disorder have experienced episodes of clinical severe depression.
  • Manic or Hypomanic episodes: There are a variety of manic symptoms including feeling incredibly happy and excited; feeling so full of energy that you might not need to sleep or eat; impulsive and/or dangerous behavior; and being unable to rest. People with Bipolar II Disorder (see below) experience a milder form of these symptoms known as hypomania.
  • Frequent or extreme mood changes: You might find that your mood changes very quickly or from one extreme to the other.
  • Frequent or extreme changes in energy level: You might go from feeling exhausted and listless to full of energy, or vice versa.
  • Frequent or extreme changes in thought processes: In a manic episode, people often feel their thoughts are racing, while people in depressive episodes may find it hard to think at all.
  • Severe episodes with hallucinations or delusions: People experiencing extreme mania may have psychotic symptoms, which can include seeing or hearing things that aren’t actually there (hallucinations) or believing things that aren’t true (delusions).

Types of bipolar disorder

There are two different specific mental health conditions that mental health professionals use to diagnose bipolar disorders:

  • Bipolar I Disorder: In Bipolar I Disorder, a person cycles between episodes of major depression and full-blown mania. This manic episode is very extreme and may include hallucinations and/or delusions.
  • Bipolar II Disorder: People with the second manic depressive illness have less severe symptoms while they still experience a major depressive episode, they alternate with milder hypomanic episodes. Hypomania symptoms are not as extreme as mania but include many of the same mood symptoms. For example, a person experiencing hypomanic symptoms might need less rest, while a person experiencing mania might not need to sleep at all.

In both cases, some people switch between the different extremes more quickly than others.

Additionally, there is a condition called Cyclothymic Disorder that is not technically bipolar disorder but shares some of the features of mood disorders. In Cyclothymic Disorder, a person experiences frequent and drastic mood changes, but the episodes are not extreme enough to be called manic depression.

How is bipolar disorder diagnosed?

There are other mental health conditions that share similar bipolar symptoms including:

A bipolar disorder diagnosis must come from a psychiatrist or mental health professional, not your primary care physician. While there is evidence to suggest that brain structure is different in people with bipolar disorder, a brain scan will not confirm a diagnosis. If you are experiencing hypo/manic and depressive symptoms or have a chronically unstable mood state, it may be a good idea to get a physical exam and mental health evaluation and discover your risk factors to prevent bipolar disorder or explore treatment options.

How to treat bipolar disorder

There are several options that may be helpful if you think you have bipolar disorder:

  • Therapy. Therapy can be a very helpful way to gain insight into your mental health condition and work on evidence-based strategies to reduce your symptoms. (See tips on finding a therapist below.)
  • Medication: Medication with mood stabilizers is a very common treatment option for bipolar disorder. Though most medications come with side effects, a psychiatric professional can help you manage these side effects and find the most effective treatment.
  • Check-ups: Symptoms of bipolar disorder can sometimes be related to underlying medical conditions. It’s important to stay up to date with visits to your primary care physician to rule out related medical conditions and physical illness.
  • Keeping a journal: Keeping track of changes in your mood, thoughts, and behavior can be a great way to gain more insight into your condition. Knowing exactly how and when these changes occur can help you and your treatment team better address your mania and depression symptoms. Writing in a journal can also help you process your emotions and reduce anxiety.
  • Hotlines: If you’re having thoughts of suicide or need immediate support, you can always call the National Suicide Prevention Hotline at 1-800-273-8255. The Substance Abuse and Mental Health Services Administration hotline at 1-800-622-4357 can also help you locate resources and treatment options.

What to look for in a therapist for bipolar disorder treatment

Several different kinds of therapy have been shown to be effective for treating bipolar disorder [1]. Most often, psychotherapy is used in combination with medication managed by a psychiatrist. Most importantly, look for a therapist who has a specialty in treating bipolar disorder.

A few of the most common psychotherapy options for bipolar disorder are:

  • Cognitive Behavioral Therapy (CBT) — this type of talk therapy helps to change how a person views a situation and change their reactive behavior to the situation.
  • Psychodynamic Therapy — this group therapy has led to improvements during a depressive episode.
  • Family Systems Therapy — this type of family-focused treatment helps the family learn how to deal with mental illness together.

Prioritize personal fit

While personality fit is a nuanced factor, it is critical to your success in therapy. Multiple studies have revealed the importance of this factor, often referred to as “therapeutic alliance.”

On your initial phone call with the therapist, ask yourself:

  • Could I see myself forming a connection with this therapist?
  • Does their approach suit my personality?
  • Do I feel like I will be heard and respected by this therapist?

Additionally, consider these factors:

  • Some therapists are more reflective and spend most of the session listening and drawing insights about your patterns and coping styles.
  • Some therapists are more directive, establishing weekly agendas and assigning tasks to complete between sessions.
  • Some utilize specific techniques or tools (exposure exercises, eye movements, tapping, breath work, guided imagery, art and music, etc.).
  • Some use a combination of multiple approaches.

Consider cost, location, and scheduling

Therapy will only work if it works for you. Before making an appointment, ask yourself honestly:

  • Can I afford these session fees? The cost of therapy for bipolar disorder depends on location, practitioner, and whether you’re using insurance.
  • Can I commit to attending sessions regularly? Remember to account for travel time, and other demands in your schedule.
  • Do the therapists’ available times work for me? Some therapists offer evening and weekend appointments if you have an otherwise limited schedule.