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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.
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
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.
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
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.
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.
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
For bipolar II disorder, your doctor will look for the same symptoms, but the manic high may be less
severe and shorter.
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.
Learning about bipolar disorder:
Living with bipolar disorder:
Health Tools help you make wise health decisions or take action to improve your health.
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
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.
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:
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.
In addition to changes in mood, some
people with bipolar disorder also have symptoms of
panic attacks, or symptoms of
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.
People with bipolar disorder—men more often than
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
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
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
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:
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.
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
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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.
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
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.
Treatment often starts with helping you through an "acute" phase or manic episode. You may be
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.
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.
Family members often feel helpless when a loved one is
depressed or manic. But you can help.
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,
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.
About 1 out of 3 people will be
completely free of symptoms of bipolar disorder by taking
mood stabilizer medicine, such as carbamazepine or lithium, for life.5
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:
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
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
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.
Omega-3 fatty acids have been getting some attention
as a possible complementary treatment for bipolar disorder. But more research
is needed to prove how well they work in treating this
The Depression and Bipolar Support Alliance publishes
brochures, books, and videotapes about the treatment of mood disorders, all
available free of charge or for a nominal fee. It also has an information and
referral line, and its website contains helpful tools and information, including personal wellness tools and links to research studies.
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its website has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
The National Alliance on Mental Illness is a national
self-help and family advocacy organization dedicated solely to improving the
lives of people who have severe mental illnesses such as schizophrenia, bipolar
disorder (manic depression), major depression, obsessive-compulsive disorder,
and panic disorder. NAMI focuses on support, education, advocacy, and research.
The mission of the organization is to "eradicate mental illness and improve the
quality of life of those affected by these diseases."
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
The National Suicide Prevention Lifeline is a 24-hour,
toll-free suicide prevention service. Crisis centers are located in 130
locations across the United States. Each caller is routed to the closest provider
of mental health and suicide prevention services.
CitationsBrent 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). Bipolar disorders section of Mood
disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1629–1653. 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.Montgomery P, Richardson AJ (2009). Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews (1).Other Works ConsultedAkiskal HS (2009). Bipolar disorders section of Mood
disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1629–1653. Philadelphia: Lippincott
Williams and Wilkins.Baloch HA, Soares JC (2010). Mood disorders. In EG Nabel, ed., ACP Medicine, section 13, chap. 2. Hamilton, ON: BC Decker.Geddes J, Briess D (2007). Bipolar disorder, search date July 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.Hirschfeld RM (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Bipolar Disorder. Arlington, VA: American Psychiatric Association. Available online: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.Sadock BJ, Sadock VA (2007). Mood disorders. In Kaplan and Sadock's Synopsis of Psychiatry, 10th ed., pp. 527–562. Philadelphia: Lippincott Williams and Wilkins.
March 1, 2012
Patrice Burgess, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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