Frequently Asked Questions about Bipolar Disorder

What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

What are the symptoms of Bipolar Disorder?
Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

Increased energy, activity, restlessness
Euphoric mood
Extreme irritability
Poor concentration
Racing thoughts, fast talking, jumping between ideas
Sleeplessness
Heightened sense of self-importance
Spending sprees
Increased sexual behavior
Abuse of drugs, such as cocaine, alcohol and sleeping medications
Provocative, intrusive or aggressive behavior
Denial that anything is wrong
Depressive Episode Signs:

Sad, anxious or empty-feeling mood
Feelings of hopelessness and pessimism
Feelings of guilt, worthlessness and helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, fatigue
Difficulty concentrating, remembering or making decisions
Restlessness and irritability
Sleeplessness or sleeping too much
Change in appetite, unintended weight loss or gain
Bodily symptoms not caused by physical illness or injury
Thoughts of death or suicide
How is bipolar disorder diagnosed?
Bipolar disorder cannot yet be diagnosed physiologically by blood tests or brain scans. Currently, diagnosis is based on symptoms, course of illness, and family history. Clinicians rule out other medical conditions, such as a brain tumor, stroke or other neuropsychiatric illnesses that may also cause mood disturbance. The different types of bipolar disorder are diagnosed based on the pattern and severity of manic and depressive episodes. Doctors usually diagnose brain and behavior disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.
How is bipolar disorder treated?
While no cure exists for bipolar disorder, it is treatable and manageable with psychotherapy and medications. Mood stabilizing medications are usually the first choice in medication. Lithium is the most commonly prescribed mood stabilizer. Anticonvulsant medications are usually used to treat seizure disorders, and sometimes offer similar mood-stabilizing effects as antipsychotics and antidepressants. Bipolar disorder is much better controlled when treatment is continuous. Mood changes can occur even when someone is being treated and should be reported immediately to a physician; full-blown episodes may be averted by adjusting the treatment.

In addition to medication, psychotherapy provides support, guidance and education to people with bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease hospitalizations and improve overall functioning. Common techniques include cognitive behavioral therapy, psychoeducation, and family therapy.

What is the difference between depression and bipolar disorder?
The main difference between bipolar disorder and major clinical depression is the presence of manic episodes. This is why depression alone is not enough to diagnose an individual with bipolar. However, one manic episode (meeting DMS-IV criteria) is sufficient to make a bipolar diagnosis.

Bipolar Disorder: Who’s at Risk?
In this article
What causes bipolar disorder?
Who is at risk of bipolar disorder?
Does bipolar disorder run in families?
Can lifestyle habits increase the risk of bipolar disorder?
Can environmental stress increase the risk of bipolar disorder?
Bipolar disorder, also known as manic depression, is an illness in which a person has periods of high mood and energy and other times of depression. People diagnosed with bipolar disorder usually have one or more major depressive episodes along with one or more manic or mixed episodes.

Bipolar mania is a prolonged state (at least one week at a time) of extreme elation or agitation accompanied by excessive energy. Symptoms of the manic “highs” include increased energy, racing thoughts and fast speech, excessive talkativeness, distractibility, reckless and aggressive behavior, grandiose thoughts, decreased need for sleep, feelings of invincibility, sexual inappropriateness including infidelity, excessive spending, and exaggerated self-confidence.

Bipolar depression is a prolonged state (at least 2 weeks at a time) of low energy levels and sadness or irritability. Symptoms of the bipolar depression may include a pessimistic attitude, social withdrawal, thoughts of death or suicide, extreme sadness, and irritability.

Manic or depressive symptoms also sometime co-occur as part of the same episode. For example, someone may have symptoms of both. When this happens, the episode is said to have ”mixed features.”
The term “rapid cycling” is used not to describe rapid shifts in mood from one moment to the next, but rather, a pattern that occurs when the patient has four or more distinct episodes of major depression, mania, and/or mixed features within one year. The length of time that the mood switches may range from days to months.

What causes bipolar disorder?
Though the exact cause of bipolar disorder has yet to be found, scientists confirm that bipolar disorder has a genetic component, meaning the disorder can run in families. Some research suggests that multiple factors may interact to produce abnormal function of brain circuits that results in bipolar disorder’s symptoms of major depression and mania. Examples of environmental factors may include stress, alcohol or substance abuse, and lack of sleep.

Who is at risk of bipolar disorder?
More than 10 million Americans have bipolar disorder. Bipolar disorder affects men and women equally, as well as all races, ethnic groups, and socioeconomic classes.

Although men and women appear to be equally affected by bipolar disorder, rapid cycling is seen more often in women. Women also tend to experience more depressive and mixed state episodes than do men. A man’s first experience with bipolar disorder may be in a manic state; women tend to first experience a depressive state.

Bipolar disorder can present itself at any age, but typically, onset occurs around age 25.

continued)
In this article
What causes bipolar disorder?
Who is at risk of bipolar disorder?
Does bipolar disorder run in families?
Can lifestyle habits increase the risk of bipolar disorder?
Can environmental stress increase the risk of bipolar disorder?
Does bipolar disorder run in families?
Numerous studies have found that people with bipolar often have at least one close relative with depression or bipolar disorder.

Children who have one parent with the disorder have about a 10%-25% chance of developing the disorder themselves; children with two parents with the disorder have a 10%-50% chance. If a non-identical twin sibling has the disorder, the chance that another sibling will have it is about 10%-25%.

Studies of identical twins have shown that genetics are not the only factor in determining who is at risk for bipolar disorder. Because identical twins share all the same genes, if bipolar disorder were purely hereditary, then all identical twins would share the disorder.

However, it has been found that if one identical twin has bipolar disorder, the chances of the other twin also having bipolar disorder ranges from 40% to 70%. It is important to note that bipolar disorder can show itself in different forms in individuals in the same families.
Scientists believe that bipolar disorder is not likely caused by any one single gene but more likely multiple genes, each contributing only a small amount to the vulnerability, acting together in combination with other environmental factors such as stress, lifestyle habits, and sleep. Scientists are working to identify these genes in the hopes that this will help doctors to better diagnose and treat the disorder.

Can lifestyle habits increase the risk of bipolar disorder?
Lack of sleep increases the risk of having an episode of mania in someone with bipolar disorder. In addition, antidepressants, particularly when taken as the only medication, may also trigger a switch into a manic state.

Excessive use of alcohol or drugs can also trigger bipolar symptoms. Research has shown that about 50% of bipolar sufferers have a substance abuse or alcohol problem. Sufferers often use alcohol or drugs in an effort to reduce unpleasant feelings during low mood periods, or as part of the recklessness and impulsivity associated with manic highs.

Can environmental stress increase the risk of bipolar disorder?
People are sometimes diagnosed with bipolar following a stressful or traumatic event in their lives. These environmental triggers can include seasonal changes, holidays, and major life changes such as starting a new job, losing a job, going to college, family disagreements, marriage, or a death in the family. Stress, in and of itself, does not cause bipolar disorder (much the way pollen doesn’t cause seasonal allergies), but in people with the biological vulnerability to bipolar disorder, having effective skills for managing life stresses can be critical to a healthy lifestyle in order to avoid things that can aggravate the illness (such as drugs and alcohol).

How To Get Mental Health Help

If you or someone you know has a mental health problem, there are ways to get help. Studies show that most people with mental health problems get better and many recover completely.

Get Immediate Help

People often don’t get the mental health help they need because they don’t know where to start. Use these resources to find the help you, your friends, or family need.

Help for Veterans and Their Families

Current and former servicemembers may face different health issues than the general public and may be at risk for mental health problems.

Health Insurance and Mental Health Services

Mental health services may be available to you through your health insurance plan. Learn more about your coverage and options.

Participate in a Clinical Trial

The National Institute of Mental Health supports research studies on mental health and disorders. Find out more about participating in a clinical trial.

Mood Disorders

These disorders, also called affective disorders, may involve:

• Feeling sad all the time
• Losing interest in important parts of life
• Fluctuating between extreme happiness and extreme sadness

The most common mood disorders are:

• Depression
• Bipolar Disorder
• Seasonal Affective Disorder (SAD)
• Self-harm