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Why it’s done
By Mayo Clinic Staff

Psychotherapy can be helpful in treating most mental health problems, including:
•Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD)
•Mood disorders, such as depression or bipolar disorder
•Addictions, such as alcoholism, drug dependence or compulsive gambling
•Eating disorders, such as anorexia or bulimia
•Personality disorders, such as borderline personality disorder or dependent personality disorder
•Schizophrenia or other disorders that cause detachment from reality (psychotic disorders)

Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life’s stresses and conflicts that can affect anyone. For example, it may help you:
•Resolve conflicts with your partner or someone else in your life
•Relieve anxiety or stress due to work or other situations
•Cope with major life changes, such as divorce, the death of a loved one or the loss of a job
•Learn to manage unhealthy reactions, such as road rage or passive-aggressive behavior
•Come to terms with an ongoing or serious physical health problem, such as diabetes, cancer or ongoing (chronic) pain
•Recover from physical or sexual abuse or witnessing violence
•Cope with sexual problems, whether they’re due to a physical or psychological cause
•Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)

In some cases, psychotherapy can be as effective as medications, such as antidepressants. However, depending on your specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. You may also need medications or other treatments.

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

•Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.

•Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.

•Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

Manic phase of bipolar disorder

Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
•Euphoria
•Inflated self-esteem
•Poor judgment
•Rapid speech
•Racing thoughts
•Aggressive behavior
•Agitation or irritation
•Increased physical activity
•Risky behavior
•Spending sprees or unwise financial choices
•Increased drive to perform or achieve goals
•Increased sex drive
•Decreased need for sleep
•Easily distracted
•Careless or dangerous use of drugs or alcohol
•Frequent absences from work or school
•Delusions or a break from reality (psychosis)
•Poor performance at work or school

Depressive phase of bipolar disorder

Signs and symptoms of the depressive phase of bipolar disorder can include:
•Sadness
•Hopelessness
•Suicidal thoughts or behavior
•Anxiety
•Guilt
•Sleep problems
•Low appetite or increased appetite
•Fatigue
•Loss of interest in activities once considered enjoyable
•Problems concentrating
•Irritability
•Chronic pain without a known cause
•Frequent absences from work or school
•Poor performance at work or school

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar disorder can also include:

•Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.

•Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.

•Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations).

Symptoms in children and adolescents

Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.

When to see a doctor

If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.

Many people with bipolar disorder don’t get the treatment they need. Despite the mood extremes, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you’re reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.

If you have suicidal thoughts

Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
•Contact a family member or friend.
•Seek help from your doctor, a mental health provider or other health care professional.
•Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
•Contact a minister, spiritual leader or someone in your faith community.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Bipolar disorder can be treated with a number of medications. Some of these medications can increase your appetite or cause changes in metabolism leading to weight gain.

Whether a certain medication will cause weight gain or other side effects varies from person to person. Likewise, how well the medication works to treat bipolar disorder symptoms differs for each individual. Because of this, finding the medications that best treat your symptoms may require some trial and error. In some cases, medications that increase the risk of weight gain may be needed only temporarily to get your symptoms under control. Then, you and your doctor can find long-term (maintenance) treatment that keeps symptoms at bay and causes the least amount of side effects.

Medications for bipolar disorders include mood stabilizers, antidepressants and antipsychotics.

•Mood stabilizers used to treat bipolar disorder include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). All of these medications are known to increase the risk of weight gain except lamotrigine.

•Antipsychotics commonly prescribed for bipolar disorder include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), and asenapine (Saphris). Some of these medications cause weight gain when taken alone, but many people need more than one medication to get better control of their symptoms. Weight gain appears to be more likely when an antipsychotic is combined with a mood stabilizer. Children and adolescents with bipolar disorder who take these medications tend to have a greater chance of gaining weight in a short amount of time.

•Antidepressants can cause weight gain in some people, but reactions to these medications vary from person to person. Paroxetine (Paxil) and mirtazapine (Remeron) may be more likely to cause weight gain than other commonly prescribed antidepressants. In general, newer, commonly prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs) don’t cause weight gain. The risk of weight gain is more likely with certain older, less commonly prescribed antidepressants — including the majority of tricyclic antidepressants and some monoamine oxidase inhibitors (MAOIs).

Some weight gain may be inevitable when taking medications needed to control your bipolar symptoms. If weight gain is an issue, ask your doctor for advice on strategies to manage it. Learning tips for healthy eating, keeping physically active and getting psychological counseling (psychotherapy) can all help. Be patient and keep working with your doctor to find the best way to keep your symptoms — and your weight — under control

Bipolar disorder in children is possible. It’s most often diagnosed in older children and teenagers, but bipolar disorder can occur in children of any age. As in adults, bipolar disorder in children can cause mood swings from the highs of hyperactivity or euphoria (mania) to the lows of serious depression.

Emotional upheaval and unruly behaviors are a normal part of childhood and the teen years, and in most cases they aren’t a sign of a mental health problem that requires treatment. All kids have rough periods — it’s normal to feel down, irritable, angry, hyperactive or rebellious at times. However, if your child’s symptoms are severe, ongoing or causing significant problems, it may be more than just a phase.

Here are some signs and symptoms of bipolar disorder in children:
•Severe mood swings that are different from their usual mood swings
•Hyperactive, impulsive, aggressive or socially inappropriate behavior
•Risky and reckless behaviors that are out of character, such as having frequent casual sex with many different partners (sexual promiscuity), alcohol or drug abuse, or wild spending sprees
•Insomnia or significantly decreased need for sleep
•Depressed or irritable mood most of the day, nearly every day during a depressive episode
•Grandiose and inflated view of own capabilities
•Suicidal thoughts or behaviors in older children and teens

Children with bipolar disorder experience symptoms in distinct episodes. Between these episodes, children return to their usual behavior and mood.

Keep in mind, a number of other childhood disorders cause bipolar-like symptoms, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, anxiety disorders and major depression. Diagnosis can be challenging because these and other mental health conditions often occur along with bipolar disorder.

If your child has serious mood swings, depression or behavior problems, consult a mental health provider who specializes in working with children and teens. Mood and behavior issues caused by bipolar disorder or other mental health conditions can lead to major difficulties. Early treatment can help prevent serious consequences and decrease the impact of mental health problems on your child as he or she gets older.

Factors that may increase the risk of developing bipolar disorder include:

•Having blood relatives such as a parent or sibling with bipolar disorder
•Periods of high stress
•Drug or alcohol abuse
•Major life changes, such as the death of a loved one
•Being in your early 20s

Conditions that commonly occur with bipolar disorder

If you have bipolar disorder, you may also have another health condition that’s diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder. They include:

•Anxiety disorders. Examples include post-traumatic stress disorder (PTSD), social phobia and generalized anxiety disorder.

•Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.

•Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.

•Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, including heart disease, thyroid problems and obesity.