• Bipolar disorder is characterized by alternating periods of mania and depression.
• There are three types of bipolar disorder: bipolar type 1, bipolar type 2, and cyclothymic disorder.
• Living with bipolar symptoms can be challenging, but treatments can help manage symptoms and improve quality of life.

Bipolar disorder is a type of mood disorder characterized by alternating periods of depression and mania. Bipolar disorder was previously called manic depression or bipolar depression because of the characteristic swings back and forth from lows (depression) to highs (mania). Bipolar disorder is also associated with problems in day-to-day functioning, changes in the immune system, and other aspects beyond mood.

In short, bipolar disorder is a complex disease that has a profound impact on the people who live with it.

Understanding Bipolar Disorder

Bipolar disorder is a mental illness that falls under the category of mood disorders. It is similar to disorders of depression (such as major depressive disorder) in that people who are bipolar often experience intense periods of depressed mood. However, episodes of manic symptoms are also a key feature of bipolar disorder.

The term “mania” refers to periods of elevated moods, increased energy, talkativeness, and feeling excited. Mania may also involve acting out of control, spending excessively, having racing thoughts, making impulsive decisions, and experiencing delusions or hallucinations.

The term “hypomania” refers to a less intense version of mania. Delusions and hallucinations do not feature in hypomanic episodes.

The term “depression” refers to periods of depressed mood, sadness, and decreased energy. Someone who is experiencing an episode of depression might also feel suicidal. Depressive behaviors in bipolar disorder look very much like the behaviors seen in major depressive disorder (sometimes referred to as “clinical depression”).

Bipolar disorder can look slightly different for each person with the diagnosis. Sometimes people think that being manic means being extremely happy. While this may be the case for some individuals, it isn’t the case for everyone experiencing mania. Mania can also mean being irritable, angry, distressed, or anxious.

Who Gets Bipolar Disorder?

Bipolar disorder is fairly uncommon. According to one large, multicountry study, the lifetime prevalence of bipolar spectrum disorders is about 2.4 percent of the general population. However, some studies have reported the prevalence rates of bipolar disorder as high as 5 percent.

Risk Factors for Developing Bipolar Disorder

One systematic review of the available data suggests there are no significant differences between ethnicities or genders regarding bipolar disorder diagnosis.

Bipolar Disorder and Heredity

The biggest risk factor for bipolar disorder is having family members with the disease. The importance of family history suggests that bipolar disorder has a strong hereditary component. In other words, bipolar disorder can run in families.

One genetic variant in the section of DNA that codes for brain-derived neurotrophic factor (BDNF) has been repeatedly shown to have a strong association with bipolar disorder. BDNF is important to cell survival, nerve growth, communication, and memory. BDNF levels have even been shown to rise and fall as a person transitions in and out of depressive or manic states.

Bipolar Disorder and Environmental Factors

Genes alone don’t explain why some people get bipolar disorder and others don’t. Environment can also play a big role. For instance, early life stress has also been shown to contribute to the development of bipolar disorder. Some researchers believe that stress makes it easier for a depressive episode to be triggered.

Genes and environment also interact in complicated ways. One study found that there is a combined effect of childhood sexual abuse and a mutation in a gene that codes for toll-like receptors, an important component of the immune system. Specifically, the study demonstrated that this combination was more likely to result in an early onset of bipolar disorder. A similar relationship has been observed between the BDNF gene mutation, childhood sexual abuse, and the onset of bipolar disorder.

Bipolar Disorder Symptoms

Symptoms of bipolar disorder range from the lows of depressive symptoms to the highs of manic symptoms. These symptoms differ from person to person and episode to episode.

Symptoms associated with the depression side of bipolar disorder include:

• Depressed mood
• Low interest in activities once enjoyed
• Low energy or fatigue
• Weight loss
• Poor sleep (insomnia or sleeping too much)
• Feelings of worthlessness or guilt
• Thinking about or planning suicide

Symptoms associated with the manic side of bipolar disorder include:

• High energy
• Decreased need for sleep
• Talkativeness
• Exaggerated feelings of importance
• Racing thoughts
• Poor decision-making
• Delusions
• Hallucinations
• Psychosis (a “break” from reality)

The type of bipolar disorder a person has is defined by the symptoms they experience.

Types of Bipolar Disorder

There are three types of bipolar disorder:

• Bipolar type 1 — The most extreme form of bipolar disorder, type 1 indicates individuals have experienced at least one manic episode in addition to the lows of depression.
• Bipolar type 2 — Individuals with this form of bipolar disorder only experience hypomania and not true mania. Therefore, this type is defined by alternating hypomanic and depressive episodes.
• Cyclothymic disorder (cyclothymia) — This type is also defined by highs and lows, but they are not as high as hypomania or as low as that experienced in the depression episodes of bipolar types 1 and 2. Cyclothymic disorder was recently reclassified as a type of bipolar disorder.

Read more about types of bipolar disorder.

Diagnosing Bipolar Disorder

Bipolar disorder is diagnosed based on the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. According to some experts, the current edition of the DSM does a better job than previous editions in recognizing cases of bipolar disorder. However, bipolar disorder remains underdiagnosed in the general population. It is often confused with major depression.

Remember, a diagnosis can only be made by a psychiatrist or clinical psychologist through a mental health assessment. A doctor may perform a physical examination to rule out other potential causes (such as thyroid disorder), but a referral to psychiatric services is usually required for a proper diagnosis.

Treating Bipolar Disorder

Although bipolar disorder can’t yet be cured, treatments for bipolar disorder can help manage symptoms of the disorder. Many people with bipolar disorder take a combination of medications to help manage lows and highs. These medications may include:

• Mood stabilizers (anticonvulsants) — Drugs that are used for seizures, at the right doses, can also be used for bipolar disorder to stabilize mood swings. Some of these drugs include Lamictal (lamotrigine) and Depakote (divalproex sodium). Lithium is an older drug, but it is still used today.
• Antidepressants — Although antidepressants don’t work for everyone, they can help some people manage their depression. Examples of antidepressants include selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine).
• Antipsychotics — These drugs can help manage episodes of mania and psychosis, delusional thinking, and other symptoms associated with mania. Risperdal (risperidone), Abilify (aripiprazole), and Latuda (lurasidone) are all used to treat bipolar disorder.

In addition to prescription drugs, psychotherapy is often a helpful treatment option for learning to manage symptoms. For instance, cognitive behavioral therapy has been shown to be helpful for symptoms associated with bipolar disorder.

Read more about treatments for bipolar disorder.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 13,000 members diagnosed with bipolar disorder come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Are you living with bipolar disorder? Share your experience in the comments below, or start a conversation by posting on your Activities page.