Bipolar disorder symptoms and types

Bipolar disorder is a condition that causes big shifts in mood, energy and activity. People with bipolar disorder have periods of unusually high or irritable mood and energy, called mania or hypomania, and usually periods of depression too. Between episodes, many people feel like themselves. Bipolar disorder is lifelong, but with the right treatment most people manage it well and live full lives.

What are the symptoms of bipolar disorder?

During a manic or hypomanic episode, a person may:

• Feel unusually happy, high, wired or irritable
• Have much more energy than usual and need far less sleep without feeling tired
• Talk fast, jump between ideas, or feel their thoughts racing
• Feel unusually confident or important
• Take on many projects at once
• Do risky things, like overspending, reckless driving or sexual risks

During a depressive episode, a person may feel sad, empty or hopeless, lose interest in things, sleep too much or too little, feel tired and slowed down, struggle to concentrate, and have thoughts of death or suicide.

The high periods are often easier for friends and family to notice than for the person having them.

What are the types of bipolar disorder?

• Bipolar I: at least one manic episode, lasting a week or more or severe enough to need hospital care. Mania can disrupt work and relationships and sometimes includes losing touch with reality. Most people with bipolar I also have depressive episodes.
• Bipolar II: at least one hypomanic episode (a milder high lasting at least four days) and at least one major depressive episode. Depression is usually the main problem.
• Cyclothymic disorder: frequent milder ups and downs for at least two years, not severe enough to count as full episodes.

Is it bipolar disorder or depression?

This is one of the most important questions in mental health care, because the treatments differ. Many people with bipolar disorder first see a doctor while depressed, and the high periods are missed. Antidepressants taken without a mood stabilizer can sometimes trigger mania in people with bipolar disorder.

If you've ever had a stretch of days where you needed little sleep, felt unusually energized or confident, and others noticed you weren't your usual self, tell your clinician, even if it felt good at the time.

The free bipolar self-check is based on the Mood Disorder Questionnaire (MDQ), which asks about those high periods. It takes about three minutes. If depression is what you're feeling now, the depression self-check is also worth taking.

How common is bipolar disorder?

About 2.8% of US adults have bipolar disorder in a given year, and about 4.4% will have it at some point in their lives, according to the National Institute of Mental Health (NIMH). It usually starts in the late teens or early twenties.

What causes bipolar disorder?

Bipolar disorder runs strongly in families, and genes play a big role. Stress, sleep loss, and alcohol or drug use can trigger episodes in people who are already prone to them. It isn't caused by personality or anything a person did wrong.

How is bipolar disorder diagnosed?

A psychiatrist or other mental health clinician diagnoses bipolar disorder through a detailed interview about your mood history, including any high periods, how long they lasted and how they affected your life. Input from a partner or family member can help, since highs are easy to miss from the inside. A doctor may also do blood tests to rule out other causes, such as a thyroid problem.

How is bipolar disorder treated?

Treatment is ongoing, even when you feel well, because it helps prevent future episodes.

Medication. Mood stabilizers such as lithium, valproate and lamotrigine, and certain antipsychotic medications, are the core of treatment. Finding the right medicine or combination can take time. Some of these medications need regular blood tests, and some aren't safe in pregnancy, so plan with your psychiatrist if you might become pregnant.

Therapy. Psychoeducation, cognitive behavioral therapy, family-focused therapy and interpersonal and social rhythm therapy help people spot early warning signs, keep regular routines and handle stress.

Daily rhythm. Regular sleep is especially important. Losing sleep can trigger mania, so keeping a steady schedule, limiting alcohol and avoiding drugs make a real difference.

Who should I see for bipolar disorder?

A psychiatrist or psychiatric nurse practitioner is the right first step, because bipolar disorder almost always needs medication and careful monitoring. A therapist can be a valuable second part of your care.

Our guide on how to find a psychiatrist who can see you soon can help you find someone taking new patients. If a family member seems to be in a severe manic episode, isn't sleeping, or is acting in ways that put them at risk, seek urgent care.

Does insurance cover bipolar disorder treatment?

Most health plans cover psychiatry visits, medication and therapy for bipolar disorder, and federal parity rules mean most plans can't make mental health care harder to use than comparable medical care. See how much does therapy cost for typical prices and the questions to ask your plan.