Mental Health: Bipolar Disorder

Last Editorial Review: 6/21/2012

Bipolar disorder, formerly called manic depression, is a mental illness that causes people to have episodes of severe high and low moods. People who have this illness switch from feeling overly happy and energized to feeling very sad and vice versa. Because of the highs and the lows -- or two poles of mood -- the condition is referred to as "bipolar" disorder. In between episodes of mood swings, a person may experience normal moods.

The word "manic" describes the periods when the person feels overly excited and confident. These feelings can quickly turn to confusion, irritability, anger, and even rage. The word "depressive" describes the periods when the person feels very sad or depressed. Because the symptoms are similar, sometimes people with bipolar disorder are incorrectly diagnosed as having major depression.

Most individuals with bipolar disorder spend more time in depressed phases than in manic phases.

What Are the Symptoms of Bipolar Disorder?

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern, and depression does not necessarily always follow manic phases. A person may also experience the same mood state several times before suddenly experiencing the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

The severity of the depressive and manic phases can differ from person to person and in the same person at different times.

Symptoms of mania ("the highs"):

  • Excessive happiness, hopefulness, and excitement
  • Sudden changes from being joyful to being irritable, angry, and hostile
  • Restlessness
  • Rapid speech and poor concentration
  • Increased energy and less need for sleep
  • High sex drive
  • Tendency to make grand and unattainable plans
  • Tendency to show poor judgment, such as deciding to quit a job
  • Drug and alcohol abuse
  • Increased impulsivity

Some people with bipolar disorder can become psychotic, seeing and hearing things that aren't there and holding false beliefs from which they cannot be swayed. In some instances they see themselves as having superhuman skills and powers, or think they are God-like.

During depressive periods ("the lows"), a person with bipolar disorder may experience:

  • Sadness
  • Loss of energy
  • Feelings of hopelessness or worthlessness
  • Loss of enjoyment from things that once were pleasurable
  • Difficulty concentrating
  • Uncontrollable crying
  • Difficulty making decisions
  • Irritability
  • Increased need for sleep
  • Insomnia
  • A change in appetite causing weight loss or gain
  • Thoughts of death or suicide
  • Attempting suicide

Who Gets Bipolar Disorder?

According to the National Institute of Mental Health, over 2 million American adults have bipolar disorder. Bipolar disorder usually begins in early adulthood, appearing before age 35. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder (ADHD).

Studies indicate that bipolar disorder is sometimes influenced by genetics and may occur more commonly within families.

While bipolar disorder occurs equally in women and men, women with bipolar disorder may have multiple distinct episodes occurring several times per year -- this is called "rapid cycling." Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.

It has been estimated that up to 60% of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder (PTSD).

What Causes Bipolar Disorder?

A definite cause for bipolar disorder or any type of depression is difficult to determine but can include genetics, changes in the brain, and environmental factors like stress and major life changes. More research is being done to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset, and what role they may play in its treatment.

How Is Bipolar Disorder Diagnosed?

A diagnosis of bipolar disorder is made only by taking careful note of symptoms and their severity, length, and frequency. The most telling symptoms include the constellation of symptoms that involve highs or lows in mood accompanied by changes in sleep, energy, thinking, and behavior. Sudden or dramatic "mood swings" per se are not part of the definition of bipolar disorder. Talking to close friends and family of the person is often very helpful to distinguish bipolar disorder from major depression or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

If you or someone you know is experiencing symptoms of bipolar disorder, seek the advice of your family health care provider or a psychiatrist. A referral may then be made to an appropriate mental health expert.

A thorough medical evaluation should be performed. Your doctor will ask questions about your personal and family history of mental illness. You may also be asked to complete a depression screening questionnaire -- a series of structured questions that you will be asked to answer verbally or in writing.

What Are the Treatments for Bipolar Disorder?

Bipolar disorder is a long-term illness that requires management throughout a person's life. People who have numerous (four or more) episodes of mood changes (rapid cycling) in a year can be much more difficult to treat. Medication is the primary treatment for bipolar disorder, but the additional use of psychotherapy or "talk" therapy is sometimes recommended to help prevent future episodes.

There are many medications available to treat bipolar disorder, including lithium and Depakote.


Lithium (brand names Eskalith, Lithobid, Lithonate), a mood-stabilizing drug, is the most commonly prescribed drug for people with bipolar disorder. It is helpful in controlling mood swings in both directions but is especially helpful in treating or preventing mania. Lithium will often reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.

Common side effects of lithium include:

Thyroid and kidney problems are a concern in people taking lithium, so your doctor will monitor the thyroid and kidney function as well as monitor the levels of lithium in your blood since levels can easily become too high. Anything that lowers the level of sodium in the body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a buildup of lithium in the body and toxicity. Be aware of these conditions and alert your doctor if you are on lithium and experience them.

The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:


Depakote is an antiseizure drug that is also effective for controlling mania. It is thought to be helpful as part of a treatment plan for people with rapid-cycling bipolar disorder. The drug has some side effects, can cause inflammation of the liver, and can decrease the amount of platelets (blood cells needed for blood to clot) that the body makes, so your doctor will monitor levels of Depakote as well as liver function and platelet counts.

Common side effects of Depakote include:

Other antiseizure drugs often used to treat bipolar disorder include Tegretol and Lamictal. Neurontin, Trileptal, and Topamax are also antiseizure drugs used for experimentally for bipolar disorder.

Most people with bipolar disorder take more than one medication. Along with the mood stabilizer—either lithium or an anticonvulsant, they may take a medication for agitation, anxiety, insomnia or depression.

Many antidepressants can be used with mood stabilizing drugs to manage the depression of bipolar disorder, although current research suggests that mood-stabilizing drugs and some atypical antipsychotics may be the most effective drug therapies. If used alone, an antidepressant can sometimes push a person with the condition into a manic state. In children, adolescents, and young adults, antidepressants can also cause or worsen suicidal thoughts or behaviors.

What Can I Expect After Treatment?

For most people, a good treatment program for bipolar disorder can stabilize moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses and controlling cycling. Those who also have a substance abuse problem may need more specialized treatment.

Can Bipolar Disorder Be Prevented?

There is no known method to prevent bipolar disorder. Because its exact cause has not yet been determined, it is especially important to know its symptoms and seek early intervention. Some people who experience bipolar disorder may become suicidal. By knowing how to recognize these symptoms, there is a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays, and suicide.

Suicide Warning Signs

  • Many depressive symptoms (changes in eating, sleeping, activities)
  • Social isolation
  • Talk of suicide, hopelessness, or helplessness
  • Increased acting-out behaviors (sexual/behavioral)
  • Increased risk-taking behaviors
  • Frequent accidents
  • Substance abuse
  • Focus on morbid and negative themes
  • Talk about death and dying
  • Increased crying or reduced emotional expression
  • Giving away possessions

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What Is Bipolar Disorder? Symptoms, Manic Episodes, Testing See Slideshow

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Reviewed by Joseph Goldberg, MD on June 21, 2012

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