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Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional and energy-level highs (mania or hypomania) and lows (depression). Mood shifts may occur only a few times a year or as often as several times a week. Some people mostly get depressed, with only one or a couple manic episodes, and others have different patterns. The symptoms of bipolar are more specific and more extreme than just having a lot of different strong moods or feeling low sometimes and feeling more energetic other times. Bipolar disorder has two classifications, bipolar I (which involves both depression and mania) and bipolar II (which involves depression and hypomania). A related disorder, cyclothymia, involves varying highs and lows that are less extreme than those of bipolar disorder and go on for at least 2 years. Cyclothymia may develop into bipolar disorder.
For a bipolar disorder diagnosis to be made, the person will have experienced one or more depressive episodes and one or more manic or hypomanic episodes, along with other symptoms. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week (or less than a week if severe). The episode includes persistently increased goal-directed activity or energy; for example, a person experiencing mania may spend all night and all day writing an opera or a complicated manuscript or creating plans for a far-fetched business venture. Other people might experience the manic person's speech as rapid and hard to follow and their ideas as grandiose, unrealistic, and overly complicated. A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least four consecutive days. It may be similar in quality to a manic episode but usually is less intense or extreme.
During both a manic and a hypomanic episode, the person must have three or more of the following symptoms (four or more if the mood is only irritable) in order for bipolar disorder to be diagnosed:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., feeling rested after only 3 hours of sleep a night)
- Unusual talkativeness
- Racing thoughts
- Increased goal-directed activity (either socially, at work or school, or sexually) or agitation
- Doing risky things that are not typical for that person and have a potential for negative consequences (e.g., unrestrained buying sprees, out-of-control sexual activity, reckless business investments, gambling)
A depressive episode involves prolonged low mood, low energy, changes in sleep and appetite or eating, lack of interest in or pleasure from things that the person used to enjoy, feelings of worthlessness or inappropriate guilt, suicidal thoughts, and other symptoms. A depressive episode may be diagnosed when these symptoms persist all day every day for 2 weeks or longer, and they are not caused by a medical or substance use issue or normal grieving after a major loss.
Although bipolar disorder can be a disruptive, long-term condition, it can often be controlled with medications and psychotherapy, as well as lifestyle changes. If you have any symptoms of depression or mania, see your doctor or mental health provider, as bipolar disorder usually doesn't get better on its own. Many people with bipolar disorder don't get the treatment they need because they don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones or because they may enjoy the feelings of euphoria and cycles of being more productive that come with mania. However, mania can lead to problems with relationships, school, work, the law, and health (due to poor decisions and low impulse control), and depression can interfere with functioning and cause suicidal thoughts and actions.
Treatment usually starts with medication to get mood swings under control. Ongoing treatment should include both therapy and medication, as well as positive lifestyle choices (e.g., no or minimal use of alcohol and other drugs, getting enough sleep). When bipolar disorder is more severe, temporary hospitalization may be needed to ensure safety, and more intensive treatment (e.g., a partial hospitalization program) may help get symptoms under control and teach coping skills for dealing with bipolar disorder. For people who have both bipolar disorder and a substance use problem, substance use treatment may also be needed.
A number of different medications may be effective for bipolar disorder. They include mood stabilizers (such as lithium), antipsychotics, and antidepressants (usually prescribed in combination with mood stabilizers or antipsychotics, because antidepressants alone may trigger manic episodes). Anti-anxiety medication may be given in the short term to help with anxiety and sleep issues.
The exact cause of bipolar disorder is unknown, but it appears to have genetic and environmental factors, and an imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role. Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:
- Having a first-degree relative, 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, or other traumatic experiences
Read more about bipolar disorder on the Mayo Clinic website.