Bipolar disorder

Bipolar disorder is a mental health condition that causes big shifts in mood, energy, activity and the ability to focus. A person may have times of feeling very "up" or wired, and other times of feeling very low and hopeless. It used to be called manic depression.^1,2

These shifts are much stronger than ordinary ups and downs. They can strain health, work and relationships.² The good news is that bipolar disorder can be treated, and a good treatment plan can improve daily life.² This page gives the big picture and links to each topic.

What is bipolar disorder?

Bipolar disorder is a mental illness, not a weakness or a choice.² It tends to come in episodes. An episode is a stretch of days or weeks when mood and energy are far from a person's usual self.¹

Three kinds of mood episodes can happen:¹

• Mania: a very high, excited or irritable mood with lots of energy. The person may sleep very little and not feel tired. They may talk fast, have racing thoughts, feel unusually important or chase pleasure far more than usual.
• Hypomania: a milder form of mania. The person may feel good and very productive. They often do not see a problem, but family may notice a change.
• Depression: feeling sad, empty or hopeless, losing interest in things, sleeping too much or too little, trouble focusing, and sometimes thoughts of death or suicide.

Some people have mixed features, which means signs of mania and depression at the same time.¹ During severe episodes, some people have psychosis (losing touch with what is real), such as hearing voices or holding false beliefs.^1,2

Learn the signs in detail on signs of mania, hypomania and bipolar depression.

Types of bipolar disorder

Four or more episodes in one year is called rapid cycling. Many people with bipolar II also have long stretches of low-grade depression.¹ Read more on types of bipolar disorder.

How common is it?

A large national survey found that about 2.8% of U.S. adults had bipolar disorder in the past year. That is about 1 in 36 people. About 4.4%, or roughly 1 in 23, will have it at some point in life.³ These numbers come from a survey done in the early 2000s.

More than 8 in 10 of these adults had serious problems with daily life because of it.³ On average, it starts around age 25.⁴

Bipolar disorder often runs in families, but no single gene causes it. Stress or trauma may raise the risk in people with a family history.¹ Having a parent or sibling with it raises your chance, but it does not mean you will get it.⁴

Many people with bipolar disorder also have anxiety, ADHD, or problems with alcohol or drugs.^1,4

Why it is often missed

People usually seek help when they feel depressed, not when they feel "up." Hypomania can feel good, so it may never be mentioned. As a result, bipolar disorder is often first treated as plain depression.^1,5 One review of 27 studies found an average delay of about 5.8 years before care started.⁵

This matters because treating bipolar depression with an antidepressant alone can sometimes set off mania or faster mood swings.^1,4 If you ever had a time of very high energy and little need for sleep, tell your doctor, even if it felt good. Family can share what they noticed.

Doctors also check for medical causes, such as thyroid problems or the effects of medicines and drugs.^1,4 Read more on getting diagnosed and on depression.

How treatment works

Bipolar disorder usually needs treatment for life, even when a person feels well. The goal is to calm the current episode and prevent the next one.^1,2

Antidepressants are used with care. They are not used alone for bipolar disorder. If one is used, it is added to a mood stabilizer.¹

Lithium needs regular blood tests. The amount that helps is close to the amount that can cause harm. Doctors check blood levels and test the kidneys and thyroid over time.⁸ Some common medicines can raise lithium levels. These include pain relievers called NSAIDs (such as ibuprofen and naproxen), water pills and some blood pressure medicines. Heavy sweating, diarrhea or not drinking enough fluids can also cause problems.⁸

Guidelines advise against valproate for anyone who could become pregnant.⁶ Our page on medicines for bipolar disorder explains each one.

No supplement is FDA-approved to treat bipolar disorder.¹ Never stop or change a medicine on your own. Talk with your doctor or pharmacist before changing anything.

Daily habits that protect your mood

Medicine works best alongside steady daily habits:^1,4

• Keep a regular routine, especially for sleep. See healthy sleep habits.
• Learn your early warning signs from past episodes, such as sleeping less or talking faster. A daily mood chart can help.
• Avoid alcohol and drugs. They can worsen mood symptoms.
• Have a plan ready for what to do and whom to call if an episode starts. Our safety plan tool can help.

Read more on living well with bipolar disorder.

Bipolar disorder in later life

One review estimates that about 1 in 4 people with bipolar disorder are 60 or older. About 5 to 10 in 100 have their first manic episode at age 50 or later.⁹

In older adults with mania, studies find signs of a brain condition in about 17% to 43%. Causes include stroke, head injury, other brain diseases and medicine side effects.⁹ New mania after 50 deserves a full medical checkup.

Older adults with bipolar disorder may have more memory and thinking problems. One review reports that about 19 in 100 developed dementia, compared with about 7 in 100 people of the same age without bipolar disorder.⁹ Lithium can still be a good choice in later life, but it needs close watching. Aging kidneys and other medicines can raise lithium levels.^8,9

Read more on bipolar disorder in later life, medicines that can affect mood and memory and our dementia guide.

Supporting someone you love

Family and friends can help with appointments and medicines and offer steady encouragement. Take care of yourself too.¹ It helps to plan ahead together while the person is well, covering money, safety and crisis steps. Read supporting someone with bipolar disorder, when a family member is in a mental health crisis and caregiver burnout.

All bipolar disorder topics

• Signs of mania, hypomania and bipolar depression
• Types of bipolar disorder
• Getting diagnosed
• Medicines for bipolar disorder
• Therapy for bipolar disorder
• Living well with bipolar disorder
• Bipolar disorder in later life
• Supporting someone with bipolar disorder

In this section

When to get help

See a doctor if you or someone close to you has times of very high energy, little sleep and racing thoughts, or depression that keeps coming back. A primary care doctor is a good first step. They can check for medical causes and refer you to a mental health professional.¹ You can also take our mental health check-in.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.