Original Article:http://www.mayoclinic.com/health/bipolar-disorder/DS00356

Bipolar disorder


From high to low. From euphoria to depression. From recklessness to listlessness. These are the extremes associated with bipolar disorder, which can be a serious and disabling mental illness. Bipolar disorder is also known as manic-depression or manic-depressive illness — manic behavior is one extreme of this disorder and depression is the other.

Bipolar disorder often begins in adolescence or early adulthood and may persist throughout life. The causes of bipolar disorder are elusive, and there's no cure.

The flares of bipolar disorder may last for weeks or months, causing great disturbances in the lives of those affected, their friends and their families. Left untreated, the condition usually worsens. But bipolar disorder can be managed with medications and other therapies.

Signs and symptoms

Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of the associated signs and symptoms varies. Bipolar disorder can range from a mild condition to a severe condition, and there may be periods of normal behavior.

Manic phase
For many people, signs and symptoms in the manic phase may include:

  • Feelings of euphoria, extreme optimism and inflated self-esteem
  • Rapid speech, racing thoughts, agitation and increased physical activity
  • Poor judgment
  • Recklessness or taking chances not normally taken
  • Difficulty sleeping
  • Tendency to be easily distracted
  • Inability to concentrate
  • Aggressive behavior

Depressive phase
In the depressive phase, signs and symptoms include:

  • Persistent feelings of sadness, anxiety, guilt or hopelessness
  • Disturbances in sleep and appetite
  • Fatigue and loss of interest in daily activities
  • Problems concentrating
  • Irritability
  • Chronic pain without a known cause
  • Recurring thoughts of suicide


Doctors and researchers don't know exactly what causes bipolar disorder. But a variety of biologic, genetic and environmental factors seem to be involved in causing and triggering episodes of this illness.

Evidence indicates that differences in the chemical messengers between nerve cells in the brain (neurotransmitters) occur in people who have bipolar disorder. In many cases, people with a bipolar disorder may have a genetic disposition for the disorder. The abnormality may be in genes that regulate neurotransmitters. However, not everyone with a family member who has bipolar disorder will develop the disease.

Factors that may contribute to or trigger episodes of bipolar disorder include drug abuse and stressful or psychologically traumatic events.

Risk factors

Bipolar disorder tends to run in families. A family history of depression appears to exist in 80 percent to 90 percent of cases of bipolar disorder. Researchers are attempting to identify genes that may make people susceptible to bipolar disorder.

When to seek medical advice

People with bipolar disorder often don't recognize how impaired they are when experiencing a mood episode and how greatly the disorder is affecting their lives and the lives of others. Friends, family and primary care physicians are all important in recognizing possible signs of bipolar disorder and urging the person to seek professional help.

If a family member or friend shows signs of bipolar disorder, encourage that person to seek the care of a psychiatrist.

Screening and diagnosis

Your doctor may ask you or a family member who has accompanied you about your signs and symptoms and to describe apparent episodes of mania and depression. Diagnosis also involves ruling out other mental health conditions that may produce some symptoms similar to bipolar disorder. These may include other mood disorders, sometimes schizophrenia, attention-deficit/hyperactivity disorder or borderline personality disorder.

You may also undergo tests to see if your mood swings are due to physical causes, such as:

  • Substance abuse. Abuse of alcohol, marijuana and cocaine may affect your moods.
  • Thyroid disorders. A blood test for thyroid function can determine whether you have a thyroid disorder, such as an underactive thyroid.

Your doctor may also ask about your use of medications, alcohol and recreational drugs and about your diet. Certain medications including corticosteroids, such as prednisone, and medications used to treat depression, anxiety and Parkinson's disease can cause mood swings. Abuse of alcohol and recreational drugs also can cause mood swings. Deficiency of vitamin B-12 may alter moods as well.


Other problems, such as anxiety disorder or alcoholism, may affect people with bipolar disorder. The length, severity and frequency of mood swings vary from person to person. In some people with bipolar disorder, there is rapid cycling with more frequent and shorter periods of mood disturbance.

It's also possible for mania and depression to be present at the same time. In this mixed state, people experience combinations of agitation, disturbances in sleep and appetite, suicidal thoughts and psychosis. Psychosis is a major mental disorder in which the personality is disorganized and contact with reality is impaired, often including auditory hallucinations and delusions — firmly held erroneous beliefs.

Bipolar disorder can have devastating effects on relationships as well as finances stemming from spending sprees during a manic episode or nearly complete isolation and withdrawal during a depressive phase.


Medication and psychotherapy are the main treatments for bipolar disorder. Occasionally, doctors use electroconvulsive therapy (ECT).

Most people with bipolar disorder take medication to regulate their moods. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for manic episodes.

Anti-seizure medications, such as valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal) are also widely used as mood regulators. Topiramate (Topamax), another anti-seizure medication, also is sometimes used to stabilize mood.

Sometimes, doctors also use antidepressant medications to treat the depression associated with bipolar disorder. These may include paroxetine (Paxil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft) or bupropion (Wellbutrin), among others. In other circumstances, doctors may use antipsychotic medications such as risperidone (Risperdal) or olanzapine (Zyprexa).

One medication, quetiapine (Seroquel), has been approved by the Food and Drug Administration to treat both the manic and depressive episodes of bipolar disorder.

According to the American Diabetes Association (ADA), certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. Therefore, the ADA recommends that doctors screen and regularly monitor people who take Risperdal, Seroquel and Zyprexa for bipolar disorder.

You may need to take medications for several weeks before they reach their full effect.

This approach is often used simultaneously with medication. Your therapist will help you detect patterns leading up to episodes of bipolar disorder, trying to identify triggers for these episodes. These patterns might include your use of medications or anything that happens to you physically or emotionally. Psychotherapy helps provide strategies for managing stress and coping with uncertainties. This, along with basic education about the nature of the disorder, helps you understand why you may well need to keep taking medication over many years.

Electroconvulsive therapy (ECT)
Doctors use this form of treatment mainly in people who have episodes of major depression associated with suicidal tendencies or in people whose medication has proved to be ineffective. In this treatment, electrodes are taped to your head. Then, while you're anesthetized and after you've received a muscle relaxant, a small amount of electrical current is passed through your brain for less than a second. This current produces a brain seizure, but because of the muscle relaxant, your body remains calm.

ECT profoundly affects brain metabolism and blood flow to various areas of the brain. How that correlates to easing depression remains unknown, but this therapy is often highly effective.


Bipolar disorder isn't an illness that you can treat on your own. But you can do some things for yourself that will bolster your treatment program:

  • Take your medications. Even if you're feeling well, resist the temptation to skip your medications. If you stop, signs and symptoms of the disorder may recur.
  • Pay attention to warning signs. You and your caregivers may have identified a pattern to your episodes of bipolar disorder and what triggers them. Call your doctor if you feel you're facing an episode. Involve family members or friends in watching for warning signs.
  • Avoid drugs and alcohol. Drugs, especially stimulants including diet drugs, and alcohol may be part of what triggers episodes of bipolar disorder.
  • Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of bipolar disorder or may interact with medications you're taking to treat bipolar disorder.

Coping skills

Coping with bipolar disorder can be difficult. Support groups can be a valuable part of a wider network of social support that includes health care professionals, family, friends and religious worship communities.

Various support groups bring together people, family and friends who are coping with any of a wide variety of physical or mental health problems. Support groups for bipolar disorder provide a setting in which people can share their common problems and provide ongoing support to one another.

Ask your doctor about self-help groups that may exist in your community. Your local health department, public library, telephone book and the Internet also may be good sources to locate a support group in your area.