Bipolar disorder

Bipolar disorder involves distinct episodes of mood that are very different from a person's usual self. During manic or hypomanic episodes, energy and mood are unusually high or irritable. During depressive episodes, mood is low and energy drops. Between episodes, many people return to a stable baseline for long stretches.

These shifts go beyond the normal ups and downs everyone experiences. A manic episode can affect sleep, judgment, work and relationships, sometimes seriously. Depressive episodes can be deep and long-lasting.

Bipolar disorder often first appears in late adolescence or early adulthood, although it can begin later. It is not a character flaw or a lack of willpower. It is a medical condition involving the brain, influenced by genes and life circumstances.

During a manic episode, a person may have:

• Elevated, euphoric or very irritable mood
• Greatly reduced need for sleep without feeling tired
• Racing thoughts and rapid, pressured speech
• Inflated self-esteem or grand ideas
• Risky behavior, such as overspending, unsafe sex or reckless driving
• Distractibility and starting many projects at once

Mania can sometimes include psychosis, with delusions or hallucinations, and may require hospital care. Hypomania is a milder form: similar changes, noticeable to others, but not severe enough to cause major disruption.

Depressive episodes bring persistent sadness or emptiness, loss of interest, fatigue, changes in sleep and appetite, difficulty concentrating, feelings of worthlessness and sometimes thoughts of death or suicide. Some people have mixed features, with high energy and low mood at the same time, which can be especially risky.

Clinicians describe several types of bipolar disorder:

• Bipolar I disorder involves at least one full manic episode. Most people with bipolar I also experience depressive episodes.
• Bipolar II disorder involves at least one hypomanic episode and at least one major depressive episode, but no full mania. Depression is often the most disabling part.
• Cyclothymic disorder involves long-lasting fluctuations between milder high and low moods that do not meet the criteria for full episodes.

Bipolar II is not simply a "milder" form. Its depressive episodes can be long and severe. Because hypomania may feel good or productive, it is often overlooked, and people may be treated for depression alone for years before the pattern is recognized.

Bipolar disorder runs in families, and genetics play an important role. However, having a relative with the condition does not mean you will develop it. Other factors that can influence onset or trigger episodes include:

• Major stress, loss or trauma
• Sleep disruption, including shift work and jet lag
• Substance use, including alcohol and stimulants
• The postpartum period
• Some medications and medical conditions

An online bipolar test or quiz can help you reflect on symptoms, but it cannot diagnose the condition. Diagnosis requires a careful assessment by a qualified professional, ideally including your history and, with your consent, input from people close to you.

Treatment usually combines medication and psychotherapy. Mood-stabilizing medication, prescribed and monitored by a psychiatrist, is a cornerstone for most people. Finding the right treatment can take time and adjustments, so regular follow-up matters. Stopping medication suddenly can trigger an episode, so changes should always be discussed with the prescriber.

Psychotherapy helps people understand their condition, recognize early warning signs and build stable routines. Evidence-based approaches include psychoeducation, cognitive behavioral therapy, interpersonal and social rhythm therapy, which focuses on regular sleep and daily routines, and family-focused therapy. Peer support groups can also make a real difference.

A written relapse prevention plan, made together with your care team and loved ones, helps everyone know what to do if early signs appear.

A psychiatrist is usually central to diagnosing bipolar disorder and managing medication. Clinical psychologists and therapists provide psychotherapy and support with coping skills, routines and relationships. Your primary care doctor can help coordinate care and check physical health.

A first appointment will cover your mood history, sleep, energy, family history, substance use and how symptoms affect your life. Tracking your mood and sleep in a simple diary before the visit can be very useful.

Bipolar disorder can involve periods of high risk, especially during severe depression, mixed episodes or mania with psychosis. Seek help immediately if you or someone you know:

• Has thoughts of suicide or self-harm
• Is acting in ways that put themselves or others in danger
• Has lost touch with reality, with hallucinations or delusions
• Has gone several nights without sleep and is escalating

In an emergency, call 911 in the US or your local emergency number. In the US you can call or text 988 to reach the 988 Suicide & Crisis Lifeline. In the UK and Ireland, Samaritans can be reached at 116 123.