Everything You Need To Know About Bipolar Disorder

A common disorder, it can be so severe that it can make daily tasks feel impossible. But with the right care, it can be successfully managed and treated

May 23, 2023

We all experience shifts in our moods at times. However, some people feel changes in mood differently. For people with bipolar disorder, experiencing heightened emotions and depressive states are often so intense that they interfere with everyday life.

Bipolar disorder (BD) is both common and treatable.

If you or someone you love has BD, a thoughtful and informed support system can help ensure symptoms are successfully managed.

Keep Reading To Learn

  • The truth about bipolar disorder
  • How to recognize BD in yourself or others
  • How to successfully manage and treat it

Understanding Bipolar Disorder

Previously called manic depression or manic-depressive illness, bipolar disorder (BD) is a serious mental health condition that leads to shifts in mood. It consists of depressive states as well as episodes of mania.

During manic episodes, people feel as if they are on a “high” and have extreme amounts of energy. In depressive episodes, people experience feelings of sadness or indifference.

In addition to changing moods, bipolar disorder causes shifts in focus and activity levels. People with untreated BD can struggle with carrying out daily tasks.

Approximately 10 million people in the U.S. have bipolar disorder. It impacts men and women equally.

BD can impact sleep, self-esteem, appetite, and concentration. People with bipolar disorder can also have physical health issues, such as migraines, high blood pressure, and heart attacks.

There are different types of bipolar disorders and like every individual living with it, the condition can impact each person differently.

There Are Various Types of Bipolar Disorders

Though every form of BD leads to mood and energy level shifts, each type of bipolar disorder has its own characteristics.

Bipolar I

Bipolar I is the “classic” type of bipolar disorder with both manic and depressive episodes present. Bipolar I is characterized by one or more manic episode that lasts for at least seven days or leads someone to seek medical care.

A manic episode involves very elevated or irritable mood. It may include increased energy, decreased need for sleep, racing thoughts, increased self-esteem, rapid speech, and changes in things like appetite and concentration.

People with bipolar I may also experience episodes of depression. Sometimes people experience both depressive and manic symptoms at the same time, which is called a “mixed episode.”

Some people with BD also experience symptoms of psychosis during a manic or depressive episode. Psychosis, or loss of contact with reality, leads the person to be unsure of what’s real and what’s not.

Symptoms of psychosis include unusual beliefs or perceptions, like believing things that are not true or seeing or hearing things that others don’t.

Both manic and depressive episodes represent distinct changes in a person’s mood and behavior that negatively impact daily life functioning.

Bipolar II

Bipolar II is defined by episodes of hypomania, or an unusually energetic state of mind that affects mood, thoughts, and behaviors. The manic episodes are not as severe as in bipolar I. They may also be shorter in duration than manic episodes in bipolar I.

While less commonly experienced than in bipolar I, folks with bipolar II disorder may also experience psychosis.

Cyclothymic Disorder

Also called cyclothymia, folks with this condition tend to move between episodes of depression and mania more quickly. The symptoms do not meet the criteria for bipolar I or bipolar II. There are still episodes of depression and episodes of mania.

In Her Own Words

DS participant Ashley

As a participant in McLean’s Deconstructing Stigma campaign, Ashley shares her story of living with bipolar disorder.

DS participant Ashley

Bipolar Disorder in Children and Teens Is Not Uncommon

Bipolar disorder is typically diagnosed during later teen years or early adulthood. However, symptoms of BD can often show up in young children.

It can be difficult to tell whether teens are experiencing normal mood swings or showing signs of a serious mental health condition.

It’s important for parents, caregivers, friends, and family members to watch for mood swings that differ from typical behavior. Behavioral changes can be a sign of the onset of a mental health concern.

The most important thing to do if you are concerned is to ask for help. Even if the child is not diagnosed with bipolar disorder, there may be another mental health issue that needs to be addressed.

What Causes Bipolar Disorder?

In order to watch for signs of BD, it is important to understand who is at risk. Even though the exact cause of bipolar disorder is still being researched, there are a number of factors that contribute to a diagnosis.

Changes in Brain Structure and Functioning

The overall structure and function of the brain are different in people who have the condition. It is possible that the way neurotransmitters pass between neurons contributes to the development of the condition.


Someone’s family history could play a role in the diagnosis of bipolar disorder. People who have one or more family members, particularly a parent or a sibling, with a diagnosis of BD are more at risk. Many genes are involved, and this is still an active area of research.

Coexisting Mental Health Issues

People who have another mental health issue are more likely to develop bipolar disorder. These often include conditions such as depression or anxiety.

Navigating Bipolar Disorder

Patient talks to clinician

Kirsten W. Bolton, LICSW, helps us understand more about bipolar disorder and how to manage symptoms.

Patient talks to clinician

Recognizing Bipolar Disorder in Yourself or Others

Just like each person looks different, the condition can vary from person to person.

It is important to understand how bipolar disorder tends to present. It’s not like a light switch of emotions, as many believe it to be. Symptoms of mania or depression may appear over the span of days, weeks, or even longer.

Some episodes may last for a day or two while others may last for a week or longer.

To understand BD, it’s important to understand the signs of manic and depressive episodes.

Some signs that someone is experiencing a manic episode include:

  • Feeling elated, high, or “up”
  • Feeling extremely irritable
  • A decreased need for sleep, sometimes going several days without sleep at all without feeling tired
  • Changes in appetite
  • Bouncing quickly between thoughts
  • Risky behavior and poor judgment, such as spending large amounts of money, drinking excessively, or risky sexual behavior
  • “Grandiose” ideas where the person feels exceptionally talented, important, or powerful

Since a manic episode can involve feelings of euphoria, it’s not unusual for people experiencing mania to want the feeling to last forever. This also explains why many who are experiencing episodes of mania may not ask for help. However, the feeling of mania will end.

Some people with BD will also experience one or more depressive episodes. They may have symptoms similar to major depressive disorder (MDD). Some of the most common symptoms include:

  • Feeling sad, hopeless, or worried most of the day, almost every day
  • Taking longer than normal to complete daily tasks
  • Loss of interest or pleasure in things they usually enjoy
  • Major changes in sleep habits, either sleeping significantly more or sleeping significantly less than usual
  • Major changes in appetite, eating more or less than usual
  • Speaking slowly, with the impression that they are having a hard time getting the words out of their mouth
  • Difficulty concentrating
  • Taking a long time to complete simple tasks
  • Losing all interest in activities that once brought joy or pleasure
  • Thoughts of death or suicide

Like manic episodes, depressive episodes eventually end. That said, sometimes the individual may go back to a state of mania.

Stock photo of hand holding other hands

It is also possible for people with BD to experience an episode that has mixed features of mania and depression. People who have such mixed states often have more serious and frequent symptoms.

Manic episodes and depressive episodes can vary in their degrees of severity. This is especially the case with bipolar II or cyclothymia.

It’s important to note that pregnancy can trigger the first episodes of bipolar disorder in women who are of childbearing age.

In some situations, people may not be able to go to school or work. In others, people may be able to continue daily activities even though they are experiencing serious symptoms.

Without proper treatment, it is possible for these episodes to get worse over time. For example, episodes of hypomania may become episodes of full-blown mania if they are not taken seriously. For all of these reasons, people with bipolar disorder should seek help from a trained mental health professional.

Even though symptoms can fluctuate over time, bipolar disorder usually requires lifelong treatment. It is possible for people to manage symptoms and improve their overall quality of life.

Bipolar Disorder and Other Mental Illnesses

People with bipolar disorder fluctuate between mania and depression. Because it can look like other illnesses, it can be difficult to diagnose.

Folks diagnosed with BD may experience another mental illness at the same time. Possibilities include eating disorders, anxiety disorders, or substance use disorders.

People with bipolar disorder have an increased risk of developing other chronic medical conditions including diabetes, obesity, migraine headaches, thyroid disease, and heart disease.

Below are just a few of the most common conditions that may look like bipolar disorder or may manifest as additional diagnoses. Anyone who has symptoms of these conditions should seek help from a trained medical professional, mental health professional, or specialist.


It is possible for someone with bipolar disorder to experience psychotic symptoms. Psychosis refers to hearing or seeing something that is not there, known as hallucinations. Or the person may have beliefs that cannot be true, known as delusions.

For example, people experiencing mania may falsely believe that they have an endless supply of money, special powers, or that they are the most famous person in the world. During episodes of depression, people with BD may falsely believe that they have no money at all, have committed a heinous crime, or that they have a serious illness that no one is able to diagnose.

Because of these psychotic symptoms, it is possible for someone with bipolar disorder to be misdiagnosed with schizophrenia. However, someone with schizophrenia must have symptoms of psychosis that are separate from manic and depressive episodes.


It is not unusual for someone with BD to also be diagnosed with anxiety. There are many types of anxiety disorders, including social anxiety and generalized anxiety.

It is also possible for people with bipolar disorder to experience panic attacks. Panic attacks are episodes of rising heart rate, sweating, and rapid breathing. People may also experience feelings of impending doom during a panic attack.


People with bipolar disorder may have attention-deficit/hyperactivity disorder (ADHD). If someone is diagnosed with BD during their adult years, it is possible they may have outgrown ADHD during their childhood. In order for someone to be diagnosed with ADHD, they need to have symptoms of hyperactivity and symptoms of attention-deficit.

Eating Disorders

It is possible for people with bipolar disorder to be diagnosed with an eating disorder as well. The most common examples include anorexia, bulimia, and binge eating disorder. Rapid changes in appetite may also be a sign of depression or other conditions.

Substance Use Disorders

It is not unusual for people with bipolar disorder to be diagnosed with substance use disorders. For example, people with BD may misuse alcohol or drugs as a means to cope with their symptoms.

They may also engage in other risky behaviors that are more common during manic episodes. It is critical for someone with a substance use disorder to be screened for BD.

Meet Andy, He Has Bipolar Disorder

McLean OnTrack

Learn more about bipolar disorder and how to get help at McLean OnTrack.

McLean OnTrack

How Bipolar Disorder Is Diagnosed and Treated

Bipolar disorder is a lifelong illness. While some people with BD may have a single episode of mania, often people experience more than one mood episode.

If not treated, BD tends to get worse over time with more frequent, more intense episodes.

The key is to treat the symptoms, so episodes can be managed. Between episodes, people with BD may be free from mood changes. Others may have lingering symptoms. By sticking to a well-rounded treatment plan, it is possible to manage symptoms effectively.

To diagnose BD, a doctor may perform a physical exam and ask questions to rule out other illnesses that may resemble bipolar disorder. To be diagnosed, a person must have at least one episode of mania and one episode of depression. A mental health professional will assess symptoms, patterns in symptoms, and their severity to determine the type of bipolar disorder it may be.

Similar to other mental health issues, bipolar disorder is treated through a combination of things, including medication, therapies, or a variety of other activities. In addition, developing healthy routines including regular sleep, exercise, and avoiding substance use are helpful for people with BD.

The foundation of successful BD treatment involves prescription medications and therapy. The vast majority of people who seek appropriate medical care make some degree of meaningful recovery.


Mood stabilizers are the foundation of BD treatment. The two most common types are lithium and valproic acid, also called valproate.

It’s important to keep in mind:

Ask Questions

All patients should ask questions. Understand the risks and benefits of the medications you are taking. Remember that there are options available. If one medication is not working well, it may be possible to switch to another.

Share Your Details

Let medical providers know if you are taking other prescription or over-the-counter medications. It’s possible for medications to negatively interact with each other, so please consult a professional and be honest about other medications you are taking.

Voice Your Concerns

If you have any concerns after starting the medication, no matter how minor, it is important to reach out to a medical provider. That way, the dose or the medication can be changed if necessary.

Follow Medical Advice

It is critical to avoid stopping use of a medication without speaking to a medical provider first. If you stop taking medication for bipolar disorder abruptly, you may begin to experience BD symptoms again.

Stick to Your Regimen

All medications must be taken consistently, as prescribed. The goal is to build up a “steady state” of the medication in the bloodstream to effectively manage symptoms.

The goal of medication is to not only stabilize the mood but to reduce symptoms. It is possible for prescriptions to prevent or reduce the intensity of manic and depressive episodes down the line.

It is important for patients to remember it can take up to two weeks for mood stabilizers to become effective. In addition, providers may prescribe an antipsychotic. Some of these medications can start working within a few hours, but some take several days—or weeks.

Medication is not a one-size-fits-all effort. Everyone reacts differently to prescription medications. They are an effective first-line treatment that can work very well with psychotherapy.

Even when people are feeling well, medication must continue. Often people stop taking medicine once they start feeling better—but that’s just a sign that it’s working and should continue being taken.

Everyone responds differently to psychiatric medications so it may take time to find the correct medication and the proper dose. It is critical to make sure a mental health provider helps to manage medication usage.

In addition to mood stabilizers, atypical antipsychotics, also called second-generation antipsychotics, are used. Some of the most common examples include olanzapine, aripiprazole, and paliperidone.

Providers may prescribe medication for symptoms in addition to those caused by bipolar disorder.


Talk therapy, or psychotherapy, is the other major component of bipolar disorder treatment. It can help people identify the symptoms they experience. It can also identify positive behaviors and skills that may help people avoid episodes by recognizing symptoms and triggers.

Once people learn to cope with troubling thoughts, emotions, and behaviors, they may be able to better manage the condition. Skills learned in therapy may reduce the frequency or severity of mood episodes and help people ensure their support system is in place and ready in case their symptoms worsen.

One of the major focus areas when treating bipolar disorder is interpersonal skills. It is critical to teach people experiencing BD how to cope with rapid mood fluctuations. If they are able to identify when they are going to have an episode of mania or depression, they can better prepare themselves and their loved ones.

Therapy also provides education, support, and guidance to family members. In some cases, family therapy can be an important part of treatment.

Family therapy may be more helpful after the treatment process has started. This is usually handled on a case-by-case basis.

Debunking Myths About Bipolar Disorder

Even though BD impacts a percentage of the population, there are still many misconceptions about the illness.

Myth: Bipolar Disorder Only Affects Mood

Even though it involves severe mood states, it also impacts sleep, self-esteem, appetite, and concentration. BD also impacts physical health. It is associated with increased risk of migraines and cardiovascular problems.

Myth: The Highs and Lows of the Condition Are the Same

This is not necessarily the case. Everyone has different episodes when it comes to bipolar disorder. For some people, the highs may be worse. For other people, the lows may be worse.

Myth: Bipolar Disorder Does Not Impact Children

It is possible for children as well as adolescents to be diagnosed with BD. Symptoms can also show up during the elementary and middle school years.

Myth: People With Bipolar Disorder Cannot Lead a Normal Life

This is a common stigma. Even though living with it is a challenge, it is possible for people to lead full, rewarding lives.

Thriving With Bipolar Disorder

It’s possible to live a well-managed life with BD. Many have benefited from adding helpful habits into their treatment plans.

Charting Mood Changes

People may not think there is any rhyme or reason to when they experience episodes of mania and when they experience episodes of depression. On the other hand, if they can recognize the typical rhythm of their mood, they may be able to manage their mood swings. In some situations, they can even predict when a new episode is going to happen and avoid it.

Sticking to a Routine

It is critical to build structure around school and work. If people help their bodies get into a rhythm, they may be able to avoid episodes down the road.

Practicing Good Sleep Hygiene

Sleep is one of the most important factors in coping with bipolar disorder. This means going to bed at the same time and waking up at the same time, even on the weekends.

It is a good idea to avoid caffeine in the afternoon and stay away from screens before bed. That way, people can fall asleep more easily.

Sleep deprivation is one of the biggest triggers of manic and depressive episodes. If people with bipolar disorder are able to avoid sleep deprivation, they may be able to reduce the frequency of their episodes.

Managing Stressors Effectively

Stress is another major trigger of episodes. If people are able to practice appropriate stress management techniques, such as yoga and meditation, they may be able to avoid manic and depressive episodes. Stress management is one of the major focuses of bipolar disorder treatment.

Prescription medications and therapy are the foundations of BD treatment. However, treatment should be comprehensive and involve many of the lifestyle changes and suggestions mentioned above.

Bipolar Disorder Can Be Managed—Don’t Lose Hope!

Trying to manage a new diagnosis—or an existing one—can be challenging. The following may be helpful to make it seem less overwhelming.

  • Stick to the treatment process; it may take some time to achieve meaningful progress, but it’s worth it
  • Keep all appointments and talk to your doctor about all questions and concerns, especially as they relate to the treatment process
  • Take all medications as directed and talk to your doctor if you need a change in treatment
  • Build a routine and stick to it; this includes exercise, sleeping, and eating
  • Try to be patient; improvement takes time and having strong social support can help
  • Stay away from alcohol and drugs as their use can influence brain connections, leading to mood swings

Even though bipolar disorder is a lifelong illness, treatment for it is effective. With management of the condition, people can both control their symptoms and live healthy lives.

McLean offers world-class bipolar disorder care. If you or a loved one are struggling with mental illness, call us today at 617.855.3141 to learn more about treatment options.

Want More Info?

Looking for even more information about bipolar disorder? You may find these resources helpful.

Interesting Articles and Videos and More

Learn more about bipolar disorder and what you can do if you or a loved one is displaying signs that they are having trouble managing their mental health.

Helpful Links

These organizations may also have useful information:

Depression and Bipolar Support Alliance
A nonprofit organization providing support groups for people with depression or bipolar disorder, as well as their friends and family. DBSA offers education, personal wellness tools, access to research studies, and assistance with finding the right treatment.

Depression and Bipolar Support Alliance Boston
A nonprofit, self-help support organization run by volunteers, for people who struggle with mood disorders, such as depression and bipolar disorder, and for family and friends.

Books About Bipolar Disorder

Book cover - Social Cognition in Psychosis

Social Cognition in Psychosis
by Kathryn Eve Lewandowski and Ahmed A. Moustafa
(Elsevier, 2019)

Book cover - Chemotherapy in Psychiatry

Chemotherapy in Psychiatry: Pharmacologic Basis of Treatments for Major Mental Illness, 3rd edition
by Ross J. Baldessarini
(Springer, 2013)

Book cover - Living With Someone With Bipolar Disorder

Living With Someone Who’s Living With Bipolar Disorder: A Practical Guide for Family, Friends and Coworkers
by Chelsea Lowe and Bruce M. Cohen, MD, PhD
(Jossey-Bass/John Wiley & Sons, Inc., 2010)