Bipolar Disorder: Symptoms, Causes, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is bipolar disorder?
Bipolar disorder is a mental health condition that causes extreme mood swings, with highs of mania or hypomania and lows of depression that affect sleep, energy, judgment and thinking. Types include bipolar I, bipolar II and cyclothymia. It is a lifelong condition that does not improve on its own, but mood stabilizers, talk therapy and healthy routines make symptoms manageable. [1] [2]
What the research says
According to PubMed:
Maintenance drugs outperform placebo. A network meta-analysis of 44 randomized trials (10,867 participants) found that several medicines, including lithium 800 mg/day, quetiapine, aripiprazole, lurasidone, carbamazepine, valproate, and olanzapine, outperformed placebo for preventing relapse in bipolar disorder (Fornaro et al., DOI).
Lithium and valproate were both linked to lower suicide risk. A cohort study with network meta-analysis found both lithium (network HR 0.46) and valproate (network HR 0.63) were associated with lower suicide risk than no treatment, with no significant difference between the two (Wei et al., DOI).
CBT may help, with modest effects. In a meta-analysis of 375 trials across mental disorders, the effect size of CBT for bipolar disorder was the lowest of those studied (g = 0.31), and the authors concluded it was possibly effective (Cuijpers et al., DOI).
Study details are from PubMed abstracts.
What exactly is bipolar disorder?
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings. These include emotional highs, known as mania or hypomania, and lows, known as depression. Hypomania is less extreme than mania [1].
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania, you may feel very excited and happy, full of energy, or unusually irritable. These swings affect sleep, energy, activity, judgment, behavior, and the ability to think clearly [1].
Episodes may occur rarely or multiple times a year, and each bout usually lasts several days. Between episodes, some people have long periods of emotional stability, while others swing frequently between depression and mania [1].
Fact | Detail |
Former name | Manic depression |
What happens | Extreme mood swings: emotional highs (mania or hypomania) and lows (depression) |
What mood swings affect | Sleep, energy, activity, judgment, behavior, and clear thinking |
How long episodes last | Usually several days; may occur rarely or multiple times a year |
Between episodes | Some have long stable periods; others swing frequently |
Long-term outlook | Lifelong condition, but symptoms are manageable with a treatment plan |
Main treatment | Medicines plus talk therapy (psychotherapy) |
What are the types of bipolar disorder?
The main types of bipolar disorder are bipolar I, bipolar II and cyclothymia, plus other types caused by certain drugs, alcohol or medical conditions.
Bipolar I: at least one manic episode, which may come before or after hypomanic or major depressive episodes. Mania may sometimes cause psychosis, a break from reality [1]
Bipolar II: at least one major depressive episode and at least one hypomanic episode, but never a manic episode. It is not a milder form of bipolar I — it's a separate diagnosis, and people with bipolar II can be depressed for longer periods [1]
Cyclothymia: at least two years (one year in children and teenagers) of many periods of hypomanic symptoms and depressive symptoms less severe than major depression [1]
Other types: bipolar and related disorders caused by certain drugs or alcohol, or by a medical condition such as Cushing's disease, multiple sclerosis, or stroke [1]
What does mania and hypomania look like?
Mania and hypomania in bipolar disorder share the same symptoms, but mania is more severe. It causes more noticeable problems at work, school, and social activities, may cause psychosis, and may require a hospital stay [1]. A manic or hypomanic episode includes three or more of these symptoms:
Symptom | What it looks like |
More active, energetic, or agitated | Much more active than usual |
Too much confidence | A distorted sense of well-being or self-confidence |
Needing less sleep | Much less sleep than usual |
Talking more | Unusually talkative, talking fast |
Racing thoughts | Jumping quickly from one topic to another |
Easy distraction | Being easily pulled off topic |
Poor decisions | Buying sprees, sexual risks, foolish investments |
What does a major depressive episode look like?
A major depressive episode in bipolar disorder includes symptoms severe enough to make day-to-day activities hard, such as work, school, social activities and getting along with others. An episode includes five or more of these symptoms [1]:
Symptom | What it looks like |
Depressed mood | Sad, empty, hopeless, or tearful; children and teens may seem irritable, angry, or hostile |
Loss of pleasure | Marked loss of interest or no pleasure in most activities |
Weight changes | Losing weight without dieting, overeating and gaining weight, or children not gaining weight as expected |
Sleep changes | Sleeping too little or too much |
Slowed or restless | Feeling restless or acting slower than usual |
Low energy | Very tired or losing energy |
Worthlessness or guilt | Feeling worthless or overly guilty |
Trouble concentrating | Can't think clearly or make decisions |
Suicidal thoughts | Thinking about, planning, or attempting suicide |
Bipolar disorder can start at any age, but it's usually diagnosed in the teenage years or early 20s. Symptoms differ from person to person and may vary over time. They may also include anxious distress, melancholy, and psychosis [1].
Two timing patterns are worth knowing: mixed, when symptoms of depression and mania or hypomania occur at the same time, and rapid cycling, when you have four mood episodes in the past year switching between mania or hypomania and major depression. Symptoms may also happen during pregnancy or change with the seasons [1].
What are the symptoms in children and teens?
Symptoms can be hard to identify in children and teens, because it's often hard to tell whether they are the usual ups and downs, due to stress or trauma, or signs of a different mental health problem. Moods can shift fast during episodes, and some children have periods without mood symptoms between episodes. The most noticeable signs may be severe mood swings that aren't like their usual mood swings [1].
What causes bipolar disorder, and who is at risk?
The cause of bipolar disorder is not known, though brain changes and genetics both appear to be involved. People with the condition appear to have physical changes in their brains, though the importance of these changes is uncertain. Genetics also play a role: it is more common in people with a first-degree relative, such as a sibling or parent, who has it [1].
Risk factor | How it raises risk |
Family history | More common with a parent or sibling who has bipolar disorder |
High stress | The death of a loved one or another traumatic event can trigger a first episode |
Drug or alcohol misuse | Substance misuse raises the risk of developing the condition |
What complications can follow if it's left untreated?
Left untreated, bipolar disorder can lead to serious problems in every area of life, including drug and alcohol misuse, suicide or suicide attempts, legal or financial problems, trouble getting along with others, and poor work or school performance [1].
It also frequently overlaps with conditions that may need treatment at the same time, including anxiety disorders, eating disorders, ADHD, PTSD, alcohol or drug misuse, borderline personality traits or disorders, and physical conditions such as heart disease, thyroid issues, headaches, or obesity. There's no sure way to prevent bipolar disorder, but getting treated as soon as you notice a mental health disorder can help stop it from getting worse [1].
When should you see a doctor?
People with bipolar disorder often don't know how much emotional instability disrupts their lives and their loved ones' lives, so they don't get the treatment they need. Some enjoy the euphoria and cycles of being more productive, but an emotional crash always follows. If you have any symptoms of depression or mania, see your healthcare or mental health professional — it doesn't get better on its own [1].
When to get emergency help: Thoughts about suicide and acting on them are common for people with bipolar disorder. If you're thinking about hurting yourself, or a loved one is in danger of suicide, contact a family member or friend, a suicide hotline, 911 or your local emergency number, or go to the emergency department. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7, free and confidential (Spanish line: 1-888-628-9454) [1].
How is bipolar disorder diagnosed?
Your evaluation may include a physical exam and lab tests to find medical problems that could cause your symptoms. You may be referred to a psychiatrist, who will talk with you about your thoughts, feelings, and behavior patterns; with your permission, family or close friends may add information. You may also be asked to keep a daily record of moods, sleep, and other factors — mood charting [2].
Step | What happens |
Physical exam and lab tests | Ruling out medical problems that could cause the symptoms |
Mental health assessment | A psychiatrist discusses thoughts, feelings, and behavior patterns; family or friends may contribute with your permission |
Mood charting | Keeping a daily record of moods, sleep, and other factors |
Review of patterns | Comparing episodes against the criteria for bipolar I, bipolar II, or cyclothymia |
Diagnosis in children uses the same criteria as adults, but symptoms often follow different patterns. Children are often also diagnosed with conditions such as ADHD or behavior problems, which can complicate diagnosis, and may need a child psychiatrist with experience in bipolar disorder [2].
How is bipolar disorder treated?
Treatment is best guided by a psychiatrist skilled in bipolar and related disorders, with a care team that may include a psychologist, social worker, or psychiatric nurse. Treatment is directed at managing symptoms [2].
Medicines are started right away to balance moods, and ongoing treatment continues for the rest of your life, even when you feel better. If you stop, symptoms can return or minor mood changes can become full-blown mania or depression [2]
Intensive outpatient programs or partial hospitalization may provide a few hours of support per day for several weeks [2]
Treatment for alcohol or drug misuse is needed — without it, bipolar disorder is very hard to manage [2]
A hospital stay may be needed if you're behaving dangerously, thinking about suicide, or detached from reality [2]
Medicines
Types and doses are based on your symptoms. You'll usually need a mood stabilizer or an antipsychotic that functions as a mood stabilizer [2].
Medicine type | How it helps | Examples |
Mood stabilizers | Control manic or hypomanic episodes; may help depressive bouts | Lithium, valproic acid, divalproex sodium, carbamazepine, lamotrigine |
Antipsychotics | Mood-stabilizing properties; FDA approved for manic/hypomanic episodes or maintenance; used alone or with mood stabilizers | Olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, asenapine, lumateperone, cariprazine |
Antidepressants | Cautiously added to manage depression; can trigger mania, so always paired with a mood stabilizer or antipsychotic | Prescribed alongside a stabilizer or antipsychotic |
Combination therapy | A combined antidepressant-antipsychotic approved for bipolar depression | Fluoxetine + olanzapine (Symbyax) |
Antianxiety medicines | Ease anxiety and improve sleep; short-term use only due to misuse risk | Benzodiazepines |
Finding the right medicine likely takes trial and error. Sometimes two or three medicines are used together, some need weeks to months to take full effect, and certain medicines need blood monitoring. Your healthcare professional generally changes only one medicine at a time. Don't stop or change medicines on your own — stopping may cause withdrawal effects, return or worsening of symptoms, very deep depression, suicidal thinking, or a manic or hypomanic episode [2].
Pregnancy: a few bipolar medicines can be linked to birth defects and may pass through breast milk. Valproic acid and divalproex sodium carry a specific warning to avoid them when pregnant, and carbamazepine may make certain birth control medicines less effective. Talk with your prescriber before becoming pregnant, or right away if you think you may be pregnant [2].
Talk therapy
Talk therapy is a vital part of treatment, in individual, family, or group settings [2].
Interpersonal and social rhythm therapy: stabilizes daily rhythms of sleeping, waking, and eating [2]
Cognitive behavioral therapy (CBT): replaces unhealthy negative beliefs and behaviors with healthy ones and helps find what triggers your episodes [2]
Psychoeducation: teaches you and your loved ones about the condition so you can get the best support and stick with treatment [2]
Family-focused therapy: builds communication that helps you stay with your plan and catch warning signs of mood swings [2]
Other treatment options
For depression that doesn't respond to medicines, electroconvulsive therapy (ECT) may be an option, including if you can't take antidepressants for reasons such as pregnancy or are at high risk of attempting suicide. Repetitive transcranial magnetic stimulation (rTMS) is being studied for people who haven't responded to antidepressants and is not as powerful as ECT. Ketamine is also being studied for bipolar depression; limited research suggests a promising, generally well-tolerated short-term treatment, though it can cause temporary dissociative effects and more studies are needed [2].
What lifestyle changes and home remedies help with bipolar disorder?
You'll probably need lifestyle changes to stop cycles of behavior that worsen bipolar disorder [2].
Quit drinking and street drugs — risk-taking behavior and substance misuse are among the biggest concerns. Get help if you have trouble quitting on your own [2]
Form healthy relationships with people who are a positive influence and can help you watch for warning signs of mood shifts [2]
Keep a healthy routine for sleeping, eating, and physical activity. If you take lithium, ask your healthcare professional about fluid and salt intake [2]
Check before taking any other medicine or supplement — for example, avoid regularly using ibuprofen when taking lithium [2]
Keep a mood chart of daily moods, treatments, sleep, activities, and feelings to identify triggers and when treatment needs to change [2]
Alternative or complementary medicine has little research for bipolar disorder and doesn't replace regular care; natural doesn't mean safe [2]
How can people cope with bipolar disorder and find support?
Learning about your condition motivates you to stick to your treatment plan and recognize mood changes, and helping family and friends learn about it matters too. Stay focused on your goals, join a support group, give your energy a positive focus with hobbies, exercise, and recreational activities, and use relaxation techniques such as yoga, massage, deep breathing, or meditation to manage stress [2].
How should you prepare for a bipolar disorder appointment?
Preparing for a bipolar disorder appointment means listing your symptoms, stresses and medicines, preparing questions and knowing what your provider may ask.
You may start with your primary care professional or a psychiatrist; bringing a family member or friend can help [2]
List your symptoms (including any that seem unrelated), major stresses or recent life changes, and all medicines, vitamins, herbs, and supplements with doses [2]
Prepare questions: whether you have bipolar disorder, what else could cause your symptoms, what tests you need, which treatments are recommended, what side effects to expect, and whether a generic alternative exists [2]
Expect questions about when symptoms began, how often moods change, suicidal thoughts, interference with daily life, family history, other health conditions, alcohol or drug use, and sleep [2]
Can bipolar disorder be managed as a lifelong condition?
Bipolar disorder brings extreme mood swings that affect sleep, energy, judgment, and daily life — but it doesn't have to control your life. The highs can feel productive and euphoric, yet a crash always follows, which is why professional treatment matters. Treatment works best under a psychiatrist's guidance: mood stabilizers and other medicines taken consistently, talk therapy that builds routine and catches triggers, mood charting that reveals your personal warning signs, and a healthy daily rhythm of sleep, diet, and activity. The single most powerful habit is staying with your medicine, even when you feel well. The first step is a conversation with a healthcare or mental health professional.
Next steps: If you or a loved one has symptoms of depression or mania, see a healthcare or mental health professional — bipolar disorder doesn't get better on its own. In a crisis in the U.S., call or text 988 to reach the 24/7 Suicide & Crisis Lifeline.
Frequently asked questions
Is bipolar II a milder form of bipolar I?
No — bipolar II is a separate diagnosis. While bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods [1].
Can you have mania and depression at the same time?
Yes. A "mixed" presentation means symptoms of depression and mania or hypomania occur at the same time. "Rapid cycling" means four mood episodes in the past year switching between mania or hypomania and major depression [1].
Why do I need to keep taking medicine when I feel fine?
Bipolar disorder is lifelong, and stopping your medicine can let symptoms come back or turn minor mood changes into full-blown mania or depression. Stopping can also cause withdrawal effects or suicidal thinking [2].
Can children get bipolar disorder?
Yes. It can start at any age, though it's usually diagnosed in the teenage years or early 20s. In children, moods can shift fast, and severe mood swings unlike a child's usual ups and downs are the most noticeable sign [1] [2].
Why are antidepressants used so carefully in bipolar disorder?
An antidepressant can sometimes trigger a manic or hypomanic episode, so it's prescribed cautiously and only alongside a mood stabilizer or antipsychotic [2].
This article is educational and is not a substitute for professional medical advice, diagnosis, or treatment. If you or someone you know is having suicidal thoughts, contact your local emergency services or a crisis hotline immediately (U.S.: call or text 988).
Related Reading
Assertive Community Treatment (ACT): What It Is and Benefits explains assertive community treatment.
Mental Status Exam: What It Checks, What Happens and What the Results Mean explains how providers check thinking, mood, behavior and memory, and what abnormal results can mean.
References
Mayo Clinic Staff. Bipolar disorder - Symptoms and causes. Mayo Clinic. May 8, 2026. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
Mayo Clinic Staff. Bipolar disorder - Diagnosis and treatment. Mayo Clinic. May 8, 2026. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
Fornaro M, et al. Efficacy and safety of pharmacological interventions for the maintenance of bipolar disorder: A systematic review and dose-related network meta-analysis across different age groups. J Affect Disord. 2026;407:121798. PMID 41985753. https://doi.org/10.1016/j.jad.2026.121798
Wei C, et al. Comparing lithium and valproate in reducing suicide risk: A territory-wide retrospective cohort study with pairwise and network meta-analysis. Psychol Med. 2026;56:e289. PMID 42765379. https://doi.org/10.1017/S0033291726105881
Cuijpers P, et al. Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses. JAMA Psychiatry. 2025;82(6):563-571. PMID 40238104. https://doi.org/10.1001/jamapsychiatry.2025.0482
National Alliance on Mental Illness. Bipolar Disorder. NAMI. Reviewed August 2017. https://www.nami.org/types-of-conditions/bipolar-disorder/
National Institute of Mental Health. Bipolar Disorder. National Institute of Mental Health (NIMH). Reviewed December 2024. https://www.nimh.nih.gov/health/topics/bipolar-disorder
Depression and Bipolar Support Alliance. Bipolar Disorder. Depression and Bipolar Support Alliance. Accessed October 14, 2026. https://www.dbsalliance.org/mental-health-education/bipolar-disorder/
MedlinePlus. Bipolar Disorder. MedlinePlus. Updated October 17, 2023. https://medlineplus.gov/bipolardisorder.html
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