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Bipolar Disorders

A person with manic-depressive psychosis. Mental illness.

What is Bipolar Disorder?

Bipolar disorder is a chronic, mental health condition that typically begins in late adolescence or early adulthood.  Often referred to as “manic-depressive disorder,” it is characterized by extreme shifts in mood, energy levels, and activity levels. It affects a person’s ability to function in daily life and can cause significant disruptions in personal relationships, work or school performance, and overall well-being.  The disorder is called bipolar because it involves two main mood states: depressive episodes and manic episodes. These episodes can last for days, weeks, or even months, and the periods of relative mood stability in between. 

During a depressive episode, individuals experience persistent feelings of sadness, hopelessness, or emptiness. They may have a loss of interest or pleasure in previously enjoyed activities, changes in appetite and sleep patterns, fatigue, difficulty concentrating, feelings of guilt or worthlessness, and thoughts of death or suicide.

On the other hand, during a manic episode, individuals experience an elevated mood, increased energy, and heightened activity levels. They may feel euphoric, have racing thoughts, engage in impulsive or risky behavior, have a decreased need for sleep, and exhibit grandiosity or inflated self-esteem. Manic episodes can be severe and lead to impaired judgment or psychotic symptoms.  When manic symptoms are severe, a diagnosis of Bipolar Disorder I is given.  When manic symptoms are milder with fewer negative impacts on one’s life (known as hypomania), then a diagnosis of Bipolar Disorder II is given.

What are symptoms of depression of Bipolar Disorder?

In bipolar disorder, the depressive symptoms are similar to those experienced in major depressive disorder. During depressive episodes, individuals with bipolar disorder may experience the following symptoms:

  • Persistent sadness: Feeling sad, hopeless, or empty for most of the day, nearly every day.
  • Loss of interest: A diminished interest or pleasure in activities that were once enjoyable, including hobbies, social interactions, or sex.
  • Significant weight or appetite changes: A noticeable decrease or increase in appetite leading to weight loss or weight gain.
  • Sleep disturbances: Insomnia (difficulty falling asleep or staying asleep) or hypersomnia (excessive sleepiness, including sleeping too much).
  • Fatigue or loss of energy: Feeling tired, lethargic, or lacking energy even after adequate rest.
  • Psychomotor agitation or retardation: Restlessness or slowed movements and speech.
  • Feelings of worthlessness or guilt: Persistent feelings of guilt, self-blame, worthlessness, or excessive self-criticism.
  • Difficulty concentrating: Trouble focusing, making decisions, or remembering things.
  • Recurrent thoughts of death or suicide: Having thoughts of death, dying, or suicide, or making suicide attempts.

It’s important to note that these depressive episodes in bipolar disorder alternate with manic (Bipolar I) or hypomanic (Bipolar II) episodes , where individuals experience elevated moods and increased energy. The presence of manic or hypomanic symptoms is what distinguishes bipolar depression from unipolar depression (major depressive disorder).

What are symptoms of mania in Bipolar Disorder?

Mania is a defining characteristic of bipolar disorder. During a manic episode, individuals experience an intense and elevated mood that significantly impacts their behavior and functioning. The symptoms of mania may include:

  • Elevated mood: Feeling extremely happy, elated, or euphoric for an extended period. This mood may be inconsistent with the person’s circumstances.
  • Increased energy and activity levels: Having a surge of energy and being highly active, often engaging in multiple tasks simultaneously. The person may feel restless and have difficulty sitting still.
  • Racing thoughts and rapid speech: Having a rapid flow of ideas and thoughts, with the person speaking quickly and excessively. The conversation may become difficult to follow.
  • Grandiosity: Having an inflated sense of self-importance, believing in one’s exceptional abilities, talents, or powers. This can manifest as an unrealistic belief in having special connections or being destined for greatness.
  • Decreased need for sleep: Feeling rested after only a few hours of sleep or having a reduced need for sleep without feeling tired. The person may engage in activities throughout the night.
  • Impulsive behavior: Engaging in high-risk or reckless activities without considering the consequences. This may include excessive spending, sexual promiscuity, substance abuse, or impulsive decision-making.
  • Poor judgment: Exhibiting impaired decision-making abilities and lacking insight into the consequences of their actions. They may engage in activities that are harmful or dangerous.
  • Increased irritability: Feeling easily agitated, impatient, or experiencing a short temper. Small setbacks or frustrations can trigger intense emotional reactions.
  • Disturbed concentration: Having difficulty focusing, becoming easily distracted, or experiencing racing thoughts that interfere with concentration and attention.
  • Psychotic symptoms (in severe cases): Experiencing hallucinations or delusions, such as hearing voices or believing in false, irrational ideas.

It’s important to note that the severity and duration of manic episodes can vary. In some cases, individuals may experience hypomania, which is a milder form of mania with similar symptoms but less intense and disruptive. Hypomanic episodes do not typically require hospitalization and may even be perceived as enjoyable by the person experiencing them.

What are hypomanic symptoms in Bipolar Disorder?

Hypomania is a milder form of mania that is characteristic of bipolar disorder. It involves a distinct period of elevated mood and increased energy, but the symptoms are less severe and do not significantly impair daily functioning. The symptoms of hypomania may include:

  • Elevated or expansive mood: Feeling unusually cheerful, upbeat, or energetic for an extended period. The mood is noticeably different from the person’s baseline.
  • Increased activity or energy levels: Having a burst of energy and being more active than usual. This may manifest as taking on multiple projects or engaging in goal-directed activities.
  • Decreased need for sleep: Feeling rested and refreshed after less sleep than usual, without experiencing fatigue or tiredness.
  • Racing thoughts: Having a rapid flow of thoughts, with ideas jumping from one topic to another. This can make it challenging to concentrate or stay focused.
  • Increased talkativeness: Speaking more than usual, talking quickly, and feeling the urge to keep talking. Conversations may become lengthy and difficult to interrupt.
  • Increased self-confidence: Feeling a heightened sense of self-esteem or self-confidence. The person may have an inflated belief in their abilities or talents.
  • Increased goal-directed behavior: Engaging in activities or projects with a heightened sense of purpose and drive. This can involve taking on new tasks or pursuing new interests.
  • Risky behavior or impulsivity: Engaging in behaviors that have the potential for negative consequences, such as reckless driving, excessive spending, impulsive decision-making, or increased sexual activity.
  • Irritability or agitation: Feeling easily annoyed, irritable, or restless. Minor frustrations may provoke stronger emotional reactions.

It’s important to note that hypomania is distinct from normal variations in mood and behavior. While hypomanic episodes are less severe than full-blown manic episodes, they still represent a departure from a person’s baseline functioning.

What causes Bipolar Disorder?

The exact cause of bipolar disorder is not fully understood. However, research suggests that several factors contribute to its development, including:

  • Genetic factors: Bipolar disorder tends to run in families, indicating a genetic component. People with a family history of the disorder are at a higher risk of developing it themselves. However, it’s important to note that having a family history does not guarantee the development of bipolar disorder, as other factors are also involved.
  • Biological factors: There are certain biological abnormalities associated with bipolar disorder. Neurotransmitter imbalances, such as disruptions in the levels of serotonin, dopamine, and norepinephrine, may play a role. Additionally, structural and functional changes in the brain, particularly in areas involved in emotional regulation and mood control, have been observed in individuals with bipolar disorder.
  • Imbalance in neurotransmitters: Bipolar disorder is associated with imbalances in neurotransmitters, which are chemical messengers in the brain that regulate mood, emotions, and other functions. Disruptions in the levels or functioning of neurotransmitters like serotonin, dopamine, and norepinephrine have been implicated in the disorder.
  • Environmental factors: Certain environmental factors can trigger or influence the onset of bipolar disorder in individuals with a genetic predisposition. These factors may include significant life stressors, traumatic experiences, substance abuse, major life changes, or disruptions in sleep patterns.
  • Neurochemical and hormonal changes: There is evidence to suggest that changes in neurochemicals and hormonal regulation in the body may contribute to the development of bipolar disorder. For example, disruptions in the hypothalamic-pituitary-adrenal (HPA) axis, which is involved in stress response, have been observed in individuals with bipolar disorder.

It’s important to note that bipolar disorder is a complex condition, and no single factor can fully explain its development. Rather, it is likely the result of a combination of genetic, biological, and environmental factors interacting with each other.

How is Bipolar Disorder treated?

Bipolar disorder is typically treated through a combination of medication, psychotherapy, and lifestyle adjustments. The treatment approach aims to stabilize mood, manage symptoms, prevent relapses, and improve overall functioning. The specific treatment plan may vary depending on the individual’s needs and the severity of their symptoms. It is important for individuals with bipolar disorder to work closely with a healthcare professional or mental health specialist to develop an appropriate treatment strategy. Here are common components of bipolar disorder treatment:

  • Medication: Mood stabilizers are often prescribed as the mainstay of medication treatment for bipolar disorder. Lithium is a commonly used mood stabilizer, but other medications such as anticonvulsants (e.g., valproate, carbamazepine), atypical antipsychotics (e.g., quetiapine, olanzapine), and sometimes antidepressants may also be prescribed. The choice of medication depends on the individual’s symptoms and treatment response. It is important to take medication as prescribed and regularly follow up with the healthcare provider to monitor its effectiveness and manage any side effects.
  • Psychotherapy: Different forms of psychotherapy can be beneficial in managing bipolar disorder. Cognitive-behavioral therapy (CBT) helps individuals identify and change negative thought patterns and behaviors that contribute to mood episodes. Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily routines and improving interpersonal relationships to manage stress and maintain stability. Family-focused therapy involves the individual and their family members in therapy sessions to enhance understanding and support.
  • Lifestyle adjustments: Establishing a regular routine with consistent sleep patterns, exercise, and a healthy diet can help manage bipolar symptoms. Avoiding alcohol and drugs is crucial, as they can worsen mood swings and interact negatively with medication. Additionally, stress reduction techniques, such as mindfulness, relaxation exercises, and stress management strategies, can be beneficial.
  • Education and self-management: Learning about bipolar disorder, its symptoms, triggers, and treatment options can empower individuals to actively participate in their own care. Self-monitoring, keeping track of mood changes and early warning signs, can help identify impending mood shifts and take preventive measures or seek help promptly.
  • Support system: Building a strong support network of family, friends, and support groups can provide understanding, encouragement, and assistance in managing bipolar disorder. Support groups specifically for individuals with bipolar disorder can offer a sense of community and provide opportunities to learn from others’ experiences.

It is important to note that treatment for bipolar disorder is often long-term and requires ongoing monitoring and adjustments. It may take time to find the most effective combination of treatments for each individual, and regular follow-up with healthcare professionals is essential to assess progress and make any necessary modifications to the treatment plan.


All content and information on this website are intended for informational and educational purposes only, it does not constitute medical advice, and does not establish any form of patient-client relationship.  While we strive to provide accurate and helpful information, it is not a substitute for any kind of professional advice, and you should not rely on solely on this information.  Always consult a profession for your specific needs when appropriate.

Emergency Information

If you or someone you love is experiencing a medical emergency, please call 9-1-1 or go to your nearest emergency room for evaluation.  For urgent issues, you can call the Philadelphia Mobile Treatment team at 215-685-6440.