Bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and abnormally elevated mood, lasting days to weeks, and in some cases months. If the elevated mood is severe or associated with psychosis, it is called mania; if it does not significantly affect functioning, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and often makes impulsive decisions with little regard for the consequences. There is usually sleep disturbance during manic phases. During periods of depression, the individual may experience crying, have a negative outlook, and demonstrate poor eye contact. An estimated 15–20% of those with BD die by suicide. Approximately 30–60% attempt suicide during their lifetime. Among those with BD, 40–50% overall and 78% of adolescents engaged in self-harm.
While the causes of this mood disorder are not clearly understood, genetic and environmental factors are thought to play a role. Genetic factors may account for up to 70–90% of the risk of developing BD. Environmental risks include a history of child abuse and long-term stress. The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode and one major depressive episode. It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes.
If these symptoms are due to drugs or medical problems, they are not diagnosed as BD.
Mood stabilizers, particularly lithium, and anticonvulsants, such as lamotrigine and valproate, as well as atypical antipsychotics are used for treatment. Atypical antipsychotics are used for acute manic episodes or when mood stabilizers are ineffective or not tolerated, with long-acting injectables available for patients with adherence issues. There is evidence that psychotherapy improves the course of BD. Use of antidepressants in depressive episodes is controversial: they can be effective, but certain classes of antidepressants increase the risk of mania. The treatment of depressive episodes, therefore, is often difficult. Electroconvulsive therapy is effective in acute manic and depressive episodes, especially with psychosis or catatonia. Admission to a psychiatric hospital may be required if someone is a risk to themselves or others; involuntary treatment is sometimes necessary if someone refuses treatment.
Bipolar I and bipolar II occur in approximately 2% of the population, while bipolar spectrum disorder has been estimated to affect as much as 6% of the population. Symptoms most commonly begin between 20–25 years old; an earlier onset is associated with a worse prognosis. Around 30% of people with BD have financial, social or work-related problems due to the condition. Bipolar disorder is the 6th leading cause of disability worldwide and leads to substantial societal costs. Due to lifestyle consequences and medication side effects, risk of death from natural causes, such as coronary artery disease, in people with BD is twice the average.
Signs and symptoms
Bipolar symptoms usually begin in adolescence or early adulthood. The condition is characterized by intermittent episodes of mania, commonly alternating with bouts of depression, with an absence of symptoms in between. During these episodes, people with bipolar disorder exhibit disruptions in normal mood, psychomotor activity —such as constant fidgeting during mania or slowed movements during depression—circadian rhythm and cognition. Mania can present with varying levels of mood disturbance, ranging from euphoria, which is associated with "classic mania", to dysphoria and irritability.Psychotic symptoms such as delusions or hallucinations may occur in both manic and depressive episodes; their content and nature are consistent with the person's mood. Approximately 60–75% of people with bipolar I disorder have experienced psychosis. Psychotic symptoms are more common in bipolar type I than in bipolar type II, though people with bipolar type II can also experience psychosis.
In some people with bipolar disorder, depressive symptoms predominate, and the episodes of mania are always the more subdued hypomania type. According to the DSM-5 criteria, mania is distinguished from hypomania by the duration: hypomania is present if elevated mood symptoms persist for at least four consecutive days, while mania is present if such symptoms persist for more than a week. Unlike mania, hypomania is not always associated with impaired functioning. The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode, or vice versa, remain poorly understood.
Several studies released in 2025 supported the claim that hypersexuality is an overlooked and under-researched symptom of BD. One survey on a population with BD has found that nearly 90% of responders suffered from hypersexuality. Other study conducted on 1170 participants with BD and hypersexual behavior discovered that 34.3% of responders were victims of sexual assault, 22.3% of rape, and 14.8% had a suicide attempt. Researchers have interpreted the underlying data as evidence that the diagnostic system terminology should be updated and that psychoeducation should include topics of hypersexuality. Another study argued that current therapeutic practices may not be sufficient in treating complex behavioral and emotional issues associated with hypersexuality in BD, which may contribute to delayed recovery and unresolved trauma.
Manic episodes
Also known as mania, a manic episode is a period of at least one week of elevated or irritable mood, which can range from euphoria to delirium. The core symptom of mania involves an increase in energy of psychomotor activity. Mania can also present with increased self-esteem or grandiosity, racing thoughts, pressured speech that is difficult to interrupt, decreased need for sleep, disinhibited social behavior, increased goal-oriented activities and impaired judgement, which can lead to impulsive or high-risk behaviours, such as unprotected sex or excessive spending. To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated, a manic episode usually lasts three to six months.In severe manic episodes, a person can experience psychotic symptoms, where thought content is affected along with mood. They may feel unstoppable, persecuted, or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas. This may lead to violent behavior and, sometimes, hospitalization in an inpatient psychiatric hospital. The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale, though questions remain about the reliability of these scales.
The onset of a manic or depressive episode is often foreshadowed by sleep disturbance. Manic individuals often have a history of substance use disorder developed over years as a form of "self-medication".
Hypomanic episodes
is the milder form of mania, defined as at least four days of the same criteria as mania, but does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features, and does not require psychiatric hospitalization. Overall functioning may increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full-blown manic episodes. Some people who experience hypomania show increased creativity, while others are irritable or demonstrate poor judgment.Hypomania may feel good to some individuals who experience it, though most people who experience hypomania state that the stress of the experience is very painful. People with bipolar disorder who experience hypomania tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, the individual will often deny that anything is wrong. If not accompanied by depressive episodes, hypomanic episodes are often not deemed problematic unless the mood changes are uncontrollable or volatile. In individuals with bipolar II disorder, depressive symptoms typically overlap with hypomania symptoms. These individuals may not be able to identify these specific symptoms as hypomania, rather they view them as typical depression with slight alterations in mood. Most commonly, symptoms continue for time periods from a few weeks to a few months.
Depressive episodes
Symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities, excessive or inappropriate guilt, hopelessness, sleeping too much or not enough, changes in appetite or weight, fatigue, problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide. Although the DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth.The earlier the age of onset, the more likely the first few episodes are to be depressive. For most people with bipolar types 1 and 2, the depressive episodes are much longer than the manic or hypomanic episodes. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and treated with prescribed antidepressants.