Bipolar Disorder

young african american man sitting with head

Bipolar disorder, also known as manic-depressive illness,
is a brain disorder that causes unusual shifts in a person’s mood, energy, and
ability to function. Different from the normal ups and downs that everyone goes
through, the symptoms of bipolar disorder are severe. They can result in damaged
relationships, poor job or school performance, and even suicide. But there is
good news: bipolar disorder can be treated, and people with this illness can
lead full and productive lives.

More than 2 million American adults,1 or about
1 percent of the population age 18 and older in any given year,2 have
bipolar disorder. Bipolar disorder typically develops in late adolescence or
early adulthood. However, some people have their first symptoms during
childhood, and some develop them late in life. It is often not recognized as an
illness, and people may suffer for years before it is properly diagnosed and
treated. Like diabetes or heart disease, bipolar disorder is a long-term illness
that must be carefully managed throughout a person’s life.

“Manic-depression distorts moods and thoughts, incites dreadful behaviors,
destroys the basis of rational thought, and too often erodes the desire and will
to live. It is an illness that is biological in its origins, yet one that feels
psychological in the experience of it; an illness that is unique in conferring
advantage and pleasure, yet one that brings in its wake almost unendurable
suffering and, not infrequently, suicide.”

“I am fortunate that I have not died from my illness, fortunate in having
received the best medical care available, and fortunate in having the friends,
colleagues, and family that I do.”

Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p.
(Reprinted with permission from Alfred A. Knopf, a division of Random
House, Inc.)

What Are the Symptoms of
Bipolar Disorder?

Bipolar disorder causes dramatic mood swings—from overly
“high” and/or irritable to sad and hopeless, and then back again, often with
periods of normal mood in between. Severe changes in energy and behavior go
along with these changes in mood. The periods of highs and lows are called
episodes of mania and depression.

Signs and symptoms of mania
(or a manic episode) include:

  • Increased energy, activity, and restlessness
  • Excessively “high,” overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, can’t concentrate well
  • Little sleep needed
  • Unrealistic beliefs in one’s abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of
the other symptoms most of the day, nearly every day, for 1 week or longer. If
the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a
depressive episode) include:

  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, a feeling of fatigue or of being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleeping too much, or can’t sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by
    physical illness or injury
  • Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most
of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person
who experiences it and may even be associated with good functioning and enhanced
productivity. Thus even when family and friends learn to recognize the mood
swings as possible bipolar disorder, the person may deny that anything is wrong.
Without proper treatment, however, hypomania can become severe mania in some
people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of
psychosis (or psychotic symptoms).
Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise
sensing the presence of things not actually there) and delusions (false,
strongly held beliefs not influenced by logical reasoning or explained by a
person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend
to reflect the extreme mood state at the time. For example, delusions of
grandiosity, such as believing one is the President or has special powers or
wealth, may occur during mania; delusions of guilt or worthlessness, such as
believing that one is ruined and penniless or has committed some terrible crime,
may appear during depression. People with bipolar disorder who have these
symptoms are sometimes incorrectly diagnosed as having schizophrenia, another
severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as
a spectrum or continuous range. At one end is severe depression, above which is
moderate depression and then mild low mood, which many people call “the blues”
when it is short-lived but is termed “dysthymia” when it is chronic. Then there
is normal or balanced mood, above which comes hypomania (mild to moderate
mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together
in what is called a mixed bipolar
state. Symptoms of a mixed state often include agitation, trouble sleeping,
significant change in appetite, psychosis, and suicidal thinking. A person may
have a very sad, hopeless mood while at the same time feeling extremely

Bipolar disorder may appear to be a problem other than mental illness—for
instance, alcohol or drug abuse, poor school or work performance, or strained
interpersonal relationships. Such problems in fact may be signs of an underlying
mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified
physiologically—for example, through a blood test or a brain scan. Therefore, a


older sad looking woman

In any given 1-year period, 9.5 percent of
the population, or about 18.8 million American adults, suffer from a depressive
illness5 The economic cost for this disorder is high, but the cost in
human suffering cannot be estimated. Depressive illnesses often interfere with
normal functioning and cause pain and suffering not only to those who have a
disorder, but also to those who care about them. Serious depression can destroy
family life as well as the life of the ill person. But much of this suffering is

Most people with a depressive illness do not seek
treatment, although the great majority—even those whose depression is extremely
severe—can be helped. Thanks to years of fruitful research, there are now
medications and psychosocial therapies such as cognitive/behavioral, “talk” or
interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that
depression is a treatable illness. If you feel that you or someone you care
about is one of the many undiagnosed depressed people in this country, the
information presented here may help you take the steps that may save your own or
someone else’s life.


A depressive disorder is an illness that involves the
body, mood, and thoughts. It affects the way a person eats and sleeps, the way
one feels about oneself, and the way one thinks about things. A depressive
disorder is not the same as a passing blue mood. It is not a sign of personal
weakness or a condition that can be willed or wished away. People with a
depressive illness cannot merely “pull themselves together” and get better.
Without treatment, symptoms can last for weeks, months, or years. Appropriate
treatment, however, can help most people who suffer from depression.


Depressive disorders come in different forms, just as is
the case with other illnesses such as heart disease. This pamphlet briefly
describes three of the most common types of depressive disorders. However,
within these types there are variations in the number of symptoms, their
severity, and persistence.

Major depression is
manifested by a combination of symptoms (see symptom list) that interfere with
the ability to work, study, sleep, eat, and enjoy once pleasurable activities.
Such a disabling episode of depression may occur only once but more commonly
occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not
disable, but keep one from functioning well or from feeling good. Many people
with dysthymia also experience major depressive episodes at some time in their

Another type of depression is bipolar
, also called manic-depressive illness. Not nearly as prevalent
as other forms of depressive disorders, bipolar disorder is characterized by
cycling mood changes: severe highs (mania) and lows (depression). Sometimes the
mood switches are dramatic and rapid, but most often they are gradual. When in
the depressed cycle, an individual can have any or all of the symptoms of a
depressive disorder. When in the manic cycle, the individual may be overactive,
overtalkative, and have a great deal of energy. Mania often affects thinking,
judgment, and social behavior in ways that cause serious problems and
embarrassment. For example, the individual in a manic phase may feel elated,
full of grand schemes that might range from unwise business decisions to
romantic sprees. Mania, left untreated, may worsen to a psychotic state.


Not everyone who is depressed or manic experiences every
symptom. Some people experience a few symptoms, some many. Severity of symptoms
varies with individuals and also varies over time.


  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once
    enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as
    headaches, digestive disorders, and chronic pain


  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior


Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. This seems to be the case with bipolar disorder.
Studies of families in which members of each generation develop bipolar disorder
found that those with the illness have a somewhat different genetic makeup than
those who do not get ill. However, the reverse is not true: Not everybody with
the genetic makeup that causes vulnerability to bipolar disorder will have the
illness. Apparently additional factors, possibly stresses at home, work, or
school, are involved in its onset.

In some families, major depression also seems to occur generation after
generation. However, it can also occur in people who have no family history of
depression. Whether inherited or not, major depressive disorder is often
associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the
world with pessimism or who are readily overwhelmed by stress, are prone to
depression. Whether this represents a psychological predisposition or an early
form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can
be accompanied by mental changes as well. Medical illnesses such as stroke, a
heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause
depressive illness, making the sick person apathetic and unwilling to care for
his or her physical needs, thus prolonging the recovery period. Also, a serious
loss, difficult relationship, financial problem, or any stressful (unwelcome or
even desired) change in life patterns can trigger a depressive episode. Very
often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder. Later episodes of illness
typically are precipitated by only mild stresses, or none at all.

Depression in Women

Women experience depre