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What You Should Know About Bipolar Disorder

Everyone experiences emotional highs and lows in life—sometimes even in the same day. But for people with bipolar disorder, these mood swings are extreme and make them feel out of control.

The ups and downs of bipolar disorder are much more intense in severity and duration than having a good day or a bad day, says UNC Health psychiatrist Kenan Penaskovic, MD.

“If someone has a quick fuse or temper and they are called bipolar, that’s not right,” Dr. Penaskovic says. “There’s the risk of both trivializing the disorder and falsely labeling someone when that happens. Those with the actual disorder find parts of their lives heavily affected.”

Read on to learn more about this difficult but treatable mental illness.

Types of Bipolar Disorder

Bipolar disorder, formerly called manic depression, is marked by prolonged and extreme states of depression and mania, which is an extremely elevated or excitable mood that can include overactivity.

Psychiatrists have identified three disorders in the bipolar category: bipolar 1, bipolar 2 and cyclothymic disorder.

  • Bipolar 1 disorder presents the most extreme highs and lows, which can last for more than a week before the person returns to what is considered a baseline, Dr. Penaskovic says. Patients with bipolar 1 can experience psychosis, including delusions, hallucinations or a loss of contact with reality.
  • Bipolar 2 disorder has less severe mood swings and is not typically associated with psychotic features. Highs and lows typically last four to seven days before the person returns to a baseline. The highs and lows of bipolar 2 aren’t as extreme as bipolar 1.
  • Cyclothymic disorder causes the least dramatic mood swings but still feels out of control for people who experience it. The highs never reach full mania, and lows do not enter a full depressive episode.

Symptoms of Bipolar Disorder

The states of mania and depression have different symptoms.

“With mania, ideas race through the mind, making it difficult to sleep or stay focused,” Dr. Penaskovic says. “Others may notice a difference in speech—the person may be talking much more rapidly than usual.”

People experiencing mania might overspend, abuse substances or engage in sexual behavior that isn’t typical for them. The excited feeling of mania can also turn into irritability.

Depressive episodes of bipolar disorder can be crippling. It may be difficult for the person to get out of bed. Some people have trouble sleeping; others sleep much more than normal. Minor decisions can feel overwhelming.

“Both mania and depression can cause huge impairments in social functioning in terms of relationships. It could be very difficult to live with individuals who have untreated or undiagnosed bipolar disorder,” Dr. Penaskovic says.

The highs and lows of bipolar disorder can also lead to suicidal thoughts or actions. Research has shown that 25 to 60 percent of people with bipolar disorder attempt suicide at least once, and between 4 and 19 percent will die by suicide. If you or a loved one experiences this, please seek help, call the National Suicide Prevention Lifeline at (800) 273-TALK (8255) or call 911.

Risk Factors for Bipolar Disorder

About 4 percent of American adults experience bipolar disorder at some point, and it affects men and women equally. No one cause has been identified, but there are several known contributing factors.

  • Genetics: While there is not a single gene that has been found to directly cause bipolar disorder, several genes are thought to play a role. The disorder is hereditary, and people whose parents have had the disorder are more likely to have it themselves. Also, children conceived by fathers older than 45 are more likely to develop bipolar disorder.
  • Brain function: Patients with bipolar disorder have altered brain function, meaning signals don’t follow the typical pathways. But Dr. Penaskovic says physicians aren’t sure if bipolar disorder causes that alteration or if the alteration causes bipolar disorder.
  • Stress: A stressful environment can trigger the highs and lows of a bipolar episode, but it doesn’t necessarily cause the disorder to develop in the first place. However, Dr. Penaskovic says people who have experienced traumatic events or abuse during childhood are more likely to experience bipolar disorder as they grow up.

Bipolar disorder symptoms usually start during a person’s early 20s but can also appear during the teen years. It can be difficult to diagnose because people usually seek treatment during a major depressive episode, so it’s treated as depression. Most people are diagnosed seven to 10 years after their symptoms first appear, Dr. Penaskovic says.

“It’s only over time, or when we see them transition into a manic phase, that we know they actually have a bipolar disorder. This is part of the reason why it can take so long to diagnose,” he says.

Treatment for Bipolar Disorder

Bipolar disorder is a lifelong diagnosis that cannot be cured. But with the right combination of treatments, a vast majority of people can live functional lives. Dr. Penaskovic recommends twofold treatments that include medication and therapy.

“Medications help stabilize someone’s mood to prevent them from getting into those highs and lows,” he says.

In therapy, patients can learn about the illness and how to manage it by identifying their triggers. They also learn to keep a record or journal of their moods and sleep to see if changes in those factors indicate they are approaching a high or low.

Sometimes the use of devices to stimulate the brain can help with bipolar disorder. For example, electroconvulsive therapy—brief electrical stimulation of the brain while a patient is under anesthesia—can change brain chemistry and provide relief from bipolar symptoms. And transcranial magnetic stimulation is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.

Pharmaceutical companies are developing new drugs for bipolar disorder, especially to target the depressive phase, Dr. Penaskovic says. These drugs aren’t all pills; last year the Food and Drug Administration approved esketamine, a nasal spray for treatment-resistant depression. Research is ongoing to determine whether it can help with bipolar disorder.


If you would like to discuss bipolar disorder and possible treatments with a provider, you can find one near you.