Key Takeaways:
- Bipolar disorder symptoms can involve changes in mood, energy, sleep, activity, judgment, and daily functioning, with patterns that vary from person to person.
- Bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other bipolar disorders are distinguished by the type, severity, and duration of mood episodes.
- Accurate diagnosis considers symptom patterns over time because bipolar depression, hypomania, and other symptoms can overlap with several mental health and medical conditions.
- Bipolar disorder treatment may include medication, psychotherapy, lifestyle and routine support, and coordinated care for co-occurring mental health or substance use conditions.
- Outpatient bipolar treatment may be appropriate for people who are clinically stable, while severe mania, psychosis, or immediate safety concerns can require a higher level of care.
Bipolar disorder is a mood disorder that can affect how a person feels, thinks, behaves, sleeps, and manages everyday responsibilities. The National Institute of Mental Health (NIMH) estimates that 2.8% of U.S. adults experience bipolar disorder in a given year and 4.4% experience it during their lifetime.
Recognizing the pattern matters because bipolar depression may initially look like major depression, while hypomania can be difficult to identify. Accurate diagnosis helps guide treatment and level-of-care decisions.
What Is Bipolar Disorder?
Bipolar disorder causes clear changes in mood, energy, activity levels, concentration, and functioning. It was formerly called manic depression, but current clinical language uses the term bipolar disorder.
A manic episode involves a marked increase or change in mood and activity that can significantly disrupt daily life or require hospital care. **Hypomania** involves similar but less severe changes, while **bipolar depression** can bring sadness, loss of interest, low energy, hopelessness, and impaired functioning.
What Are the Types of Bipolar Disorder?
Bipolar disorders are classified according to the pattern, intensity, and duration of mood episodes. Those distinctions affect diagnosis, treatment planning, and symptom monitoring.
Bipolar I Disorder
Bipolar I disorder is defined by at least one manic episode lasting seven days or longer, or by manic symptoms severe enough to require hospital care. Major depressive episodes are common but are not required for the diagnosis.
Bipolar II Disorder
Bipolar II disorder involves hypomanic episodes and major depressive episodes without a history of a full manic episode. Hypomania can feel productive or manageable, so bipolar II may be missed when someone seeks care mainly for depression.
Cyclothymic Disorder
Cyclothymic disorder, or cyclothymia, involves recurring periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. It is a chronic symptom pattern, not a condition defined by isolated two-week periods.
Other Specified and Unspecified Bipolar Disorders
Some people have clinically significant bipolar symptoms that do not fit bipolar I, bipolar II, or cyclothymic disorder. Clinicians may use an “other specified” or “unspecified” bipolar and related disorder diagnosis based on the available symptom pattern.
Symptoms of Bipolar Disorder
Symptoms vary substantially between people. Clinicians look for changes from a person’s usual mood, energy, behavior, sleep, judgment, and functioning, along with how long those changes last.
Signs of Mania or Hypomania
Common signs can include:
- Elevated or unusually irritable mood: A person may feel unusually “up,” powerful, agitated, or easily angered. The change is typically noticeable compared with their usual behavior.
- Less need for sleep and increased activity: Someone may sleep very little and still feel highly energized, restless, or driven to take on many activities. Racing thoughts and rapid speech can occur.
- Impulsive or risky behavior: Mania can affect judgment and lead to spending, sexual behavior, substance use, driving, or other out-of-character actions. Severe episodes may include hallucinations or delusions.
Hypomania can involve similar symptoms without the same degree of impairment as mania. A person may not recognize it as a problem, particularly when increased energy feels positive.
Signs of a Depressive Episode
Bipolar depression may include:
- Persistent sadness, emptiness, or hopelessness: A person may lose interest in usual activities or feel worthless. Thoughts about death or suicide can also occur.
- Changes in energy or sleep: Fatigue, restlessness, slowed movement, insomnia, or sleeping much more than usual may develop. These symptoms can interfere with work, school, relationships, and basic tasks.
- Problems with concentration and decision-making: Thinking may feel slowed and everyday decisions can become difficult. Appetite or weight may also change.
Mixed Features
Mood episodes can include mixed features, meaning symptoms associated with both depression and mania or hypomania occur during the same episode. Someone may feel deeply depressed while also experiencing high energy, agitation, racing thoughts, or reduced need for sleep.
What Causes Bipolar Disorder?
There is no single known cause. NIMH describes bipolar disorder as involving a combination of genetic, biological, and environmental factors.
Bipolar disorder can run in families, but no single gene determines whether someone will develop it. Research also identifies brain differences in some people with bipolar disorder, while stress or trauma may interact with underlying vulnerability.
How Is Bipolar Disorder Diagnosed?
Diagnosis is based on clinical history, including symptom severity, duration, frequency, and changes over time. A clinician may also ask about family history, medications, substance use, sleep, medical conditions, and past periods of unusually high energy or reduced need for sleep.
A physical exam or laboratory testing may help rule out conditions such as thyroid disease. Diagnosis can be complicated because bipolar depression can resemble major depressive disorder, while other symptoms may overlap with ADHD, anxiety disorders, substance-related conditions, or psychotic disorders.
How Is Bipolar Disorder Treated?
Treatment is individualized according to the bipolar disorder type, current episode, symptom severity, medical history, co-occurring conditions, and past treatment response. NIMH identifies medication and psychotherapy, often used together, as central approaches.
Medication
Mood stabilizers and atypical antipsychotic medications are commonly used. Medication choices can differ between acute episodes and long-term maintenance, and finding an effective regimen may require adjustments.
Antidepressants require particular care. NIMH notes that they are generally not used alone in bipolar disorder because antidepressant monotherapy can trigger mania or rapid cycling in some people.
Psychotherapy
Psychotherapy can help people recognize mood changes, strengthen coping skills, manage stress, and follow treatment plans. Approaches may include cognitive behavioral therapy, family-focused therapy, psychoeducation, and interpersonal and social rhythm therapy.
Lifestyle and Routine Support
Daily habits do not replace clinical treatment, but they can support it. Consistent sleep and activity schedules, regular appointments, exercise, mood tracking, and avoiding alcohol or non-prescribed drugs can help people recognize and manage symptom patterns.
Sleep changes can accompany or precede mood episodes. A clinician can help identify early warning signs and create a response plan before symptoms become more disruptive.
Treatment for Co-Occurring Conditions
Anxiety disorders, ADHD, eating disorders, and substance use disorders can occur alongside bipolar disorder. Treatment planning should account for these conditions because symptoms can overlap and complicate diagnosis or management.
Bipolar Disorder and Substance Use
Bipolar disorder and substance use disorder can occur together, but one diagnosis should not automatically be assumed to cause the other. Substance use can also mimic or intensify mood symptoms, making assessment more difficult.
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends integrated screening and treatment when mental health and substance use disorders co-occur. Coordinated care addresses both conditions rather than treating one while overlooking the other.
When Is a Higher Level of Care Needed?
Routine outpatient treatment is not appropriate for every phase of bipolar disorder. Severe mania, psychosis, inability to care for basic needs, acute suicidal risk, or behavior that creates an immediate safety concern may require emergency assessment or inpatient stabilization.
If someone is in suicidal crisis or emotional distress, call 988or text 988. For an immediate life-threatening emergency, call 911.
Outpatient Bipolar Disorder Treatment at Mission Harbor
For people who are stable enough to remain in an outpatient setting, structured care can provide more support than occasional appointments. Mission Harbor Behavioral Health offers individualized mental health treatment in Santa Barbara and Los Angeles, including therapy, psychiatric services, and care for co-occurring mental health and substance use concerns.
Available levels of care include a Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP), when clinically appropriate. The right level depends on symptoms, safety, functioning, treatment history, and how much structure a person needs while living in the community.
Get Support for Bipolar Disorder
Bipolar disorder can affect relationships, work, school, finances, and physical well-being, but effective treatment can help people manage symptoms and improve functioning. A thorough assessment looks at the full pattern of mood symptoms rather than one difficult day or one depressive episode.
If bipolar disorder symptoms are interfering with your life or a loved one’s ability to function, contact Mission Harbor Behavioral Health to discuss assessment and outpatient treatment options. A clinician can help determine what type of support and level of care may be appropriate.
