Bipolar disorder, also known as manic-depressive illness, is a serious brain disease that causes extreme shifts in mood, energy, and functioning. Men and women are equally likely to develop this disabling illness, which affects approximately 1 percent of American adults ages 18 to 54 in a given year. Different from normal mood states of happiness and sadness, symptoms of bipolar disorder can be severe and life threatening. Bipolar disorder, which tends to run in families, typically emerges in adolescence or early adulthood and continues to flare up across the life course, disrupting work, school, family, and social life. Bipolar disorder is characterized by symptoms that fall into several major categories.
Episodes of Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were one enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide. Episodes of Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; goal-directed activity done to excess such as spending money; physical agitation; and excessive involvement in risky behaviors or activities. Episodes of hypomania, or mild mania, include symptoms such as increased energy, elevated mood, irritability, and intrusiveness, which may cause little impairment in functioning but are noticeable to others. Psychosis: Sometimes, severe depression or mania is accompanied by periods of psychosis. Psychotic symptoms include; hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person’s cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time. “Mixed” state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation. Episodes of mania, depression, or mixed state typically recur and become more frequent across the life span. hese episodes, especially early in the course of illness, are separated by periods of wellness during which a person suffers few to no symptoms. When four or more episodes of illness occur within a 12 month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with bipolar disorder do not achieve full remission of symptoms. Certain forms of psychotherapy, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, psychoeducation, and family therapy. Lithium has long been used as a first-line treatment for bipolar disorder. Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Newer anticonvulsant medications, including lamotrigine and gabapentin, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful. During a depressive episode, people with bipolar disorder commonly require treatment with antidepressant medication. The relative efficacy of various antidepressant medications in this disorder has not yet been determined by adequate scientific study. Typically, lithium or anticonvulsant mood stabilizers are given along with an antidepressant to protect against a switch into mania or rapid cycling, which can be provoked in some people with bipolar disorder by antidepressant medications. In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe refractory symptoms of bipolar disorder and prevent recurrences of mania. Further research is necessary, however, to establish the safety and efficacy of atypical antipsychotics as long-term treatments for bipolar disorder. Fact Sheets, Major Mental Disorders; Symptoms and Treatments
Mental Health: A Report by the Surgeon General
Department of Health and Human Services The entire 487 page report, Mental Health: A Report by the Surgeon General is available online. For more detailed information on bipolar disorder (manic-depressive illness), be sure to visit our Reference Shelf. Supplemental information can be found in our , and Videos sections. Return to Basic/General Information About Depression and Bipolar Disorder (Manic-Depressive Illness) [
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