Condition

Bipolar Disorder: Types, Symptoms, and Treatment

Summary

Bipolar disorder is a mood disorder defined by recurring episodes of mania or hypomania and episodes of depression. An estimated 2.8% of U.S. adults have it in a given year and 4.4% over a lifetime, and roughly 83% of those affected have serious impairment. Long-term treatment relies on mood stabilizers such as lithium, valproate, and lamotrigine plus atypical antipsychotics, with adjunctive psychotherapy to lower relapse; antidepressants alone are not recommended.

Written by Gale Editorial · grounded in the cited clinical sources below · Updated 2026-07-07. How we write.

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What is bipolar disorder?

Bipolar disorder is a mood disorder defined by recurring episodes of two opposite states: periods of abnormally elevated, expansive, or irritable mood and increased energy (mania or hypomania), and periods of depression 3. Between episodes, many people return to their usual level of functioning. The condition was historically called manic-depressive illness.

An estimated 2.8% of U.S. adults have bipolar disorder in a given year, and about 4.4% will meet diagnostic criteria at some point in their lives 1. A 2023 review estimated the condition affects roughly 8 million adults in the United States and about 40 million people worldwide 2. Among U.S. adults with bipolar disorder, an estimated 82.9% have serious functional impairment — the highest share of serious impairment among the mood disorders 1. The typical age of onset is between 15 and 25 years 2.

Bipolar I, bipolar II, and cyclothymia

Bipolar disorders are grouped by the type and severity of the mood episodes a person has experienced 3.

Bipolar I disorder is defined by the presence of at least one manic episode. Depressive episodes also occur in most people with bipolar I, but they are not required for the diagnosis 3.

Bipolar II disorder is defined by at least one major depressive episode together with at least one hypomanic episode, and no history of a full manic episode 3. It is not simply a milder form of bipolar I — the depressive burden can be substantial.

Cyclothymic disorder (cyclothymia) involves prolonged periods, lasting more than two years, of numerous hypomanic and depressive symptoms that do not meet the full criteria for a manic, hypomanic, or major depressive episode 3.

Mania vs. hypomania vs. depression

The three episode types differ in duration, severity, and consequences 3.

Manic episode. A distinct period of abnormally elevated, expansive, or irritable mood with increased energy or activity, lasting at least one week (or any duration if hospitalization is required) 3. A manic episode results in severe impairment in functioning, may include psychotic features such as hallucinations or delusions, or may require hospitalization 3.

Hypomanic episode. The same kind of mood and energy change, lasting at least four consecutive days 3. Hypomania is noticeable to others but, by definition, does not cause marked impairment, does not involve psychotic features, and does not require hospitalization — that threshold is the key line between hypomania and mania 3.

Depressive episode. Resembles a major depressive episode: persistent low mood or loss of interest, changes in sleep and appetite, fatigue, difficulty concentrating, feelings of worthlessness, and thoughts of death or suicide 3. Across the course of the illness, roughly 75% of symptomatic time is spent in depression or with depressive symptoms rather than in mania or hypomania 2.

Symptoms

Bipolar disorder produces two contrasting symptom clusters, and a given person may swing between them or experience features of both at once 3.

During mania or hypomania:

  • Elevated, expansive, or irritable mood
  • Increased energy or goal-directed activity
  • Decreased need for sleep — feeling rested after little sleep
  • Racing thoughts or rapid, pressured speech
  • Inflated self-esteem or grandiosity
  • Distractibility
  • Impulsive or risky behavior — spending sprees, reckless driving, risky sexual behavior

During a depressive episode:

  • Persistent sadness, emptiness, or hopelessness
  • Loss of interest or pleasure in usual activities
  • Fatigue or loss of energy
  • Sleeping too much or too little; appetite changes
  • Difficulty concentrating or making decisions
  • Feelings of worthlessness or guilt
  • Thoughts of death or suicide

The mix and timing of these symptoms is what distinguishes bipolar disorder from unipolar depression, and it is why a full history of past elevated-mood periods matters at diagnosis 2.

Diagnosis: why bipolar disorder is often missed

Bipolar disorder is frequently diagnosed years after it begins. Depression is the most frequent initial presentation, so a person may be treated for major depressive disorder for a long time before a manic or hypomanic episode is recognized 2. On average, diagnosis is delayed by about nine years following the first depressive episode 2.

Part of the reason is that hypomania can feel productive rather than distressing, so people often do not report it. Clinicians therefore ask specifically about past periods of elevated mood, reduced need for sleep, and uncharacteristic risk-taking 3. Getting the distinction right matters because the treatment differs from unipolar depression: antidepressants are not recommended as a standalone treatment for bipolar disorder 2. Early diagnosis and treatment are associated with a more favorable course 2.

Treatment: mood stabilizers and psychotherapy

Bipolar disorder is a long-term condition, and treatment aims both to resolve acute episodes and to prevent new ones 2.

Mood stabilizers and antipsychotics. Long-term (maintenance) treatment relies on mood stabilizers such as lithium, valproate, and lamotrigine, and on atypical antipsychotic medications such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine 2. These medicines differ in their side-effect profiles — several antipsychotics are associated with weight gain — so the choice is individualized 2. Antidepressants are not recommended as monotherapy, because without a mood stabilizer they can risk destabilizing mood 2.

Lithium and suicide risk. Lithium has an established anti-suicidal effect that appears partly independent of its mood-stabilizing action. A meta-analysis of 48 randomized trials (6,674 participants) found lithium reduced the odds of suicide compared with placebo (odds ratio 0.13) and reduced total deaths (odds ratio 0.38) 5.

Psychotherapy. Structured psychotherapy added to medication improves outcomes. A component network meta-analysis of 39 randomized trials (3,863 participants) found that manualized psychotherapies combined with medication produced lower relapse rates than usual care (odds ratio 0.56), and that psychoeducation and skills training delivered in a family or group format outperformed individual delivery 4. Cognitive behavioral therapy showed benefit for depressive symptoms, and family-focused and interpersonal and social rhythm therapies are also used 4.

Suicide risk, physical health, and long-term outlook

Bipolar disorder carries meaningful medical risk. It is associated with a loss of roughly 10 to 20 potential years of life, driven largely by excess deaths from cardiovascular disease and suicide 6. Suicide risk is highest during depressive and mixed states 6, which is one reason continuity of care and safety planning are central to treatment.

Long-term maintenance treatment, monitoring of physical health, and steady clinical follow-up reduce these risks; lithium in particular has a documented protective effect against suicide 56. With consistent treatment, many people with bipolar disorder have long periods of stability between episodes, and earlier diagnosis and treatment are linked to a better prognosis 2.

Example practice profiles

3 example practice profiles focus on bipolar disorder →

Common questions

Bipolar I disorder is defined by at least one manic episode — a period of elevated or irritable mood and high energy lasting at least a week, causing severe impairment, psychotic features, or hospitalization. Bipolar II disorder involves at least one major depressive episode plus at least one hypomanic episode (a milder, shorter elevated state) but no full manic episode. Bipolar II is not simply a milder illness; its depressive burden can be substantial.

Both involve abnormally elevated or irritable mood with increased energy. A manic episode lasts at least one week (or less if hospitalization is needed) and causes marked impairment, may include psychotic symptoms such as hallucinations or delusions, or requires hospitalization. A hypomanic episode lasts at least four days and is noticeable to others but does not cause marked impairment, does not involve psychosis, and does not require hospitalization.

Depression is usually the first episode people experience, so they may be treated for major depressive disorder before a manic or hypomanic episode is recognized. Hypomania can also feel productive rather than distressing, so people often do not report it. On average, diagnosis is delayed by about nine years after the first depressive episode, which is why clinicians ask specifically about past periods of elevated mood, reduced sleep need, and risk-taking.

Antidepressants are not recommended as a standalone treatment for bipolar disorder. Used without a mood stabilizer, they can risk destabilizing mood. Long-term treatment centers on mood stabilizers such as lithium, valproate, and lamotrigine and on atypical antipsychotic medications, often combined with structured psychotherapy.

Evidence supports a protective effect. A meta-analysis of 48 randomized trials with 6,674 participants found that lithium reduced the odds of suicide compared with placebo (odds ratio 0.13) and reduced total deaths (odds ratio 0.38). This anti-suicidal effect appears to be partly independent of lithium's mood-stabilizing action, though treatment decisions depend on an individual clinical assessment.

Yes, as an addition to medication rather than a replacement for it. A network meta-analysis of 39 randomized trials found that manualized psychotherapy combined with medication lowered relapse rates compared with usual care, and that psychoeducation and skills training delivered in a family or group format worked better than individual delivery. Cognitive behavioral therapy showed benefit for depressive symptoms.

Seek emergency care for thoughts of suicide or self-harm (call or text 988), for a manic episode with psychosis or behavior that endangers the person or others, or for new severe mood changes in the weeks after childbirth, which can include postpartum psychosis. In the United States, the 988 Suicide and Crisis Lifeline is free and available 24/7, and 911 is appropriate for immediate danger.

Related conditions

Depression: Signs, Causes, and Treatment · Anxiety: Symptoms, Types, and Treatment · Substance Use Disorder: Spectrum, Diagnosis, and Treatment · Perinatal and Postpartum Mental Health: Depression, Anxiety, and Psychosis

Specialties

Behavioral Health: What Therapists and Psychiatrists Treat

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When to seek care

  • —Thoughts of suicide, self-harm, or death — call or text 988 immediately
  • —A manic episode with psychosis (hallucinations or delusions), reckless spending, or behavior that endangers you or others
  • —Days with little or no sleep, rapid speech, grandiosity, or impulsive decisions that put safety at risk
  • —Depressive symptoms that impair daily functioning or include hopelessness
  • —Using alcohol or other substances to manage mood — SAMHSA National Helpline 1-800-662-4357
  • —New severe mood changes during pregnancy or in the weeks after delivery (postpartum psychosis is a medical emergency)

If you are having thoughts of suicide or self-harm, call or text 988 (Suicide and Crisis Lifeline) — free, confidential, available 24/7. For a manic episode with psychosis, an immediate threat to safety, or postpartum psychosis, call 911 or go to the nearest emergency department. For substance use, call SAMHSA's National Helpline at 1-800-662-4357.

General health information, not medical advice. Synthetic demonstration content.

References

  1. 1.National Institute of Mental Health (NIMH) (2024). Bipolar Disorder: Statistics. NIMH. link ✓Past-year prevalence 2.8% of U.S. adults (males 2.9%, females 2.8%); lifetime prevalence 4.4%; 82.9% serious impairment (highest among mood disorders) and 17.1% moderate impairment; adolescent prevalence 2.9%
  2. 2.Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M (2023). Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA. doi:10.1001/jama.2023.18588 ✓Affects ~8 million U.S. adults and ~40 million worldwide; age of onset usually 15-25 years; diagnosis delayed a mean of ~9 years after first depressive episode; ~75% of symptomatic time is depressive; maintenance treatment with mood stabilizers (lithium, valproate, lamotrigine) and atypical antipsychotics (quetiapine, aripiprazole, asenapine, lurasidone, cariprazine); antidepressants not recommended as monotherapy; early diagnosis linked to better prognosis
  3. 3.Coryell W (2026). Bipolar Disorders. Merck Manual Professional Edition. link ✓Bipolar I defined by >=1 manic episode; bipolar II defined by >=1 major depressive plus >=1 hypomanic episode and no manic episode; cyclothymic disorder = prolonged (>2 year) hypomanic and depressive symptoms below full-episode threshold; manic episode >=1 week (or less if hospitalization needed) with severe impairment/psychosis/hospitalization; hypomanic episode >=4 days without marked impairment, psychosis, or hospitalization; manic and depressive symptom clusters
  4. 4.Miklowitz DJ, Efthimiou O, Furukawa TA, Scott J, McLaren R, Geddes JR, Cipriani A (2021). Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.2993 ✓39 randomized trials, 3,863 participants; manualized psychotherapy plus medication lowered recurrence vs control (OR 0.56, 95% CI 0.43-0.74); family/group psychoeducation and skills training superior to individual delivery; CBT associated with benefit for depressive symptoms
  5. 5.Cipriani A, Hawton K, Stockton S, Geddes JR (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. doi:10.1136/bmj.f3646 ✓48 randomized controlled trials, 6,674 participants; lithium reduced completed suicide vs placebo (OR 0.13, 95% CI 0.03-0.66) and total deaths (OR 0.38, 95% CI 0.15-0.95); anti-suicidal effect partly independent of relapse prevention
  6. 6.McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RB (2020). Bipolar disorders. The Lancet. doi:10.1016/S0140-6736(20)31544-0 ✓Bipolar disorder associated with a loss of approximately 10-20 potential years of life, with excess mortality driven largely by cardiovascular disease and suicide

https://www.gale.care/conditions/bipolar-disorder · 6 sources. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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