Bipolar Disorder Fact Sheet

(April 2025) Bipolar disorder is a psychiatric disease that may also be called manic-depressive illness or manic depression. It causes unusual shifts in mood, energy, and activity levels, making it difficult for the person affected to manage daily activities.

• Severe bipolar disorder was estimated affect 2.8 percent of the population aged 18 or older and 2.9 percent aged 13-18.
• More than 50% of patients with bipolar disorder are not adherent to treatment.
• Bipolar disorder is associated with high rates of suicide attempts and 15-20 percent dying by suicide.
• Bipolar disorder symptoms typically start during late adolescence or early adulthood, with half of all cases starting before age 25.
• Bipolar disorder usually lasts a lifetime, with episodes of mania and depression that recur across time. Many people are symptom free between episodes, but for some people symptoms linger without reprieve.

The National Institute of Mental Health (NIMH) distinguishes between bipolar disorder and typical mood fluctuations: “Everyone experiences ups and downs, but with bipolar disorder, the range of mood changes can be extreme.”

Like with many psychiatric conditions, symptoms often go unrecognized long before a person accesses treatment. According to NIMH, “Although symptoms may come and go, bipolar disorder usually requires lifelong treatment and does not go away on its own. Bipolar disorder can be an important factor in suicide, job loss, ability to function, and family discord. However, proper treatment can lead to better functioning and improved quality of life.”

Signs and Symptoms

Mood episodes: Distinct periods that represent a drastic departure from what is typical for the person. Irritability and explosive behaviors can co-occur with mania and/or depression, all of which can cause vocational and relationship challenges.

Manic episodes: Feeling overexcited, jumpy, or wired with racing and/or jumbled thoughts and ideas. Behaviors might be impulsive, dangerous, expensive, or reckless. Sleeplessness is common, and a person may feel unusually important, talented, or powerful.

Depressive episodes: Feeling down or restless with trouble concentrating, making decisions, or following through with even basic tasks. Sleep disturbances may co-occur with a lack of interest in almost all activities and feelings of hopelessness, worthlessness, and suicidal ideation.

Mixed states: Mood episodes that include symptoms of both mania and depression. A person might feel very sad or hopeless while at the same time feeling extremely energized. Trouble sleeping, major changes in appetite, and suicidal thoughts can be part of a mixed state.

Hypomania: A less extreme form of mania. A person may feel very good, be highly productive, and function well. However, hypomania can devolve into severe mania or depression without proper treatment.

Psychosis: Sometimes present during severe episodes of mania and/or depression, psychosis represents an abnormal mental state involving significant problems with reality testing. With bipolar disorder, behavioral symptoms of psychosis may reflect the person’s extreme mood and can manifest through delusions, hallucinations, and significantly disorganized speech.

Types of bipolar disorder

• Bipolar I Disorder — defined by manic episodes that last at least seven days (most of the day, nearly every day) or when manic symptoms are so severe that hospital level care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features are also possible. The experience of four or more episodes of mania or depression within a year is termed “rapid cycling.”
• Bipolar II Disorder — defined by a pattern of depressive and hypomanic episodes, but the hypomanic episodes are less severe than the manic episodes in bipolar I disorder. Many people with bipolar II disorder spend extended periods in a persistent, low-grade depressive state.
• Cyclothymic Disorder, or Cyclothymia — defined by recurrent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as fully hypomanic or depressive episodes.

Bipolar disorder can worsen if left undiagnosed and untreated, according to NIMH: “Episodes may become more frequent or more severe over time without treatment. Also, delays in getting the correct diagnosis and treatment can contribute to personal, social and work-related problems. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.”

Treating bipolar disorder

Although there is no cure for bipolar disorder, proper treatment can help to control symptoms. The NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a long-term outpatient study designed to find out which treatments, or combinations of treatments, are most effective for treating episodes of depression and mania and for preventing recurrent episodes in people with bipolar disorder.

Medications

• Mood stabilizers: Used to improve symptoms during acute manic, hypomanic, and mixed episodes and may also reduce symptoms of depression. Lithium was the first federally approved mood stabilizer and remains widely used under trade names such as Eskalith, Lithobid, and Lithonate.
• Anticonvulsants: Also to stabilize moods, valproic acid (divalproex/Depakote) was approved for treating mania in 1995. Lamotrigine (Lamictal) has been approved for maintenance treatment and is often effective in treating depressive symptoms.
• Antipsychotics: Sometimes used to treat symptoms of severe bipolar disorder, when psychotic features are present, and in combination with other medications. Commonly prescribed atypical antipsychotics are Olanzapine (Zyprexa), generally used for severe mania or psychosis; Aripprazole (Abilify), for symptoms of mania or mixed episodes; and Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon), for symptoms of mania.
• Clozapine: A differently acting atypical antipsychotic, clozapine (Clozaril) may be effective when a psychotic illness is otherwise treatment-resistant or includes features that pose a high risk for violence and/or suicide. For many years Clozapine was limited by strict usage protocols that ended Feb. 25, 2025. Grassroots advocates played a role in convincing the U.S. Food and Drug Administration (FDA) to end those restrictions, called REMS — Risk Evaluation and Mitigation Strategy.
• Anti-anxiety medications: Prescribed in some cases for insomnia, agitation or other symptoms, especially during a manic phase. Options include lorazepam (Ativan) and clonazepam (Klonopin).
• Antidepressants: May be prescribed to treat symptoms of depression in bipolar disorder but can increase the risk of mania, hypomania, or rapid-cycling symptoms. Typically, antidepressants are prescribed only in combination with mood stabilizers. Commonly prescribed antidepressants include bupropion (Wellbutrin); selective serotonin reuptake inhibitors such as fluoxetine (Prozac); fluvoxamine (Luvox); paroxetine (Paxil), and sertraline (Zoloft). Other choices if those do not work or cause unpleasant side effects: mirtazapine (Remeron), monoamine oxidase inhibitors such as phenelzine (Nardil) and tranylcypromine (Parnate); nefazodone (Serzone); tricyclic antidepressants such as amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor); and venlafaxine (Effexor).

Other Treatments

Additional treatments within the continuum of care may include:

• Psychotherapy: Treatment outcomes can be improved when medication therapies are combined with therapies such as cognitive behavioral therapy (CBT), cognitive behavioral therapy for psychosis (CBTp), dialectical behavioral therapy (DBT), motivational interviewing, family therapy, interpersonal therapy and/or psychoeducation.
• Substance use treatment: If bipolar disorder includes co-occurring symptoms of substance use disorder (SUD), combined care may be necessary.
• Electroconvulsive therapy (ECT): Brain stimulation may relieve severe symptoms but is usually only considered if an individual’s illness has not improved after other treatments such as medication or psychotherapy, or in cases that require rapid response, such as with suicide risk or catatonia (a state of unresponsiveness).
• Transcranial magnetic stimulation (TMS): A type of brain stimulation that uses magnetic waves, rather than the electrical stimulus of ECT, TMS may relieve depression over a series of treatment sessions. Although not as powerful as ECT, TMS does not require general anesthesia and presents little risk of memory or adverse cognitive effects.
• Light therapy: Evidence-based to treat seasonal affective disorder (SAD), light therapy may benefit people with bipolar disorder if there is a seasonal worsening of depression in the winter or for milder forms of bipolar depression.