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Overview

You may have heard about celebrities who struggle with bipolar disorder. Due to a persistent stigma attached to this serious mental disorder, people may delay seeking help. The good news is that with proper treatment you or someone you know can live a productive life. 

A person with bipolar disorder experiences extreme highs and lows for short or sustained periods of time. During manic, or high-energy, periods, impulsiveness can be difficult to control, leading to shopping frenzies, for example. At the other extreme, depressive episodes reflect the same symptoms found in clinical depression, including low moods and energy.

While it is a serious illness, with proper, ongoing treatment, those with bipolar disorder can often regain stability and thrive. “We are fortunate at Yale to have many faculty members with expertise in the research and treatment of mood disorders,” says Hilary Blumberg, MD, a Yale Medicine psychiatrist and director of the Mood Disorders Research Program at Yale School of Medicine.

What are the symptoms of bipolar disorder?

Mania. The hallmark of bipolar disorder is a manic episode that lasts at least one week. Mania is an excessively elevated mood state that includes feelings of euphoria. It might also cause a person to be uncharacteristically irritable and quick to get into conflicts. When people are experiencing mania, they might get only a few hours of sleep, yet feel rested. They might throw themselves into projects, buy things that they can’t afford, and/or engage in risky sexual behaviors. 

Depression. Most people with bipolar disorder also have one or more episodes of severe depression. These periods—which last two weeks or longer—are marked by sadness, a lack of pleasure, low energy and a lack of productivity. Individuals with bipolar disorder often spend more time depressed than in elevated mood states.

As with many mental health conditions, both forms of bipolar disorder exist on a spectrum. Some people only have one or two manic episodes in their lifetime, whereas others frequently cycle between mania and depression.

Suicidal thoughts and behaviors. There is a very high risk of suicide among those with bipolar disorder. Up to 50 percent will make a suicide attempt and 15 to 20 percent will die by suicide. Research has shown that treatment can reduce suicide risk.

How is bipolar disorder diagnosed?

When diagnosing bipolar disorder, a clinician questions the patient to determine current and past symptoms. He or she will also inquire about a family history of bipolar disorder. A patient who has had one manic episode will be diagnosed with bipolar disorder, regardless of whether he or she has had a depressive episode. If a patient has experienced hypomania—a less extreme episode of mania—he or she may be diagnosed with bipolar disorder II.

How does bipolar disorder relate to other conditions?

Anxiety is often present in patients with bipolar disorder. Other related conditions include attention deficit hyperactivity, substance abuse and borderline personality disorders. 

During severe episodes, individuals with bipolar disorder can experience transient psychotic symptoms, such as hearing voices, and other symptoms that are often associated with schizophrenia.

What are the risk factors for bipolar disorder?

Genetics. The current understanding is that several genes could be involved in the development of the disorder.

Family history. People with bipolar disorder often have a relative with bipolar disorder. Risk is elevated if you have a first-degree relative—immediate family members such as mother, father, or sibling—with bipolar disorder. Relatives may also have major depressive disorder, anxiety, schizophrenia or substance abuse, pointing to possible underlying genetic commonalities among these conditions. Sometimes bipolar disorder is incorrectly diagnosed as one of these other disorders.

Age. Initial episodes of mania often occur in late adolescence and early adulthood. Increasingly, bipolar disorder is being diagnosed in children and teens. 

How is bipolar disorder treated?

Medication. There are many pharmacological options for those with bipolar disorder. One standard treatment is lithium, a drug that research has shown may reduce a person’s risk of suicide. Clinicians may prescribe a combination of medications—including anticonvulsants, antipsychotics and antidepressants—in order to manage the condition and prevent episodes of mania and/or depression. The key is personalizing medical treatment to address the symptoms and needs of the patient.

Psychotherapy. Talk therapies such as interpersonal and social rhythm therapy have been shown to be effective, often in conjunction with medication. Behavioral therapy and sleep hygiene counseling, as well as educating friends and family members about the nascent signs of manic and depressive episodes, are also effective tools in treating the condition.

What makes Yale Medicine's approach to treating bipolar disorder unique?

Researchers at Yale Medicine are working hard to find biomarkers for mood disorders, including bipolar disorder. Understanding the relationship between brain activity and mental illness to identify biomarkers and new treatment targets is what researchers are striving toward. 

Yale Medicine investigators are also developing other lines of research, including cutting-edge genetics analysis, novel medications and a greater understanding of suicidal thoughts and behaviors. “Our researchers are well-informed by the newest research and include this information to make the best decisions for the treatment of each individual," Dr. Blumberg says.