You may have heard about celebrities who struggle with bipolar disorder, but because of a persistent stigma attached to this serious mental disorder, people may delay seeking help. The good news is that there are now many treatments available to help people with bipolar disorder.

While it is a serious illness, with proper and ongoing treatment, people 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 bipolar disorder,” says Hilary Blumberg, MD, a Yale Medicine psychiatrist and director of the Mood Disorders Research Program at Yale School of Medicine.

The symptoms of bipolar disorder include episodes of mania or hypomania (elevated or irritable mood, increased energy with little sleep, impulsive or risky behavior) and depression (sadness, loss of pleasure, low energy, sleeping more).

• Mania. The hallmark of bipolar disorder I is a manic episode that lasts at least one week. Mania is an excessively elevated mood state that can include feelings of euphoria or cause a person to be unusually irritable and quick to get into conflicts. When people are experiencing mania, they can feel highly energetic even though they might get only a few hours of sleep. They might throw themselves into projects, buy things that they can’t afford, engage in risky sexual behaviors, and/or have other impulses to do other things that can be difficult to control. There is another type of bipolar disorder, bipolar disorder II, in which a person does not have manic episodes, but does have hypomanic episodes that are milder and may only last for days.
• 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, a lack of productivity. They may also find that they sleep a lot. Individuals with bipolar disorder I or II 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 have only one or two manic or hypomanic 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 people with bipolar disorder. It has been estimated that as many as 50% will make a suicide attempt and 15% to 20% will die by suicide. Research has shown that treatment can reduce suicide risk.

When diagnosing bipolar disorder, a clinician questions a person to determine current and past symptoms. They will also ask about a family history of bipolar disorder. A person who has had one manic episode will be diagnosed with bipolar disorder I, regardless of whether they have had a depressive episode. If someone has experienced hypomania, they may be diagnosed with bipolar disorder II.

Anxiety is often present in people with bipolar disorder. Other related conditions include substance and borderline personality disorders.

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

Risk factors for bipolar disorder include genetics, family history (especially an immediate family member with bipolar disorder), and age, with initial episodes often beginning in late adolescence or early adulthood.

• Genetics. The current understanding suggests that several genes could be involved in the development of bipolar disorder.
• Family history. People with bipolar disorder often have a relative with the condition. Risk is elevated if you have an immediate family member with bipolar disorder.
  
  Relatives may also have major depressive disorder, anxiety, schizophrenia or substance abuse, pointing to possible underlying genetic connections among these conditions. Sometimes bipolar disorder is incorrectly diagnosed as one of these other disorders.
• Age. Initial episodes of bipolar disorder often occur in late adolescence and early adulthood, although this can occur later.

Treatment for bipolar disorder includes medication (sometimes in combination), psychotherapy, and other emerging options such as brain stimulation methods, digital tools (smartphone apps), and bright light.

• Medication. There are many options for people with bipolar disorder. One standard treatment is lithium, a drug that research has shown may reduce a person’s risk of suicide. Today, there are many other medications that can reduce symptoms of bipolar disorder and prevent episodes—including anticonvulsants, antipsychotics, and antidepressants. Clinicians may prescribe a combination of medications. The key is to personalize medical treatment to address the symptoms and needs of the patient.
• Psychotherapy. Talk therapies 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 early signs of manic and depressive episodes, are also effective tools in treating the condition.
• Other treatments. With new advances, other types of treatments are emerging that can include ways to stimulate parts of the brain involved in bipolar disorder. Other treatment strategies can involve digital technologies such as smartphone apps or the use of bright light.

Physicians at Yale Medicine are conducting leading-edge research on bipolar disorder. They have made pioneering discoveries about the brain in bipolar disorder and how it relates to genetics and the environment. Yale Medicine investigators are also developing novel treatments to reduce symptoms and prevent suicide. “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.