Bipolar disorder

Bipolar disorder is a serious medical condition that causes extreme swings in a person’s mood, energy, and ability to function. These mood changes, called manic and depressive episodes, are not the same as the typical ups and downs that everyone goes through from time to time. These mood changes are also different from those caused by premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).

There are different types of bipolar disorder. The two most common types are bipolar I (pronounced “bipolar one”) and bipolar II (pronounced “bipolar two”). The different types of bipolar disorder are based on how severe a person’s mood and behavior changes are and how quickly they come and go. Some types of bipolar disorder are more severe than others, but all types of bipolar disorder can be treated. Learn more about the different types of bipolar disorder.

Bipolar I (pronounced “bipolar one”) disorder is the most severe type of bipolar disorder. It affects women and men equally, but it is often diagnosed later in life for women than for men.³ Bipolar I disorder causes severe swings in mood and energy, from highs (manic episodes) to lows (depressive episodes).

Bipolar II (pronounced “bipolar two”) disorder is the most common type of bipolar disorder. It affects more women than men.³

Women with bipolar II disorder experience similar mood changes to people with bipolar I, but the manic episodes are less severe. These less intense episodes are called hypomania. However, women with bipolar II tend to have depressive episodes more often.³

Because hypomanic episodes are less severe than manic episodes, women with bipolar II may be more able than women with bipolar I to live in the community with family and complete everyday tasks at work, school, or home. Bipolar II disorder can usually be treated without hospitalization.

The term “episode” may be used to describe what happens when a person with bipolar disorder has several manic or depressive symptoms for most of the day, nearly every day, for at least 1 to 2 weeks. Sometimes symptoms are so severe that the person cannot do everyday tasks at work, school, or home.

A hypomanic episode, also called hypomania, has fewer or milder symptoms than a manic episode.

Women who have mood changes with hypomanic episodes may have a milder but still serious condition called bipolar II disorder.

Symptoms of mania or a manic episode include:

Mood changes:

• Feeling “high,” or having an overly happy or outgoing mood with a lot of energy
• Having an extremely irritable mood, feeling agitated, or feeling jumpy or wired

Behavioral changes:

• Talking very fast, jumping from one idea to another, or having racing thoughts
• Being easily distracted all of the time
• Taking on many new projects without getting others completed
• Being unusually “wired” or restless
• Getting little to no sleep
• Having an unrealistic positive belief in one’s abilities (such as being able to fly or read minds)
• Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments

A manic episode can be followed by a depressive episode. A person can also experience a “mixed state” in which she or he feels symptoms of both mania and depression.

Symptoms of depression or a depressive episode include:

Mood changes:

• A long period (more than 2 weeks) of feeling worried, empty, hopeless, or sad
• Loss of interest in activities once enjoyed

Behavioral changes:

• Feeling tired or “slowed down”
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other daily habits
• Thinking of death or suicide or attempting suicide

A person can also experience a “mixed state” in which she or he feels symptoms of both mania and depression.

Experts do not know what causes bipolar disorder. Some possible causes include:⁴

• Biology. The way the brain is shaped and how it functions may be different in people with bipolar disorder.⁵
• Chemistry. In people with bipolar disorder, levels of brain chemicals may not be balanced correctly. These chemicals usually help regulate thoughts, moods, and behaviors so that a person does not feel so high or low.
• Family history. Bipolar disorder is more common in people who have a sibling, parent, or child with the condition. Certain genes may be involved in causing bipolar disorder.

Women and men are equally likely to have bipolar I disorder, but women are more likely to have bipolar II disorder and may experience more rapid cycling between highs and lows.¹

Women with bipolar disorder are also more likely than men with bipolar disorder to have other physical and mental health conditions, including problems with alcohol use, depression caused by bipolar disorder, thyroid disease, obesity caused by medicines that treat bipolar disorder, and migraine headaches.¹

Changing hormones during the menstrual cycle and menopause can also affect how severe a woman’s bipolar disorder is, but they do not cause bipolar disorder.²

To diagnose bipolar disorder, doctors may do a blood test, talk to you about your moods and behaviors, and have you keep a daily record of your thoughts and activities.

With your permission, a doctor may also want to talk to your close friends or family members to better understand your behavior and determine whether you have showed symptoms of bipolar disorder.

There is no cure for bipolar disorder. But treatment helps most people with bipolar disorder have fewer depressive and manic episodes. People with the disorder will need treatment throughout their lives to control bipolar symptoms.

Treatment for bipolar disorder may include:

• Medicine. You will probably need to start taking medicine right away to balance your moods. Medicines include lithium and other mood stabilizers, certain antipsychotics, anti-anxiety medicines, and antidepressants. Antidepressants can increase the risk of mania in bipolar depression. Women are more likely than men to gain weight from these medicines. Women may also need to start on a lower dose of a medicine than men do.¹ Medicines can take time, a few weeks or a month, to work.
• Therapy, also called talk therapy. Talk therapy can help people manage their bipolar symptoms by helping them recognize when they have or are about to have a manic or depressive episode.
• Electroconvulsive therapy (ECT). ECT is a type of treatment that uses low levels of electricity to stimulate parts of the brain. This treatment is usually used when other types of treatment, such as medicine and talk therapy, haven’t worked.⁶ Although ECT is usually used to treat severe depressive episodes, it can also be used to treat a manic episode.
• Hospitalization. Sometimes, people with bipolar disorder need to stay in the hospital temporarily if they have long periods of severe mania or depression, including suicidal thoughts or psychosis (having thoughts or seeing things that make it difficult for you to tell what is real and what isn’t).

If you think that you or someone you know has bipolar disorder, see a doctor, nurse, or mental health professional right away. The earlier you get treatment for bipolar disorder, the better the treatment works. Come prepared with a list of symptoms and examples of behaviors that you think may be caused by bipolar disorder.

Women who have bipolar disorder are at risk for experiencing an episode after giving birth, especially a depressive episode.^7,1 Women who experience a depressive or manic episode after giving birth are also more likely to have episodes after other pregnancies.² Women with bipolar disorder are at high risk of developing postpartum psychosis, which is a medical emergency.

Talk to your doctor or nurse if you are trying to get pregnant or are pregnant. Some medicines are not safe to take during pregnancy.

Yes. Certain medicines to treat bipolar disorder are safe to take while breastfeeding.⁷ Talk to your doctor about what medicines you can take after giving birth.

Learn more about medicines and breastfeeding in our Breastfeeding section. You can also enter your medicine into the LactMed^® database to find out whether your medicine passes through your breastmilk and, if so, any possible side effects for your nursing baby.

For more information about bipolar disorder, call the OWH Helpline at 1-800-994-9662 or check out the following resources from these organizations:

• Accommodation and Compliance Series: Employees With Bipolar Disorder — Publication from the Job Accommodation Network.
• Bipolar Disorder — Publication from the National Institute on Mental Health.
• Bipolar Disorder — Fact sheet from the Depression and Bipolar Support Alliance.
• Bipolar Disorder — Fact sheet from the National Alliance on Mental Illness.
• Myths and Facts about Depression and Bipolar Disorder (PDF file, 4.0 MB) — Information from the Depression and Bipolar Support Alliance.
• What Helps and What Hurts: When someone you care about has depression or bipolar disorder (PDF file, 56.6 KB) — Information from the Depression and Bipolar Support Alliance.
• “What is Bipolar Disorder?” A Guide to Hope and Recovery For African Americans — Information from Mental Health America.

1. Freeman, M.P., Smith, K.W., Freeman, S.A., McElroy, S.L., Kmetz, G.F., Wright, R., et al. (2002). The Impact of Reproductive Events on the Course of Bipolar Disorder in Women. Journal of Clinical Psychiatry; 63(4): 284–287.
2. Sit, D. (2004). Women and Bipolar Disorder Across the Life Span. Journal of the American Medical Women’s Association; 59(2): 91–100.
3. Arnold, L.M. (2003). Gender differences in bipolar disorder. Psychiatric Clinics of North America; 26(3): 595–620.
4. Martinowich, K., Schloesser, R.J., Manji, H.K. (2009). Bipolar disorder: from genes to behavior pathways. Journal of Clinical Investigation; 119(4): 726–736.
5. National Institute of Mental Health (NIMH). (2016). Bipolar Disorder.
6. NIMH. (2016). Brain stimulation therapies.
7. Pacchiarotti, I., León-Caballero, J., Murru, A., Verdolini, N., Furio, M.A., Pancheri, C., et al. (2016). Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. European Neuropsychopharmacology; 26(10): 1562–1578.