Bipolar Disorder: Types, Symptoms, Diagnosis, and Treatment

Bipolar mood disorder is defined by clear changes in mood, energy, and activity levels that swing between contrasting states. People may experience periods of high energy, heightened mood, rapid thoughts, and risk-taking during manic or hypomanic phases, followed by stretches of deep sadness, fatigue, and low motivation during depressive episodes. These mood fluctuations can vary in duration and intensity, sometimes shifting quickly and other times evolving over days or weeks. The shifts are not simply “ups and downs”; they reflect distinct patterns that can affect sleep, concentration, relationships, work or school, and overall functioning. With education, support, and ongoing care, many people with bipolar disorder learn to recognize early warning signs, build resilience, and live meaningful, engaged lives.

Types of bipolar disorder

Bipolar I

Bipolar I disorder is characterized by at least one manic episode that lasts at least seven days, or by manic symptoms that are so severe that immediate hospitalization is needed. Depressive episodes often occur as well, lasting two weeks or longer, but a major depressive episode is not required for the diagnosis. Manic episodes may involve inflated self-esteem, decreased need for sleep, excessive talkativeness, racing thoughts, distractibility, reckless spending or risky behavior, and heightened goal-directed activity. Some people experience psychotic symptoms during severe episodes. With effective treatment, individuals can manage mood cycling and maintain daily functioning.

Bipolar II

Bipolar II disorder involves a pattern of depressive episodes and hypomanic episodes. Hypomania is a milder form of mania that lasts at least four consecutive days and is noticeable to others but does not cause the severe impairment or hospitalization that mania does. People with bipolar II can experience intense depressive episodes, which may be disabling and require treatment. The distinction between Bipolar I and Bipolar II hinges on the presence of full manic episodes versus hypomanic episodes and the level of impairment they cause.

Cyclothymic disorder

Cyclothymic disorder (cyclothymia) is a chronic mood pattern in which numerous periods of hypomanic-like symptoms and periods of depressive symptoms occur for at least two years (one year for children and adolescents). The mood shifts are less intense than mania or major depression, but they persist for long periods and can still disrupt functioning. Cyclothymia can progress to bipolar I or II if not addressed, so ongoing care and monitoring are important.

Manic and depressive episodes

Manic or hypomanic episodes involve elevated or irritable mood, increased energy, and changes in behavior that are noticeable to others. Symptoms may include rapid speech, reduced need for sleep, racing thoughts, distractibility, grandiose plans, risky activities, and distractibility. Mania is a quality-of-life concern when it leads to poor judgment or danger and may require hospitalization. Depressive episodes feature persistent sadness or emptiness, fatigue, changes in appetite or sleep, concentration difficulties, feelings of guilt or worthlessness, and possible thoughts of death or suicide. Depressive episodes can be deeply disabling and are a major focus of treatment. Some people experience mixed features, where symptoms of both mania and depression occur together, which can be particularly challenging and may require careful management.

Triggers and contributing factors

• Sleep disruption and irregular routines, which can destabilize mood
• Intense stress from work, relationships, or life events
• Substance use, including alcohol and recreational drugs
• Medication changes or interactions, including antidepressants used without mood stabilizers
• Seasonal changes or lack of daylight
• Medical conditions or hormonal changes

Triggers are not the sole cause of bipolar episodes, but they can precipitate mood shifts in someone who is predisposed. Building regular sleep, stress management, and early intervention strategies can reduce the risk of full-blown episodes and help maintain stability.

Diagnosis process

Diagnosis typically involves a comprehensive evaluation by a clinician, such as a psychiatrist or psychologist. The process includes:

• A detailed clinical interview about mood history, sleep patterns, energy levels, behavior, and functioning
• Medical and family history to identify other conditions that may mimic mood disorders
• Assessment for time frames and symptom patterns that align with DSM-5 criteria for manic, hypomanic, and depressive episodes
• Rule-out of other causes, such as thyroid problems, substance use, or other psychiatric conditions
• Sometimes structured interviews or screening tools are used, and ongoing observation over time may refine the diagnosis

Because bipolar disorder involves mood patterns that unfold over weeks to months, a careful, ongoing assessment is essential. If a clinician suspects bipolar disorder, they may work with the person to develop a bipolar care plan that can evolve as symptoms change.

Treatment options

Medication

Treatment often combines medications with psychotherapy. The goal is to stabilize mood, prevent relapses, and improve overall functioning. Common medication strategies include:

• Mood stabilizers such as lithium or anticonvulsants like valproate (divalproex) and lamotrigine. These medications help prevent both manic and depressive episodes in many people.
• Antipsychotic medications, including second-generation agents such as quetiapine, lurasidone, olanzapine, risperidone, or cariprazine, which can treat manic, hypomanic, or depressive symptoms depending on the case.
• Antidepressants may be used in some cases, usually in combination with a mood stabilizer to reduce the risk of triggering mania. The decision to use antidepressants is individualized and monitored closely.
• Special considerations: It may take several weeks to find the right medication and dose, and some people experience side effects that require adjustments. Regular follow-up with a clinician is essential.

Therapies and psychosocial approaches

Therapy complements medication by helping people understand their mood patterns, manage symptoms, and improve daily life. Evidence-based options include:

• Cognitive-behavioral therapy (CBT), which focuses on identifying and changing thought patterns and behaviors that contribute to mood swings
• Psychoeducation, teaching patients and families about bipolar disorder, treatment plans, and early warning signs
• Interpersonal and social rhythm therapy (IPSRT), which emphasizes regular daily routines and stable sleep/wake cycles to stabilize mood
• Family-focused therapy, which involves education and communication strategies for families to support the person with bipolar disorder
• Group therapy and support groups, which provide shared experiences and practical coping tips

In some cases, short-term hospitalization is necessary to ensure safety during severe mood episodes. For treatment-resistant depression or mania, clinicians may discuss options such as electroconvulsive therapy (ECT) or other emerging approaches, always tailored to the individual’s needs and preferences.

Living successfully with bipolar disorder

Many people with bipolar disorder pursue fulfilling careers, relationships, and hobbies. Success often hinges on combining medical treatment with practical self-management and a supportive network. Key strategies include:

• Establishing a daily routine that prioritizes regular sleep, meals, exercise, and medication adherence
• Working closely with a healthcare team to monitor symptoms, side effects, and functional goals
• Creating a crisis plan that lists warning signs, coping steps, and emergency contacts
• Leveraging psychoeducation to recognize early mood changes and request timely help
• Maintaining healthy habits: avoiding alcohol and non-prescribed substances, eating balanced meals, and staying physically active
• Using support networks, including trusted friends, family, or peer support groups, to reduce isolation
• Communicating openly with employers or educators about needs and accommodations when appropriate
• Practicing self-compassion and reducing self-stigma by learning that bipolar disorder is a treatable medical condition

Living well with bipolar disorder involves ongoing learning and adaptation. With accurate diagnosis, a personalized treatment plan, and supportive relationships, many people experience improved mood stability and greater participation in daily life. It’s important to regularly review goals, celebrate small successes, and seek help early when warning signs appear.

Resources for further reading and support

• National Institute of Mental Health (NIMH) — Bipolar Disorder
• National Alliance on Mental Illness (NAMI) — Bipolar Disorder
• Depression and Bipolar Support Alliance (DBSA) — About Bipolar Disorder
• SAMHSA National Helpline

If you or someone you know is at immediate risk of harming themselves or others, seek emergency help right away. Reaching out to a trusted clinician, a local crisis line, or an urgent care center can connect you with urgent support. Bipolar disorder is a medical condition, and effective care plans are available—one step at a time.