Understanding Bipolar Disorder: Signs, Causes, and Modern Treatment

Bipolar disorder involves episodic shifts between manic or hypomanic states and depression, sometimes with mixed features or rapid cycling. Genetic and environmental factors contribute, and substance use can worsen outcomes. Treatment is long-term and typically combines mood-stabilizing medication (lithium or others), psychotherapy, lifestyle changes, and close follow-up; lithium has strong evidence for reducing suicide risk.

What is bipolar disorder?

Bipolar disorder is a mood disorder marked by recurring episodes of mania or hypomania and depressive episodes. People with bipolar disorder experience pronounced changes in energy, activity, sleep, and behavior that are more severe than normal mood swings.

Symptoms: mania, hypomania, depression, and mixed states

Mania and hypomania involve an abnormally elevated, expansive, or irritable mood and increased activity or energy. Common signs include decreased need for sleep, racing thoughts, impulsive or risky behavior, and pressured speech.

Depressive episodes bring low mood, loss of interest, fatigue, changes in appetite or sleep, and difficulty concentrating. Some people experience mixed features or dysphoria - symptoms of mania and depression occurring at the same time - which can increase distress and risk.

Clinicians use the term "rapid cycling" when a person has four or more mood episodes in a year. Rapid cycling and mixed states are recognized in modern diagnostic systems such as the DSM-5.

Causes and risk factors

Bipolar disorder arises from multiple factors. Genetic predisposition plays a role: having a family history raises risk compared with the general population, though the exact percentage varies by study . Brain imaging and genetic research continue to investigate biological contributors.

Life events, sleep disruption, and substance use (alcohol or drugs) can trigger or worsen mood episodes. Comorbid substance use and other psychiatric disorders are common and can complicate diagnosis and treatment.

Typical course and onset

Symptoms most often appear in late adolescence or early adulthood, though onset can occur earlier or later. Episodes can last days to weeks or longer. Without treatment, mood episodes tend to recur, and the condition can significantly impair functioning.

Bipolar disorder is associated with an elevated risk of suicide; early recognition and ongoing care reduce that risk.

Treatment and outlook

Modern treatment is typically long-term and individualized. Evidence-based approaches include mood stabilizers (for example, lithium and anticonvulsants), certain atypical antipsychotics, psychotherapy (such as cognitive-behavioral therapy and psychoeducation), and lifestyle measures to stabilize sleep and routines.

Lithium remains a foundational mood stabilizer and has the strongest evidence for reducing suicide risk, but other medications and combinations are widely used depending on symptoms and side-effect profiles.

In severe or treatment-resistant cases, options such as electroconvulsive therapy (ECT) may be considered under specialist care. Collaborative care, ongoing follow-up, and attention to co-occurring substance use and medical issues improve long-term outcomes.

When to seek help

Seek professional evaluation if mood episodes cause marked changes in behavior, relationships, work, or school, or if you experience suicidal thoughts. Early diagnosis and consistent treatment reduce recurrence and improve quality of life.

1. Confirm current prevalence estimates for bipolar disorder (global and U.S. figures).
2. Verify specific heritability or parent-to-child transmission percentages for bipolar disorder.