Bipolar Disorder

Last Updated: November 2, 2022

Bipolar disorder is a mental illness characterized by intense mood swings of emotional highs (mania or hypomania) and lows (depression), which correspond with changes in behavior, energy, and activity levels.

Bipolar Disorder falls under theMental Healthcategory.

What is bipolar disorder?

Bipolar disorder, which is also known as manic-depressive disorder, is a mental illness that causes extreme mood swings. These mood swings consist of emotional highs (manic or hypomanic episodes) and lows (depressive episodes). There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymic disorder. People with bipolar disorder often experience decreased quality of life and overall functioning. Among all mental illnesses, bipolar disorder has the highest suicide rate.[1][2][3]

What are the main signs and symptoms of bipolar disorder?

People with bipolar I experience manic episodes. Common symptoms during manic episodes – which last ≥1 week – include an unusual increase in self-esteem, a decreased need for sleep, feeling unusually important, racing thoughts, increased energy, and risky behaviors (spending too much money, reckless driving, etc.).

People with bipolar II experience hypomanic episodes, which are milder symptoms of mania.

People with bipolar I and II experience depressive episodes. Common symptoms during depressive episodes – which last ≥2 weeks – include feeling sad or hopeless, losing interest in previously enjoyable activities, increased or decreased appetite, excessive fatigue, and suicidal thoughts.

There may also be mixed episodes where both manic and depressive symptoms co-occur.

People with cyclothymic disorder experience symptoms of both hypomanic and depressive episodes, but don’t meet the criteria for these episodes. [4][3]

How is bipolar disorder diagnosed?

A thorough evaluation by a mental health provider is required to identify bipolar disorder. Two commonly-used sets of diagnostic criteria are those in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the International Classification of Disease (ICD), published by the World Health Organization.

What are some of the main medical treatments for bipolar disorder?

Treatment focuses on managing acute episodes (manic, hypomanic, and depressive) and on providing maintenance care to prevent acute episodes from recurring. A combination of medication and psychotherapy is often used.

Medications such as mood stabilizers, antipsychotics, and antidepressants are commonly used. However, antidepressants should not be used in people with a history of rapid cycling (≥4 acute episodes within a year).[4][5]

Have any supplements been studied for bipolar disorder?

Fish oil and N-Acetyl-Cysteine seem to be particularly helpful for depressive episodes.[6][7] Coenzyme Q10, Folic acid, zinc, and probiotics also show some promise for treating bipolar disorder.[7]

Are there any other treatments for bipolar disorder?

Numerous psychotherapy modalities, including cognitive behavioral therapy, family-focused therapy, interpersonal social rhythm therapy, and mindfulness, may be helpful in addition to medication. However, the form of psychotherapy chosen should be specific to the individual's unique needs.[8][5]

People with bipolar disorder may also benefit from neuromodulation treatments such as Electroconvulsive Therapy (ECT) or repetitive Transcranial Magnetic Stimulation (rTMS). Although electroconvulsive therapy has shown to be an effective treatment, there is limited research on using rTMS.[9]

Bright light therapy can also help reduce symptoms of depression in people with bipolar disorder.[10]

How could diet affect bipolar disorder?

According to observational studies, people with bipolar disorder are less likely to follow a Mediterranean dietary pattern and tend to consume less seafood. Some studies also found that diets rich in essential fatty acids correlate with improved symptoms of bipolar disorder. Because most of the research is observational, more rigorous studies are required to assess the relationship between diet and bipolar disorder.[7]

What causes bipolar disorder?

The exact cause of bipolar disorder is unknown. It does, however, appear to be influenced by psychosocial, genetic, and biological factors.[2]

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  1. ^Gonda X, Pompili M, Serafini G, Montebovi F, Campi S, Dome P, Duleba T, Girardi P, Rihmer ZSuicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factorsJ Affect Disord.(2012 Dec 20)
  2. ^McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RBBipolar disorders.Lancet.(2020-12-05)
  3. ^Bipolar Disorder: MedlinePlus; Bethesda, MD: National Library of Medicine US, cited October 31, 2022
  4. ^Bobo WVThe Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update.Mayo Clin Proc.(2017-10)
  5. ^Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk MCanadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder.Bipolar Disord.(2018-03)
  6. ^Nery FG, Li W, DelBello MP, Welge JAN-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials.Bipolar Disord.(2021-11)
  7. ^Gabriel FC, Oliveira M, Martella BM, Berk M, Brietzke E, Jacka FN, Lafer BNutrition and bipolar disorder: a systematic review.Nutr Neurosci.(2022-May-24)
  8. ^Dean OM, Gliddon E, Van Rheenen TE, Giorlando F, Davidson SK, Kaur M, Ngo TT, Williams LJAn update on adjunctive treatment options for bipolar disorder.Bipolar Disord.(2018-03)
  9. ^Loo C, Katalinic N, Mitchell PB, Greenberg BPhysical treatments for bipolar disorder: a review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques.J Affect Disord.(2011-Jul)
  10. ^Shengjun Wang, Zhigang Zhang, Li Yao, Nannan Ding, Lingjie Jiang, Yuchen WuBright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysisPLoS One.(2020 May 21)
  11. ^Tondo L, Hennen J, Baldessarini RJRapid-cycling bipolar disorder: effects of long-term treatments.Acta Psychiatr Scand.(2003-Jul)
Examine Database References
  1. Bipolar Disorder Symptoms - Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal RRandomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorderJ Clin Psychiatry.(2013 Nov)
  2. Bipolar Disorder Symptoms - Frangou S, Lewis M, McCrone PEfficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled studyBr J Psychiatry.(2006 Jan)
  3. Bipolar Disorder Symptoms - Keck PE Jr, Mintz J, McElroy SL, Freeman MP, Suppes T, Frye MA, Altshuler LL, Kupka R, Nolen WA, Leverich GS, Denicoff KD, Grunze H, Duan N, Post RMDouble-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorderBiol Psychiatry.(2006 Nov 1)
  4. Bipolar Disorder Symptoms - Hirashima F, Parow AM, Stoll AL, Demopulos CM, Damico KE, Rohan ML, Eskesen JG, Zuo CS, Cohen BM, Renshaw PFOmega-3 fatty acid treatment and T(2) whole brain relaxation times in bipolar disorderAm J Psychiatry.(2004 Oct)
  5. Bipolar Disorder Symptoms - Murphy BL, Stoll AL, Harris PQ, Ravichandran C, Babb SM, Carlezon WA Jr, Cohen BMOmega-3 fatty acid treatment, with or without cytidine, fails to show therapeutic properties in bipolar disorder: a double-blind, randomized add-on clinical trialJ Clin Psychopharmacol.(2012 Oct)
  6. Bipolar Disorder Symptoms - Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LBOmega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trialArch Gen Psychiatry.(1999 May)
  7. Bipolar Disorder Symptoms - Amann BL, Mergl R, Vieta E, Born C, Hermisson I, Seemueller F, Dittmann S, Grunze HA 2-year, open-label pilot study of adjunctive chromium in patients with treatment-resistant rapid-cycling bipolar disorderJ Clin Psychopharmacol.(2007 Feb)
  8. Bipolar Disorder Symptoms - Chengappa KN, Levine J, Gershon S, Mallinger AG, Hardan A, Vagnucci A, Pollock B, Luther J, Buttenfield J, Verfaille S, Kupfer DJInositol as an add-on treatment for bipolar depressionBipolar Disord.(2000 Mar)
  9. Bipolar Disorder Symptoms - Brown ES, Gorman AR, Hynan LSA randomized, placebo-controlled trial of citicoline add-on therapy in outpatients with bipolar disorder and cocaine dependenceJ Clin Psychopharmacol.(2007 Oct)
  10. Bipolar Disorder Symptoms - Douglas G. Kondo, M.D, Young-Hoon Sung, M.D, Tracy L. Hellem, B.S, Kristen K. Delmastro, B.S, Eun-Kee Jeong, Ph.D, Namkug Kim, Ph.D, Xianfeng Shi, Ph.D, and Perry F. RenshawOpen-Label Uridine for Treatment of Depressed Adolescents with Bipolar DisorderJournal of Child and Adolescent Psychopharmacology.()
  11. Depression Symptoms - Mehrpooya M, Yasrebifar F, Haghighi M, Mohammadi Y, Jahangard LEvaluating the Effect of Coenzyme Q10 Augmentation on Treatment of Bipolar Depression: A Double-Blind Controlled Clinical TrialJ Clin Psychopharmacol.(2018 Oct)
  12. Oxidative Stress Biomarkers - Jahangard L, Yasrebifar F, Haghighi M, Ranjbar A, Mehrpooya MInfluence of adjuvant Coenzyme Q10 on inflammatory and oxidative stress biomarkers in patients with bipolar disorders during the depressive episodeMol Biol Rep.(2019 Oct)
  13. Depression Symptoms - Nery FG, Li W, DelBello MP, Welge JAN-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials.Bipolar Disord.(2021-11)