Bipolar disorder, which is also known as manic-depressive illness and
will be called by both names throughout this publication--is a mental
illness involving episodes of serious mania and depression. The person's
mood usually swings from overly "high" and irritable to sad and
hopeless and then back again, with periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early adulthood and
continues throughout life. It is often not recognized as an illness, and
people who have it may suffer needlessly for years or even decades.
Effective treatments are available that greatly alleviate the suffering
caused by bipolar disorder and can usually prevent its devastating
complications. These include marital break-ups, job loss, alcohol and drug
abuse, and suicide.
Here are some facts about bipolar disorder.
Manic-Depressive Illness Has a Devastating Impact on Many People.
- At least 2 million Americans suffer from manic-depressive illness.
For those afflicted with the illness, it is extremely distressing and
- Like other serious illnesses, bipolar disorder is also hard on
spouses, family members, friends, and employers.
- Family members of people with bipolar disorder often have to cope
with serious behavioral problems (such as wild spending sprees) and the
lasting consequences of these behaviors.
- Bipolar disorder tends to run in families and is believed to be
inherited in many cases. Despite vigorous research efforts, a specific
genetic defect associated with the disease has not yet been detected.
- Bipolar illness has been diagnosed in children under age 12, although
it is not common in this age bracket. It can be confused with
attention-deficit/hyperactivity disorder, so careful diagnosis is
D/ART: A National Educational Program
The National Institute of Mental Health (NIMH) has launched the
Depression/Awareness, Recognition, and Treatment (D/ART) campaign to help
- Recognize the symptoms of depressive disorders, including bipolar
- Obtain an accurate diagnosis
- Obtain effective treatments
- Encourages and trains health care professionals to recognize the
signs of manic-depressive illness and utilize the most up-to-date
- Organizes citizens' advocacy groups to extend the D/ART program
- Works with industry to improve recognition, treatment, and insurance
coverage for depressive disorders
Bipolar disorder involves cycles of mania and depression.
Signs and symptoms of mania include discrete periods of:
- Increased energy, activity, restlessness, racing thoughts, and rapid
- Excessive "high" or euphoric feelings
- Extreme irritability and distractibility
- Decreased need for sleep
- Unrealistic beliefs in one's abilities and powers
- Uncharacteristically poor judgment
- A sustained period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
Signs and symptoms of depression include discrete periods of:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in ordinary activities, including sex
- Decreased energy, a feeling of fatigue or of being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleep disturbances
- Loss of appetite and weight, or weight gain
- Chronic pain or other persistent bodily symptoms that are not caused
by physical disease
- Thoughts of death or suicide; suicide attempts
It may be helpful to think of the various mood states in
manic-depressive illness as a spectrum or continuous range. At one end is
severe depression, which shades into moderate depression; then come mild
and brief mood disturbances that many people call "the blues,"
then normal mood, then hypomania (a mild form of mania), and then mania.
Some people with untreated bipolar disorder have repeated depressions
and only an occasional episode of hypomania (bipolar II). In the other
extreme, mania may be the main problem and depression may occur only
infrequently. In fact, symptoms of mania and depression may be mixed
together in a single "mixed" bipolar state.
Descriptions provided by patients themselves offer valuable insights
into the various mood states associated with bipolar disorder:
I doubt completely my ability to do anything well. It seems as
though my mind has slowed down and burned out to the point of being
virtually useless....[I am] haunt[ed]...with the total, the desperate
hopelessness of it all... Others say, "It's only temporary, it will
pass, you will get over it," but of course they haven't any idea of
how I feel, although they are certain they do. If I can't feel, move,
think, or care, then what on earth is the point?
At first when I'm high, it's tremendous...ideas are fast...like
shooting stars you follow until brighter ones appear...all shyness
disappears, the right words and gestures are suddenly
there...uninteresting people, things, become intensely interesting.
Sensuality is pervasive, the desire to seduce and be seduced is
irresistible. Your marrow is infused with unbelievable feelings of ease,
power, well-being, omnipotence, euphoria...you can do anything...but,
somewhere this changes.
The fast ideas become too fast and there are far too
many...overwhelming confusion replaces clarity...you stop keeping up with
it--memory goes. Infectious humor ceases to amuse. Your friends become
frightened...everything is now against the grain...you are irritable,
angry, frightened, uncontrollable, and trapped.
Recognition of the various mood states is essential so that the person
who has manic-depressive illness can obtain effective treatment and avoid
the harmful consequences of the disease, which include destruction of
personal relationships, loss of employment, and suicide.
Manic-depressive illness is often not recognized by the patient,
relatives, friends, or even physicians.
- An early sign of manic-depressive illness may be hypomania--a state
in which the person shows a high level of energy, excessive moodiness or
irritability, and impulsive or reckless behavior.
- Hypomania may feel good to the person who experiences it. Thus, even
when family and friends learn to recognize the mood swings, the
individual often will deny that anything is wrong.
- In its early stages, bipolar disorder may masquerade as a problem
other than mental illness. For example, it may first appear as alcohol
or drug abuse, or poor school or work performance.
- If left untreated, bipolar disorder tends to worsen, and the person
experiences episodes of full-fledged mania and clinical depression.
Most people with manic depressive illness can be helped with
- Almost all people with bipolar disorder--even those with the most
severe forms--can obtain substantial stabilization of their mood swings.
- One medication, lithium, is usually very effective in controlling
mania and preventing the recurrence of both manic and depressive
- Most recently, the mood stabilizing anticonvulsants carbamazepine and
valproate have also been found useful, especially in more refractory
bipolar episodes. Often these medications are combined with lithium for
- Some scientists have theorized that the anticonvulsant medications
work because they have an effect on kindling, a process in which
the brain becomes increasingly sensitive to stress and eventially begins
to show episodes of abnormal activity even in the absence of a stressor.
It is thought that lithium acts to block the early stages of this
kindling process and that carbamazepine and valproate act later.
- Children and adolescents with bipolar disorder are generally treated
with lithium, but carbamazepine and valproate are also used.
- Valproate has recently been approved by the Food and Drug
Administration for treatment of acute mania.
- The high potency benzodiazepines clonazepam and lorazepam may be
helpful adjuncts for insomnia.
- Thyroid augmentation may also be of value.
- For depression, several types of antidepressants can be useful when
combined with lithium, carbamazepine, or valproate.
- Electroconvulsive therapy (ECT) is often helpful in the treatment of
severe depression and/or mixed mania that does not respond to
- As an adjunct to medications, psychotherapy is often helpful in
providing support, education, and guidance to the patient and his or her
- Constructing a life chart of mood symptoms, medications, and life
events may help the health care professional to treat the illness
- Because manic-depressive illness is recurrent, long-term preventive
(prophylactic) treatment is highly recommended and almost always
Anyone with bipolar disorder should be under the care of a psychiatrist
skilled in the diagnosis and treatment of this disease.
Other mental health professionals, such as psychologists and
psychiatric social workers, can assist in providing the patient and his or
her family with additional approaches to treatment.
Help can be found at:
- University- or medical school-affiliated programs
- Hospital departments of psychiatry
- Private psychiatric offices and clinics
- Health maintenance organizations
- Offices of family physicians, internists, and pediatricians
People With Manic-Depressive Illness Often Need Help To Get Help.
- Often people with bipolar disorder do not recognize how impaired they
are or blame their problems on some cause other than mental illness.
- People with bipolar disorder need strong encouragement from family
and friends to seek treatment. Family physicians can play an important
role for such referral.
- If this does not work, loved ones must take the patient for proper
mental health evaluation and treatment.
- If the person is in the midst of a severe episode, he or she may have
to be committed to a hospital for his or her own protection and for much
- Anyone who is considering suicide needs immediate attention,
preferably from a mental health professional or a physician; school
counselors and members of the clergy can also assist in detecting
suicidal tendencies and/or making a referral for more definitive
assessment or treatment. With appropriate help and treatment, it is
possible to overcome suicidal tendencies.
- It is important for patients to understand that bipolar disorder will
not go away, and that continued compliance with treatment is needed to
keep the disease under control.
- Ongoing encouragement and support are needed after the person obtains
treatment, because it may take a while to discover what therapeutic
regimen is best for that particular patient.
- Many people receiving treatment also benefit from joining mutual
support groups such as those sponsored by the National Depressive and
Manic Depressive Association (NDMDA), the National Alliance for the
Mentally Ill (NAMI), and the National Mental Health Association.
- Families and friends of people with bipolar disorder can also benefit
from mutual support groups such as those sponsored by NDMDA and NAMI.
- National Institute of Mental Health
- Public Inquiries, Room 7C-02
- 5600 Fishers Lane
- Rockville, MD 20857
- National Depressive and Manic Depressive Association
- 730 Franklin Street, Suite 501
- Chicago, IL 60610
- (312) 642-0049; (312) 642-7243 FAX; 1-800-826-3632
- National Alliance for the Mentally Ill
- 200 North Glebe Road, Suite 1015
- Arlington, VA 22203-3754
- (703) 524-7600; (703) 524-9094 FAX; 1-800-950-NAMI (6264)
- National Foundation for Depressive Illness
- P.O. Box 2257
- New York, NY 10116
- (212) 268-4260; (212) 268-4434 FAX; 1-800-248-4344
- National Mental Health Association
- 1021 Prince Street
- Alexandria, VA 22314-2971
- (703) 684-7722; (703) 684-5968 FAX; 1-800-969-NMHA (6642)
The year 1996 marks the fiftieth anniversary of the National Institute
of Mental Health (NIMH). Throughout the past 50 years, the results of
research supported by the Institute have brought new hope to millions of
people who suffer from mental illness and to their families and friends.
In work with animals as well as human participants, researchers have
advanced our understanding of the brain and vastly expanded the capability
of mental health professionals to diagnose, treat, and prevent mental and
During this last decade of the twentieth century--designated "The
Decade of the Brain" by the U.S. Congress--knowledge of brain
function has exploded. Research is yielding information about the causes
of mental disorders such as depression, bipolar disorder, schizophrenia,
panic disorder, and obsessive-compulsive disorder. With this knowledge,
scientists are developing new therapies to help more people overcome
The National Institute of Mental Health is part of the National
Institutes of Health (NIH), the Federal Government's primary agency for
biomedical and behavioral research. NIH is a component of the U.S.
Department of Health and Human Services.
This publication was written by Mary Lynn Hendrix of the Office of
Scientific Information, National Institute of Mental Health. Expert
assistance was provided by Frederick K. Goodwin, M.D., Robert M. Post,
M.D., Hagop S. Akiskal, M.D., and William Z. Potter, M.D.
All material in this pamphlet is free of copyright restrictions and may
be copied, reproduced, or duplicated without permission from the
Institute; citation of the source is appreciated.
- U.S. Department of Health and Human Services
- National Institutes of Health
- NIH Publication No. 95-3679
- September 1995