What is bipolar disorder?

Bipolar disorder is a mood disorder that can cause intense mood swings:

• Sometimes you may feel extremely "up," elated, irritable, or energized. This is called a manic episode.
• Other times you may feel "down," sad, indifferent, or hopeless. This is called a depressive episode.
• You may have both manic and depressive symptoms together. This is called a mixed episode.

Along with the mood swings, bipolar disorder causes changes in behavior, energy levels, and activity levels.

Bipolar disorder used to be called other names, including manic depression and manic-depressive disorder.

What are the types of bipolar disorder?

There are three main types of bipolar disorder:

• Bipolar I disorder involves manic episodes that last at least 7 days or manic symptoms so severe that you need immediate hospital care. Depressive episodes are also common. Those often last at least two weeks. This type of bipolar disorder can also involve mixed episodes.
• Bipolar II disorder involves depressive episodes. But instead of full-blown manic episodes, there are episodes of hypomania. Hypomania is a less severe version of mania.
• Cyclothymic disorder, or cyclothymia, also involves hypomanic and depressive symptoms. But they are not as intense or as long-lasting as hypomanic or depressive episodes. The symptoms usually last for at least two years in adults and for one year in children and teenagers.

With any of these types, having four or more episodes of mania or depression in a year is called "rapid cycling."

What causes bipolar disorder?

The exact cause of bipolar disorder is unknown. Several factors likely play a role in the disorder. They include genetics, brain structure and function, and your environment.

Who is at risk for bipolar disorder?

You are at higher risk for bipolar disorder if you have a close relative who has it. Going through trauma or stressful life events may raise this risk even more.

What are the symptoms of bipolar disorder?

The symptoms of bipolar disorder can vary. But they involve mood swings known as mood episodes:

• The symptoms of a manic episode can include
  • Feeling very up, high, or elated
  • Feeling jumpy or wired, more active than usual
  • Having a very short temper or seeming extremely irritable
  • Having racing thoughts and talking very fast
  • Needing less sleep
  • Feeling like you are unusually important, talented, or powerful
  • Do risky things that show poor judgment, such as eating and drinking too much, spending or giving away a lot of money, or having reckless sex
• The symptoms of a depressive episode can include
  • Feeling very sad, hopeless, or worthless
  • Feeling lonely or isolating yourself from others
  • Talking very slowly, feeling like you have nothing to say, or forgetting a lot
  • Having little energy
  • Sleeping too much
  • Eating too much or too little
  • Lack of interest in your usual activities and being unable to do even simple things
  • Thinking about death or suicide
• The symptoms of a mixed episode include both manic and depressive symptoms together. For example, you may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Some people with bipolar disorder may have milder symptoms. For example, you may have hypomania instead of mania. With hypomania, you may feel very good and find that you can get a lot done. You may not feel like anything is wrong. But your family and friends may notice your mood swings and changes in activity levels. They may realize that your behavior is unusual for you. After the hypomania, you might have severe depression.

Your mood episodes may last a week or two or sometimes longer. During an episode, symptoms usually occur every day for most of the day.

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, your health care provider may use many tools:

• A physical exam
• A medical history, which will include asking about your symptoms, lifetime history, experiences, and family history
• Medical tests to rule out other conditions
• A mental health evaluation. Your provider may do the evaluation or may refer you to a mental health specialist to get one.

What are the treatments for bipolar disorder?

Treatment can help many people, including those with the most severe forms of bipolar disorder. The main treatments for bipolar disorder include medicines, psychotherapy, or both:

• Medicines can help control the symptoms of bipolar disorder. You may need to try several different medicines to find which one works best for you. Some people need to take more than one medicine. It's important to take your medicine consistently. Don't stop taking it without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicines.
• Psychotherapy (talk therapy) can help you recognize and change troubling emotions, thoughts, and behaviors. It can give you and your family support, education, skills, and coping strategies. There are several different types of psychotherapy that may help with bipolar disorder.
• Other treatment options include
  • Electroconvulsive therapy (ECT), a brain stimulation procedure that can help relieve symptoms. ECT is most often used for severe bipolar disorder that is not getting better with other treatments. It may also be used when someone needs a treatment that will work more quickly than medicines. This might be when a person has a high risk of suicide or is catatonic (unresponsive).
  • Getting regular aerobic exercise may help with depression, anxiety, and trouble sleeping
  • Keeping a life chart can help you and your provider track and treat your bipolar disorder. A life chart is a record of your daily mood symptoms, treatments, sleep patterns, and life events.

Bipolar disorder is a lifelong illness. But long-term, ongoing treatment can help manage your symptoms and enable you to live a healthy, successful life.

When you have bipolar disorder, you experience frequent mood swings—from extreme lows to extreme highs. Sometimes you feel both at the same time.

You may brush off these changes as "just being moody." But, in reality, you or someone you know could have a serious mental illness.

Bipolar disorder can ruin relationships with spouses, family members, friends, or co-workers. People with the disorder may also think about hurting themselves.

While bipolar disorder is a lifelong illness, medication and talk therapy can help people manage it and lead healthy lives.

Who does it affect?

Bipolar disorder affects 1% to 2% of the U.S. population. About 10% to 15% of people with bipolar disorder have a high risk of suicide.

What are the symptoms?

There are four basic types of bipolar disorder. All of them involve clear changes in mood, energy, and activity levels. The moods are known as manic and depressive episodes.

Bipolar disorder is a lifelong disease, but medication and talk therapy can help people manage it.

What is a depressive episode?

People with bipolar disorder experience severe depression or have low energy for several days or weeks. This is known as a depressive episode. Other symptoms include sleeping too much or too little, worrying a lot, forgetting things, and feeling sad or empty. In severe episodes, suicidal thoughts or behavior may arise. Sufferers may also experience psychotic symptoms, such as delusions.

What is a manic episode?

During a manic episode, people with bipolar disorder find it hard to focus at home, school, or work. They may feel like their mind is racing. People may also feel jumpy or "high," talk fast, and do risky things. Psychotic symptoms are common with manic episodes, and may lead to a misdiagnosis of schizophrenia.

How is bipolar disorder diagnosed?

If you think you or a loved one may have bipolar disorder, speak to your doctor or a mental health care provider. The provider will review your medical history and ask you about your physical and mental health.

How is bipolar disorder treated?

A psychiatrist (doctor who specializes in treating mental illness) can prescribe medication to help you manage your moods and feel like yourself again.

Medications include mood stabilizers, antidepressants, and sleep medicines.

Talk therapy also helps many people with bipolar disorder. You and your provider will decide what treatment plan works best for you.

If you or someone you know is having thoughts about suicide, call the National Suicide Prevention Line at 1-800-273-8255. It is open 24 hours, 7 days a week. Calls are private.

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

• Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
• Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
• Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Researchers are studying the possible causes of bipolar disorder. Most agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness.

Brain Structure and Functioning: Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

The cause of mood disorders, including bipolar disorder, remains unclear. Studies have strongly suggested that genetics play an important role in the development of mood disorders, but there is no clear pattern of inheritance. They are likely caused by the interaction of several genes with environmental factors (called complex or multifactorial inheritance). In the general population (i.e. for individuals with no close family history), the risk to develop manic depressive illness is about 2-3%. Children with a parent or sibling who has bipolar disorder are approximately four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important.

Note for Health Care Providers: People with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania. Taking a careful medical history is essential to ensure that bipolar disorder is not mistaken for major depression. This is especially important when treating an initial episode of depression as antidepressant medications can trigger a manic episode in people who have an increased chance of having bipolar disorder.

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.”

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Medications

Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best.

Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

People taking medication should:

• Talk with their health care provider to understand the risks and benefits of the medication.
• Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
• Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
• Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

Avoid stopping a medication without talking to a health care provider first. Suddenly stopping a medication may lead to a “rebound” or worsening of bipolar disorder symptoms. For basic information about medications, visit NIMH’s Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the U.S. Food and Drug Administration (FDA) Medication Guides website.

Psychotherapy

Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. It can provide support, education, and guidance to people with bipolar disorder and their families. Treatment may include therapies such as cognitive-behavioral therapy (CBT) and psychoeducation, which are used to treat a variety of conditions.

Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy. Determining whether intensive psychotherapeutic intervention at the earliest stages of bipolar disorder can prevent or limit its full-blown onset is an important area of ongoing research.

Other Treatment Options

Some people may find other treatments helpful in managing their bipolar symptoms, including:

Electroconvulsive Therapy (ECT): ECT is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. With modern ECT, a person usually goes through a series of treatment sessions over several weeks. ECT is delivered under general anesthesia and is safe. It can be effective in treating severe depressive and manic episodes, which occur most often when medication and psychotherapy are not effective or are not safe for a particular patient. ECT can also be effective when a rapid response is needed, as in the case of suicide risk or catatonia (a state of unresponsiveness).

More research is needed to determine the effects of other treatments, including:

Transcranial magnetic stimulation (TMS): TMS is a newer approach to brain stimulation that uses magnetic waves. It is delivered to an awake patient most days for 1 month. Research shows that TMS is helpful for many people with various subtypes of depression, but its role in the treatment of bipolar disorder is still under study.

Supplements: Although there are reports that some supplements and herbs may help, not enough research has been conducted to fully understand how these supplements may affect people with bipolar disorder.

It is important for a health care provider to know about all prescription drugs, over-the-counter medications, and supplements a patient is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Beyond Treatment: Things You Can Do

Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.

Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps – including self-reports, self- ratings, and activity data – with their health care providers and therapists.

Finding Treatment

• A family health care provider or doctor is a good resource and can be the first stop in searching for help.
• For general information on mental health and to find local treatment services, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).
• The SAMHSA website has a Behavioral Health Treatment Services Locator that can search for treatment information by address, city, or ZIP code.
• Visit NIMH’s Help for Mental Illnesses webpage for more information and resources.

For Immediate Help

If you are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to everyone. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

If you are thinking about harming yourself or thinking about suicide:

• Tell someone who can help right away.
• Call your licensed mental health professional if you are already working with one.
• Call your doctor or health care provider.
• Go to the nearest hospital emergency department or call 911.

If a loved one is considering suicide:

• Do not leave him or her alone.
• Try to get your loved one to seek immediate help from a doctor, health care provider, or the nearest hospital emergency room or call 911.
• Remove access to firearms or other potential tools for suicide, including medications.

You—or a loved one—feel depressed. Then very excited, or even “hyper.” Then depressed again. These ups and downs can be a sign of bipolar disorder, a brain disorder.

Though there is no cure for this disorder, medications approved by the U.S. Food and Drug Administration can treat symptoms and help you feel better.

Symptoms

Bipolar disorder can be present even if symptoms do not appear extreme. There is more than one type of bipolar disorder: bipolar I disorder and bipolar II disorder.

Bipolar I disorder (also known as manic-depressive illness) causes unusual shifts in mood, energy, activity levels, and the lack of ability to do everyday tasks. Symptoms include periods of depression alternating with periods of energized behavior (called “mania” or “manic episodes”).

In the second type of this disorder, called bipolar II disorder, a person with a less severe manic episode (called “hypomania”) may be productive and may not feel like anything is wrong. But this hypomania can then switch to major depressive episodes. So diagnosis is important.

Symptoms of depression include:

• Feeling very sad or hopeless
• Not having energy
• Feeling like you can’t enjoy anything
• Thinking about death or suicide

Symptoms of mania include:

• An elevated or irritable mood
• Increased activity and restlessness
• Racing thoughts or talking fast
• A decreased need for sleep

“People experiencing mania also can engage in impulsive behavior such as buying sprees and other risky behaviors,” says Mitchell Mathis, M.D., director of the Division of Psychiatry Products at the FDA. “This behavior is unusual for the person and can be dangerous.”

What to Do if You Suspect Bipolar Disorder

If you suspect you have a bipolar disorder, you should be evaluated by a mental health professional.

If you or a loved one has unstable mood symptoms, don’t ignore them. Talk with a doctor or other licensed mental health professional to get help.

“A doctor can complete a medical history, physical exam, and laboratory exam to rule out physical conditions that may cause similar symptoms. If symptoms are not caused by other illnesses, the doctor may then provide a referral to a mental health professional,” Mathis says.

Bipolar Disorder Treatments

“Today, people with bipolar disorder have more FDA-approved treatment options,” Mathis says.

Medications to treat bipolar disorder include:

• mood stabilizers, which help balance certain brain chemicals to prevent mania, hypomania, or depressive episodes
• antipsychotic drugs, which include relatively newer drugs called “atypical antipsychotics”

“Atypical antipsychotics are often used as the first-line treatment in severely manic patients because they work quickly and are, in several ways, safer than the older antipsychotic drugs,” Mathis explains.

That said, medications may have side effects. For instance, side effects of mood stabilizers can include nausea, trembling, and increased thirst. And side effects of antipsychotic medications can include sleepiness, dizziness, and feeling restless.

In addition, if you take atypical antipsychotics, your doctor should regularly monitor your weight, blood sugar, and blood cholesterol, Mathis notes, because these medications can cause problems like weight gain and increased cholesterol.

Treatment for Bipolar Disorder Is Different from Treatment for Depression

With depression (also called “major depressive disorder” or “unipolar depression”), people feel low. But remember bipolar disorder includes lows and highs.

Although patients with depression can be treated with antidepressants, note that antidepressants in bipolar patients can cause manic episodes.

“If you experience manic symptoms, tell your health care provider so that you receive the correct diagnosis and medication,” Mathis says.

Considerations for Pregnant Women

The FDA ensures that approved medications are safe and effective when prescribed according to the labeling. However, the FDA has little information about pregnant women who use antipsychotic drugs because research studies for these medications generally do not include these women.

If you’re being treated for bipolar disorder and are pregnant, planning to become pregnant, or breastfeeding, work with your doctor to consider the risks and benefits of medication.

If you take medication while pregnant, you may be able to help other pregnant women and doctors find out more about the safety of that medication by joining a pregnancy registry. These registries collect data on safety issues during pregnancy. The FDA does not run registries.

The Bottom Line—and What to Do if You’re in Crisis

Everyone responds to treatment differently, so you may need to try several treatments before you find one that’s best for you. But treatment can help.

If you’re ever in crisis or thinking about suicide, immediately tell someone who can help. You can call your doctor, go to a hospital emergency room, or even call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This line is open 24 hours a day, 7 days a week and all calls are confidential.

Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.

• Get treatment and stick with it—recovery takes time and it’s not easy. But treatment is the best way to start feeling better.
• Keep medical and therapy appointments and talk with the provider about treatment options.
• Take all medicines as directed.
• Structure activities: keep a routine for eating and sleeping, and make sure to get enough sleep and exercise.
• Learn to recognize your mood swings and warning signs, such as decreased sleep.
• Ask for help when trying to stick with your treatment.
• Be patient; improvement takes time. Social support helps.
• Avoid misuse of alcohol and drugs.

Remember: Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

Most people feel happy and energized on some days and less so on others. But if these mood changes last for a week or more and are severe—making it hard for you to sleep, stay focused or go to work—it may be a sign of bipolar disorder. Not only can bipolar disorder damage relationships, affect your grades and make it hard to keep a job; it can also be dangerous.

People with bipolar disorder—also called manic-depressive illness—go through extreme changes in mood, energy and behavior. These “mood episodes” can continue for a week or 2, and sometimes longer, with symptoms lasting every day for most of the day.

Sometimes people with bipolar disorder become very sad and much less active. They have trouble concentrating, forget things and lose interest in fun activities. They may try to hurt or even kill themselves. This is called depression.

People with bipolar disorder also go through periods of feeling unusually happy. They become more energetic and active than usual. They become impulsive and take great risks. They might do things that make them lose their jobs, their spouse or all their money. This is called mania. “They don’t see the consequences of their behaviors,” explains Dr. Carlos A. Zarate of NIH’s National Institute of Mental Health (NIMH). “Or they do see it but they don’t care.”

Bipolar disorder is fairly common, but it’s difficult to tell exactly how widespread it is. “There are a variety of illnesses that are similar to bipolar disorder, but with less severe upswings,” says NIMH’s Dr. Francis J. McMahon. Researchers estimate that bipolar disorder affects nearly 6 million American adults in a given year.

Children and teens can also have bipolar disorder. NIMH’s Dr. Ellen Leibenluft, whose work focuses on children, explains that a recent upsurge in diagnoses has led to controversy about whether children with severe irritability, but without clear episodes of mania, are being misdiagnosed as having bipolar disorder. “There really isn’t debate about whether there is bipolar disorder in children,” Leibenluft says. “What’s debated is how common it is.” But the bottom line is that any child diagnosed with bipolar disorder needs help.

Researchers are gaining new insights into what goes awry in the brains of people with bipolar disorder. For example, people with the disorder seem to have different ways of perceiving emotions in others’ faces.

One area that seems to play a role in bipolar disorder is deep inside your brain: the amygdala. “The amygdala tells us what in our environment is emotionally important,” Leibenluft says. “It seems to be acting differently in bipolar disorder, in both adults and children. We see an increased activity in the amygdala in response to emotional triggers in the environment.”

Scientists have also been finding clues in genes. “We’ve known for at least 50 years that the majority of bipolar disorder is caused by genes,” McMahon says, “but those genes have been remarkably difficult to pin down.”

Scientists know that bipolar disorder is largely genetic because of twin studies. When an identical twin has bipolar disorder, their twin, who has the same inherited DNA, also has bipolar disorder 60-80% of the time. Non-identical twins, who share only about half their DNA, tend to share bipolar disorder only about 20% of the time. “That tells us that about two-thirds of the risk for bipolar disorder can be explained by genes,” McMahon says.

McMahon and his colleagues have been comparing the genomes of people with and without bipolar disorder, searching for genetic variations—small genetic differences—that appear more often in people with the disorder.

“We’ve found 3 or 4 genes that are consistently associated with bipolar disorder,” McMahon says. But the genes that researchers have found thus far collectively increase the risk of bipolar disorder by only about 10-20%. McMahon says that many other genes must be involved as well.

If scientists could identify the genetic changes that lead to bipolar disorder, they might eventually be able to design a more accurate test or better treatments for the disorder.

Research may also uncover ways to lower your risk for bipolar disorder. “Even in identical twins, who have identical genes,” McMahon says, “a third escape the illness for reasons we don’t understand. Life experiences or other non-genetic factors may be involved. But we have a poor understanding of what those might be.”

While there’s no cure for bipolar disorder, treatment can help prevent episodes and control their symptoms. Different types of medication can help. So can talk therapy.

If you think you or a family member has bipolar disorder, call your doctor to get assessed. “Getting help sooner rather than later is really important,” McMahon says. “You don’t have to go first to a psychiatrist. Your primary care doctor can get you started.”

If you’re diagnosed with bipolar disorder, Zarate says, learn as much as you can about it. “You as the patient can take responsibility for your own illness and should do everything in your power to stay well,” he says. He suggests mood charting—tracking what brings about episodes and how well the medications are working. Mood charts can help you and your doctor design a more effective treatment plan.

“It’s important to have a good support system of friends and family,” Zarate adds. They can help by learning to spot the signs of an episode and what to do when they see the warning signs.

Be patient. “People sometimes get frustrated,” Zarate says. “These kinds of medications don’t work overnight.” It can take several weeks to control your symptoms—and several months to really stabilize the disorder. So stick to your plan and keep in touch with your doctor.

Don’t be shy about getting help. With treatment, you can lead a successful life.

Dealing with Bipolar Disorder

If you have bipolar disorder, get treatment and stick with it. Here are some tips:

• Talk to your doctor about your treatment.
• Stay on your medication.
• Keep a routine for eating and sleeping.
• Get enough sleep.
• Learn to recognize your mood swings.
• Ask a friend or relative to help you stick with your treatment.
• Be patient. Improvement takes time.
• Chart your moods to help figure out what triggers episodes and how medications are working.

Bev Miller relies on faith, family, and perseverance to stay healthy

Imagine your life as a roller coaster: the excitement of climbing to the top and the terrifying feeling when the roller coaster drops down at lightning-fast speed.

That's what life was like for Bev Miller of Wauseon, Ohio. More than 40 years ago, she was diagnosed with bipolar disorder at the age of 23.

The extreme highs and lows she felt were the symptoms of the disorder, which she now manages with medication.

Highs and lows

At times, she felt energized and on top of the world. She convinced herself that she only needed four hours of sleep.

"My life has more purpose by helping other people. I wouldn't change that."

- Bev Miller

"My mind was always racing like a video on fast-forward," Bev recalls. "Busy, busy, busy. Plans, plans, plans."

Then, she would spiral down into a deep depression.

"You enjoy the climb up a roller coaster so much that you go off into the clouds and remain there until your thoughts come back to reality," Bev says. "But then, you fall from the clouds into a deep, dark hole."

In her 20s, Bev was hospitalized twice because of mania and once for a suicide attempt. Her mood instability and depression would have made it hard to keep a steady job, but Bev was lucky. She worked for her family business and was able to get support when she needed it.

Since then, the stability of living near family, professional counseling, and medication has helped her manage the disease.

Mennonite community

When her pastor told her about an ad in a local magazine seeking people for an NIH clinical study, Bev signed up.

Because they traditionally marry one another, Mennonites have more similar genes than people in the general population. By studying these similar genes, researchers hope to find better treatments for bipolar disorder.

Bev's siblings and many others in her Mennonite community were also tested for bipolar disorder.

Staying mindful

Today, Bev shares her story with others.

Her openness gives others with mental illness the support they need to get counseling and medication.

"My life has more purpose by helping other people. I wouldn't change that," she says.

If you know someone who may be suffering from mental illness, Bev advises you to be mindful of what that person might be going through.

"Instead of saying ‘How are you?' try saying, "Hey, good to see you!" Bev says.

Image credit: Courtesy of Bev Miller

Research investigates genetic links by studying Amish, Mennonites

Researchers are looking to certain U.S. states, including Ohio and Pennsylvania, to better understand bipolar disorder—a mental illness that is often passed down through our genes.

Why look there? That's where many Amish and Mennonite families in the U.S. live. These families tend to have similar genes because they trace their families back to relatively few ancestors and traditionally marry and have children with one another.

Researchers at NIH's National Institute of Mental Health (NIMH) hope that studying these families will explain how—and which—genes carry the disease.

Genetic answers

"Bipolar disorder is one of the most strongly inherited mental illnesses, so we want to understand why people inherit these genes and come up with better ways to treat the disorder," says Francis McMahon, M.D.

Dr. McMahon is chief of the Human Genetics Branch at NIMH's Intramural Research Program. He helps oversee bipolar research at NIH.

Bipolar disorder causes people to have intense mood changes. These moods are stronger than just feeling happy or sad.

Many people are diagnosed with bipolar disorder as adults. But researchers now believe bipolar disorder can start before people are even born.

"We've always known that the risk was linked to genes, but we didn't know what kind of genes caused it," Dr. McMahon says.

"Bipolar disorder is one of the most strongly inherited mental illnesses, so we want to understand why people inherit these genes and then come up with better ways to treat it."

- Francis McMahon, M.D.

Researching stem cells

By studying the genetic material (DNA) in Amish and Mennonite study participants, researchers can track differences in their genes and find out which particular genes increase the risk for bipolar disorder.

But that's just the first step.

Dr. McMahon and his team then use special human cells (stem cells) from these high-risk participants and turn them into brain cells.

While it sounds almost futuristic, the process could have a major impact on future research and treatment.

"Through this research, it's then possible to discover how bipolar genes actually change the brain," Dr. McMahon says. "These changes could show how genes carry the risk of bipolar disorder."

This research will also help us understand why a treatment may work for one patient—but not another.

While improving treatment is key, Dr. McMahon says finding a way to stop bipolar disorder is the ultimate goal.

"Medication can reduce the amount of bipolar episodes, but we also want to cure it," he says.

Getting involved

For people with bipolar disorder or those who just want to help improve research, Dr. McMahon encourages signing up for clinical studies.

"People need to be treated and need to be involved. Those are the best ways to keep a positive attitude about living with mental illness," he says.

A study called the Amish-Mennonite Bipolar Disorder Genetics Study (AMBiGen) needs volunteers.

The study will look at genetic differences that put us at risk for developing mental health issues, like bipolar disorder. Family members with and without mental health challenges are welcome to participate.

Interested in signing up? Call 1-866-644-4363 or send an email to bipolargenes@mail.nih.gov.