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Bipolar disorder: More than just mood swings

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Everyone has times when they feel over the moon and times when they’re down in the dumps. But for people living with bipolar disorder, mood changes can be much more serious and interfere with everyday life.
Written by Marcy Lovitch
Updated on December 26, 2022

It’s normal to have days when you feel up, up, up. And it’s just as normal to come crashing down to earth a day or 2 later. But bipolar disorder is different. It’s a serious mental illness that can cause extreme shifts in your mood.

So what causes bipolar disorder? And who’s at risk? As with most mental health disorders, scientists don’t have all the answers. Here’s what they do know about this disease that affects roughly 5% of adults and 3% of teenagers.

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What is bipolar disorder?

People with bipolar disorder used to be called “manic depressives.” That’s because a person’s mood could go from very high (mania) to very low (depression). But this mental illness doesn’t just cause mood shifts. It also changes the way you act, sleep and even think. It can make it tough for you to hold down a job, go to school or have a relationship.

“An easy way to understand bipolar disorder is to think of it as an energy disorder. The normal flow of energy throughout someone’s life is disrupted,” says William Anixter, MD. He’s a psychiatrist and the director of the community program at CooperRiis, a mental health residential treatment facility in Asheville, North Carolina.

“With bipolar disorder, there are certain times when energy surges and episodes where it drops off drastically. Then the person can switch into a depression or go back to normal, meaning they’re not manic or depressed,” he explains.

So when you go through a manic phase, you might be excited, super happy and productive. You might be chatty and confident. Your thoughts come fast and furious. During the depressive stage, you may feel sad, lonely, hopeless, worthless or lethargic.

Not everyone with bipolar disorder is the same, though. Some people cycle through these shifts every day. Others have 2 to 3 episodes during their lives. And someone else might have that same number in a year. Roughly 1 in 10 people with bipolar disorder will have only 1 episode, according to the American Psychiatric Association.

Are there different types of bipolar disorder?

There are 3 types of bipolar disorder. They all involve clear changes in mood, energy and activity level. The biggest difference is how long those episodes last and how severe they are. But remember, you may not fit into these neat categories.

  • Bipolar I. With this type, you are either very manic or very depressed. The manic episodes last at least 7 days. The depression lasts at least 2 weeks.
  • Bipolar II. The highs in this type aren’t as extreme and don’t last as long. Typically they last 4 days in a row. The lows are the same as with bipolar I, lasting at least 2 weeks.
  • Cyclothymic. You still have emotional ups and downs. But they’re not as extreme, and they don’t last as long.

What causes bipolar disorder?

No one knows exactly. But there are certain risk factors that increase the odds of developing it. They include:

  • Your brain. Magnetic resonance imaging shows that the brains of people with bipolar disorder (or any mental health condition) are different than the brains of those without the condition. It could have to do with the way certain brain chemicals work together. Or the gray matter (the brain’s tissue) might be thinner in some key areas.
  • Your genes. Bipolar disorder runs in families. “If you have bipolar disorder, the chance you have a relative with it is very high. And if a parent has it, there’s a 10% to 20% risk their child will have it too,” says Dr. Anixter.
  • Environmental stressors. This might be something such as a death in the family, a move, even starting college. But the event doesn’t cause bipolar. It triggers it in people who are already at risk. A stressful event can also trigger a relapse.
  • Seasonal changes. The stability of your moods may be very sensitive to light and daylight, similar to what we see with seasonal affective disorder, says Dr. Anixter. “In places with brighter light and more sun, we may see less instances of bipolar disorder,” he adds. Japanese researchers have found that bright light therapy can reduce depression in bipolar patients.

Recommended reading: How your pharmacist can help with depression, anxiety and more.

Who develops bipolar disorder?

Just about anyone can develop it. It tends to show up first when a person is in their late teens or early 20s. But some people may have their first episode in their 40s or 50s. Even kids can have bipolar disorder.

Men and women have it in equal numbers. But the disease may affect them in different ways.

“There is some evidence that men are more likely to have a manic episode as their first bipolar symptom. Women are more likely to experience depression or a mixed episode first. That’s when you experience both manic and depressive symptoms in the same period, says Michele Lucero, PsyD. She’s a licensed psychologist and the administrative director of the behavioral health service line at Mount Sinai South Nassau’s Mental Health Counseling Center in Baldwin, New York.

Women are also more likely to have rapid cycling. That means having 4 or more mood swings in a year. One reason may be women’s fluctuating hormone levels. The key times are right before your period, and during pregnancy, perimenopause and menopause.

“Women can experience different mood swings during these times,” says Dr. Anixter. “There are many behavioral changes that can happen as a result. This may worsen the symptoms of bipolar disorder.”

Another explanation could be that bipolar disorder in women may be going under the radar. Doctors may be misdiagnosing women with depression. So those women get antidepressants instead of specific medications that help bipolar disorder. That was the conclusion of a study published in the International Journal of Bipolar Disorders.

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How is bipolar disorder diagnosed?

Most people get help because their friends or family are worried. But if the person doesn’t think they have a problem (and many people with bipolar disorder don’t), they likely won’t go to a doctor.

“We rarely meet people in their manic state unless they require hospitalization,” says Dr. Anixter. That is more common with bipolar I patients, he adds. If the mania isn’t that severe, “they’re not seeking help because they’re happy and feel good. It’s more likely we’ll meet them when they’re depressed.”

To diagnose bipolar disorder, a provider will do a physical exam. They will also order tests to rule out any other illnesses. If there’s no other explanation, the doctor may refer the person to a psychiatrist or other mental health pro.

How is bipolar disorder treated?

The 2-for-1 punch of medication and psychotherapy is the most effective treatment for bipolar disorder, says Lucero. The 2 most common types of talk therapy are cognitive behavioral therapy and dialectical behavioral therapy.

These types of therapies teach people skills to help them manage unhelpful behaviors and thoughts. For example, you’d learn skills that help you control impulses or how to feel more hopeful when you’re depressed.

There are several other goals in therapy, says Lucero. One is to recognize the warning signs of a manic or depressive phase. The other is to do things that will improve your mood and manage stress. That could be sticking to a consistent routine, exercising more, eating healthy foods and getting more sleep.

Recommended reading: Your top 10 questions about treatment for bipolar disorder.

What are the medications for bipolar disorder?

Doctors want to treat manic symptoms as well as depression. So mood stabilizers are the key to managing bipolar disorder, says Dr. Anixter. Doctors also use antipsychotics in combination with mood stabilizers to help people with both manic and depressive episodes.

Some of the more common medications include:

Sometimes, doctors add antidepressants to manage depression. But since antidepressants have a risk of triggering mania, you usually take the antidepressant with a mood stabilizer.

It may take some time to find the right medication or combination of medications. But keep trying. Medications can make all the difference once you get the right one(s).

Can bipolar disorder be cured?

Sadly, no. But it is treatable and manageable. Taking care of yourself is one good way of managing it. So is finding a good therapist or support group. And, of course, make sure to stay on top of your medications.

The good news: With the right treatment plan, your symptoms can disappear for long periods of time. And that’s important. You’ll be able to get your life back on track without the scary highs and lows.

Be sure to search for your prescription on the Optum Perks discount app before heading to the pharmacy. You could find coupons for up to 80% off.

Additional sources:
Women and bipolar disorder: International Journal of Bipolar Disorders (2021). “Has bipolar disorder become a predominantly female gender related condition? Analysis of recently published large sample studies”
Bipolar overview: Substance Abuse and Mental Health Services Administration
Bipolar statistics: Depression and Bipolar Support Alliance