What is Bipolar Disorder?

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. 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 people:

D/ART Also:


Bipolar Disorder Involves Cycles of Mania and Depression.

Signs and symptoms of mania include:

Signs and symptoms of depression include:

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:

Depression: "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?"

Hypomania: "At first when I'm high, it's tremendous...ideas are fast...like shooting stars you follow 'til 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."

Mania: 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.

Also in its early stages, bipolar disorder may masquerade as some 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 Bipolar Disorder Can Be Helped With Treatment. Getting Help

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: People With Manic-Depressive Illness Often Need Help To Get Help.


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
2101 Wilson Boulevard, Suite 302
Arlington, VA 22201
(703) 524-7600; (703) 524-9094 FAX; 1-800-950-NAMI (6264)

National Foundation for Depressive Illness
P.O. Box 2257
New York, NY 10016
(212) 268-4260; (212) 268-4434 FAX; 1-800-248-4344

National Mental Health Association
1201 Prince Street
Alexandria, VA 22314-2971
(703) 684-7722; (703) 684-5968 FAX; 1-800-969-6942


Research conducted and supported by the National Institute of Mental Health (NIMH) brings hope to millions of people who suffer from mental illness and to their families and friends. In many years of work with animals as well as human subjects, researchers have advanced our understanding of the brain and vastly expanded the capability of mental health professionals to diagnose, treat, and prevent mental and brain disorders.

Now, in the 1990s, which the President and Congress have declared "The Decade of the Brain," we stand at the threshold of a new era in brain and behavioral sciences. Through research, we will learn even more about mental disorders such as depression, manic-depressive illness, schizophrenia, panic disorder, and obsessive-compulsive disorder. And we will be able to use this knowledge to develop new therapies that can help more people overcome mental illness.

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.

All material appearing in this brochure is in the public domain and may be reproduced or copied without permission from the Institute; citation of the source is appreciated.


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., and Hagop S. Akiskal, M.D., NIMH staff members. Their help in assuring the accuracy of this pamphlet is gratefully acknowledged.

U.S. Department of Health and Human Services Public Health Service

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