2/16/24 - Bipolar disorder is characterized by mood swings ranging from depressive lows to manic highs.
Bipolar disorder affects about 8 million people in the US and an estimated 40 million individuals worldwide. Symptoms of bipolar disorder typically start between age 15 to 25 years, often with an initial episode of depression.
What Are the Types of Bipolar Disorder?
Individuals with bipolar I disorder have at least 1 episode of mania, defined as an elevated or irritable mood lasting at least 1 week that may require hospitalization. Symptoms of mania include impulsivity, risk-taking behavior, restlessness, grandiosity, racing thoughts, decreased need for sleep, increased productivity, and impaired judgment.
Individuals with bipolar II disorder have hypomania (a milder form of mania) for at least 4 consecutive days along with a previous episode of depression.
How Is Bipolar Disorder Diagnosed?
Bipolar disorder is diagnosed in individuals who have episodes of depression and mania. Clinicians should ask all patients with depression about symptoms of mania, such as excessive energy, reduced need for sleep, increased sexuality, and elevated or irritable mood. Family members often can provide insight into their relative’s recent patterns of behavior and decision-making. It is important to identify individuals with bipolar disorder because early diagnosis and treatment often results in a better prognosis.
Approximately 70% of people with bipolar disorder also have an anxiety disorder and slightly more than half have a substance use disorder. Personality disorders affect about one-third of individuals with bipolar disorder and approximately 10% to 20% have attention-deficit/hyperactivity disorder.
How Is Bipolar Disorder Treated?
Medication is the mainstay of treatment for bipolar disorder. Most people with bipolar disorder need lifelong treatment to decrease manic or depressive symptoms, reduce relapses, and improve functioning and quality of life. Treatment should be tailored to a patient’s symptoms, presence of other mental health conditions, prior response to treatment, and personal preferences. Treatment for bipolar disorder typically includes 1 or more of the following:
Mood stabilizers such as lithium, valproate, and lamotrigine
Atypical antipsychotic drugs such as quetiapine, aripiprazole, and cariprazine
Psychotherapy to reduce relapses and symptoms, lower hospitalization rates, and improve medication adherence
Inpatient care if a patient’s judgment is severely impaired during a manic episode
Electroconvulsive therapy, which delivers electrical shocks to the brain under anesthesia, for patients with severe bipolar depression who do not improve with conventional treatments
Life Expectancy of Individuals With Bipolar Disorder
Individuals with bipolar disorder have a life expectancy that is 12 to 14 years shorter than the general population, primarily due to an increased risk of suicide and heart disease. Bipolar disorder is associated with metabolic syndrome (high blood pressure, high blood glucose, excess body fat around the waist, and abnormal cholesterol levels), obesity, cigarette smoking, and type 2 diabetes.
Interventions to Decrease Risk of Heart Disease in Individuals With Bipolar Disorder
Individuals with bipolar disorder who smoke cigarettes benefit from intensive smoking cessation programs with tailored behavioral counseling and care coordination to reduce the risk of heart disease. Physical activity and dietary modifications are recommended for all individuals with bipolar disorder.
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Article Information
Rebecca Voelker, MSJ1
JAMA. Published online February 16, 2024. doi:10.1001/jama.2023.24844