Bipolar Disorder: Symptoms, Types & Treatment

What Is Bipolar Disorder?

Bipolar disorder is a chronic mental health condition that causes dramatic shifts in mood, energy, activity levels, and the ability to carry out daily tasks. These mood episodes range from manic or hypomanic highs to depressive lows, with periods of normal mood in between. Previously called manic-depressive illness, bipolar disorder affects approximately 1-2.4% of the global population.

Bipolar disorder fundamentally alters how your brain regulates mood, causing you to experience emotional states that are far more intense and prolonged than typical mood fluctuations. Unlike ordinary ups and downs that everyone experiences, the mood episodes in bipolar disorder are severe enough to significantly impair your ability to function at work, school, or in relationships. Understanding this condition is essential because early diagnosis and proper treatment can dramatically improve quality of life.

The condition is characterized by cycling between two opposite poles of mood - hence the name "bipolar." During a manic episode, you may feel extraordinarily energetic, creative, and euphoric, or alternatively, extremely irritable and agitated. These periods can last a week or longer and often involve decreased need for sleep, racing thoughts, and impulsive behavior. During a depressive episode, you experience the opposite extreme - profound sadness, loss of interest in activities you once enjoyed, fatigue, and difficulty concentrating. These episodes can last two weeks or more.

What makes bipolar disorder particularly challenging is that both manic and depressive states can feel genuine and compelling at the time. During mania, the elevated mood and increased productivity can feel wonderful, making it difficult to recognize that something is wrong. Many people enjoy the energy and confidence of hypomanic states and may resist treatment that would reduce these feelings. However, untreated mania can escalate into dangerous behavior, psychosis, or severe depression.

Research has established that bipolar disorder has a strong genetic component. If you have a first-degree relative (parent, sibling, or child) with bipolar disorder, your risk of developing the condition is approximately 10 times higher than the general population. However, genetics alone don't determine whether you'll develop bipolar disorder - environmental factors, life experiences, and brain chemistry all play important roles in its development.

The History of Understanding Bipolar Disorder

The recognition of bipolar disorder dates back to ancient times. Greek physician Aretaeus of Cappadocia first described the connection between mania and depression in the 1st century AD. However, it wasn't until 1854 that French psychiatrists Jules Baillarger and Jean-Pierre Falret independently described the condition as a distinct illness involving cycling moods. The term "manic-depressive" was coined by German psychiatrist Emil Kraepelin in the early 20th century. The current name "bipolar disorder" was introduced in 1980 to reduce stigma and better describe the condition's fundamental nature.

Who Gets Bipolar Disorder?

Bipolar disorder affects people across all demographics, regardless of race, ethnicity, or socioeconomic status. It typically first appears in late adolescence or early adulthood, with the average age of onset being around 25 years. However, the condition can develop at any age, including childhood (though pediatric bipolar disorder presents differently and is more controversial to diagnose). Men and women are affected equally overall, though there are some differences in how the condition manifests between genders - women are more likely to experience rapid cycling and depressive episodes, while men may have more manic episodes.

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder symptoms include manic episodes (elevated mood, decreased sleep need, racing thoughts, increased activity, impulsive behavior) and depressive episodes (persistent sadness, loss of interest, fatigue, sleep changes, feelings of worthlessness, thoughts of death). Symptoms vary between types and individuals, and most people have periods of normal mood between episodes.

The symptoms of bipolar disorder are organized into distinct categories based on the type of mood episode you're experiencing. It's crucial to understand these symptoms because early recognition can lead to faster treatment and better outcomes. Many people live with undiagnosed bipolar disorder for years because they don't recognize their symptoms or only seek help during depressive episodes, not realizing that previous periods of high energy and productivity were actually hypomanic or manic episodes.

Manic Episode Symptoms

A manic episode represents the "high" pole of bipolar disorder and is defined as a distinct period of abnormally elevated, expansive, or irritable mood lasting at least seven days (or any duration if hospitalization is required). During a manic episode, you may experience several of the following symptoms most of the day, nearly every day:

• Abnormally elevated mood: Feeling unusually happy, euphoric, or "on top of the world" without an apparent reason
• Dramatically increased energy and activity: Taking on multiple projects, staying busy constantly, unable to sit still
• Decreased need for sleep: Feeling rested after only a few hours of sleep or going days without sleep without feeling tired
• Racing thoughts: Thoughts jumping rapidly from one idea to another, difficulty concentrating on one thing
• Pressured speech: Talking rapidly, excessively, or being difficult to interrupt
• Grandiosity: Inflated self-esteem, feeling uniquely talented or powerful, believing you have special abilities or connections
• Increased risk-taking: Engaging in pleasurable activities with high potential for painful consequences, such as spending sprees, sexual indiscretions, or foolish business investments
• Distractibility: Attention easily drawn to unimportant or irrelevant things

During a manic episode, your judgment becomes impaired, though you may not realize it at the time. Decisions that seem perfectly reasonable during mania - such as maxing out credit cards, quitting your job to pursue an unrealistic venture, or engaging in risky sexual behavior - often have devastating consequences once the episode passes. Some people describe the experience as feeling invincible, as if nothing could go wrong and normal rules don't apply to them.

Hypomanic Episode Symptoms

Hypomania is essentially a milder form of mania that lasts at least four consecutive days. The symptoms are similar to mania but less severe and don't cause the same level of impairment. You can still function at work and in relationships during hypomania, unlike during a full manic episode. However, hypomania is still a significant departure from your normal baseline and represents a distinct change that is observable by others.

Many people find hypomanic episodes pleasant or even productive. During these periods, you might feel more energetic, creative, and socially confident than usual. You may sleep less but still feel well-rested, accomplish more than usual, and feel generally optimistic. The danger lies in hypomania's potential to escalate into full mania or to precede a depressive crash. Additionally, even "mild" impairments in judgment during hypomania can lead to decisions you later regret.

Depressive Episode Symptoms

Depressive episodes in bipolar disorder are similar to major depressive disorder but are part of the bipolar cycle. A depressive episode lasts at least two weeks and includes five or more of the following symptoms:

• Persistent sad, empty, or hopeless mood: Feeling down, tearful, or emotionally numb most of the day
• Loss of interest or pleasure: Activities that once brought joy no longer seem appealing or worthwhile
• Significant weight changes: Unintentional weight loss or gain, or marked changes in appetite
• Sleep disturbances: Insomnia or sleeping excessively (hypersomnia)
• Psychomotor changes: Restlessness and agitation, or slowed movements and speech noticeable to others
• Fatigue: Loss of energy, feeling exhausted even after rest
• Feelings of worthlessness or guilt: Excessive or inappropriate guilt, harsh self-criticism
• Difficulty thinking: Trouble concentrating, making decisions, or remembering things
• Thoughts of death: Recurrent thoughts of death, suicidal ideation, or suicide attempts

Bipolar depression tends to be particularly severe and debilitating. It often involves more hypersomnia (excessive sleeping), psychomotor slowing, and atypical features compared to unipolar depression. The depressive phases of bipolar disorder typically last longer than manic phases and are responsible for the majority of disability associated with the condition.

Mixed Episodes and Rapid Cycling

Some people experience mixed episodes (also called mixed features), where symptoms of both mania and depression occur simultaneously or in rapid sequence. You might feel energized and agitated while also experiencing hopelessness and suicidal thoughts - a particularly dangerous combination. Mixed episodes are associated with higher suicide risk than pure manic or depressive episodes.

Rapid cycling refers to having four or more mood episodes within a 12-month period. About 10-20% of people with bipolar disorder experience rapid cycling at some point, and it's more common in women. Rapid cycling tends to be associated with poorer treatment response and may be triggered by antidepressant medications.

What Are the Different Types of Bipolar Disorder?

There are several types of bipolar disorder: Bipolar I (full manic episodes), Bipolar II (hypomanic episodes with major depression), Cyclothymic disorder (chronic fluctuating moods that don't meet full criteria), and other specified/unspecified bipolar disorders. The type affects treatment approach and prognosis.

Understanding the different types of bipolar disorder is crucial for accurate diagnosis and effective treatment. While all forms involve mood instability, they differ in the severity and pattern of mood episodes. Getting the correct diagnosis ensures you receive the most appropriate treatment - for example, treating bipolar II with antidepressants alone (without a mood stabilizer) can trigger hypomanic episodes.

Bipolar I Disorder

Bipolar I is characterized by at least one lifetime manic episode lasting at least seven days, or manic symptoms so severe that immediate hospital care is needed. Most people with bipolar I also experience major depressive episodes and hypomanic episodes, but these are not required for diagnosis - the defining feature is the occurrence of full mania.

Manic episodes in bipolar I are severe enough to cause marked impairment in social or occupational functioning. They may include psychotic features such as delusions (false beliefs) or hallucinations. During a manic episode, you might believe you have special powers, are on a mission from God, or are being persecuted. These psychotic symptoms typically resolve when the manic episode ends.

Bipolar II Disorder

Bipolar II involves at least one hypomanic episode and at least one major depressive episode, but no full manic episodes. While sometimes considered "milder" than bipolar I, this characterization is misleading. People with bipolar II often experience more frequent and severe depressive episodes, spending more time in depression overall. The depressive burden in bipolar II can be just as disabling as bipolar I.

Bipolar II can be harder to diagnose because hypomanic episodes may feel good and productive rather than problematic. Many people with bipolar II first seek treatment during a depressive episode and may be initially misdiagnosed with major depressive disorder. This is why it's crucial to mention any periods of unusual energy, decreased sleep need, or elevated mood when being evaluated for depression.

Cyclothymic Disorder

Cyclothymic disorder (cyclothymia) involves chronic fluctuating moods with periods of hypomanic symptoms and periods of depressive symptoms lasting for at least two years (one year in children and adolescents). The symptoms never meet the full criteria for a hypomanic episode or major depressive episode. While less severe than bipolar I or II, cyclothymia is a chronic condition that significantly impacts quality of life and may develop into bipolar I or II over time.

Other Specified and Unspecified Bipolar Disorders

Some people experience bipolar-like symptoms that don't fit neatly into the above categories. This might include very short hypomanic episodes (less than 4 days), hypomanic episodes without enough symptoms, or cycling that's hard to categorize. These conditions are diagnosed as "other specified bipolar and related disorder" or "unspecified bipolar and related disorder."

When Should You Seek Medical Care?

Seek medical care if you experience symptoms of mania or depression that interfere with your daily life, relationships, or work. Seek emergency care immediately if you have thoughts of suicide or self-harm, symptoms so severe you cannot care for yourself, or concerns that you might harm yourself or others.

Many people with bipolar disorder delay seeking treatment, often for years after symptoms first appear. During manic or hypomanic episodes, you may feel better than ever and see no need for help. During depressive episodes, the hopelessness and fatigue can make seeking treatment feel impossible. However, early treatment significantly improves outcomes - the longer bipolar disorder goes untreated, the more episodes you're likely to have, and episodes may become more severe over time.

You should schedule an appointment with a healthcare provider if you recognize symptoms of mania, hypomania, or depression in yourself, especially if:

• Your mood interferes with work, school, or relationships
• You've noticed significant changes in sleep, energy, or activity levels
• You have family members with bipolar disorder or other mood disorders
• You've been treated for depression but haven't responded well to treatment
• Others have expressed concern about changes in your behavior

How Is Bipolar Disorder Diagnosed?

Bipolar disorder is diagnosed through a comprehensive psychiatric evaluation that includes a detailed history of mood episodes, symptom assessment using diagnostic criteria (DSM-5 or ICD-10), physical examination to rule out other causes, blood tests (thyroid function, drug screening), and often input from family members who can provide objective observations.

Accurate diagnosis of bipolar disorder is essential but can be challenging. On average, it takes about 10 years from symptom onset to receive a correct diagnosis, and many people are initially misdiagnosed with major depression, anxiety disorders, or even personality disorders. This delay matters because treating bipolar disorder as unipolar depression (using antidepressants alone) can worsen the condition by triggering manic episodes or accelerating cycling.

A thorough diagnostic evaluation typically begins with your primary care physician, who may then refer you to a psychiatrist for specialized assessment. The evaluation process includes several components:

Clinical Interview

The most important diagnostic tool is a detailed clinical interview. Your healthcare provider will ask about your current symptoms, their duration and severity, and how they affect your daily life. Crucially, they'll also ask about your entire mood history, looking for past episodes that might indicate bipolar disorder even if your current episode is depressive. Be honest and thorough - mention any periods of unusual energy, decreased sleep need, or elevated mood, even if they felt good at the time.

Diagnostic Criteria Assessment

Clinicians use established diagnostic criteria from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10/ICD-11 (International Classification of Diseases) to determine whether your symptoms meet the threshold for bipolar disorder and which type. You may be asked to complete questionnaires such as the Mood Disorder Questionnaire (MDQ) or the Bipolar Spectrum Diagnostic Scale (BSDS) to screen for bipolar features.

Collateral Information

Because insight can be impaired during mood episodes - particularly mania - information from family members or close friends is extremely valuable. They can provide objective observations about changes in your behavior, energy levels, and functioning that you might not recognize in yourself. If possible, bring someone who knows you well to your diagnostic evaluation.

Medical Workup

Your provider will perform or order tests to rule out medical conditions that can mimic bipolar symptoms. These typically include:

• Thyroid function tests: Both overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid can cause mood symptoms
• Complete blood count and metabolic panel: To assess overall health and rule out other conditions
• Drug and alcohol screening: Substance use can cause mood symptoms or trigger episodes
• Brain imaging (in some cases): CT or MRI if there's concern about neurological conditions

How Is Bipolar Disorder Treated?

Bipolar disorder treatment typically involves a combination of medication (mood stabilizers like lithium, anticonvulsants, and/or atypical antipsychotics), psychotherapy (CBT, interpersonal therapy, family therapy), lifestyle modifications (regular sleep, stress management, exercise), and ongoing monitoring. Treatment is lifelong and aims to prevent episodes, reduce symptom severity, and improve quality of life.

Effective treatment of bipolar disorder requires a comprehensive, multimodal approach that addresses both acute episodes and long-term maintenance. The goals of treatment are to reduce the frequency and severity of mood episodes, treat acute symptoms when they occur, improve functioning between episodes, and reduce the risk of suicide. Most people with bipolar disorder need treatment throughout their lives, even when feeling well.

Medication: The Foundation of Treatment

Medication is the cornerstone of bipolar disorder treatment. Unlike unipolar depression where psychotherapy alone can sometimes be effective, bipolar disorder almost always requires medication to achieve stability. The main medication categories include:

Mood Stabilizers

Lithium remains the gold standard mood stabilizer after more than 50 years of use. It's highly effective for preventing both manic and depressive episodes and is the only medication proven to reduce suicide risk in bipolar disorder. Lithium requires regular blood tests to monitor levels (therapeutic range is narrow) and kidney and thyroid function. Common side effects include tremor, increased thirst and urination, and weight gain, but many people tolerate it well.

Valproate (Depakote) is another effective mood stabilizer, particularly useful for rapid cycling or mixed episodes. It requires monitoring of blood levels and liver function. Side effects may include weight gain, sedation, and hair thinning.

Lamotrigine (Lamictal) is especially effective for preventing depressive episodes and is often used in bipolar II. It must be titrated slowly to avoid a rare but serious skin reaction (Stevens-Johnson syndrome). It's generally well-tolerated with fewer side effects than lithium or valproate.

Carbamazepine is sometimes used when other mood stabilizers are ineffective or not tolerated. It has more drug interactions than other options.

Atypical Antipsychotics

Second-generation (atypical) antipsychotics are increasingly used in bipolar disorder, both for acute episodes and maintenance. Options include quetiapine (particularly effective for bipolar depression), olanzapine, risperidone, aripiprazole, and lurasidone. Side effects vary but may include weight gain, metabolic changes, and sedation.

Antidepressants

Antidepressants are used cautiously in bipolar disorder because they can trigger mania or accelerate cycling. When needed for depressive episodes, they should always be combined with a mood stabilizer. Some guidelines recommend avoiding traditional antidepressants entirely in bipolar I.

Psychotherapy

Psychotherapy, combined with medication, significantly improves outcomes in bipolar disorder. Effective therapeutic approaches include:

Cognitive Behavioral Therapy (CBT) helps you identify and change negative thought patterns and behaviors that contribute to mood episodes. It teaches practical skills for managing stress, improving sleep, and recognizing early warning signs.

Interpersonal and Social Rhythm Therapy (IPSRT) focuses on stabilizing daily routines, particularly sleep-wake cycles, and improving interpersonal relationships. It's specifically designed for bipolar disorder.

Family-Focused Therapy involves family members in treatment, improving communication, reducing family stress, and helping loved ones recognize and respond to early warning signs.

Psychoeducation teaches you and your family about bipolar disorder, its treatment, and how to recognize and respond to early warning signs. Understanding your condition is a crucial part of managing it effectively.

Electroconvulsive Therapy (ECT)

ECT is an effective treatment option for severe or treatment-resistant bipolar episodes, particularly severe depression with suicidal thoughts, severe mania, or when medications aren't working or aren't safe (such as during pregnancy). Modern ECT is safe, performed under anesthesia, and can produce rapid improvement when other treatments have failed.

Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS is a non-invasive treatment that uses magnetic pulses to stimulate brain regions involved in mood regulation. It's primarily used for bipolar depression when medications haven't been fully effective. Treatment involves daily sessions over several weeks and doesn't require anesthesia.

How Can You Prevent Mood Episodes?

Preventing bipolar mood episodes involves maintaining consistent medication, prioritizing sleep hygiene, managing stress, avoiding alcohol and drugs, recognizing early warning signs, maintaining regular daily routines, building a strong support system, attending regular appointments, and developing a crisis plan for when symptoms worsen.

While bipolar disorder cannot be cured, many aspects of the condition can be effectively managed to reduce the frequency and severity of mood episodes. Prevention strategies focus on lifestyle modifications, medication adherence, and early intervention when warning signs appear.

Prioritize Sleep

Sleep disruption is perhaps the most potent trigger for manic episodes. Even one night of lost sleep can precipitate mania in vulnerable individuals. To protect your sleep:

• Maintain a consistent sleep schedule, going to bed and waking at the same time daily
• Aim for 7-9 hours of sleep per night
• Avoid night shifts and jobs requiring irregular sleep
• Limit caffeine, especially in the afternoon and evening
• Create a dark, quiet, comfortable sleep environment
• Avoid screens for at least an hour before bed

Take Medication Consistently

Medication adherence is the single most important factor in preventing mood episodes. Many relapses occur because people stop taking their medication, often because they feel well and believe they no longer need it. Remember that feeling well is a sign that your treatment is working, not that you don't need it. If side effects are problematic, work with your doctor to find alternatives rather than stopping on your own.

Monitor Your Mood

Keeping a daily mood diary helps you recognize patterns and early warning signs. Track your mood, sleep, medications, and any significant events or stressors. Many people use smartphone apps for this purpose. Review your mood data with your treatment team to identify triggers and catch episodes early.

Recognize Your Early Warning Signs

Most people have personal early warning signs that precede full mood episodes. These might include sleep changes, subtle mood shifts, increased irritability, or specific behaviors. Learning to recognize your unique warning signs - ideally with input from family members who know you well - allows for early intervention that can prevent a full episode.

Develop a Crisis Plan

Work with your treatment team and family to create a written crisis plan that specifies what to do when warning signs appear or symptoms worsen. Include contact information for your psychiatrist, therapist, trusted family members, and local crisis resources. Specify what interventions have worked in the past and what authority family members have if your judgment becomes impaired.

Avoid Alcohol and Drugs

Substance use is extremely common among people with bipolar disorder but significantly worsens outcomes. Alcohol and recreational drugs can trigger mood episodes, interfere with medications, impair judgment, and increase suicide risk. If you struggle with substance use, seek treatment specifically designed for co-occurring disorders.

What Is It Like Living with Bipolar Disorder?

Living with bipolar disorder involves ongoing treatment, lifestyle adaptations, and learning to manage a chronic condition. With proper care, most people achieve significant stability and lead fulfilling lives with meaningful relationships, successful careers, and personal accomplishments. Recovery is a journey that includes both challenges and growth.

Receiving a diagnosis of bipolar disorder can evoke complex emotions - relief at finally having an explanation for your experiences, grief about having a lifelong condition, and perhaps fear about what the future holds. These reactions are normal and valid. Over time, most people come to integrate their diagnosis into their identity while recognizing that bipolar disorder does not define who they are.

Recovery from bipolar disorder doesn't mean being completely symptom-free (though some people achieve this). Rather, recovery means developing the tools and support to manage your condition effectively, pursuing goals that are meaningful to you, and having a life that feels worth living. Many people with bipolar disorder describe their recovery journey as profoundly transformative, leading to greater self-awareness, resilience, and appreciation for stability.

Work and Career

Most people with well-managed bipolar disorder can maintain successful careers. However, you may need to make accommodations such as prioritizing sleep over overtime, managing stress levels, and possibly having flexibility for appointments. Whether to disclose your diagnosis at work is a personal decision that depends on your workplace culture, the severity of your symptoms, and whether you need formal accommodations.

Relationships

Bipolar disorder can strain relationships, particularly if episodes have caused hurt in the past. Open communication with partners, family, and close friends about your condition, treatment, and warning signs helps build a supportive environment. Couples therapy or family therapy can help repair relationships and improve communication. With treatment and mutual effort, people with bipolar disorder can have healthy, stable, loving relationships.

Connecting with Others

Connecting with others who have bipolar disorder can be incredibly valuable. Support groups - whether in-person or online - provide a space to share experiences, learn from others, and feel less alone. Organizations like the Depression and Bipolar Support Alliance (DBSA) offer peer-led support groups and educational resources.

How Can Family Members and Caregivers Help?

Family members can help by learning about bipolar disorder, recognizing early warning signs, participating in treatment when appropriate, providing practical support during episodes, maintaining their own wellbeing, and helping create a stable, low-stress home environment. Family involvement significantly improves treatment outcomes.

If your loved one has bipolar disorder, your support plays a crucial role in their recovery. At the same time, caring for someone with a serious mental illness can be emotionally and practically demanding. Balancing support for your loved one with care for yourself is essential for both of you.

Educate Yourself

Learn as much as you can about bipolar disorder - its symptoms, treatment, and course. Understanding what your loved one experiences helps you respond with empathy rather than frustration or fear. Attend psychoeducation sessions with your loved one if offered, and consider reading books or attending family support groups.

Participate in Treatment When Appropriate

With your loved one's permission, communicate with their treatment team. Provide information about symptoms you've observed, participate in family therapy sessions, and help monitor medication adherence and warning signs. Establish a plan in advance for what to do during crises, including who to contact and when to seek emergency care.

Recognize Warning Signs

Family members often notice mood changes before the person with bipolar disorder recognizes them. Learn your loved one's specific warning signs - perhaps they become more talkative, irritable, or start staying up late before manic episodes, or withdraw socially and sleep more before depression. Gently point out these observations without being accusatory.

Take Care of Yourself

Caregiver burnout is real and can impair your ability to help your loved one. Maintain your own social connections, hobbies, and self-care routines. Set boundaries to protect your own mental health. Consider joining a support group for families of people with mental illness, such as those offered by NAMI (National Alliance on Mental Illness). Seek your own therapy if needed - caring for a loved one with bipolar disorder can be traumatic, and you deserve support too.

What Causes Bipolar Disorder?

Bipolar disorder results from a complex interaction of genetic factors (highly heritable, multiple genes involved), brain chemistry and structure differences, and environmental triggers (stress, trauma, sleep disruption). No single cause has been identified - rather, it's a combination of vulnerability factors and precipitating events.

Understanding what causes bipolar disorder helps reduce stigma and inform prevention and treatment strategies. While we don't know exactly what causes bipolar disorder, research has identified several contributing factors that interact in complex ways.

Genetic Factors

Bipolar disorder is one of the most heritable psychiatric conditions. If you have a first-degree relative (parent, sibling, or child) with bipolar disorder, your risk is about 10 times higher than the general population. Twin studies show that if one identical twin has bipolar disorder, the other has a 40-70% chance of developing it. However, genetics don't determine destiny - many people with genetic vulnerability never develop the condition, and many people with bipolar disorder have no family history.

No single "bipolar gene" exists. Instead, many genes each contribute a small amount to risk. Research has identified genes involved in neurotransmitter systems, circadian rhythms, and cell signaling, but the genetic picture remains incomplete.

Brain Differences

Brain imaging studies reveal structural and functional differences in people with bipolar disorder, particularly in regions involved in emotion regulation such as the prefrontal cortex and limbic system. Neurotransmitter systems - particularly those involving dopamine, serotonin, and norepinephrine - function differently in bipolar disorder. However, these differences may be consequences of the disorder rather than causes.

Environmental Triggers

Environmental factors can trigger the onset of bipolar disorder in vulnerable individuals and precipitate episodes in those already diagnosed:

• Stressful life events: Both positive and negative stressors can trigger episodes, including job changes, relationship changes, moving, and becoming a parent
• Childhood trauma: Adverse childhood experiences are associated with earlier onset and more severe course
• Sleep disruption: A powerful trigger for manic episodes
• Substance use: Can trigger initial onset and subsequent episodes
• Seasonal changes: Some people have mood episodes that correspond to changes in daylight