Bipolar Disorder

Bipolar disorder (manic-depression) is a mood disorder that impacts approximately 4% of the population, compared to a lifetime prevalence of 17% for unipolar depression, and is equally prevalent among men and women. Commonly first diagnosed between the ages of 18 - 24 years, this disorder can have serious and significant effects on families, social relationships, and work life or academic progress. The recent Mental Health Report of the US Surgeon General lists bipolar disorder (along with unipolar depression, schizophrenia, and obsessive-compulsive disorder) as one of the top 10 leading causes of disability in the United States.

Bipolar disorder is characterized by extreme variations in mood, from mania and/or irritability to depression. Alterations in mood (commonly referred to as "mood swings") between mania and depression can be frightening and disturbing for persons who have this disorder as well as family members and those people who know and work with them. Manic episodes can be especially distressing because they are often associated with high-risk behaviors like substance abuse, sexual promiscuity, immoderate spending, violent behavior, and disregard for danger. The capacity for empathy is also typically reduced or absent, leaving family members and others without the usual interpersonal protections and understandings that empathy (knowing how our words and actions affect others) provides.

Bipolar II disorder is characterized by recurring episodes of depression and hypomania. Hypomania differs from full mania in the following ways - although expansive and elevated mood states are present, gross lapses of judgment or impulsive behavior tend not to occur. Hypomania does not impair functioning as significantly as mania, and may even be felt as enhancing functioning by the person with the disorder.

Bipolar disorders can be successfully treated. Medications are available to "prevent" recurrent episodes of depression or mania. These "mood stabilizing" medications include lithium and anticonvulsant medications such as valproic acid.

Criteria for Major Depressive Episode and Manic Episode

Major depressive episode

Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
  • Insomnia or hypersomnia (sleeping too much) nearly every day
  • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide

Manic episode

A. A distinct period of abnormally and persistently elevated, expansive , or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Criteria are excerpted from Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, © 1994, American Psychiatric Association.

Useful Links:


  • Jamison KR: An Unquiet Mind: A Memoir of Moods and Madness. New York, Vintage Books, 1995
  • Mondimore FM: Bipolar Disorder: A Guide for Patients and Families. Baltimore, Johns Hopkins University Press, 1999
  • A Brilliant Madness: Living With Manic-Depressive Illness by Patty Duke, Mary Lou Pinckert, Gloria Hochman
  • The Bipolar Workbook by Monica Ramirez BascoThe Bipolar Survival Guide: What You and Your Family Need to Know by David J. Miklovitz


Adapted with permission from the University of Michigan Depression Center Web site.