Introduction: Bipolar Disorder 

This booklet discusses bipolar disorder in adults. For information on bipolar  disorder in children and adolescents, see the NIMH booklet, “Bipolar Disorder in  Children and Teens: A Parent’s Guide.” 

What is bipolar disorder? 

Bipolar disorder, also known as manic-depressive illness, is a brain disorder  that causes unusual shifts in mood, energy, activity levels, and the ability to  carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are  different from the normal ups and downs that everyone goes through from time to  time. Bipolar  disorder symptoms can result in damaged relationships, poor job or  school performance, and even suicide. But bipolar disorder can be treated, and  people with this illness can lead full and productive lives. 

Bipolar disorder often develops in a person's late teens or early adult  years. At least half of all cases start before age 25. Some people  have their first symptoms during childhood, while others may develop symptoms  late in life. 

Bipolar disorder  is not easy to spot when it starts. The symptoms may seem  like separate problems, not recognized as parts of  a larger problem. Some people  suffer for years before they are properly diagnosed and treated. Like diabetes  or heart disease, bipolar disorder is a long-term  illness that must be carefully  managed throughout a person's life. 

What are the symptoms of bipolar disorder? 

People with bipolar disorder experience unusually intense emotional states  that occur  in distinct periods called "mood episodes." An overly joyful or  overexcited state is called a manic episode, and an extremely sad or hopeless  state is called a depressive episode. Sometimes, a mood episode includes  symptoms of both mania and depression. This is called a mixed state. People with  bipolar disorder also may be explosive and irritable during a mood episode. 

Extreme changes in energy, activity, sleep, and behavior go along with these  changes in mood. It is possible for someone with bipolar disorder to experience  a long-lasting period of unstable moods rather than discrete episodes of  depression or mania. 

A person may be having an episode of bipolar disorder if he or she has a  number of manic or depressive symptoms for most of the day, nearly every day,  for at least one or two weeks. Sometimes symptoms are so severe that the person  cannot function normally at work, school, or home. 

Symptoms of bipolar disorder are described below. 

Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes  A long period of feeling "high," or an overly happy or outgoing mood  Extremely irritable mood, agitation, feeling "jumpy" or  "wired."  Behavioral Changes  Talking very fast, jumping from one idea to another, having racing thoughts  Being easily distracted  Increasing goal-directed activities, such as taking on new projects  Being restless  Sleeping little  Having an unrealistic belief in one's abilities  Behaving impulsively and taking part in a lot of pleasurable, high-risk  behaviors, such as spending sprees, impulsive sex, and impulsive business  investments.

Mood Changes  A long period of feeling worried or empty  Loss of interest in activities once enjoyed, including  sex.  Behavioral Changes  Feeling tired or "slowed down"  Having problems concentrating, remembering, and making decisions  Being restless or irritable  Changing eating, sleeping, or other habits  Thinking of death or suicide, or attempting  suicide.

In addition to mania and depression, bipolar disorder can cause a range of  moods, as shown on the scale. 

One side of the scale includes severe depression, moderate depression,  and mild low mood. Moderate depression may cause less extreme symptoms, and mild low  mood is called dysthymia when it is chronic or long-term. In the middle of the  scale is normal or balanced mood. 

At the other end of the scale are hypomania and severe mania. Some people  with bipolar disorder experience hypomania. During hypomanic episodes, a person  may have increased energy and activity levels that are not as severe as typical  mania, or he or she may have episodes that last less than a week and do not  require emergency care. A person having a hypomanic episode may feel very good,  be highly productive, and function well.  This person may not feel that anything  is wrong even as  family and friends recognize the mood swings as possible  bipolar disorder. Without proper treatment, however, people with hypomania may  develop severe mania or depression. 

During a mixed state, symptoms often include agitation, trouble sleeping,  major changes in appetite,  and suicidal thinking. People in a mixed state may  feel very sad or hopeless while feeling extremely energized. 

Sometimes, a person with severe episodes of mania or depression has psychotic  symptoms too, such as hallucinations or delusions. The psychotic symptoms tend  to reflect  the person's extreme mood. For example, psychotic symptoms for a  person having a manic episode may include believing he or she is famous, has a  lot  of money, or has special powers. In the same way, a person having a  depressive episode may believe he or she is ruined and penniless, or has  committed a crime. As a result, people with bipolar disorder who have psychotic  symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe  mental illness that is linked with hallucinations and delusions. 

People with bipolar disorder may also have behavioral problems. They may  abuse alcohol or substances, have relationship problems, or perform poorly in  school or at work. At first, it's not easy  to recognize these problems as signs  of a major mental illness. 

How does bipolar disorder affect someone over  time? 

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression  typically come back over time. Between episodes, many people with bipolar  disorder are free of symptoms, but some people may have lingering symptoms. 

Doctors usually diagnose mental disorders using guidelines from the  Diagnostic and Statistical Manual of Mental Disorders, or DSM. According  to the DSM, there are four basic types of bipolar disorder: 

1. Bipolar I Disorder  is mainly defined by manic or mixed  episodes that last at least seven days, or by manic symptoms that are so severe  that the person needs immediate hospital care. Usually, the person also has  depressive episodes, typically lasting at least two weeks. The symptoms of mania  or depression must  be a major change from the person's normal behavior. 
2. Bipolar II Disorder  is defined by a pattern of depressive  episodes shifting back and forth with hypomanic episodes, but no full-blown  manic or mixed episodes. 
3. Bipolar Disorder Not Otherwise Specified (BP-NOS)  is  diagnosed when a person has symptoms of the illness that do not meet diagnostic  criteria for either bipolar I or II. The symptoms may not last long enough, or  the person may have too few symptoms, to be diagnosed with bipolar I or II.  However, the symptoms are clearly out of the person's normal range of behavior. 
4. Cyclothymic Disorder, or Cyclothymia, is a mild form of  bipolar disorder. People who have cyclothymia have episodes of hypomania that  shift back and forth with mild depression for  at least two years. However,  the symptoms do not meet the diagnostic requirements for any other type  of bipolar  disorder. 

Some  people may be diagnosed  with rapid-cycling bipolar  disorder. This is when a person has four or more episodes of major  depression, mania, hypomania, or mixed symptoms within a year. Some  people experience more than one episode in a week, or even within one day. Rapid  cycling seems to be more common in people who have severe bipolar disorder and  may be more common in people who have their first episode at a younger age. One  study found that people with rapid cycling had their first episode about four  years earlier, during mid to late teen years, than people without rapid cycling  bipolar disorder. Rapid cycling affects more women than  men. 

Bipolar disorder tends to worsen if it is not treated. Over time, a person  may  suffer more frequent and more severe episodes than when the illness first  appeared. Also, delays in getting the correct diagnosis and  treatment make a person more likely to experience personal, social, and  work-related problems. 

Proper diagnosis and treatment helps people with bipolar disorder lead  healthy and productive lives. In most cases, treatment can help reduce the  frequency and severity of episodes. 

What illnesses often co-exist with bipolar  disorder? 

Substance abuse is very common among people with bipolar disorder, but the  reasons for this link are unclear. Some people with bipolar disorder  may try to treat their symptoms with alcohol or drugs. However, substance abuse  may trigger or prolong bipolar symptoms, and the behavioral control problems  associated with mania can result in a person drinking too much. 

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social  phobia, also co-occur often among people with bipolar disorder.   Bipolar disorder also co-occurs with attention deficit hyperactivity disorder  (ADHD), which has some symptoms that overlap with bipolar disorder, such as  restlessness and being easily distracted. 

People with bipolar disorder are also at higher risk for thyroid disease,  migraine headaches, heart disease, diabetes, obesity, and other physical  illnesses. These illnesses may cause symptoms of mania or  depression. They may also result  from treatment for bipolar disorder. 

Other illnesses can make it hard to diagnose and treat bipolar disorder.  People with bipolar disorder should monitor their physical and mental health. If  a symptom does not get better with treatment, they should tell their doctor. 

What are the risk factors for bipolar  disorder? 

Scientists are learning about the possible causes of bipolar disorder. Most  scientists agree that there is no single cause. Rather, many factors likely act  together to produce the illness or increase risk. 

Genetics 

Bipolar  disorder tends to run in families, so researchers are looking for  genes that may increase a person's chance  of developing the illness. Genes are  the "building blocks" of heredity. They help control how the body and brain work  and grow. Genes are contained inside a person's cells that are passed down from  parents to children. 

Children with a parent or sibling who has bipolar disorder are four to six  times more likely to develop the illness, compared with children who do not have  a family history of bipolar disorder. However, most children with a  family history of bipolar disorder will not develop the illness. 

Genetic research on bipolar disorder is being helped by advances in  technology. This type of research is now much quicker and more far-reaching  than in the past. One example is the launch of the Bipolar Disorder Phenome Database,  funded in part by NIMH. Using the database, scientists will be able to link  visible signs of the disorder with the genes that may influence them. So far,  researchers using this database found that most people with bipolar disorder  had: 

• Missed work because of their illness 
• Other illnesses at the same time, especially alcohol and/or substance abuse  and panic disorders 
• Been treated  or hospitalized for  bipolar disorder. 

The researchers also identified certain traits that appeared to run in  families, including: 

• History of psychiatric hospitalization 
• Co-occurring obsessive-compulsive  disorder (OCD) 
• Age at first manic episode 
• Number and frequency of manic episodes. 

Scientists continue to study these traits, which may help them find the genes  that cause bipolar disorder some day. 

But genes are not the only risk factor for bipolar disorder. Studies of  identical twins have shown that the twin of a person with bipolar illness does  not always develop the disorder. This  is important because identical twins share  all of the same genes. The study results suggest factors besides genes are also  at work. Rather, it is likely that many different genes and a person's  environment are involved. However, scientists do not yet fully understand how  these factors interact to cause bipolar disorder. 

Brain structure and functioning 

Brain-imaging studies are helping scientists learn what happens in the brain  of a person with bipolar disorder.  Newer brain-imaging tools,  such as functional magnetic resonance imaging (fMRI) and positron emission  tomography (PET), allow researchers to take pictures of the living brain at  work. These tools help scientists study the brain's structure and activity. 

Some imaging studies show how the brains of people with bipolar disorder may  differ from the brains of healthy people or people with other mental disorders.  For example, one study using MRI found that the pattern of brain development in  children with bipolar disorder was similar to that in children with  "multi-dimensional impairment," a disorder that causes symptoms that overlap  somewhat with bipolar disorder and schizophrenia.   This suggests  that the common pattern of brain development may be linked to general risk for  unstable moods. 

Learning  more about these differences, along with information gained from  genetic studies, helps scientists better understand bipolar disorder. Someday  scientists may be able to predict which types  of treatment will work most  effectively. They may even find ways to prevent bipolar disorder. 

How is bipolar disorder diagnosed? 

The first step in getting a proper diagnosis is to talk to a doctor, who may  conduct a physical examination, an interview, and lab tests. Bipolar disorder  cannot currently be identified through a blood test or a brain scan, but these  tests can help rule out other contributing factors, such as a stroke or brain  tumor. If the problems are not caused by other illnesses, the doctor may conduct  a mental health evaluation. The doctor may also provide a referral to a trained  mental health professional, such as a psychiatrist, who is experienced in  diagnosing and treating bipolar disorder. 

The doctor or mental health professional should conduct a complete diagnostic  evaluation. He or she should discuss any family history of bipolar disorder or  other mental illnesses and get a complete history of symptoms. The doctor or  mental health professionals should also talk to the person's close relatives or  spouse and note how they describe the person's symptoms and family medical  history. 

People with bipolar disorder are more likely to seek help when they are  depressed than when experiencing mania or hypomania. Therefore, a  careful medical history is needed to assure that bipolar disorder is not  mistakenly diagnosed as major depressive disorder, which is also called unipolar  depression. Unlike people with bipolar disorder, people who have unipolar  depression do not experience mania. Whenever possible, previous records and  input from family and friends should also be included in the medical  history. 

How is bipolar disorder treated? 

To date, there is no cure for bipolar disorder. But proper treatment helps  most people with bipolar disorder gain better control of their mood swings and  related symptoms. This is also true for people with the most  severe forms of the illness. 

Because bipolar disorder is a lifelong and recurrent illness, people with the  disorder need long-term treatment to maintain control of bipolar symptoms. An  effective maintenance treatment plan includes medication and psychotherapy for  preventing relapse and reducing symptom severity. 

Medications 

Bipolar disorder can be diagnosed and medications prescribed by people with  an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a  psychiatrist. In some states, clinical psychologists, psychiatric nurse  practitioners, and advanced psychiatric nurse specialists can also prescribe  medications. Check with your state's licensing agency to find out more. 

Not everyone responds to medications in the same way. Several different  medications may need to be tried before the best course of treatment is  found. 

Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life  events can help the doctor track and treat the illness most effectively.  Sometimes this is called a daily life chart. If a person's symptoms change or if  side effects become serious, the doctor may switch or add medications. 

Some of the types of medications generally used to treat bipolar disorder are  listed on the next page. Information on medications can change. For the most up  to date information on use and side effects contact the  U.S. Food and Drug Administration (FDA). 

1. Mood stabilizing medications  are usually the first choice  to treat bipolar disorder. In general, people with bipolar disorder continue  treatment with mood stabilizers for years. Except for lithium, many of these  medications are anticonvulsants. Anticonvulsant medications are usually used to  treat seizures, but they also help control moods. These medications are commonly  used as mood stabilizers in bipolar disorder: 

• Lithium (sometimes known as Eskalith or Lithobid) was the first  mood-stabilizing medication approved by the U.S. Food and Drug Administration  (FDA) in the 1970s for treatment of mania. It is often very effective in  controlling symptoms of mania and preventing the recurrence of manic and  depressive episodes. 
• Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995  for treating mania, is a popular alternative to lithium for bipolar disorder. It  is generally as effective as lithium for treating bipolar disorder.^23,  24  Also see the section in this booklet, "Should  young women take valproic  acid?" 
• More recently, the anticonvulsant lamotrigine (Lamictal) received FDA  approval for maintenance treatment of bipolar disorder. 
• Other anticonvulsant medications, including gabapentin (Neurontin),  topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No  large studies have shown that these medications are more effective than mood  stabilizers. 

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA  warning. The warning states that their use may increase the risk of suicidal  thoughts and behaviors. People taking anticonvulsant medications for bipolar or  other illnesses should be closely monitored for new or worsening symptoms of  depression, suicidal thoughts or behavior, or any unusual changes in mood or  behavior. People taking these medications should not make any changes without  talking to their health care professional. 

1. Atypical antipsychotic medications  are sometimes used to  treat symptoms of bipolar disorder. Often, these medications are taken with  other medications. Atypical antipsychotic medications are called "atypical" to  set them apart from earlier medications, which are called "conventional" or  "first-generation" antipsychotics. 

• Olanzapine (Zyprexa), when given with an antidepressant medication, may help  relieve symptoms of severe mania or psychosis. Olanzapine is also  available in an injectable form, which quickly treats agitation associated with  a manic or mixed episode. Olanzapine can be used for maintenance treatment of  bipolar disorder as well, even when a person does not have psychotic symptoms.  However, some studies show that people taking olanzapine may gain weight and  have other side effects that can increase their risk for diabetes and heart  disease. These side effects are more likely in people taking olanzapine when  compared with people prescribed other atypical antipsychotics. 
• Aripiprazole (Abilify), like olanzapine, is approved for treatment of a  manic or mixed episode. Aripiprazole is also used for maintenance treatment  after a severe or sudden episode. As with olanzapine, aripiprazole also can be  injected for urgent treatment of symptoms of manic or mixed episodes of bipolar  disorder. 
• Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic  episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it  became the first atypical antipsychotic to also receive FDA approval for the  treatment of bipolar depressive episodes. 
• Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical  antipsychotics that may also be prescribed for controlling manic or mixed  episodes. 

1. Antidepressant medications  are sometimes used to treat  symptoms of depression in bipolar disorder. People with bipolar disorder who  take antidepressants often take a mood stabilizer too. Doctors usually require  this because taking only an antidepressant can increase a person's risk of  switching to mania or hypomania, or of developing rapid cycling  symptoms. To prevent this switch, doctors who prescribe  antidepressants for treating bipolar disorder also usually require the person to  take a mood-stabilizing medication at the same time. 

Recently, a large-scale, NIMH-funded study showed that for many people,  adding an antidepressant to a mood stabilizer is no more effective in treating  the depression than using only a mood stabilizer. 

• Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion  (Wellbutrin) are examples of antidepressants that may be prescribed to treat  symptoms of bipolar depression. 

Some medications are better at treating one type of bipolar symptoms than  another. For example, lamotrigine (Lamictal) seems to be helpful in controlling  depressive symptoms of bipolar disorder. 

What are the side  effects of these medications? 

Before starting a new medication, people with bipolar disorder should talk to  their doctor about the possible risks and benefits. 

The psychiatrist prescribing the medication or pharmacist can also answer  questions about side effects. Over the last decade, treatments have improved,  and some medications now have fewer or more tolerable side effects than earlier  treatments. However, everyone responds differently to medications. In some  cases, side effects may not appear until a person has taken a medication for  some time. 

If the person with bipolar disorder develops any severe side effects from a  medication, he or she should talk to the doctor who prescribed it as soon as  possible. The doctor may change the dose or prescribe a different medication.  People being treated for bipolar disorder should not stop taking a medication  without talking to a doctor first. Suddenly stopping a medication may lead to  "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or  potentially dangerous withdrawal effects are also possible. 

The following sections describe some common side effects of the different  types of medications used to treat bipolar disorder. 

1. Mood Stabilizers 

In some cases, lithium can cause side effects such as: 

• Restlessness  
• Dry mouth 
• Bloating or indigestion 
• Acne  
• Unusual discomfort to cold temperatures 
• Joint or muscle pain 
• Brittle nails or hair. 

Lithium also causes side effects not listed here. If extremely bothersome or  unusual side effects occur, tell your doctor as soon as possible. 

If a person with bipolar disorder is being treated with lithium, it is  important to make regular visits to the treating doctor. The doctor needs to  check the levels of lithium in the person's blood, as  well as kidney and thyroid  function. 

Common side effects of other mood stabilizing medications include: 

• Drowsiness  
• Dizziness  
• Headache  
• Diarrhea  
• Constipation  
• Heartburn  
• Mood swings 
• Stuffed or runny nose, or other cold-like  symptoms. 

2. Atypical Antipsychotics 

Some people have side effects when they start taking atypical antipsychotics.  Most side effects go away after a few days  and often can be managed  successfully. People who are taking antipsychotics should not drive until they  adjust to their new medication. Side effects of many antipsychotics include: 

• Drowsiness  
• Dizziness when changing positions 
• Blurred vision 
• Rapid heartbeat 
• Sensitivity to the sun 
• Skin rashes 
• Menstrual problems for women. 

Atypical antipsychotic medications can cause major weight gain and changes in  a person's metabolism. This may increase a person's risk of getting diabetes and  high cholesterol.³⁸  A person's weight, glucose levels, and lipid  levels should be monitored regularly by a doctor while taking these  medications. 

In rare cases, long-term use of atypical antipsychotic drugs may lead to a  condition called tardive dyskinesia (TD). The condition causes muscle movements  that commonly occur around the mouth. A person with TD cannot control these  moments. TD can range from mild to severe, and it cannot always be cured. Some  people with TD recover partially or fully after they stop taking the drug. 

3. Antidepressants 

The antidepressants most commonly prescribed for treating symptoms of bipolar  disorder can also cause mild side effects that usually do not last long. These  can include: 

• Headache, which usually goes away within a few days. 
• Nausea (feeling sick to your stomach), which usually goes away within a few  days. 
• Sleep problems, such as sleeplessness or drowsiness. This may happen during  the first few weeks but then go away. To help lessen these effects, sometimes  the medication dose can be reduced, or the time of day it is taken can be  changed. 
• Agitation (feeling jittery). 
• Sexual problems, which can affect both men and women. These include reduced  sex drive and problems having and enjoying sex. 

Some antidepressants are more likely to cause certain side effects than other  types. Your doctor or pharmacist can answer questions about these medications.  Any unusual reactions or side effects should be reported to a doctor  immediately. 

For the most up-to-date information on medications for treating bipolar  disorder and their side effects, please see the online  NIMH  Medications booklet. 

Psychotherapy 

In addition to medication, psychotherapy, or "talk" therapy, can be an  effective treatment for bipolar disorder. It can provide support, education, and  guidance to people with bipolar disorder and their families. Some psychotherapy  treatments used to treat bipolar disorder include: 

1. Cognitive behavioral therapy (CBT)  helps people with  bipolar disorder learn to change harmful or negative thought patterns and  behaviors. 
2. Family-focused therapy  includes family members. It helps  enhance family coping strategies, such as recognizing new episodes early and  helping their loved one. This therapy also improves communication and  problem-solving. 
3. Interpersonal and social rhythm therapy  helps people with  bipolar disorder improve their relationships with others and manage their daily  routines. Regular daily routines and sleep schedules may help protect against  manic episodes. 
4. Psychoeducation  teaches people with bipolar disorder about  the illness and its treatment. This treatment helps people recognize signs of  relapse so they can seek treatment early, before a full-blown episode occurs.  Usually done in a group, psychoeducation may also be helpful for family members  and caregivers. 

A licensed psychologist, social worker, or counselor typically provides these  therapies. This  mental health professional often works with the psychiatrist to  track progress. The number, frequency,  and type of sessions should be based on  the treatment needs of each person. As with medication, following the doctor's  instructions  for any psychotherapy will provide the greatest benefit. 

For more information, see the  Substance  Abuse and Mental Health Services Administration  web page on choosing a  mental health therapist. 

Recently, NIMH funded a clinical trial called the  Systematic  Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the  largest treatment study ever conducted for bipolar disorder. In a study on  psychotherapies, STEP-BD researchers compared people in two groups. The first  group was treated with collaborative care (three sessions  of psychoeducation  over six weeks). The second group was treated  with medication and intensive  psychotherapy (30 sessions  over nine months of CBT, interpersonal and social  rhythm therapy, or family-focused therapy). Researchers found that the second  group had fewer relapses, lower hospitalization rates, and were better able to  stick with their treatment plans.   They were also more likely to get  well faster and stay well longer. 

NIMH is supporting more research on which combinations of psychotherapy and  medication work best. The goal is to help people with bipolar disorder live  symptom-free for longer periods and to recover from episodes more quickly.  Researchers also hope to determine whether psychotherapy helps delay the start  of bipolar disorder in children at high risk for the illness. 

Visit the NIMH Web site for more information on  psychotherapy. 

Other treatments 

1. Electroconvulsive Therapy (ECT)—For cases in which  medication and/or psychotherapy does not work, electroconvulsive therapy (ECT)  may be useful. ECT, formerly known as "shock therapy," once had a bad  reputation. But in recent years, it has greatly improved and can provide relief  for people with severe bipolar disorder who have not been able to feel better  with other treatments. 

   Before ECT is administered, a patient takes a muscle relaxant and is put  under brief anesthesia. He or she does not consciously feel the electrical  impulse administered in ECT. On average, ECT treatments last from 30–90 seconds.  People who have ECT usually recover after 5–15 minutes  and are able to go home  the same day. 

   Sometimes ECT is used for bipolar symptoms when other medical conditions,  including pregnancy, make the use of medications too risky. ECT is a highly  effective treatment for severely depressive, manic, or mixed episodes, but is  generally not a first-line treatment. 

   ECT may cause some short-term side effects, including confusion,  disorientation, and memory loss. But these side effects typically clear soon  after treatment. People with bipolar disorder should discuss possible benefits  and risks of ECT with an experienced doctor. 

2. Sleep Medications—People with bipolar disorder who have  trouble sleeping usually sleep better after getting treatment for bipolar  disorder. However, if sleeplessness does not improve, the doctor may suggest a  change in medications. If the problems still continue, the doctor may prescribe  sedatives or other sleep medications. 

People with bipolar disorder should tell their doctor about all prescription  drugs, over-the-counter medications, or supplements they are taking. Certain  medications and supplements taken together may cause unwanted or dangerous  effects. 

What can people with bipolar disorder expect from  treatment? 

Bipolar disorder has no cure, but can be effectively treated over the  long-term. It is best controlled when treatment is continuous, rather than on  and off. In the STEP-BD study, a little more than half of the people treated for  bipolar disorder recovered over one year's time. For this study, recovery meant  having two or fewer symptoms of the disorder for at least eight weeks. 

However, even with proper treatment, mood changes can occur. In the STEP-BD  study, almost half of those who recovered still had lingering symptoms. These  people experienced a relapse or recurrence that was usually a return to a  depressive state.If a person had a mental illness in addition to  bipolar disorder, he or she was more likely to experience a  relapse. Scientists are unsure, however, how these other illnesses  or lingering symptoms increase the chance of relapse. For some people, combining  psychotherapy with medication may help to prevent or delay  relapse. 

Treatment may be more effective when people work closely with a doctor and  talk openly about their concerns and choices. Keeping track of mood changes and  symptoms with a daily life chart can help a doctor assess a person's response to  treatments. Sometimes the doctor needs to change a treatment plan to make sure  symptoms are controlled most effectively. A psychiatrist should guide any  changes in type or dose of medication. 

How can I help a friend or relative who has  bipolar disorder? 

If you know someone who has bipolar disorder, it affects you too. The first  and most important thing you can do is help him or her get the right diagnosis  and treatment. You may need to make the appointment and go with him or her to  see the doctor. Encourage your loved one to stay in treatment. 

To help a friend or relative, you can: 

• Offer emotional support, understanding, patience, and encouragement 
• Learn about bipolar disorder so you can understand what your friend or  relative is experiencing 
• Talk to your friend or relative and listen carefully 
• Listen to feelings your friend or relative expresses-be understanding about  situations that may trigger bipolar symptoms 
• Invite your friend or relative out for positive distractions, such as walks,  outings, and other activities 
• Remind your friend or relative that, with time and treatment, he or she can  get better. 

Never ignore comments about your friend or relative harming himself or  herself. Always report such comments to his or her therapist or doctor. 

Support for caregivers 

Like other serious illnesses, bipolar disorder can be difficult for spouses,  family members, friends, and other caregivers. Relatives and friends often have  to cope with the person's serious behavioral problems, such as wild spending  sprees during mania, extreme withdrawal during depression, poor work or school  performance. These behaviors can have lasting consequences. 

Caregivers usually take care of the medical needs of their loved ones. The  caregivers have to deal with how this affects their own health. The stress that  caregivers are under may  lead to missed work or lost free time, strained  relationships with people who may not understand the situation, and physical and  mental exhaustion. 

Stress from caregiving can make it hard to cope with a loved one's bipolar  symptoms. One study shows that if a caregiver is under a lot of stress, his or  her loved one has more trouble following the treatment plan, which increases the  chance for a major bipolar episode. It is important that people  caring for those with bipolar disorder also take care of themselves. 

How can I help myself if I have bipolar  disorder? 

It may be very hard to take that first step to help yourself. It may take  time, but you can get better with treatment. 

To help yourself: 

• Talk to your doctor about treatment options and progress 
• Keep a regular routine, such as eating meals at the same time every day and  going to sleep at the same time every night 
• Try to get enough sleep 
• Stay on your medication 
• Learn about warning signs signaling a shift into depression or mania 
• Expect your symptoms to improve gradually, not immediately. 

Where can I go for help? 

If you are unsure where to go for help, ask your family doctor. Others who  can help are listed below. 

• Mental health specialists, such as psychiatrists, psychologists, social  workers, or mental health counselors 
• Health maintenance organizations 
• Community mental health centers 
• Hospital psychiatry departments and outpatient clinics 
• Mental health programs at universities or medical schools 
• State hospital outpatient clinics 
• Family services, social agencies, or clergy 
• Peer support groups 
• Private clinics and facilities 
• Employee assistance programs 
• Local medical and/or psychiatric societies. 

You can also check the phone book under "mental health," "health," "social  services," "hotlines," or "physicians" for phone numbers and addresses. An  emergency room doctor can also provide temporary help and can tell you where and  how to get further help. 

What if I or someone I know is in crisis? 

If you are thinking about harming yourself, or know someone who is, tell  someone who can help immediately. 

• Call your doctor. 
• Call 911 or go to a hospital emergency room to get immediate help or ask a  friend or family member to help you do these things. 
• Call the toll-free, 24-hour hotline of the National Suicide Prevention  Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk  to a trained counselor. 

Make sure you or the suicidal person is not left alone.