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Bipolar Disorder

Bipolar Disorder (BD) is a treatable mood disorder that affects approximately 4 percent of the U.S. population with equal prevalence among women and men (including all subtypes: BD I, BD II and BD not otherwise specified). BD is characterized by extreme shifts in energy, behavior and mood cycling between the “highs” of mania or hypomania to the “lows” of depression. BD episodes may also present as a mix of high energy and low mood states (i.e., mixed mania) in which some will experience agitation, anger or rage as well as depressive symptoms.


Symptoms of Mania

  • Extended period of feeling "high," overly happy or extra outgoing
  • Unusually confident, grandiose or exaggerated sense of self
  • Excessive irritability or aggression
  • Rapid speech that is difficult to interrupt
  • Racing thoughts, flight of ideas, extreme distractibility
  • Overly restless or increased goal-oriented activity sexually, socially or at work/school
  • Less need for sleep without feeling tired
  • Impulsive or excessive engagement in pleasurable or high-risk behaviors such as excessive spending, gambling or sexual indiscretions
  • Poor judgement

Symptoms of Depression

  • Persistent sadness
  • Lack of interest
  • Irritability or anxiety
  • Excessive guilt or feelings of worthlessness
  • Inability to enjoy things that were once pleasurable
  • Social withdrawal
  • Sleep disturbance including difficulty going to sleep, staying asleep or early morning awakening
  • Increased fatigue or lethargy
  • Inability to concentrate or make decisions
  • Decreased or increased appetite, which may be associated with decreased or increased weight
  • Hopelessness
  • Suicidal thoughts

Manic and depressive episodes consist of multiple symptoms that co-occur and are present majority of the time for a distinct period. Manic episodes typically include three or four (including irritability) symptoms that co-occur for one week and are often associated with impaired function. Hypomanic mood states may last for fewer days and are not likely to cause impairment.  

Risk Factors

  • History of a first-degree relative with BD or another mental illness
  • Trauma or stressful life events
  • History of postpartum psychosis
  • Brain structure

Treatment of BD

Pharmacotherapy is the mainstay of treatment for BD in combination with psychotherapy. Interpersonal Social Rhythms Therapy (IPSRT), mid-day chronotherapy or light therapy and support groups are useful adjuncts to treatment. Optimal treatment differs between individuals and must be determined through discussions with the patient and psychiatrist/psychologist. 

Bipolar Disorder & Women

BD typically onsets at 18 years of age, which means that women experience this illness throughout their childbearing years. Women are more likely to have a diagnosis of BD II disorder, which is characterized by hypomanic “highs” and predominantly depressive episodes. They are also more likely to experience rapid cycling, seasonal changes in mood and mixed episodes of BD. Women also experience longer delays in diagnosis compared to men. 

Treatment of Bipolar Disorder in Pregnancy, Postpartum & Lactation 

Treatment of BD during pregnancy and lactation is ideally addressed prior to conception. Pharmacotherapy is the recommended treatment during pregnancy, postpartum and lactation in addition to psychotherapy, chronotherapy and/or IPSRT. Choice of drug therapy requires a risk-benefit assessment with a specialized psychiatrist to identify an option with optimal effect and minimal adverse outcomes. Perinatal management of pharmacotherapy must account for the impact of physiological changes in pregnancy on drug concentration, which may require dose adjustment to maintain drug effectiveness. 

Get Care

Members of the Asher Center for the Study and Treatment of Depressive Disorders provide clinical care through Feinberg-affiliate care sites. Visit our Patient Care page for more information.

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