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Bipolar Disorder & Bipolar Depression

Bipolar disorder brings shifts in mood, energy and activity — from highs called mania or hypomania to deep lows of depression. It is a long-term condition, and with steady treatment many people manage it well and live full lives.

If you are in crisis or thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat online. It is free, confidential and open 24/7 (988 Lifeline). If a life is in immediate danger, call 911 or go to the nearest emergency room (NIMH). People with bipolar disorder who think or talk about suicide need emergency attention right away (MedlinePlus).

Severe mania or psychosis needs urgent help. Get help right away for symptoms of mania — such as going days with little need for sleep, racing thoughts, or reckless, risky behavior — or if someone sees or hears things that are not there, has an urge to hurt themselves or others, or can’t care for themselves (MedlinePlus). Severe episodes can bring psychosis, a loss of touch with reality (NIMH), and some people need a hospital stay until they are stable (MedlinePlus). If anyone is in danger, call 911.

Never stop a mood stabilizer or other prescribed medicine on your own, even if you feel well. Stopping or changing medicines can make symptoms come back or become much worse (MedlinePlus); talk with your prescriber first (NIMH, MedlinePlus).

What is bipolar disorder?

Bipolar disorder (once called manic-depressive illness or manic depression) is a mental illness that causes clear shifts in a person’s mood, energy, activity levels and concentration (NIMH). Everyone has ups and downs, but in bipolar disorder the changes can be extreme. Mood episodes usually last a week or two, sometimes longer, with symptoms most of the day, every day; in between, mood usually returns to a person’s healthy baseline (NIMH). It usually needs lifelong treatment and doesn’t go away on its own — but proper treatment can lead to better functioning and a better quality of life (NIMH). Treatment helps many people, even those with the most severe forms (NIMH).

The mood episodes

  • Mania: feeling very up, elated or extremely irritable; feeling jumpy or wired; racing thoughts; a decreased need for sleep; talking fast; feeling unusually important or powerful; and a strong appetite for pleasurable activities (NIMH). Mania can bring poor judgment and reckless behavior, such as risky spending, sex, gambling, or drinking and drug use (MedlinePlus).
  • Hypomania: like mania but less severe, and less disruptive to daily life. People may feel very good and productive and not notice anything is wrong, though family and friends often do (NIMH).
  • Depression: feeling very down, sad, anxious or hopeless; feeling slowed down or restless; trouble concentrating; sleeping too little or too much; losing interest in almost everything; and sometimes thoughts of death or suicide (NIMH). Episodes of depression are more common than episodes of mania (MedlinePlus).
  • Mixed episodes: manic and depressive symptoms at the same time (NIMH, MedlinePlus).

The main types

  • Bipolar I disorder: manic episodes lasting at least 7 days, or severe enough to need hospital care. Depressive episodes, typically lasting at least 2 weeks, usually occur too. Four or more episodes of mania or depression in a year is called “rapid cycling” (NIMH).
  • Bipolar II disorder: depressive episodes and hypomanic episodes, but not the full manic episodes of bipolar I. Many people with bipolar II spend long stretches in a persistent, low-grade depression (NIMH).
  • Cyclothymic disorder (cyclothymia): recurring hypomanic and depressive symptoms that aren’t intense or long enough to count as full episodes (NIMH).

How common is it, and who gets it?

A national survey (conducted 2001–2003) estimated that 2.8% of U.S. adults had bipolar disorder in the past year — similar for men (2.9%) and women (2.8%) — and that 4.4% of adults have it at some point in their lives. A companion survey of teens aged 13–18 (2001–2004) estimated that 2.9% had had it (NIMH statistics). Symptoms most often start in late adolescence or early adulthood, occasionally in childhood (NIMH); MedlinePlus puts the most common start at ages 15 to 25 (MedlinePlus).

The exact cause is unknown. Bipolar disorder often runs in families, mostly because of genes — many genes, not one — but not everyone with a family history develops it, and trauma or stressful life events may play a part (NIMH). Childbirth, periods of insomnia, recreational drug use and some medicines, such as antidepressants or steroids, can trigger a manic episode (MedlinePlus).

How bipolar depression differs from “regular” depression

A depressive episode in bipolar disorder can look just like other depression. The difference is the person’s history of highs. People with bipolar II disorder may seek help only when they are depressed, and hypomania can go unnoticed — one reason some people live with bipolar disorder for years before it is diagnosed (NIMH).

Why it matters: if subtle signs of bipolar disorder are missed and depression is treated with an antidepressant alone (without a mood stabilizer), it may trigger a manic episode or rapid cycling (NIMH). If you have ever had a period of unusually high energy, little need for sleep or racing thoughts, tell the person treating your depression — and mention any family history of bipolar disorder.

Diagnosis

A provider may do a physical exam and lab tests to rule out other illnesses, then refer you for an evaluation by a mental health professional (NIMH). The diagnosis rests on the severity, length and frequency of symptoms over your lifetime, and your family history. Thyroid disease and some prescribed, recreational or illicit drugs can mimic or worsen mood symptoms (NIMH). The provider may also ask to talk with family members about your symptoms (MedlinePlus).

Conditions that often come along

Many people with bipolar disorder also have anxiety disorders, ADHD, problems with drugs or alcohol, or eating disorders (NIMH); NIMH research is looking at how anxiety and substance use disorders interact with bipolar disorder (NIMH). See our Anxiety guide. Alcohol and other substances can make bipolar symptoms worse and raise the risk of suicide (MedlinePlus).

When to get help: if you notice extreme shifts in mood, energy or sleep, or depression that keeps coming back, talk to a primary care provider, who can refer you to a psychiatrist, psychologist or clinical social worker (NIMH). Bipolar disorder is a long-term condition, but ongoing treatment can help you manage symptoms and live a healthy life (NIMH).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Long-term care from a psychiatric provider: mood stabilizers such as lithium, certain anticonvulsants and second-generation (atypical) antipsychotics, plus talk therapy such as family-focused or interpersonal and social rhythm therapy. ECT for severe or urgent cases. Therapy commonly runs about $80–$200 a session at market rates; nonprofit sliding-scale networks offer $40–$70 sessions ($40–$80 for family sessions). Marketplace plans must cover mental health, and Medicare Part B covers outpatient care at 20% coinsurance after the deductible. 988 is free. Medicine prices being researched. Treatment helps many people, even with severe forms, but usually needs to be lifelong. Finding the right medicine can take trial and error, and regular blood tests are often needed. Antidepressants are not used alone.
Chiropractic Being researched — coming soon.
Acupuncture Needle sessions added to — never in place of — medicine and therapy. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Very little research. In two small trials, people improved whether they got real or placebo acupuncture, so there’s no good evidence it treats bipolar disorder.
Herbal medicine Omega-3 fatty acids, added to standard treatment, are the supplement most studied for bipolar depression. St. John’s wort should be avoided. Cost estimate being researched. Omega-3 evidence is mixed: some small studies suggest help for depressive symptoms, none for mania. No supplement is FDA-approved for bipolar disorder or replaces medicine. St. John’s wort has been linked to mania and psychosis and interacts with many medicines.
Massage therapy Relaxing hands-on bodywork for stress, alongside standard care. About $50–$90 for 45–60 minutes at clinics and spas; $60–$120 with an independent therapist. May help you relax, but it hasn’t been well studied in bipolar disorder and doesn’t treat mood episodes. Low risk with a trained therapist.
MBHA Wellness Coach A steady sleep and daily routine, mood charting, spotting early warning signs, avoiding alcohol and drugs, exercise, stress management, a written crisis plan, and connecting you and your family with support groups. Cost estimate being researched. Healthy routines and early action support treatment and may help prevent relapse, but they don’t replace medicine and therapy.

Approach 1 of 6

Conventional medicine (AMA)

Mental health professionals treat bipolar disorder with medicines, psychotherapy, or a combination (NIMH). The goals are to make episodes less frequent and less severe, help you function well and enjoy life at home and at work, and prevent self-injury and suicide (MedlinePlus). You will usually see a psychiatrist or psychiatric nurse practitioner regularly to review your medicines and side effects (MedlinePlus).

1. Medicines

Medicines are an essential part of treatment (MedlinePlus). Some people need to try several before finding what works best, and different medicines may be used for an acute episode than for long-term care (NIMH). We name medicines only — your prescriber will choose the medicine and dose.

  • Mood stabilizers such as lithium or valproate can help prevent mood episodes or make them less severe (NIMH). Lithium is approved for mania and bipolar disorder, and some studies suggest it may lower the risk of suicide with long-term use (NIMH). It may take 1 to 3 weeks or longer to feel its full benefit (MedlinePlus).
  • Certain anticonvulsants are also used as mood stabilizers, and can work better than lithium for some people, such as those with mixed symptoms or rapid cycling (NIMH).
  • Second-generation (atypical) antipsychotics are among the most commonly prescribed medicines for bipolar disorder (NIMH), and are sometimes used to treat bipolar depression (NIMH).

Medicines for bipolar depression

Bipolar depression is often treated with a mood stabilizer or an atypical antipsychotic. For some people an antidepressant may be added, but antidepressants are not used alone because they can trigger a manic episode or rapid cycling (NIMH).

Five atypical antipsychotics have FDA approval for bipolar depression: quetiapine (approved for this use in 2004), the olanzapine-fluoxetine combination (2012), lurasidone (2013), cariprazine (2019) and lumateperone (2021). No mood stabilizer has FDA approval specifically for acute bipolar depression. A 2024 analysis of trials found all five worked better than placebo, with quetiapine and lurasidone showing the most favorable effects, and noted that their side effects, including effects on weight and metabolism, differ (Li et al., 2024). Which one suits you is a decision for you and your prescriber.

Monitoring and safety

  • Lithium: providers generally ask for regular monitoring of lithium levels and kidney and thyroid function (NIMH). Keep all lab appointments (MedlinePlus). Tell your prescriber about every other medicine and supplement you take — common pain relievers such as ibuprofen and naproxen may interact with lithium — and about severe diarrhea, heavy sweating or fever, pregnancy or plans to become pregnant. Follow your doctor’s advice on fluids and salt (MedlinePlus).
  • Anticonvulsants usually call for regular checks of medicine levels, side effects and interactions (NIMH).
  • Atypical antipsychotics: your provider may ask you to have your weight, blood sugar and blood fats (lipids) checked regularly (NIMH).

Stay on your medicine and talk before changing anything. Feeling better — or missing the energy of a high — can make it tempting to stop, but stopping or changing medicines can bring symptoms back or make them much worse. Family and friends can help you take medicines the right way (MedlinePlus). Report side effects to your provider right away (NIMH), and let a provider help you change the plan safely (NIMH).

2. Talk therapy

Psychotherapy can offer support, education, skills and strategies to people with bipolar disorder and their families, and several types can be effective when used together with medicine (NIMH):

  • Interpersonal and social rhythm therapy helps you understand and work with your biological and social rhythms, such as daily routines and sleep (NIMH).
  • Family-focused therapy has been shown to help teens and adults when started with mood-stabilizing medicine after an episode of bipolar depression or mania (NIMH). Involving family and caregivers may help lower the chance of symptoms returning (MedlinePlus).
  • Cognitive behavioral therapy (CBT) is an important treatment for depression, and CBT adapted for insomnia can be especially helpful as part of treating bipolar depression (NIMH).

3. Brain stimulation and other treatments

  • Electroconvulsive therapy (ECT) is FDA-cleared for severe depressive episodes in people 13 and older with depression or bipolar disorder (NIMH). It is usually considered when other treatments haven’t helped, or when a fast response is needed, such as with suicide risk or catatonia (NIMH). It is done under anesthesia; common side effects include headache, muscle aches, confusion and memory loss, which usually improves in the days and weeks after treatment (NIMH).
  • Transcranial magnetic stimulation (TMS) uses magnetic waves to relieve depression; it is less powerful than ECT but needs no anesthesia (NIMH). For bipolar depression specifically, the FDA has so far given it a “breakthrough device” designation (2020), which marks promising early evidence rather than clearance (NIMH).
  • Light therapy may be considered when depression regularly worsens in winter (NIMH) — ask your provider before trying a light box.
  • Hospital care: during a severe manic or depressive episode, a short hospital stay can keep you safe until you are stable (MedlinePlus).

What it costs

  • Therapy without insurance: the nonprofit Open Path Collective puts typical U.S. market rates at about $80–$200 a session. Its network offers sliding-scale individual sessions of $40–$70 and couples or family sessions of $40–$80, after a one-time $65 membership fee, for people who lack insurance or adequate mental health coverage and can’t afford market rates (Open Path Collective).
  • Insurance and parity: all Health Insurance Marketplace plans cover mental health care, including psychotherapy and counseling, as an essential health benefit, and can’t deny coverage or charge more for a pre-existing mental health condition (HealthCare.gov). Under the federal parity law, copays, deductibles, visit limits and prior-authorization rules for mental health care must be comparable to those for medical care (U.S. Department of Labor).
  • Medicare: Part B covers outpatient mental health care — individual, group and family therapy, care at community mental health centers, telehealth and safety planning for people at risk of suicide; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Medicaid is the single largest payer for mental health services in the U.S. (Medicaid.gov).
  • Low-cost and free help: your state or county health department’s website lists local services, many employers offer a free, confidential Employee Assistance Program, and SAMHSA runs an online locator for mental health services (NIMH). The 988 Lifeline is free (988 Lifeline).
  • Prescription medicines and lab tests: MBHA cost estimate being researched.

How well it works — what to expect

Treatment helps many people, even those with the most severe forms of bipolar disorder (NIMH). Even with treatment, most people have episodes again at some point (MedlinePlus), which is why long-term care, regular check-ins and a plan for early warning signs matter. Lithium doesn’t cure bipolar disorder, but it can help control it (MedlinePlus). Improvement takes time, and social support helps (NIMH).

Find a medical doctor in our directory

Approach 3 of 6

Acupuncture

Some people with bipolar disorder explore acupuncture to support their overall wellness (NIMH). There is very little research on it for bipolar disorder, and it should only ever be added to — never used in place of — medicine and therapy.

What the research says

  • Two small randomized trials (2009) added acupuncture to stable medication for 20 people with hypomania and 26 with depression. Everyone improved, whether they got targeted acupuncture or a comparison treatment, and the researchers saw similar benefits from “placebo” and real acupuncture. Side effects were few (Dennehy et al., 2009).
  • A 2022 study of 36 people with hard-to-treat depression, 21 of them with bipolar disorder, reported better mood, physical symptoms and quality of life after 12 weeks of weekly acupuncture added to usual care, but it had no comparison group, so it can’t show that acupuncture caused the change (Matsuura et al., 2022).
  • NIMH notes that complementary approaches, unlike proven medicines and psychotherapy, have not been comprehensively studied in bipolar disorder, and none is FDA-approved to treat it (NIMH).

In short: acupuncture may feel calming for some people, but there is no good evidence that it treats bipolar disorder or prevents mood episodes.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique; the FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH). Choose a licensed practitioner and let your psychiatric provider know.

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics with shared rooms charge about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

The FDA has not approved any complementary health approach, including herbs and supplements, for treating bipolar disorder. Some may be used safely alongside standard treatment, but talk with your provider first (NIMH). No supplement replaces mood-stabilizing medicine. Dietary supplements are not approved by the FDA before they are sold (NCCIH).

St. John’s wort — avoid it

St. John’s wort is promoted for depression, but it is a poor fit for bipolar depression. There are case reports of it worsening psychotic symptoms in people with bipolar disorder (NCCIH); NCCIH warns that people with bipolar disorder are at risk of a rare side effect, psychosis (NCCIH clinical digest); and a review of case reports describes mania linked to St. John’s wort (Joshi & Faubion, 2005). It also interacts in dangerous, sometimes life-threatening ways with many medicines, can weaken some of them, and taken with certain antidepressants can cause serious serotonin-related side effects (NCCIH). Don’t take it without your prescriber’s advice.

Omega-3 fatty acids (fish oil)

Omega-3s have been studied as an add-on to standard treatment, and the evidence is mixed:

  • A 2008 Cochrane review found five studies of variable quality; only one, with 75 people, could be analyzed. It showed a benefit for depressive symptoms but not mania, and the authors said the findings must be viewed with caution (Cochrane review, 2008).
  • A 2012 meta-analysis of 5 data sets (291 people) found a moderate benefit for bipolar depression when omega-3s were added to medicine, but no significant effect on mania; smaller studies tended to show bigger effects (Sarris et al., 2012).
  • A 2021 systematic review of supplements in bipolar disorder called the evidence for omega-3s “promising, albeit conflicting” (Ashton et al., 2021), and 2022 international clinician guidelines gave omega-3s only weak support for bipolar depression, recommending such supplements mainly as add-ons within standard medical care (WFSBP/CANMAT taskforce, 2022).

Side effects of omega-3 supplements are usually mild, such as an unpleasant taste, bad breath, headache, heartburn, nausea or diarrhea (NCCIH).

If you take lithium

Tell your doctor and pharmacist about every vitamin, supplement and herbal product you take or plan to take; your doctor may need to change your medicine or watch you more closely (MedlinePlus).

Before you try any herb or supplement, talk with your prescriber or pharmacist, especially if you take a mood stabilizer or antipsychotic, or are pregnant or breastfeeding (NIMH, NCCIH). Never use a supplement in place of prescribed medicine. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage is one of the approaches some people with bipolar disorder use to manage stress and support overall wellness. Like other complementary approaches, it hasn’t been comprehensively studied in bipolar disorder (NIMH), and it doesn’t treat mood episodes. Some studies in other conditions, such as fibromyalgia and HIV, suggest massage may ease anxiety and depression (NCCIH).

Safety

The risk of harm appears to be low. Rare serious problems such as a blood clot, nerve injury or broken bone have occurred, sometimes with vigorous deep-tissue massage or in frail older adults. Forty-five states and the District of Columbia license or certify massage therapists. Don’t use massage to put off seeing a provider (NCCIH).

What it costs

About $50–$90 for 45–60 minutes at gyms, clinics and spas, and $60–$120 with an independent therapist (CostHelper). Ask your plan whether it covers any massage.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the everyday routines that support your treatment, and help you and your family plan ahead. These habits work best alongside medicine and therapy; they don’t replace them. NIMH’s first piece of advice is simple: get treatment and stick with it (NIMH).

Protect your sleep and routine

Periods of insomnia can trigger a manic episode (MedlinePlus). Keeping a regular routine for eating, sleeping and exercise is one of NIMH’s self-care tips (NIMH), and getting enough sleep is a key skill taught in bipolar support programs (MedlinePlus). A coach can help you set steady bed and wake times — and plan ahead for big disruptions such as a new baby, since childbirth can also trigger mania (MedlinePlus) — building on the rhythm-focused work of interpersonal and social rhythm therapy if you’re in it (NIMH).

Chart your mood

Keeping a life chart or mood journal helps you recognize your mood swings (NIMH). The Depression and Bipolar Support Alliance offers a free Wellness Tracker for logging moods, symptoms, medicines and lifestyle (DBSA). Bring your chart to appointments.

Know your early warning signs

Learning to watch for the return of symptoms, knowing what to do when they appear, and finding and avoiding your triggers are skills that support programs teach (MedlinePlus). Your own signs are personal; a coach can help you list the first changes you and your family tend to notice, using the symptoms of mania and depression — such as a decreased need for sleep, fast talking, heavy spending, or pulling away from friends — as a starting point (NIMH, MedlinePlus).

Avoid alcohol and drugs

NIMH advises avoiding drugs and alcohol (NIMH). They can make bipolar symptoms worse and raise the risk of suicide, and recreational drug use can trigger mania (MedlinePlus).

Move and manage stress

Exercise such as jogging, swimming or cycling can help with depression and anxiety, promote better sleep, and support heart and brain health (NIMH). In people with a genetic risk, stressful life events may play a part in bringing on bipolar disorder (NIMH), so a coach can help you build calm into your week and set realistic goals. Be patient: improvement takes time (NIMH).

Write a crisis plan

Guidance for bipolar care recommends a personal care plan that lists your early warning signs and triggers, what you would like to happen if you become unwell, and your recovery goals — so the people around you can step in early (NICE quality standard). Make it with your treatment team, and include your prescriber’s number, your medicines, 988 and 911 (988 Lifeline). Medicare Part B covers safety planning for people at risk of suicide (Medicare.gov).

Family education and support

  • Family members can help: offer patience and encouragement, listen, learn the person’s triggers and watch for major mood changes, help with rides to appointments or picking up prescriptions, remind them that getting better is possible — and take care of themselves too (NIMH).
  • Joining a support group may help both you and your loved ones (MedlinePlus). The Depression and Bipolar Support Alliance (DBSA) runs in-person and online peer support groups for people with depression or bipolar disorder, and offers resources for family, friends and caregivers (DBSA). Its local chapters’ groups are peer-run and are not group therapy (DBSA).
  • Finding a provider: start with your primary care provider, check your county health department, or ask HR about an Employee Assistance Program (NIMH). If things ever feel unbearable, call or text 988 (988 Lifeline).

Still being researched: Chiropractic. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bipolar Disorder & Bipolar Depression? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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