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Bipolar disorder is a cycling mood disorder characterized by extreme shifts in mood, energy, and functioning. The condition is also called manic-depressive disorder because of the alternating periods of depression and mania. Bipolar disorder is often not recognized because many patients do not consider the “highs” of mania a symptom of a mental illness.  Treatment is usually sought during the depressive period, which often causes the condition to be misdiagnosed as major depression. Bipolar disorder is often mistaken for a health issue unrelated to mental illness (e.g., poor academic performance, difficult interpersonal relationships, substance abuse).

Bipolar disorder consists of specific types of episodes. They include:

• Manic episodes. Characterized by highs in mood, very high self-esteem, increased activity and energy, and poor functioning. Patients may have extreme confidence with racing thoughts and make rash, impulsive decisions in situations where they would otherwise exhibit better judgment. For example, a patient may decide to go on a spending spree, have aggressive driving with road rage  or engage in sexually promiscuous behavior.
  
  
• Depressive episodes. Lows in mood, often with reduced energy and motivation. Patients may not want to participate iny activities, and may feel that anything they attempt will fail or meet with disaster. Thoughts of suicide are also common in this period.
  
  
• Mixed episodes. Episodes that display features of both mania and depression. These features may occur at the same time or may rapidly alternate. For example, a patient may feel very good emotionally but have very little energy, or may experience a sudden and drastic drop or increase in self-esteem.
  
  
• Hypomanic episodes. Low-grade highs in mood, typically without the lapses in judgment common in full manic episodes. These are rarely recognized as mood episodes, but are generally seen as a particularly good mood.

Manic episodes may occur immediately before or after a depressive episode or there may be a period of normal mood between the episodes. Some patients retain some symptoms (e.g., shifting mood) between episodes. Episodes of altered mood generally follow a pattern characteristic for a particular patient. For example, one patient may always experience a very short hypomanic episode between a manic and a depressive episode whereas another may have short manic episodes followed consistently long hypomanic episodes. However, the time between episodes may decrease as the patient ages.

Episodes may last from days to months and usually recur over a lifetime. Most patients who experience a single manic episode will experience other types of episodes in the future. These episodes may be manic, mixed, hypomanic or major depressive episodes.

According to the National Alliance on Mental Illness (NAMI), about 2.3 million adult Americans, or around 1.2 percent or the population, are diagnosed with bipolar disorder. The condition occurs equally in all genders, races and ethnicities.

The onset of bipolar disorder usually occurs in late adolescence or early adulthood, and the average age of onset is 20. However, the disorder can occur at any age. Bipolar disorder was once thought to be very rare in children under the age of 12 years, but recent studies show that it may be more common than previously believed.

Men are more likely to experience a manic episode before a depressive episode. The number of manic episodes also tends to outnumber the depressive episodes in men. By contrast, women are more likely to have a major depressive episode before a manic episode and more depressive episodes than manic episodes. Women are also more likely to experience rapid cycling (four or more episodes per year). Ultradian cycling (drastic mood changes in the course of a single day) is rare and less studied in both genders.

Bipolar disorder appears to affect children more severely than adults. According to the Course and Outcome of Bipolar Illness in Youth (COBY) study, children with the disorder experience longer symptomatic periods, more frequent cycling and/or more mixed episodes than adults. The National Institutes of Health-funded study also found that the severity of the disorder in children progresses at a much higher rate than in adults with bipolar disorder.

Bipolar disorder has one of the highest mortality rates of all mental illnesses. Delusions of invulnerability may lead to dangerous, reckless behavior. Furthermore, according to the National Mental Health Association (NMHA), one in five patients with bipolar disorder die by suicide.

Alcohol and other substance abuse problems are common in patients with bipolar disorder and may worsen the condition. Numerous mental health disorders including panic disorder, attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are also associated with bipolar disorder.

Thyroid disorder occurs frequently with bipolar disorder and may lead to episodes or worsen symptoms in patients with bipolar disorder. This is more common in women. Neurological disorders may occur along with bipolar disorder in patients who first experience a manic episode in their older years, and this comorbidity may increase mortality. In some cases, a patient’s mood may stabilize during pregnancy. However, there is an increased risk of postpartum (following pregnancy)  fluctuations, including postpartum depression (PPD) or psychosis.