Bipolar Disorder
Bipolar disorder involves episodes of mania or hypomania alongside depressive episodes, managed per the VA/DoD 2023 Clinical Practice Guideline and the American Psychiatric Association guideline.
Symptoms
Manic episodes (lasting a week or longer) bring elevated or irritable mood, decreased need for sleep, racing thoughts, and impulsive behavior; hypomanic episodes are similar but shorter (4+ days) and less severe. Depressive episodes mirror major depression, lasting 2 weeks or longer.
Causes and risk
A strong genetic component combined with environmental triggers; disrupted sleep and circadian rhythm can precipitate episodes.
How it is evaluated
Diagnosis follows DSM-5-TR criteria for the specific mood episodes experienced; screening tools like the Mood Disorders Questionnaire can help, and diagnosis is often delayed since early episodes can be mistaken for unipolar depression, per JAMA review data.
Treatment
Mood stabilizers (lithium, valproate, lamotrigine) and atypical antipsychotics (quetiapine, aripiprazole, and others) are used alone or in combination; lithium requires kidney and thyroid monitoring, and antipsychotics require metabolic monitoring. Antidepressant monotherapy is avoided since it can trigger a manic episode.
When to seek care
Severe mania (with reckless or dangerous behavior), psychosis, or any thoughts of suicide or self-harm are medical emergencies -- call 911 or the 988 Suicide and Crisis Lifeline. Abruptly stopping medication also raises relapse risk and should be discussed with your prescriber first.