Bipolar Disorder: A Plain-English Guide

Reading time: about 5 minutes. General education only, not medical advice.

What is it?

Bipolar disorder is a long-term health condition that affects mood, energy and activity levels. People with bipolar disorder have periods when their mood is very high or very low. These periods are called mood episodes. They are more than the normal ups and downs everyone has. They can last days or weeks and can make daily life, work and relationships hard.

Bipolar disorder is nobody's fault. It is not a weakness or a choice. Many people with bipolar disorder live full, meaningful lives, especially with good support and treatment. It often starts in the late teens or early adult years, but it can begin at any age.

There are a few types. In bipolar I, people have at least one episode of mania (a very high or irritable mood). In bipolar II, people have hypomania (a milder high) and periods of depression. Cyclothymia means milder ups and downs that go on for a long time.

Common signs and experiences

During a high (mania or hypomania), a person may:

  • feel very happy, excited, or irritable
  • have lots of energy and need much less sleep
  • talk fast and jump between ideas
  • feel unusually important or powerful
  • do risky things, like spending a lot of money or driving fast

During a low (depression), a person may:

  • feel very sad, empty or hopeless
  • lose interest in things they usually enjoy
  • feel tired, slow or restless
  • sleep too much or too little
  • find it hard to think or make decisions
  • have thoughts of death or suicide

Some people have mixed features, with signs of highs and lows at the same time. In severe episodes, some people have psychosis: seeing or hearing things others don't, or holding strong beliefs that aren't based on reality. Between episodes, many people feel well.

How it's diagnosed

There is no blood test or brain scan for bipolar disorder. A doctor or psychiatrist talks with the person about their moods, sleep, energy and history. They may ask family members what they have noticed. A physical exam and blood tests can help rule out other causes, such as thyroid problems or the effects of drugs. Keeping a mood diary can help. Because people often seek help during a low, bipolar disorder is sometimes first mistaken for depression.

Usual treatments today

Bipolar disorder is usually treated over the long term, even when someone feels well.

  • Medication. Doctors often prescribe mood stabilisers (such as lithium) or certain antipsychotic medicines. Some people also take other medicines for depression or sleep. Medicines can have side effects, and finding the right one can take time.
  • Talking therapy. Therapies such as cognitive behavioural therapy (CBT) and family-focused therapy can help people spot early warning signs, manage stress and stick with a routine.
  • Lifestyle and support. Regular sleep, avoiding alcohol and drugs, and support from family, friends or peer groups can all help.
  • Other options. For hard-to-treat episodes, some people are offered treatments such as electroconvulsive therapy (ECT).

Where metabolic health fits in

Metabolism is how the body turns food into energy. Mitochondria are tiny parts inside our cells that make most of that energy. The brain uses a lot of energy.

Researchers are looking at metabolism in bipolar disorder for a few reasons:

  • People with bipolar disorder have higher rates of problems such as obesity, insulin resistance (when the body struggles to use the hormone insulin) and type 2 diabetes. Some medicines can add to this.
  • Some studies suggest that energy use in brain cells, including mitochondria, may work differently in bipolar disorder.
  • Some medicines used for bipolar disorder were first used for epilepsy. The ketogenic diet (a very low-carb, high-fat diet) has long been used for some kinds of epilepsy. So scientists wondered if it might help mood too.

A small pilot study at Stanford tested a ketogenic diet in adults with bipolar disorder or schizophrenia who also had metabolic problems. Over four months, many had better metabolic health and some had better mental health scores. But it was small and had no comparison group.

This is emerging research, not established treatment, and it is not a cure. Larger, careful trials are needed. Diet changes are being studied as something added to usual care, not a replacement for it.

Safety first. Do not start a ketogenic or other therapeutic diet on your own. These diets can change how some medicines work, including mood stabilisers and diabetes medicines. They can cause side effects, and they may not be safe for everyone, for example during pregnancy or with some kidney, liver or eating problems. In studies, people were followed by doctors and dietitians.

When to get help

See a doctor if you notice big mood swings, much less need for sleep, or low moods that won't lift. Get help quickly if a high is becoming unsafe or if someone is having thoughts of suicide.

  • US: call or text 988 (Suicide & Crisis Lifeline), or chat at 988lifeline.org.
  • Emergency: call 911 or go to the nearest emergency room.
  • Outside the US: contact your local emergency number.

Latest research on bipolar disorder

Disclaimer

This page is for general education only. It is not medical advice, and it is not a diagnosis or treatment plan for anyone. We are not able to review anyone's situation. Metabolic psychiatry is a young field, and research summaries here may be incomplete or out of date, so please read the original sources. Always talk with your own doctor, psychiatrist or other qualified clinician before changing a diet, starting a supplement, or starting, stopping or changing any medication. Stopping psychiatric medication suddenly can be dangerous. Read the full disclaimer.

If you are in crisis in the US, call or text 988. For emergencies, call 911.

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