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JAMA Patient Page
February 4, 2009

Bipolar Disorder

JAMA. 2009;301(5):564. doi:10.1001/jama.301.5.564

Bipolar disorder, formerly known as manic depression, is a mental illness that affects as many as 10 million individuals in the United States alone. It is called bipolar disorder because there are 2 phases to the illness: an "up," or manic phase, and a "down," or depressive phase. Bipolar disorder is distinguished from unipolar depression, which is recurrent episodes of depression without any episodes of elevated mood. Persons who have bipolar disorder may have either more episodes of mania or more episodes of depression in the course of their illness. Like other chronic illnesses (such as diabetes and hypertension), bipolar disorder can be treated. Bipolar disorder is associated with a high rate of suicide. It is important for persons with bipolar disorder to receive proper diagnosis and treatment with a psychiatrist as early as possible to minimize their risk of self-harm. Psychiatrists are medical doctors who have specialized education in treating persons who have mental illness. The February 4, 2009, issue of JAMA contains an article about smoking cessation in persons with bipolar disorder and other mental illnesses.

Signs and symptoms

Manic phase:

  • Extremely elevated mood

  • Irritability or anger

  • Fast speech

  • Flight of ideas (racing or distracted thoughts, rapid switch from one subject to another)

  • Risky behavior (including gambling, sexual promiscuity, and substance abuse)

  • Poor judgment

  • Decreased need for sleep

  • Less severe episodes of elevated mood are called hypomania

Depressive phase:

  • Extreme sadness

  • Inactivity and disinterest in usual activities

  • Crying, anxiety, or irritability

  • Feeling of hopelessness or overwhelming guilt

  • Unintentional weight loss or gain

  • Substance abuse

  • Suicidal thoughts


  • Bipolar disorder usually is first diagnosed in young adults or persons in their late teens, though it can occur in children and older adults as well.

  • Because the symptoms of bipolar disorder are variable, it may be difficult to diagnose bipolar disorder right away.

  • A medical history and physical examination should be performed to look for other causes of symptoms and other psychiatric diagnoses.

  • Family members and friends are useful in helping to evaluate an individual thought to have bipolar disorder, because denial of problems may also be a symptom.


Because bipolar disorder is a chronic illness, continuous treatment is necessary to prevent relapse of manic or depressive symptoms, to improve overall health, and to maximize the quality of life. Several types of medications may be used, alone or in combination, to treat bipolar disorder. All the medications used in treatment of bipolar disorder have adverse effects that must be considered; you and your doctor may try several medication schedules to achieve the best results for your personal situation. Psychotherapy (talking treatment) may also be helpful. Women who are pregnant, nursing, or may become pregnant cannot use many of the medications typically prescribed for bipolar disorder; it is important to talk with your doctor if pregnancy is considered.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at Many are available in English and Spanish. A Patient Page on depression was published in the November 12, 2008, issue and one on suicide was published in the May 25, 2005, issue.

Sources: National Institute of Mental Health, American Psychiatric Association, National Alliance on Mental Illness

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.