Manic‑depressive disorder (bipolar): what to look for and what to do

Do your mood swings go beyond normal ups and downs? Manic‑depressive disorder — now usually called bipolar disorder — causes clear episodes of mania or hypomania and major depression. Knowing the difference between those episodes and normal stress can change how you get help.

Mania feels like extreme energy and poor judgment. You might sleep very little, talk fast, jump between ideas, spend money impulsively, or take risks you normally wouldn’t. Hypomania is similar but milder and shorter. Depression looks almost opposite: low energy, trouble concentrating, loss of interest in things you used to enjoy, changes in appetite or sleep, and sometimes thoughts of death or suicide. If either side interferes with work, relationships, or safety, it’s a sign to act.

Treatments that actually work

Medication plus therapy is the most reliable approach. Lithium remains a gold standard for preventing mood swings; it cuts suicide risk and needs regular blood tests to check levels, kidney, and thyroid function. Valproate (divalproex) helps mania but is unsafe in pregnancy and needs liver and platelet checks. Lamotrigine is often used for bipolar depression and maintenance. Atypical antipsychotics like quetiapine, olanzapine, or aripiprazole can treat both mania and depression in many people.

Therapy matters too. Cognitive behavioral therapy (CBT) and family‑focused therapy teach coping skills, early warning signs, and how to stick with treatment. Psychoeducation helps you and your family spot relapse signs early. For severe or treatment‑resistant episodes, options include electroconvulsive therapy (ECT) or hospital care — these are effective and used when safety or function is at risk.

Practical steps you can use now

Start tracking mood, sleep, and medication in a simple diary or an app. A pattern often appears before full episodes — less sleep, rising energy, or increasing irritability. Keep a stable sleep schedule: regular sleep is one of the easiest, most powerful stabilizers. Avoid alcohol and recreational drugs — they can trigger episodes and make meds less effective.

Make a safety plan: who you call if things get worse, what meds you take, and any trusted contacts. If you have thoughts of harming yourself or others, seek emergency help immediately or contact a crisis line. Tell your primary care doctor or a psychiatrist about any suicidal thoughts, severe insomnia, or psychosis (hearing or seeing things that aren’t there).

Be clear with your provider about family planning — some mood stabilizers are unsafe in pregnancy. Ask about side effects, blood tests, and how long you’ll need medication. If you’re not improving, don’t drop meds abruptly; call your prescriber first.

Support groups, education programs, and workplace accommodations can make daily life easier. Bring notes to appointments: dates and examples of mood highs and lows, sleep changes, and any risky behavior. That short record helps your clinician make the right plan fast.

You don’t have to manage this alone. With the right combination of treatment, monitoring, and practical routines, people with bipolar disorder can reduce episodes and regain stability.