Millions of adults in the United States have bipolar disorder. It can cause severe episodes of mania and depression, but with proper treatment—including psychotherapy (talk therapy) and medications—many people find they manage their symptoms well.

If you or a loved one have thoughts of suicide during a depressive or manic episode, get help immediately from a mental health professional. Call 911 or your local emergency number or contact the National Suicide Prevention Lifeline at 988.

Depression

Depression is a deep, dark period of severe sadness that can last weeks or longer. It can affect how a person feels, thinks and works. During a depressive episode, a person might have thoughts of suicide or of hurting himself or others. These feelings are usually accompanied by other symptoms like a lack of interest in previously enjoyable activities, low energy, difficulty sleeping, weight loss and a feeling that things won’t get better. In some cases, people with bipolar disorder also experience psychotic symptoms like false beliefs or hallucinations during a depressive episode.

People with bipolar disorder sometimes don’t realize how much their mood swings affect their lives and the lives of those closest to them. It’s important to let friends and family know what to watch for so they can help if needed. During manic episodes, people may become very productive or exhibit risky or impulsive behaviors such as reckless driving, spending sprees or sexual promiscuity. In some cases, these episodes require hospitalization to ensure a person’s safety and prevent harm to themselves or others.

Manic and depressive episodes of bipolar disorder are usually triggered by changes in the brain chemicals that regulate moods. They can be caused by stress, illness or drug use. Some people may also have genetic or biological predisposition to these episodes. It isn’t possible to prevent these episodes, but medication and psychotherapy can lessen their severity and frequency.

It’s important to keep up with treatment even when a person is feeling well. Avoiding substances like alcohol, recreational drugs and tobacco is also important. Taking a regular schedule of sleep and eating healthy meals is helpful. Exercise is good for the body and mind and can help reduce mania and depression. Talk therapy, or psychotherapy, is an important part of the treatment plan for most people with bipolar disorder. It can help a person understand their emotions, thoughts and behaviors and learn coping skills.

Getting the right diagnosis and getting treatment as soon as possible can prevent or greatly reduce the length of manic and depressive episodes. A mental health professional will evaluate a person’s symptoms, lifetime history and experiences as well as their family history. The professional will then develop a diagnosis based on the evidence.

Mania

During manic episodes (also called mania), people have feelings of extreme euphoria or high spirits. They may talk a lot, sleep little, and be very active. They may also have false beliefs or perceptions, such as seeing, hearing, or feeling things that are not there. They can also be irritable, suspicious, and even delusional.

Those with bipolar disorder experience these episodes more than others do. They can be very dangerous and lead to harmful behavior or even hospitalization. Mania can also interfere with a person’s ability to think, function at work or school, and be able to interact with family and friends.

There are several ways to get help for a manic episode. Talking with a mental health professional is important, as is taking medication. If you are having a severe manic episode, it is often necessary to get emergency treatment in the hospital.

If you are having a mild or moderate manic episode, your doctor may recommend psychotherapy, such as psychodynamic therapy or cognitive behavioral therapy. In some cases, electroconvulsive therapy (ECT) is used to treat a serious manic episode. During this treatment, controlled currents of electricity are passed through the brain to cause a brief seizure and affect certain chemicals and neurons.

Depression is another major symptom of bipolar disorder. During a depressive episode, a person feels sad and hopeless, often with no reason or explanation for the mood. It can be hard to get out of bed or take care of basic needs, and thoughts about suicide may arise.

Some people with bipolar disorder experience mixed episodes that include both manic and depressive symptoms. During a mixed episode, some people may feel less depressed than usual and have some of the euphoria associated with mania.

You can help avoid episodes by paying attention to warning signs and involving your family members in watching for them. A good way to spot early signs is to keep a diary of your daily feelings. There are apps and journals available that can help you do this, or you can keep track of your moods using a calendar. It can also be helpful to share your journal with your doctor so that they can monitor how well your treatment is working.

Mixed Episodes

People with bipolar disorder sometimes have manic and depressive symptoms at the same time. This is called a mixed episode. It can be very difficult to deal with and is often the worst part of the disorder. Mixed episodes can last for several days or even weeks. Symptoms may include sadness and hopelessness (depression) while feeling agitated, restless and high energy (mania).

People who have had two or more episodes of depression and manic symptoms over the past 12 months are considered to have bipolar disorder. The diagnosis is based on your symptoms, family history, and other information from your doctor.

Doctors aren’t sure what causes bipolar disorder. However, they know that certain things can trigger an episode or worsen the symptoms of a mood swing. These include traumatic events, stress, drug and alcohol use, poor diet, and lack of exercise. It also seems that genetics plays a role, because some family members of people with bipolar disorder have the condition, too.

There’s no way to prevent bipolar disorder, but getting treatment early can help. Treatment can include medicines and psychotherapy, such as talk therapy or cognitive behavioral therapy. These therapies can teach you coping skills and help you change the thoughts and behaviors that contribute to your mood swings.

It’s important to stick with your treatment plan. Abruptly stopping medication can cause serious problems, such as a more severe episode of depression or mania. If you’re having suicidal thoughts, get help right away. Call 911 or your local suicide hotline. You can also call the 988 Suicide and Crisis Lifeline, which is available 24 hours a day, seven days a week in the United States.

It’s also important to have a strong support system and a good network of family and friends. Your loved ones might not understand what you’re going through, but they can help you manage your symptoms by being there for you and encouraging you to seek treatment. A little self-compassion can go a long way, too. Remember that you didn’t choose to have this illness, and it isn’t your fault.

Suicide

People with bipolar disorder may experience periods of depression as well as episodes of mania, and some have both. During depression, feelings of hopelessness, sadness and loss of pleasure in activities are common. In some cases, people may also feel agitated or restless and have thoughts of suicide. These feelings are called major depressive episodes or “down” moods.

During a manic episode, people may feel elated or excited. They may also be very irritable or aggressive, and they can have unusually fast thinking. Other signs include an exaggerated sense of confidence and energy, and reckless behaviors like spending sprees or risky sexual behavior. Manic episodes can also lead to psychosis, in which people become detached from reality and begin hearing voices or believing untruths, according to the Mayo Clinic.

It’s important to pay attention to warning signs of both mania and depression and involve family members and friends in watching for them. Getting treatment at the first sign of symptoms can help prevent an episode from getting worse and can reduce the frequency and severity of these mood swings. It’s also important to follow your treatment plan and avoid substances that can exacerbate or trigger symptoms, such as alcohol and recreational drugs.

Many different medications can treat bipolar disorder. A doctor will recommend one that’s right for you based on your medical history, symptoms, and unique needs. You may also need to see a mental health professional for psychotherapy, which can help you learn to cope with and manage your symptoms.

If you have suicidal thoughts, don’t ignore them. Call 911 or the National Suicide Prevention Lifeline at 988 for support and assistance from a counselor. If someone you know is in danger, stay with them and ensure they get immediate emergency care if needed.

Though suicide is very rare among people with bipolar disorder, it’s important to take any thoughts of suicide seriously and seek treatment immediately if necessary. The good news is that a combination of treatment and support can help prevent suicide, even in those with severe bipolar disorder.