Quick answer
Bipolar disorders are shifts in mood, energy and activity that go beyond everyday ups and downs: periods of elevated energy (mania or hypomania) and periods of depression. They're very treatable, especially once the pattern is clearly understood. Treatment usually centers on medication to steady mood, explained clearly, along with routines like protecting sleep.
Key takeaways
- Bipolar disorders are a spectrum: bipolar I, bipolar II and cyclothymia.
- Bipolar disorder can go undiagnosed for years. People often seek help only for depression, because high periods can feel good and go unnoticed.
- Diagnosis depends on the pattern over time, so a careful evaluation matters.
- Medication, usually a mood stabilizer, is central, and we explain every choice.
What bipolar disorders are
Bipolar disorders are shifts in mood, energy and activity that go beyond everyday ups and downs. They can change how you think, feel and get through the day.
They're best understood as a spectrum. Some people have intense periods of mania: A period of unusually elevated or irritable mood with much more energy than usual, less need for sleep and impulsive decisions, severe enough to disrupt life.; others have milder hypomania: A milder form of mania: a stretch of days with unusually high energy, less need for sleep and racing ideas, without the severe disruption of full mania. that's easy to miss. Most also have periods of depression. What matters most is the pattern over time, and how it affects your life.
Bipolar I
Includes at least one period of full mania. Depression is common too.
About bipolar IBipolar II
Hypomania rather than full mania, often with longer stretches of depression.
About bipolar IICyclothymia
Ups and downs that keep coming back but aren't intense or long enough to count as full episodes. Source: NIMH
Common signs, in plain language
During a high (elevated) period
- Much more energy than usual
- Needing far less sleep, without feeling tired
- Racing thoughts, or jumping between ideas
- Feeling unusually confident or driven
- Quick decisions you might not usually make
At first this can feel productive or even good, which is one reason it's often missed.
During a low (depressive) period
- Low mood, heaviness or emptiness
- Low energy and motivation
- Trouble concentrating
- Sleeping much more, or much less
- Everyday tasks feel harder
These are common experiences, not a checklist for diagnosis. Only a full evaluation can tell what's going on.
How it's diagnosed
Bipolar disorder can go undiagnosed for years. Many people seek help only when they're depressed, so the high periods aren't always recognized. During a low period, bipolar depression can look just like depression. What tells them apart is a history of hypomania or mania. That's why a careful evaluation looks at patterns across time, not a single moment.
- Your history of mood changes, both high and low periods
- Changes in sleep, energy and behavior
- How it affects work, relationships and daily life
- Family history and past treatment, including how you responded to medications
- Overlap with other conditions, such as anxiety or depression
This is part of a comprehensive psychiatric evaluation, where the goal is a clear, accurate understanding before any treatment decision.
How it's treated with medication
Bipolar disorders are very treatable, especially once the pattern is clearly understood. Medication is usually central. The goal isn't to remove emotion but to create a steadier, more predictable baseline.
Treatment usually centers on a mood stabilizer: A medication that helps prevent mood episodes or make them less severe.. Antidepressants are used more cautiously in bipolar disorder than in depression, usually alongside a mood stabilizer, because on their own they can trigger a high or increase cycling.
There's no single right medication. We weigh the type of bipolar disorder, your past responses, side effects, other health conditions, pregnancy plans, and your own preferences, and we explain each choice so you understand it.
Routines matter too. A regular sleep routine helps, along with noticing early warning signs and keeping regular follow-up visits.
What progress looks like
- Fewer and less intense mood swings
- Steadier daily routines
- Noticing early warning signs sooner
- More consistent energy and focus
- More confidence managing changes
Progress isn't about eliminating every mood change. It's about reducing the extremes so life feels more predictable.
Is it this or that?
Bipolar depression, or depression?
| Bipolar depression | Depression (unipolar) | |
|---|---|---|
| What it feels like | Low mood, loss of interest, fatigue, sleep changes. Often looks the same as depression. | Low mood, loss of interest, fatigue, sleep changes. |
| What tells them apart | A history of hypomania or mania, even if it felt good at the time. | No history of hypomania or mania. |
| Clues that may point to bipolar | A past period of unusually high or irritable mood, more energy and less need for sleep, even if it was brief or felt good. | No past high periods. Sleeping too little or too much can happen in either. |
| Role of antidepressants | Used cautiously, usually with a mood stabilizer. | Commonly used, and often the first medication tried. |
Bipolar depression
- What it feels like
- Low mood, loss of interest, fatigue, sleep changes. Often looks the same as depression.
- What tells them apart
- A history of hypomania or mania, even if it felt good at the time.
- Clues that may point to bipolar
- A past period of unusually high or irritable mood, more energy and less need for sleep, even if it was brief or felt good.
- Role of antidepressants
- Used cautiously, usually with a mood stabilizer.
Depression (unipolar)
- What it feels like
- Low mood, loss of interest, fatigue, sleep changes.
- What tells them apart
- No history of hypomania or mania.
- Clues that may point to bipolar
- No past high periods. Sleeping too little or too much can happen in either.
- Role of antidepressants
- Commonly used, and often the first medication tried.
No single symptom tells them apart. The history of high periods is what makes the diagnosis, which is why a careful evaluation matters. Sources: NIMH: Bipolar disorder · NIMH: Depression
Medication quick facts
FDA-approved medications include
These are the medications FDA-approved for bipolar disorder, and each card shows which type and which phase. FDA approval reflects which uses a manufacturer chose to study and submit, not the only medications that help. For medications also commonly used off-label, see our pages on bipolar I disorder and bipolar II disorder. Your provider will talk with you about what fits you.
There's no single right medication. Browse by type; your provider will talk through which options fit you.
Lithium
A mood stabilizer (antimanic medication)
- FDA-approved in bipolar for
- Treating and preventing episodes of mania.
- Monitoring
- Regular lab tests check how your body is handling lithium.
- Day to day
- Keep your fluid and salt intake steady, as your provider directs.
- Good to know
- Lithium can also lower the risk of suicide.
Source: MedlinePlus: Lithium · NIMH: Bipolar disorder
General information, not medical advice; talk with your provider.
Lamotrigine (Lamictal)
A mood stabilizer (anticonvulsant)
- FDA-approved in bipolar for
- Lengthening the time between mood episodes in bipolar I. It isn't used to treat an episode that's already happening.
- Important
- It can cause serious rashes. Your provider starts with a low dose and raises it slowly; report any rash right away.
- Interactions
- Tell your provider if you take valproate (Depakote), which raises the risk of rash with lamotrigine.
Source: MedlinePlus: Lamotrigine
General information, not medical advice; talk with your provider.
Divalproex (Depakote)
A mood stabilizer (anticonvulsant)
- FDA-approved in bipolar for
- Treating mania.
- Monitoring
- Regular lab tests check how your body is responding.
- Important
- It can cause serious liver damage, and serious birth defects if taken during pregnancy.
- Pregnancy
- If you could become pregnant, ask your provider about other options.
Source: MedlinePlus: Valproic acid
General information, not medical advice; talk with your provider.
Carbamazepine, extended-release (Equetro)
A mood stabilizer (anticonvulsant)
- FDA-approved in bipolar for
- Treating manic or mixed episodes in bipolar I.
- Important
- Rarely (about 1 to 6 in 10,000 new users), it can cause serious, sometimes life-threatening skin reactions, usually in the first few months. The risk is about 10 times higher in people of Asian ancestry, and the label recommends HLA-B*1502 genetic testing before starting for people with ancestry in genetically at-risk populations, mainly Asian ancestry. It can also lower blood cell counts.
- Monitoring
- Lab tests before and during treatment.
- Birth control
- It can make hormonal birth control less effective.
Source: MedlinePlus: Carbamazepine · FDA label (DailyMed): Equetro
General information, not medical advice; talk with your provider.
Aripiprazole (Abilify)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I, alone or alongside lithium or valproate. Its long-acting injections (Abilify Maintena, Abilify Asimtufii) are approved for maintenance.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Aripiprazole
General information, not medical advice; talk with your provider.
Asenapine (Saphris)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
- How it's taken
- A tablet that dissolves under the tongue. Tell your provider about any heart rhythm problems.
Source: MedlinePlus: Asenapine
General information, not medical advice; talk with your provider.
Cariprazine (Vraylar)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes, and depressive episodes, in bipolar I.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Cariprazine
General information, not medical advice; talk with your provider.
Lumateperone (Caplyta)
An atypical antipsychotic
- FDA-approved in bipolar for
- Depressive episodes in bipolar I and II.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
- How it's taken
- A capsule taken with food once a day.
Source: MedlinePlus: Lumateperone
General information, not medical advice; talk with your provider.
Lurasidone (Latuda)
An atypical antipsychotic
- FDA-approved in bipolar for
- Depressive episodes in bipolar I.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Lurasidone
General information, not medical advice; talk with your provider.
Olanzapine (Zyprexa)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I, and maintenance.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Olanzapine
General information, not medical advice; talk with your provider.
Olanzapine and fluoxetine
An antipsychotic combined with an SSRI antidepressant (brand: Symbyax)
- FDA-approved in bipolar for
- Depressive episodes in bipolar I.
- Good to know
- The Symbyax brand is no longer sold, but generic versions may be available.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
- Important
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: MedlinePlus: Fluoxetine · Olanzapine · FDA label (DailyMed): olanzapine and fluoxetine (generic Symbyax)
General information, not medical advice; talk with your provider.
Quetiapine (Seroquel)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic episodes, depressive episodes, and maintenance alongside lithium or valproate.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Quetiapine
General information, not medical advice; talk with your provider.
Risperidone (Risperdal)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
Source: MedlinePlus: Risperidone
General information, not medical advice; talk with your provider.
Iloperidone (Fanapt)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I, in adults (approved April 2024). Also approved for schizophrenia.
Source: FDA label (DailyMed): Fanapt
General information, not medical advice; talk with your provider.
Milsaperidone (Bysanti)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes in bipolar I, in adults (approved February 20, 2026). Also approved for schizophrenia.
- Good to know
- A newly approved medication, so there's less real-world experience with it.
Source: FDA label (DailyMed): Bysanti
General information, not medical advice; talk with your provider.
Ziprasidone (Geodon)
An atypical antipsychotic
- FDA-approved in bipolar for
- Manic or mixed episodes, and maintenance alongside lithium or valproate.
- Watch for
- Can raise blood sugar, even without diabetes; weight gain and drowsiness are possible. Your provider may check blood sugar, cholesterol and weight.
- How it's taken
- Capsules taken twice a day with food. Tell your provider about any heart rhythm problems.
Source: MedlinePlus: Ziprasidone
General information, not medical advice; talk with your provider.
Also FDA-approved for bipolar I: quetiapine extended-release (Seroquel XR), olanzapine and samidorphan (Lybalvi), long-acting risperidone injections for maintenance (Risperdal Consta, Rykindo, Uzedy) and the older antipsychotic chlorpromazine. For bipolar II depression, only quetiapine (Seroquel, Seroquel XR) and lumateperone (Caplyta) are FDA-approved. Links go to each FDA label.
Brand names are listed for recognition only. Antipsychotics carry a warning about older adults with dementia, which mainly concerns people older than the adults we see.
What to expect
What to expect with treatment
1Start your intake packet
Fill out our secure intake packet. Once it's submitted, we'll verify your insurance and call you to schedule your appointment.
2A careful evaluation
A longer video visit about what you're experiencing, your history, your health and your goals.
3Your diagnosis, explained
We explain what we think is going on, and why.
4A plan you understand
If medication could help, we talk through the options, side effects and what to expect, and decide together. If you'd benefit from therapy or another kind of care, we help you find it.
5Follow-up and adjustment
We check how you're doing and adjust carefully over time.
Bring this to your visit
Questions to ask your provider
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Before your first visit
Information your provider will want to know
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Frequently asked questions
What's the difference between bipolar I and bipolar II?
Bipolar I involves at least one period of full mania. Bipolar II involves hypomania, a milder high, often with longer stretches of depression.
Can bipolar disorder be treated?
Yes. With the right treatment, many people reach stability and manage their symptoms well.
Do I need medication?
Medication is usually a key part of treatment, but the approach depends on your symptoms and needs. We explain the options so you can decide together.
I was diagnosed with depression. Could it be bipolar disorder?
Sometimes. People often seek help only for depression, and high periods aren't always noticed. A careful evaluation looks at your full history.
Can I stop my medication if I feel better?
Please don't stop on your own; talk with your provider first. If you want to come off a medication, your provider can help you taper carefully and gradually.
Is a psychiatric nurse practitioner the same as a psychiatrist?
Both diagnose psychiatric conditions and prescribe psychiatric medication. Ours are board-certified psychiatric nurse practitioners (PMHNP-BC), focused on careful evaluation and medication management.
Check your understanding
Three quick questions
1What best tells bipolar depression apart from depression?
The depressive symptoms often look the same. The history of high periods is what makes the difference.
2Why are antidepressants used cautiously in bipolar disorder?
That's why they're usually used alongside a mood stabilizer, if at all.
3What's the goal of a mood stabilizer?
The aim is fewer and milder mood episodes.
Myth or fact? Bipolar disorder
Choose an answer for each to see the explanation. Nothing is saved.
1Bipolar disorder just means being moody.
Myth. It's a pattern of distinct periods of elevated and low mood and energy that go beyond everyday mood changes.
2Feeling great, full of energy and needing little sleep can be a symptom.
Fact. That can be hypomania. It often feels good at the time, which is why it's easy to miss.
3Antidepressants alone are the usual treatment for bipolar depression.
Myth. In bipolar disorder, antidepressants are used cautiously, usually alongside a mood stabilizer.
The science: how we checked this
Sources
- NIMH: Bipolar disorder
- NIMH: Depression
- FDA label (DailyMed): Equetro
- MedlinePlus: Lithium
- MedlinePlus: Lamotrigine
- MedlinePlus: Valproic acid
How we checked this
- Summarized in our own words from ANK's existing bipolar disorders page, Alyssa Killion's articles on bipolar disorder and mood stabilizers, and the sources above.
- Signs are described in plain language and aren't a diagnostic checklist.
- Clinically reviewed by Alyssa Killion, MSN, APN, PMHNP-BC. Last reviewed October 26, 2026.
