I want

What is Bipolar Disorder

Diseases
Revital Ordan, Psychiatric Nurse, Director of the Outpatient Division, Mental Health Division, Ministry of Health;  Dr. Marina Schwartz Ventik, Director of the Department of Psychiatry, Leumit Health Care Services
15 October 2025

Bipolar disorder, formerly known as “manic depression”is a mental disorder  that is characterized by extreme mood swings, energy and function. The prevalence of this disorder in the general population is1.6%.  It manifests, on the one hand, as episodes of mania or hypomania while, on the other hand, episodes of depression, or mixed episodes.

There are three main types of the disorder:

  • Bipolar I Disorder - which is characterized by manic episodes (even a one-time occurrence of a manic episode is sufficient for a diagnosis), with and without accompanying depressive episode.
  • Bipolar II Disorder - characterized by milder episodes of hypomania, including accompanying depressive episodes.
  • Cyclothymic disorder-a milder form of thedisorder. Characterized by more moderate but longer, mood swings.

Typicalsymptomsof a manic episode: occur for at leastoneweekincluding: extremely elevated mood, increased energy, inflated self-esteem and diminished need for sleep. In contrast, symptoms of a depressive episode appear for at least two weeks and include poor mood, loss of interest and enjoyment, changes in appetite and sleep patterns, sense of slowness or restlessness, diminished ability to focus and make decisions, and occasionnally suicidal ideation.

Risk factors for the disorder: genetic tendency, environmental and psycho-social factors, exposure to addictive substances.

Bipolar disorder, formerly known as “manic-depression," is a mood disorder characterized by mood swing as well as shifts in energy, and activity levels. It affects an average of 1.6% of the general population. 

The disorder is characterized by periods of mood dysregulation and imbalance, affecting energy levels and functional ability.   People with this disorder experience periods of intense and extreme emotional highs. These periods, which last from days to months, are called episodes.  

Manic episode vs. depressive episode

During a manic or hypomanic episode (hypomania being a milder form of mania), the person experiences an elevated or irritable mood and may feel euphoric or excessively agitated, restless, unusually energetic, and impulsive. In contrast, during a depressive episode, the person will experience overwhelming sadness, lack of interest, fatigue, and a significant slowdown in activity. Some people also experience mixed episodes, in which there are very frequent shifts between depression and mania or hypomania.  

It is important to understand that both conditions are fundamentally marked by significant and severe mental distress, with impaired functioning that may put the individual and those around them at risk. In most cases, the mood between episodes is relatively stable, allowing individuals to lead full and productive lives.  

About mood disorders

Naturally, in every person, mood is flexible, fluctuating between different emotions and responding to internal and external circumstances.   In conditions involving mood disorders, such as depression or bipolar disorder, there is a change in the quality of mood — meaning it is not simply happiness or sadness as experienced during emotional stability, but an emotion that is fundamentally different in nature.   Furthermore, the intensity of emotions is also different, involving extremely intense feelings and emotions.   Mood fluctuations can be characterized by frequent or extreme shifts and often do not correspond to the surrounding situations.  

Coping with bipolar disorder is complex, affecting not only the emotional and psychological level but also social and functional aspects.   Beyond the ongoing distress, functional difficulties, and impacts on all areas of life, it is also important to understand that the longer and more frequent the episodes are, the harder it becomes to return to a balanced mood with minimal symptoms and normal functioning.   Appropriate treatment and support, therefore, can help prevent or reduce episodes, lessen the severity of symptoms and extreme mood swings, and provide tools for better and easier coping.  

Types of Bipolar Disorder

The category of bipolar disorder includes three different diagnoses:  

  • Bipolar I disorder is diagnosed when there is at least one manic episode characterized by severe symptoms lasting for at least one week, often requiring intensive treatment and supervision in a hospital or alternative hospitalization setting. It is assumed that in these cases a depressive episode has also occurred or will occur, but it is not required for the diagnosis. 
  • Bipolar II disorder is diagnosed when there is a hypomanic episode lasting at least 4 days (featuring symptoms similar to mania but milder in intensity and with less impairment in functioning), alongside a depressive episode.
  • Cyclothymic disorder (Cyclothymia): A milder form of bipolar disorder. It is characterized by prolonged mood instability, with periods of hypomanic symptoms and periods of depressive symptoms of lesser intensity, lasting for at least two years.   The symptoms of cyclothymia do not meet the diagnostic criteria for a hypomanic or depressive episode, but over time, this disorder can progress and develop into Bipolar I or II disorder. 

Symptoms

The two episodes that characterize bipolar disorder manifest very differently in behavior, thinking, and feelings:

  • Manic episode

    Symptoms characteristic of a manic episode (for diagnosis, they must be present for at least 7 days) include: 

    • Extremely elevated mood, euphoria, or extreme irritability and agitation.
    • Increased energy and heightened activity levels.
    • Exaggerated and inflated self-esteem to the point of delusions of grandeur.
    • Decreased need for sleep.
    • Racing thoughts and rapid speech.
    • Poor judgment leading to impulsive, undesirable, and risky behavior.

    The symptoms characteristic of a hypomanic episode is similar to those of a manic episode, lasting at least 4 days, but are less severe, do not include psychotic symptoms, and cause less impairment in functioning.  

  • Depressive episode

    Symptoms characteristic of a depressive episode (for diagnosis, they must be present for at least two weeks):  

    • Poor mood, sadness, and a feeling of emptiness for most of the day.
    • Loss of interest and pleasure, with a significant decrease in the enjoyment of all pleasurable activities.
    • Significant changes in appetite and sleep patterns.
    • Decreased energy, fatigue, and a feeling of slowing down, or alternatively — restlessness.
    • Feelings of worthlessness or excessive and inappropriate guilt.
    • Decreased abilities in concentration, memory, and decision-making.
    • Thoughts about death, suicidal ideation or suicide attempts.

     

In most cases, the disorder begins with 2–3 depressive episodes, with the first manic episode appearing only after several years. Only in 10%–20% of cases is the first episode a manic episode. Nevertheless, the manic episode is often experienced as a “bolt from the blue” due to its intensity and severity while depressive episodes are not always perceived as a mental disorder but rather as a temporary crisis that may not necessarily be diagnosed or treated.   

As the disorder progresses, the intervals between episodes tend to shorten — from several years between episodes at the beginning of the disorder to just a few months later on. 

Risk factors for flareups of biopolar disease

Research on mood disorders indicates that bipolar disorder results from a complex interaction of multiple factors.   While the exact cause of the disorder is not fully known, several risk factors have been identified that increase the likelihood of developing the illness.  It is important to emphasize that the presence of one or more risk factors does not guarantee that a person will develop the disorder; it only increases the likelihood.   The main risk factors are:

There is a higher prevalence of bipolar disorder among individuals who have an immediate relative with the condition, which suggests a genetic component. Genetic studies have identified several genes that may be associated with the disorder, but no single “bipolar gene” has yet been found to be responsible. It is likely that multiple genes, in combination with environmental factors, increase the risk.

Significant life events, especially those involving stress, trauma, or loss, can act as triggers and provoke episodes in individuals with a genetic predisposition to the disorder. Major life changes, such as moving to a new home, starting new studies or work, losing a close person, or experiencing a family crisis, can cause emotional instability that may develop into a manic or depressive episode. Chronic stress resulting from situations such as chronic financial difficulties, an unstable family environment, or psychological and physical abuse can also increase the risk of developing the disorder, especially in individuals with a genetic background.

The use of certain medications, such as steroids, Parkinson’s disease treatments, or antidepressants, can trigger a manic episode, especially in individuals with a genetic predisposition to bipolar disorder. The use of addictive and psychoactive substances such as alcohol, cannabis, cocaine, or amphetamines can also trigger a manic or psychotic episode. It is important to distinguish between situations where symptoms are directly caused by drug or medication use, or during withdrawal (meaning that stopping the use and completing withdrawal under treatment will lead to symptom resolution), and situations in which substance use has only “unmasked” an existing bipolar disorder or increased the risk of its development. In the second case, even after stopping substance use, bipolar disorder will continue to manifest and require appropriate treatment.

The importance of early treatment

Understanding the risk factors for bipolar disorder enables earlier identification of initial signs and the provision of preventive treatment, which may help prevent worsening and deterioration of the condition.   Individuals with high-risk factors, such as a family history of the disorder, trauma, or significant life events, may benefit from professional monitoring and support. 

It is important to understand that the presence of risk factors does not mean the disorder is inevitable or that it cannot be successfully managed. With accurate diagnosis, appropriate medication, psychological therapy, and lifestyle changes, many people living with bipolar disorder are able to lead full, creative, and fulfilling lives. 

You might be interested in:

Mental Health Hotlines of the HMOs