Bipolar disorder is characterized by extremes in mood and related changes in behavior and thoughts. In
this condition, an individual experiences both highs (mania or its milder form, hypomania), and lows (depression),
or a mixture of symptoms at the same time. What is tricky about manic symptoms is that, unlike depression, they may
not be recognized by individuals with the condition, and in fact the symptoms may be enjoyable to them. The symptoms
of bipolar disorder come and go, but the condition itself is chronic and requires ongoing management, like diabetes
does. However, with good treatment and self-management skills, individuals with bipolar disorder can lead productive
and fulfilling lives.
Previously called manic depressive disorder, bipolar disorder is relatively common – about one in every hundred
people (1%) develop bipolar disorder.
Some common symptoms of bipolar disorder are:
Mania (highs): may include feelings of euphoria, increased energy, and a heightened sense of
optimism. Often times, people feel sped up and have too much energy; they usually have little need for sleep and
cannot turn off the racing thoughts in their mind. Many people also have periods of elevated energy and drive that
is not pleasant but is more irritable or even depressive. Milder forms of mania are called hypomania.
Depression (lows): consists of sad or blue moods, sometimes with a sense that things are bad
and will never get better. Often people stop feeling pleasure in usual activities, become unrealistically
pessimistic, hopeless, guilty, or even think about ending their lives. Sometimes there are physical changes as
well, including inability to sleep and loss of appetite or eating too much.
Other Symptoms: often accompany bipolar disorder. Common “co-travelers” with bipolar disorder
include anxiety disorders such as post-traumatic stress disorder (PTSD) or substance use disorders. Occasionally
individuals may experience hallucinations (voices or visions) or delusions (strange, fixed beliefs) when severely
manic or depressed. These other symptoms need treatment as well.
Some ideas about what causes bipolar disorder:
There is no single identifiable cause of bipolar disorder, rather a variety of individual characteristics and
outside factors that likely combine to activate bipolar symptoms in a person, usually around early adulthood.
Genetics: There is some indication that genetics plays a role in making an individual more
susceptible to bipolar disorder, but researchers have been unable to find a single gene cause. It is more likely
that the disorder is caused by a combination of genetic factors and environmental triggers. It is important to
know, though, that just because a person has bipolar disorder does not mean that their children will—in fact, it’s
more likely that they will not have the disorder.
Biological factors: Research has linked bipolar disorder to problems with certain brain
chemicals called neurotransmitters (for example, norepinephrine, serotonin, and dopamine). These neurotransmitters
let brain cells communicate with one another, and research indicates that problems in this communication is in some
way related to bipolar disorder.
Psychological factors: There is no one psychological theory that can be used to explain bipolar
disorder. Research has focused less on causes of the disorder and more on factors that affect its course (see next
bullet). Psychological theories such as cognitive, behavior, and interpersonal theory have all been used as models
for the development of treatment strategies.
Life stressors: Research suggests that both physical stressors (like change in seasons or use
of drugs) and social stressors (like family stress or job stress) can affect the course of the symptoms, sometimes
even triggering an episode.
There are no laboratory tests, no brain scans, and no paper-and-pencil tests that tell you if you have bipolar
disorder. Sometimes, though, brain scans are used to make sure that physical problems like a tumor are not causing
the symptoms. Genetic testing available on the web cannot tell you, either; these tests tend to be a waste of
money. Rather, the diagnosis is made by an experienced clinical provider from taking a careful history and
interview observations. And it is not just a matter of opinion.
Making the correct clinical diagnosis is important, and good treatment leads to better outcomes. However, making
a diagnosis does not mean that you become your diagnosis. It is important to explore what the condition means to
your life—neither ignoring the condition nor surrendering your life and self-worth to it.
VA Programs & Services
Treatment for bipolar disorder involves working with mental health professionals to develop a plan with both
medication and psychosocial interventions to achieve optimal health. Bipolar is a spectrum disorder because each
person’s symptoms, life circumstances, and other health and mental health issues create a uniqueness that makes it
impossible to treat everyone in the same way.
Medication is necessary in most cases. A medication that works well for one Veteran may not help another, so it is
important to work closely with prescribers to find a medication that works. No one treatment is best for all
Veterans. Programs and services at the VA treat each Veteran as an individual and work to determine which treatments
and programs fit best with each Veterans’ personal needs and goals.
Psychological Treatments and Social Supports
Veterans can also talk with Mental Health Professionals (MHPs) about trauma they’ve experienced, substance use,
challenging life circumstances, or other pain that may be affecting them. Psychosocial interventions are considered
essential to promoting the recovery of Veterans who are diagnosed with bipolar disorder, and should be offered along
with medications. Psychosocial interventions have been shown to improve outcomes in individuals already taking
The VA provides the following psychosocial interventions for bipolar disorder:
Psychoeducation involves teaching Veterans with bipolar disorder about the condition, treatment, and ways to
recognize signs of relapse so that early intervention can be sought before a full‐blown episode occurs.
Psychoeducation also may be helpful for family members.
Life Goals helps Veterans with bipolar disorder achieve personal wellness goals through a combination of self-
management skills, individualized guidance in healthy lifestyles, and symptom management. Life Goals is a brief
intervention that is often provided in the context of an ongoing care management program called Life Goals
Collaborative Care (LGCC). LGCC is available at a growing number of VA medical centers, including by means of
videoconferencing technologies that link Veterans to centers of expertise in bipolar treatment.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) helps Veterans diagnosed with bipolar disorder learn to change
negative thought patterns and behaviors associated with the condition.
Illness Management and Recovery (IMR)
Illness Management and Recovery (IMR) helps people obtain information and learn skills to
support their mental health and recovery.
Peer Support Technicians
Peer Support Technicians (also called Peer Specialists or Peer Counselors) have personal
experiences with bipolar disorder and recovery, and have completed peer-counselor training. They can help Veterans
navigate the VA mental health system, put Veterans in touch with community and VA resources, or assist Veterans in
advocating for their needs. As a Veteran who “has been there” regarding mental illness, they can be terrific allies
in a person’s recovery journey.
Other programs aimed at housing, employment, vocational training, and health behavior change are also
available to help Veterans design programming that best meets their needs and goals. Each VA has a Local Recovery
Coordinator (LRC) who leads recovery discussion groups, creates special education programs, and makes recovery-
focused programs available to Veterans. LRCs can help Veterans with bipolar disorder find resources to promote their
recovery. They can also help you to arrange services.
Depression and Bipolar Support Alliance
(DBSA)*: A national organization focusing on the most prevalent mental illnesses. Provides information and links to local
support groups for individuals with bipolar disorder, as well as a few brochures such as: Myths and Facts about Depression and
What is bipolar disorder?*: The National Alliance on Mental Illness (NAMI) describes bipolar disorder, recovery
and coping strategies. NAMI is a grassroots organization dedicated to improving the lives of individuals and families affected by
mental illness. NAMI provides information on symptoms, causes, diagnosis, treatment and more. The NAMI main office phone number is
(703) 524-7600. The NAMI Helpline is (800) 950-6264.
The National Institute of Mental
Health (NIMH)*: A website full of articles, research results, and links to clinical trials on bipolar disorder.The NIMH is a
national organization whose mission is to transform the understanding and treatment of mental illnesses through basic and clinical
research, paving the way for prevention, recovery and cure. It provides information on the latest scientific information as well as
ongoing studies relevant to bipolar disorder.
The Veterans Crisis Line is a toll-free, confidential resource
that connects Veterans in crisis and their families and friends with qualified, caring VA responders. Veterans and their loved ones
can call 1-800-273-8255 and Press 1, chat online at www.VeteransCrisisLine.net*, or send a text message to 838255 to receive free, confidential support 24 hours a
day, 7 days a week, 365 days a year, even if they are not registered with VA or enrolled in VA health care.