Bipolar Disorder

Bipolar disorder is a medical condition that affects mood, energy, thinking and judgement in episodes. Periods of depression alternate with periods when mood and energy run unusually high, and in between many people have long stretches of wellness. The episodes last days and weeks rather than hours, and that is what separates the condition from ordinary changes in mood.

What bipolar disorder is, and what it is not

In everyday speech, bipolar has come to mean mood that flips quickly. The condition is something else. The Centre for Addiction and Mental Health describes movement between three states: periods of elevated mood and energy, periods of depression, and periods of wellness. Mania lasts at least a week and brings a clear change in sleep, speech, confidence and judgement that other people notice. Depressive episodes last two weeks or more.

There is also more than one form. In bipolar I disorder the elevated periods reach the level called mania. In bipolar II disorder they are milder, called hypomania, and occur alongside depressive episodes. Hypomania often does not look like illness from the inside: it can feel like a productive stretch, which is one reason it gets missed.

Signs and symptoms

• During an elevated episode: unusually high, expansive or irritable mood with far more energy than usual, lasting at least a week in mania
• Needing much less sleep than usual without feeling tired
• Talking quickly, racing thoughts, jumping between ideas, and being easily distracted
• Exaggerated self-confidence, and decisions that carry more risk than usual with money, driving, work or sex
• In hypomania, a milder version of the same pattern that does not seriously disrupt daily life and is often missed
• During a depressive episode: low mood, loss of interest, changes in sleep and appetite, low energy, trouble concentrating and feelings of worthlessness, lasting two weeks or more
• In severe episodes of either kind, some people lose touch with reality and hear or believe things that others do not

Not everyone has both kinds of episode in the same measure. Some people spend far more time in depression than in elevated mood, and the pattern can change with age. Sleep is often the first thing to shift.

What raises the risk

Some risk factors cannot be changed:

• A family history of bipolar disorder or depression, since genetics plays an important part
• Being a young adult, since Canadian survey rates are highest between the ages of 15 and 24
• Having already had a depressive episode, since a first elevated episode can come later and change the diagnosis

Others can often be worked on, usually with support from a health care team:

• Alcohol and other substance use, which can set off or worsen an episode
• Broken or irregular sleep, including shift work and travel across time zones, since sleep loss is a common trigger
• Long stretches of high stress and family conflict, which can trigger an episode in someone susceptible rather than cause the illness
• Stopping or changing a medicine without discussing it with the prescriber first

How bipolar disorder is diagnosed in Canada

No blood test or scan diagnoses bipolar disorder. Clinicians work from medical history and symptoms while ruling out other causes such as thyroid disease, so blood work and a medication review are usually part of the assessment. The heart of the diagnosis is a careful history of mood over time: how long each period lasted, how high the highs went, how much they affected sleep, judgement and daily life, and what family members have experienced. With your permission, a clinician will often ask someone close to you what they noticed, because hypomania is frequently clearer to other people than to the person living it. An assessment usually starts with a family doctor or nurse practitioner and involves a psychiatrist. Because a first episode is often a depressive one, some people are treated for depression before bipolar disorder is recognised. That is why clinicians ask specifically about past periods of unusually high mood, high energy or much less sleep.

Treatment and day-to-day management

Clinical research for Bipolar Disorder is enrolling. See the current studies ↓

Care in Canada follows guidelines from the Canadian Network for Mood and Anxiety Treatments and the International Society for Bipolar Disorders. It combines medicines with psychological work and long-term monitoring, chosen for the phase being treated as well as for keeping well between episodes. Depending on your history, a health care team may discuss:

• Mood-stabilising medicines such as lithium, valproate and lamotrigine, selected for the phase being treated and for longer-term maintenance
• Second-generation antipsychotic medicines such as quetiapine, olanzapine and lurasidone, used on their own or alongside a mood stabiliser
• Careful decisions about antidepressants, which are handled differently in bipolar disorder than in depression and usually considered only alongside a mood stabiliser
• Psychoeducation and psychological therapies, including cognitive behavioural therapy, family-focused therapy and interpersonal and social rhythm therapy, plus practical work on sleep and daily routines
• Regular monitoring, including blood tests for some medicines, and electroconvulsive therapy for severe episodes or episodes that have not responded to other approaches

What suits one person will not suit another, and pregnancy, other medical conditions and side effects all change the picture. These are decisions for you and your own clinician, and this page is not a recommendation about any of them.

When to talk to a doctor

• If you are thinking about suicide or about hurting yourself, help is available now. The 9-8-8 Suicide Crisis Helpline answers calls and texts from anywhere in Canada, free, 24 hours a day, every day of the year: call or text 9-8-8. If you are in immediate danger, call 911 or go to your nearest emergency department.
• Get help the same day if you or someone close to you has gone several days with very little sleep and much more energy than usual, is acting in ways that put safety, money or relationships at serious risk, or is hearing, seeing or believing things others do not. Contact your health care provider, call a crisis line, or go to an emergency department.
• Contact your prescriber promptly if you feel more agitated, sped up or elevated after starting or changing a medicine, if you are thinking about stopping a medicine, if you are pregnant or planning a pregnancy, or if you are using alcohol or other substances more than before.

Why clinical research matters for bipolar disorder

Two problems stand out. The first is time: a 2026 international study in the journal Bipolar Disorders, drawing on 28 experts from several countries, found that young people face long delays before bipolar disorder is diagnosed and limited access to evidence-based care. It listed nine gaps, among them the lack of an agreed definition of early-stage bipolar disorder, a shortage of validated tools for diagnosis and monitoring, few treatments studied at that stage, and research data that sits in separate silos. The second problem is that existing medicines work better for some phases of the illness than others, particularly the depressive phase, and side effects lead some people to stop. Studies are currently looking at earlier recognition, treatments aimed at bipolar depression, long-term maintenance, psychological and family-based programmes, digital tools for tracking mood and sleep, and shared datasets across countries.

Clinical studies are how any of that gets tested. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can tell in advance whether a study will help you personally.

Learn more from Canadian sources

• 9-8-8 Suicide Crisis Helpline: call or text 9-8-8, any time
• Centre for Addiction and Mental Health: bipolar disorder
• Mood Disorders Society of Canada: education and peer support
• Canadian Mental Health Association: find your local branch