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Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiologic mechanisms underlying bipolar disorder.

  2. Recognize the symptoms of a manic episode and depressive episode in patients with bipolar disorder.

  3. Identify common comorbidities of bipolar disorder.

  4. Recognize the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria for bipolar disorder as well as the subtypes of bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

  5. List the desired therapeutic outcomes for patients with bipolar disorder.

  6. Explain the use of drugs as first-line therapy in bipolar disorder, including appropriate dosing, expected therapeutic effects, potential adverse effects, and important drug–drug interactions.

  7. Recommend individualized drug therapy for acute treatment and relapse prevention based on patient-specific data.

  8. Recommend monitoring methods for assessment of therapeutic and adverse effects of drugs used in the treatment of bipolar disorder.

  9. Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients.

  10. Educate patients with bipolar disorder about their illness, drug therapy required for effective treatment, and the importance of adherence.




Bipolar disorder is characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is chronic, with relapses and remissions. Mood episodes can be manic, depressed, or mixed. They can be separated by periods of long stability or cycle rapidly. They occur with or without psychosis. Disability and other consequences (eg, increased risk of suicide) can be devastating to patients and families. Correct and early diagnosis and treatment are essential to prevent complications and maximize response to treatment.






Bipolar disorders are categorized into bipolar I disorder, bipolar II disorder, and other specified and unspecified bipolar and related disorders. Bipolar I disorder is characterized by one or more manic or mixed mood episodes. Bipolar II disorder is characterized by one or more major depressive episodes and at least one hypomanic episode. Hypomania is an abnormally and persistently elevated, expansive, or irritable mood but not of sufficient severity to cause significant impairment and does not require hospitalization. The lifetime prevalence of bipolar I disorder is estimated at 0.6%. The lifetime prevalence of bipolar II disorder is about 0.4%. When including the entire spectrum of bipolar disorders, the prevalence is approximately 3%.2


Bipolar I disorder affects men and women equally. Bipolar II is more common in women. Rapid cycling and mixed mood episodes occur more in women. In all, 78% to 85% of individuals with bipolar disorder report having another Diagnostic and Statistical Manual, 5th edition (DSM-5), diagnosis during their lifetime. The most common comorbid conditions are anxiety, substance abuse, and impulse control disorders. Medical comorbidities are common.2


The mean age of onset is 20 years, although onset may occur ...

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