Bipolar disorder, also known as manic-depressive illness, is a brain
disorder that causes unusual shifts in a person's mood, energy, and ability to
function. Different from the normal ups and downs that everyone goes through,
the symptoms are severe. They can result in damaged
relationships, poor job or school performance, and even suicide. But there is
good news: it can be treated, and people with this illness can
lead full and productive lives.
More than 2 million American adults,1 or
about 1 percent of the population age 18 and older in any given year,2
have bipolar disorder. Bipolar disorder typically develops in late adolescence
or early adulthood. However, some people have their first symptoms during
childhood, and some develop them late in life. It is often not recognized as
an illness, and people may suffer for years before it is properly diagnosed
and treated. Like diabetes or heart disease, bipolar disorder is a long-term
illness that must be carefully managed throughout a person's life.
"Manic-depression distorts moods and thoughts, incites dreadful
behaviors, destroys the basis of rational thought, and too often erodes the
desire and will to live. It is an illness that is biological in its origins,
yet one that feels psychological in the experience of it; an illness that is
unique in conferring advantage and pleasure, yet one that brings in its wake
almost unendurable suffering and, not infrequently, suicide."
"I am fortunate that I have not died from my illness, fortunate in
having received the best medical care available, and fortunate in having the
friends, colleagues, and family that I do."
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
(Reprinted with permission from Alfred A. Knopf, a division of Random House,
Bipolar disorder causes dramatic mood swings—from overly "high"
and/or irritable to sad and hopeless, and then back again, often with periods
of normal mood in between. Severe changes in energy and behavior go along with
these changes in mood. The periods of highs and lows are called episodes
of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
- Increased energy, activity, and restlessness
- Excessively "high," overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Distractibility, can't concentrate well
- Little sleep needed
- Unrealistic beliefs in one's abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of
the other symptoms most of the day, nearly every day, for 1 week or longer. If
the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode)
- Lasting sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue or of being "slowed
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can't sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that are not caused by
physical illness or injury
- Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last
most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania.
Hypomania may feel good to the person who experiences it and may even be
associated with good functioning and enhanced productivity. Thus even when
family and friends learn to recognize the mood swings as possible bipolar
disorder, the person may deny that anything is wrong. Without proper
treatment, however, hypomania can become severe mania in some people or can
switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis
(or psychotic symptoms). Common psychotic symptoms are hallucinations
(hearing, seeing, or otherwise sensing the presence of things not actually
there) and delusions (false, strongly held beliefs not influenced by logical
reasoning or explained by a person's usual cultural concepts). Psychotic
symptoms in bipolar disorder tend to reflect the extreme mood state at the
time. For example, delusions of grandiosity, such as believing one is the
President or has special powers or wealth, may occur during mania; delusions
of guilt or worthlessness, such as believing that one is ruined and penniless
or has committed some terrible crime, may appear during depression. People
with bipolar disorder who have these symptoms are sometimes incorrectly
diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder
as a spectrum or continuous range. At one end is severe depression, above
which is moderate depression and then mild low mood, which many people call
"the blues" when it is short-lived but is termed "dysthymia"
when it is chronic. Then there is normal or balanced mood, above which comes
hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur
together in what is called a mixed bipolar state. Symptoms of
a mixed state often include agitation, trouble sleeping, significant change in
appetite, psychosis, and suicidal thinking. A person may have a very sad,
hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness—for
instance, alcohol or drug abuse, poor school or work performance, or strained
interpersonal relationships. Such problems in fact may be signs of an
underlying mood disorder.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified
physiologically—for example, through a blood test or a brain scan.
Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms,
course of illness, and, when available, family history. The diagnostic
criteria for bipolar disorder are described in the Diagnostic and
Statistical Manual for Mental Disorders, fourth edition (DSM-IV).3
- Descriptions offered by people with bipolar disorder give valuable
insights into the various mood states associated with the illness:
Depression: I doubt completely my ability to do
anything well. It seems as though my mind has slowed down and burned out
to the point of being virtually useless…. [I am] haunt[ed]… with the
total, the desperate hopelessness of it all…. Others say, "It's
only temporary, it will pass, you will get over it," but of course
they haven't any idea of how I feel, although they are certain they do.
If I can't feel, move, think or care, then what on earth is the point?
Hypomania: At first when I'm high, it's
tremendous… ideas are fast… like shooting stars you follow until
brighter ones appear…. All shyness disappears, the right words and
gestures are suddenly there… uninteresting people, things become
intensely interesting. Sensuality is pervasive, the desire to seduce and
be seduced is irresistible. Your marrow is infused with unbelievable
feelings of ease, power, well-being, omnipotence, euphoria… you can do
anything… but, somewhere this changes.
Mania: The fast ideas become too fast and there are
far too many… overwhelming confusion replaces clarity… you stop
keeping up with it—memory goes. Infectious humor ceases to amuse. Your
friends become frightened…. everything is now against the grain… you
are irritable, angry, frightened, uncontrollable, and trapped.
Some people with bipolar disorder become suicidal. Anyone who is
thinking about committing suicide needs immediate attention, preferably from a
mental health professional or a physician. Anyone who talks about suicide
should be taken seriously. Risk for suicide appears to be higher
earlier in the course of the illness. Therefore, recognizing bipolar disorder
early and learning how best to manage it may decrease the risk of death by
Signs and symptoms that may accompany suicidal feelings include:
- talking about feeling suicidal or wanting to die
- feeling hopeless, that nothing will ever change or get better
- feeling helpless, that nothing one does makes any difference
- feeling like a burden to family and friends
- abusing alcohol or drugs
- putting affairs in order (e.g., organizing finances or giving away
possessions to prepare for one's death)
- writing a suicide note
- putting oneself in harm's way, or in situations where there is a danger
of being killed
If you are feeling suicidal or know someone who is:
- call a doctor, emergency room, or 911 right away to get immediate help
- make sure you, or the suicidal person, are not left alone
- make sure that access is prevented to large amounts of medication,
weapons, or other items that could be used for self-harm
While some suicide attempts are carefully planned over time, others are
impulsive acts that have not been well thought out; thus, the final point in
the box above may be a valuable long-term strategy for people with
bipolar disorder. Either way, it is important to understand that suicidal
feelings and actions are symptoms of an illness that can be treated. With
proper treatment, suicidal feelings can be overcome.
What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span.
Between episodes, most people with bipolar disorder are free of symptoms, but
as many as one-third of people have some residual symptoms. A small percentage
of people experience chronic unremitting symptoms despite treatment.4
The classic form of the illness, which involves recurrent episodes of mania
and depression, is called bipolar I disorder. Some people,
however, never develop severe mania but instead experience milder episodes of
hypomania that alternate with depression; this form of the illness is called bipolar
II disorder. When four or more episodes of illness occur within a
12-month period, a person is said to have rapid-cycling
bipolar disorder. Some people experience multiple episodes within a single
week, or even within a single day. Rapid cycling tends to develop later in the
course of illness and is more common among women than among men.
People with bipolar disorder can lead healthy and productive lives when the
illness is effectively treated (see below—"How Is
Bipolar Disorder Treated?"). Without treatment, however, the natural
course of bipolar disorder tends to worsen. Over time a person may suffer more
frequent (more rapid-cycling) and more severe manic and depressive episodes
than those experienced when the illness first appeared.5
But in most cases, proper treatment can help reduce the frequency and severity
of episodes and can help people with bipolar disorder maintain good quality of
Can Children and Adolescents Have Bipolar Disorder?
Both children and adolescents can develop bipolar disorder. It is more
likely to affect the children of parents who have the illness.
Unlike many adults with bipolar disorder, whose episodes tend to be more
clearly defined, children and young adolescents with the illness often
experience very fast mood swings between depression and mania many times
within a day.6 Children with mania are more
likely to be irritable and prone to destructive tantrums than to be overly
happy and elated. Mixed symptoms also are common in youths with bipolar
disorder. Older adolescents who develop the illness may have more classic,
adult-type episodes and symptoms.
Bipolar disorder in children and adolescents can be hard to tell apart from
other problems that may occur in these age groups. For example, while
irritability and aggressiveness can indicate bipolar disorder, they also can
be symptoms of attention deficit hyperactivity disorder, conduct disorder,
oppositional defiant disorder, or other types of mental disorders more common
among adults such as major depression or schizophrenia. Drug abuse also may
lead to such symptoms.
For any illness, however, effective treatment depends on appropriate
diagnosis. Children or adolescents with emotional and behavioral symptoms
should be carefully evaluated by a mental health professional. Any
child or adolescent who has suicidal feelings, talks about suicide, or
attempts suicide should be taken seriously and should receive immediate help
from a mental health specialist.
What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder
through several kinds of studies. Most scientists now agree that there is no
single cause for bipolar disorder—rather, many factors act together to
produce the illness.
Because bipolar disorder tends to run in families, researchers have been
searching for specific genes—the microscopic "building blocks" of
DNA inside all cells that influence how the body and mind work and
grow—passed down through generations that may increase a person's chance of
developing the illness. But genes are not the whole story. Studies of
identical twins, who share all the same genes, indicate that both genes and
other factors play a role in bipolar disorder. If bipolar disorder were caused
entirely by genes, then the identical twin of someone with the illness would always
develop the illness, and research has shown that this is not the case. But if
one twin has bipolar disorder, the other twin is more likely to develop the
illness than is another sibling.7
In addition, findings from gene research suggest that bipolar disorder,
like other mental illnesses, does not occur because of a single gene.8
It appears likely that many different genes act together, and in combination
with other factors of the person or the person's environment, to cause bipolar
disorder. Finding these genes, each of which contributes only a small amount
toward the vulnerability to bipolar disorder, has been extremely difficult.
But scientists expect that the advanced research tools now being used will
lead to these discoveries and to new and better treatments for bipolar
Brain-imaging studies are helping scientists learn what goes wrong in the
brain to produce bipolar disorder and other mental illnesses.9,10
New brain-imaging techniques allow researchers to take pictures of the living
brain at work, to examine its structure and activity, without the need for
surgery or other invasive procedures. These techniques include magnetic
resonance imaging (MRI), positron emission tomography (PET), and functional
magnetic resonance imaging (fMRI). There is evidence from imaging studies that
the brains of people with bipolar disorder may differ from the brains of
healthy individuals. As the differences are more clearly identified and
defined through research, scientists will gain a better understanding of the
underlying causes of the illness, and eventually may be able to predict which
types of treatment will work most effectively.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe
forms—can achieve substantial stabilization of their mood swings and related
symptoms with proper treatment.11,12,13
Because bipolar disorder is a recurrent illness, long-term preventive
treatment is strongly recommended and almost always indicated. A strategy that
combines medication and psychosocial treatment is optimal for managing the
disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is
continuous than if it is on and off. But even when there are no breaks in
treatment, mood changes can occur and should be reported immediately to your
doctor. The doctor may be able to prevent a full-blown episode by making
adjustments to the treatment plan. Working closely with the doctor and
communicating openly about treatment concerns and options can make a
difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep
patterns, and life events may help people with bipolar disorder and their
families to better understand the illness. This chart also can help the doctor
track and treat the illness most effectively.
Medications for bipolar disorder are prescribed by psychiatrists—medical
doctors (M.D.) with expertise in the diagnosis and treatment of mental
disorders. While primary care physicians who do not specialize in psychiatry
also may prescribe these medications, it is recommended that people with
bipolar disorder see a psychiatrist for treatment.
Medications known as "mood stabilizers" usually are prescribed to
help control bipolar disorder.11 Several
different types of mood stabilizers are available. In general, people with
bipolar disorder continue treatment with mood stabilizers for extended periods
of time (years). Other medications are added when necessary, typically for
shorter periods, to treat episodes of mania or depression that break through
despite the mood stabilizer.
- Lithium, the first mood-stabilizing medication approved by the U.S. Food
and Drug Administration (FDA) for treatment of mania, is often very
effective in controlling mania and preventing the recurrence of both manic
and depressive episodes.
- Anticonvulsant medications, such as valproate (Depakote®) or
carbamazepine (Tegretol®), also can have mood-stabilizing
effects and may be especially useful for difficult-to-treat bipolar
episodes. Valproate was FDA-approved in 1995 for treatment of mania.
- Newer anticonvulsant medications, including lamotrigine (Lamictal®),
gabapentin (Neurontin®), and topiramate (Topamax®),
are being studied to determine how well they work in stabilizing mood
- Anticonvulsant medications may be combined with lithium, or with each
other, for maximum effect.
- Children and adolescents with bipolar disorder generally are treated
with lithium, but valproate and carbamazepine also are used. Researchers
are evaluating the safety and efficacy of these and other psychotropic
medications in children and adolescents. There is some evidence that
valproate may lead to adverse hormone changes in teenage girls and
polycystic ovary syndrome in women who began taking the medication before
age 20.14 Therefore, young female
patients taking valproate should be monitored carefully by a physician.
- Women with bipolar disorder who wish to conceive, or who become
pregnant, face special challenges due to the possible harmful effects of
existing mood stabilizing medications on the developing fetus and the
nursing infant.15 Therefore, the benefits
and risks of all available treatment options should be discussed with a
clinician skilled in this area. New treatments with reduced risks during
pregnancy and lactation are under study.
Treatment of Bipolar Depression
Research has shown that people with bipolar disorder are at risk of
switching into mania or hypomania, or of developing rapid cycling, during
treatment with antidepressant medication.16
Therefore, "mood-stabilizing" medications generally are
required, alone or in combination with antidepressants, to protect people with
bipolar disorder from this switch. Lithium and valproate are the most
commonly used mood-stabilizing drugs today. However, research studies continue
to evaluate the potential mood-stabilizing effects of newer medications.
- Atypical antipsychotic medications, including clozapine (Clozaril®),
olanzapine (Zyprexa®), risperidone (Risperdal®),
quetiapine (Seroquel®), and ziprasidone (Geodon®),
are being studied as possible treatments for bipolar disorder. Evidence
suggests clozapine may be helpful as a mood stabilizer for people who do
not respond to lithium or anticonvulsants.17
Other research has supported the efficacy of olanzapine for acute mania,
an indication that has recently received FDA approval.18
Olanzapine may also help relieve psychotic depression.19
- If insomnia is a problem, a high-potency benzodiazepine medication such
as clonazepam (Klonopin®) or lorazepam (Ativan®)
may be helpful to promote better sleep. However, since these medications
may be habit-forming, they are best prescribed on a short-term basis.
Other types of sedative medications, such as zolpidem (Ambien®),
are sometimes used instead.
- Changes to the treatment plan may be needed at various times during the
course of bipolar disorder to manage the illness most effectively. A
psychiatrist should guide any changes in type or dose of medication.
- Be sure to tell the psychiatrist about all other prescription drugs,
over-the-counter medications, or natural supplements you may be taking.
This is important because certain medications and supplements taken
together may cause adverse reactions.
- To reduce the chance of relapse or of developing a new episode, it is
important to stick to the treatment plan. Talk to your doctor if you have
any concerns about the medications.
People with bipolar disorder often have abnormal thyroid gland function.5
Because too much or too little thyroid hormone alone can lead to mood and
energy changes, it is important that thyroid levels are carefully monitored by
People with rapid cycling tend to have co-occurring thyroid problems and
may need to take thyroid pills in addition to their medications for bipolar
disorder. Also, lithium treatment may cause low thyroid levels in some people,
resulting in the need for thyroid supplementation.
Medication Side Effects
Before starting a new medication for bipolar disorder, always talk with
your psychiatrist and/or pharmacist about possible side effects. Depending on
the medication, side effects may include weight gain, nausea, tremor, reduced
sexual drive or performance, anxiety, hair loss, movement problems, or dry
mouth. Be sure to tell the doctor about all side effects you notice during
treatment. He or she may be able to change the dose or offer a different
medication to relieve them. Your medication should not be changed or stopped
without the psychiatrist's guidance.
As an addition to medication, psychosocial treatments—including certain
forms of psychotherapy (or "talk" therapy)—are helpful in
providing support, education, and guidance to people with bipolar disorder and
their families. Studies have shown that psychosocial interventions can lead to
increased mood stability, fewer hospitalizations, and improved functioning in
several areas.13 A licensed psychologist,
social worker, or counselor typically provides these therapies and often works
together with the psychiatrist to monitor a patient's progress. The number,
frequency, and type of sessions should be based on the treatment needs of each
Psychosocial interventions commonly used for bipolar disorder are cognitive
behavioral therapy, psychoeducation, family therapy, and a newer technique,
interpersonal and social rhythm therapy. NIMH researchers are studying how
these interventions compare to one another when added to medication treatment
for bipolar disorder.
- Cognitive behavioral therapy helps people with bipolar disorder learn to
change inappropriate or negative thought patterns and behaviors associated
with the illness.
- Psychoeducation involves teaching people with bipolar disorder about the
illness and its treatment, and how to recognize signs of relapse so that
early intervention can be sought before a full-blown illness episode
occurs. Psychoeducation also may be helpful for family members.
- Family therapy uses strategies to reduce the level of distress within
the family that may either contribute to or result from the ill person's
- Interpersonal and social rhythm therapy helps people with bipolar
disorder both to improve interpersonal relationships and to regularize
their daily routines. Regular daily routines and sleep schedules may help
protect against manic episodes.
- As with medication, it is important to follow the treatment plan for any
psychosocial intervention to achieve the greatest benefit.
- In situations where medication, psychosocial treatment, and the
combination of these interventions prove ineffective, or work too slowly
to relieve severe symptoms such as psychosis or suicidality,
electroconvulsive therapy (ECT) may be considered. ECT may also be
considered to treat acute episodes when medical conditions, including
pregnancy, make the use of medications too risky. ECT is a highly
effective treatment for severe depressive, manic, and/or mixed episodes.
The possibility of long-lasting memory problems, although a concern in the
past, has been significantly reduced with modern ECT techniques. However,
the potential benefits and risks of ECT, and of available alternative
interventions, should be carefully reviewed and discussed with individuals
considering this treatment and, where appropriate, with family or friends.20
- Herbal or natural supplements, such as St. John's wort (Hypericum
perforatum), have not been well studied, and little is known about
their effects on bipolar disorder. Because the FDA does not regulate their
production, different brands of these supplements can contain different
amounts of active ingredient. Before trying herbal or natural
supplements, it is important to discuss them with your doctor. There is
evidence that St. John's wort can reduce the effectiveness of certain
medications.21 In addition, like
prescription antidepressants, St. John's wort may cause a switch into
mania in some individuals with bipolar disorder, especially if no mood
stabilizer is being taken.22
- Omega-3 fatty acids found in fish oil are being studied to determine
their usefulness, alone and when added to conventional medications, for
long-term treatment of bipolar disorder.23
A Long-Term Illness That Can Be Effectively Treated
Even though episodes of mania and depression naturally come and go, it is
important to understand that bipolar disorder is a long-term illness that
currently has no cure. Staying on treatment, even during well times, can
help keep the disease under control and reduce the chance of having
recurrent, worsening episodes.
Do Other Illnesses Co-occur with Bipolar Disorder?
Alcohol and drug abuse are very common among people with bipolar disorder.
Research findings suggest that many factors may contribute to these substance
abuse problems, including self-medication of symptoms, mood symptoms either
brought on or perpetuated by substance abuse, and risk factors that may
influence the occurrence of both bipolar disorder and substance use disorders.24
Treatment for co-occurring substance abuse, when present, is an important part
of the overall treatment plan.
Anxiety disorders, such as post-traumatic stress disorder and
obsessive-compulsive disorder, also may be common in people with bipolar
Co-occurring anxiety disorders may respond to the treatments used for bipolar
disorder, or they may require separate treatment. For more information on
anxiety disorders, contact NIMH (see below).
How Can Individuals and Families Get Help for Bipolar Disorder?
Anyone with bipolar disorder should be under the care of a psychiatrist
skilled in the diagnosis and treatment of this disease. Other mental health
professionals, such as psychologists, psychiatric social workers, and
psychiatric nurses, can assist in providing the person and family with
additional approaches to treatment.
Help can be found at:
- University—or medical school—affiliated programs
- Hospital departments of psychiatry
- Private psychiatric offices and clinics
- Health maintenance organizations (HMOs)
- Offices of family physicians, internists, and pediatricians
- Public community mental health centers
People with bipolar disorder may need help to get help.
- Often people with bipolar disorder do not realize how impaired they are,
or they blame their problems on some cause other than mental illness.
- A person with bipolar disorder may need strong encouragement from family
and friends to seek treatment. Family physicians can play an important
role in providing referral to a mental health professional.
- Sometimes a family member or friend may need to take the person with
bipolar disorder for proper mental health evaluation and treatment.
- A person who is in the midst of a severe episode may need to be
hospitalized for his or her own protection and for much-needed treatment.
There may be times when the person must be hospitalized against his or her
- Ongoing encouragement and support are needed after a person obtains
treatment, because it may take a while to find the best treatment plan for
- In some cases, individuals with bipolar disorder may agree, when the
disorder is under good control, to a preferred course of action in the
event of a future manic or depressive relapse.
- Like other serious illnesses, bipolar disorder is also hard on spouses,
family members, friends, and employers.
- Family members of someone with bipolar disorder often have to cope with
the person's serious behavioral problems, such as wild spending sprees
during mania or extreme withdrawal from others during depression, and the
lasting consequences of these behaviors.
- Many people with bipolar disorder benefit from joining support groups
such as those sponsored by the National Depressive and Manic Depressive
Association (NDMDA), the National Alliance for the Mentally Ill (NAMI),
and the National Mental Health Association (NMHA). Families and friends
can also benefit from support groups offered by these organizations. For
contact information, see the "For More Information"
section at the back of this booklet.
What About Clinical Studies for Bipolar Disorder?
Some people with bipolar disorder receive medication and/or psychosocial
therapy by volunteering to participate in clinical studies (clinical trials).
Clinical studies involve the scientific investigation of illness and treatment
of illness in humans. Clinical studies in mental health can yield information
about the efficacy of a medication or a combination of treatments, the
usefulness of a behavioral intervention or type of psychotherapy, the
reliability of a diagnostic procedure, or the success of a prevention method.
Clinical studies also guide scientists in learning how illness develops,
progresses, lessens, and affects both mind and body. Millions of Americans
diagnosed with mental illness lead healthy, productive lives because of
information discovered through clinical studies. These studies are not always
right for everyone, however. It is important for each individual to consider
carefully the possible risks and benefits of a clinical study before making a
decision to participate.
In recent years, NIMH has introduced a new generation of
"real-world" clinical studies. They are called
"real-world" studies for several reasons. Unlike traditional
clinical trials, they offer multiple different treatments and treatment
combinations. In addition, they aim to include large numbers of people with
mental disorders living in communities throughout the U.S. and receiving
treatment across a wide variety of settings. Individuals with more than one
mental disorder, as well as those with co-occurring physical illnesses, are
encouraged to consider participating in these new studies. The main goal of
the real-world studies is to improve treatment strategies and outcomes for all
people with these disorders. In addition to measuring improvement in illness
symptoms, the studies will evaluate how treatments influence other important,
real-world issues such as quality of life, ability to work, and social
functioning. They also will assess the cost-effectiveness of different
treatments and factors that affect how well people stay on their treatment
The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
is seeking participants for the largest-ever, "real-world" study of
treatments for bipolar disorder. To learn more about STEP-BD or other clinical
studies visit the National Library of Medicine's clinical trials database http://www.clinicaltrials.gov,
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