Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness and/or episodes is particularly important. Patients who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.

Who gets bipolar disorder?

Bipolar disorder strikes about two million people in the United States. Both men and women are affected at the same rate. Differing rates of bipolar disorder have not been reported for different races. Although race was once considered a factor for developing bipolar disorder, it did not seem to have an effect when other factors such as socioeconomic status and age were taken into account. Lower socioeconomic status may be slightly linked to a higher rate of bipolar disorder. Bipolar disorder is more common in those who have a sibling or parent with the illness and in families having several generations affected with mood disorders.

The estimated average age for the onset of bipolar disorder is during the early 20s, although the illness may begin as early as when a child enters elementary school. In fact, the illness appears before age 20 in about one in five manic individuals.

Younger patients first may suffer cyclothymia. Although people with cyclothymia display less intense symptoms, nearly half of them will progress to having a full manic episode. Younger patients who have full manic episodes are called juvenile bipolar patients.