Bipolar disorder: symptoms, how it differs from mood swings and what helps

“Manic depression” is an older name for bipolar disorder that many people still use (NIMH, 2025). Everyone’s mood goes up and down, but in bipolar disorder, high periods (mania or hypomania) and low periods (depression) that are clearly different from a person’s usual self come as “episodes” lasting days to weeks (WHO, 2024). Between episodes, mood can stay stable for weeks, months or years (NHS, 2024). The WHO’s International Classification of Diseases (ICD-11) calls it bipolar type I disorder when someone has had at least one manic or mixed episode, and bipolar type II when they have had hypomanic and depressive episodes but never mania. When mild highs and lows keep coming back for at least 2 years, causing distress or problems in daily life, without meeting the threshold for a depressive episode, it is called cyclothymic disorder (WHO, 2024).

The WHO estimates that in 2023 about 36 million people worldwide, or 1 in 226, were living with bipolar disorder (WHO, 2026). In the World Mental Health Surveys, which interviewed more than 61,000 adults in 11 countries, 0.6% had had bipolar type I at some point in their lives and 0.4% type II; including people just below the diagnostic threshold, the figure was 2.4%. Fewer than half of them had received mental health treatment (Merikangas et al., 2011). Korea’s 2021 national mental health survey left bipolar disorder out because it is too rare in the community to estimate reliably from a sample (Rim et al., 2023).

In Korea’s health insurance statistics, the number of people treated with bipolar affective disorder (F31) as the main diagnosis rose from 53,056 in 2010 to 144,347 in 2025. In 2025, 62.9% were women, and people in their 20s were the largest age group (33,525). These figures count people treated, not how many people have bipolar disorder, and they do not on their own show that the illness has become more common (Health Insurance Review and Assessment Service, 2026).

mind.io does not offer a bipolar disorder test. If low mood keeps going, see depression symptoms as well. Bipolar disorder can raise the risk of suicide (WHO, 2026). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Mania is a state lasting at least a week (unless treatment shortens it) in which, for most of the day nearly every day, mood is extremely high or irritable and energy and activity are greatly increased. Speech speeds up, thoughts race from one to the next, people feel unusually important, and they may feel fine on only 2 or 3 hours of sleep, which is different from insomnia, where someone wants to sleep but cannot. They are easily distracted and may chase pleasure without regard for the consequences or make big decisions without planning. Mania can seriously disrupt daily life, may need intensive treatment such as a hospital stay to prevent harm to the person or others, and can come with delusions or hallucinations (WHO, 2024). The WHO also gives examples of risk-taking such as overspending, risky sexual activity and drinking (WHO, 2026).

Hypomania involves similar changes lasting at least several days, but not severe enough to cause marked problems in daily life, and without delusions or hallucinations. Even so, it is a change that people who know the person well can notice (WHO, 2024). During hypomania, people may feel very good and productive and not think anything is wrong, so family and friends often notice first (NIMH, 2025). Korea’s National Mental Health Information Portal describes the high period as lasting at least 7 days in type I and at least 4 days in type II (National Mental Health Information Portal, 2020). Joy that fits the situation, such as winning the lottery, graduating or falling in love, is not counted as mania or hypomania (WHO, 2024).

A depressive episode means low mood or loss of interest for most of the day, nearly every day, for at least two weeks, which sets it apart from the mood ups and downs everyone has (WHO, 2026). A mixed episode is when manic and depressive symptoms come together, or alternate quickly from day to day or within the same day, for at least two weeks: someone may feel revved up with racing thoughts and at the same time hopeless or suicidal (WHO, 2024). Depressive episodes with mixed features are considered a particularly dangerous period, with a higher short-term risk of suicide attempts (Yatham et al., 2018).

In type I, manic and depressive episodes usually alternate, and over time depressive episodes often become more common than manic ones (WHO, 2026). Type II means hypomania instead of mania; it does not mean a milder illness. Many people with type II spend long periods in a persistent, low-grade depressive state (NIMH, 2025). In a study that rated 146 people with type I every week for an average of 12.8 years, starting in the late 1970s when treatment was different from today, they had symptoms in 47.3% of weeks, mostly depressive (31.9%) rather than manic, and milder, below-threshold symptoms were more common than full-blown ones (Judd et al., 2002). Bipolar disorder usually starts in the late teens or early adulthood (NIMH, 2025), but type I can begin at any age (WHO, 2024).

Everyone’s mood goes up and down. Feeling low or high for a few hours or a day can happen in people without bipolar disorder (National Mental Health Information Portal, 2020). In bipolar disorder, mood changes last days to weeks and come with changes in behaviour and energy that others can notice (NIMH, 2025). Mood that changes several times a day is not on its own a sign of bipolar disorder; what matters is whether there are episodes, a different state lasting days or more (WHO, 2024).

With borderline personality traits, mood can also swing strongly, but usually in response to triggers such as stress in relationships, and the swings last hours, or at most a few days. In bipolar disorder, mood changes last longer (WHO, 2024; Paris & Black, 2015). It is relatively common to have both, so a specialist looks at how the person is outside mood episodes (WHO, 2024). Adult ADHD can look similar because of distractibility and impulsivity, but bipolar disorder comes in episodes with a high or irritable mood (WHO, 2024). Adult ADHD itself is covered in adult ADHD symptoms. Physical conditions such as thyroid disease, some prescribed medicines, and alcohol and drugs can cause or worsen similar symptoms, so these are checked too (NIMH, 2025). Diagnosis is made through a clinical interview; no blood test or brain scan can diagnose it yet (HAS, 2015).

In bipolar disorder, depression often comes first, before the diagnosis is made (National Mental Health Information Portal, 2020). Hypomania rarely feels like a problem to the person, so people tend to seek help only when they are depressed (WHO, 2024). During depression, people may not recall earlier high periods or may not see them as part of an illness, and the most frequent misdiagnosis is depression (Yatham et al., 2018). A meta-analysis of 27 studies (9,415 patients) found that it took 5.8 years on average from the start of bipolar disorder to its treatment or diagnosis, and longer in studies with more type II patients or an earlier age of onset (Dagani et al., 2017). Guidelines note that many people are not correctly diagnosed until up to 10 years after their symptoms begin (Yatham et al., 2018).

In an analysis of 56 studies that followed people diagnosed with depression for a long time, some were later diagnosed with bipolar disorder, with the highest risk in the first 5 years. This was more likely when a family member had bipolar disorder, when depression started at a young age, or when there had been psychotic symptoms such as hearing voices or delusions (Ratheesh et al., 2017). In Korean health insurance data, too, some people who started antidepressant treatment for depression later had their diagnosis changed to bipolar disorder, with the highest rate at ages 18 to 29 (Kim et al., 2020).

If you are being treated for depression, tell your doctor about any past periods of several days when you were unusually overactive or uninhibited. UK guidelines (NICE) advise asking people with depression about such periods and considering a specialist assessment if they lasted 4 days or more, and advise against using questionnaires in primary care to identify bipolar disorder. With the person’s consent, what family members say also helps (NICE, 2014; HAS, 2015). mind.io’s depression check-in (PHQ-9) looks only at depressive symptoms over the past 2 weeks, so it cannot tell bipolar depression from depression. In children and teenagers, it is hard to tell from normal mood changes; if you are worried, talk to a child and adolescent psychiatrist (HAS, 2015).

Bipolar disorder is a condition whose symptoms can be managed with treatment. The WHO says that even though symptoms often come back, recovery is possible, and with appropriate care people can cope with their symptoms and live meaningful and productive lives. Medicines are essential, but on their own they are usually not enough for full recovery, so psychological therapy and day-to-day self-management go alongside them (WHO, 2026).

The main medicines are mood stabilisers and some antipsychotics (WHO, 2026; NIMH, 2025). Korea’s medication guideline for bipolar disorder (2022), based on an expert consensus survey answered by 87 Korean psychiatrists, also builds the treatment of mania on these medicines, as other countries’ guidelines do (Jeong et al., 2023). In an analysis of 5 trials (770 people) comparing a widely used mood stabiliser with placebo, the risk of relapse fell by about a third; the effect on manic relapse was clear, while the effect on depressive relapse was smaller and less certain (Geddes et al., 2004). In an analysis of 48 trials in mood disorders, the same medicine was linked to fewer deaths by suicide than placebo (Cipriani et al., 2013). Which medicine suits you is decided with your doctor, weighing benefits, side effects and your circumstances. Some mood stabilisers can harm an unborn baby, so if you are pregnant or planning a pregnancy, talk to your doctor before changing or stopping any medicine (WHO, 2023; NHS, 2024). The early weeks after childbirth are the time of greatest risk of hypomania (WHO, 2024), so if you are planning a pregnancy, make a plan with your doctor in advance.

Treating a depressive episode with an antidepressant alone can trigger mania or rapid cycling, so in bipolar disorder antidepressants are not used on their own (NIMH, 2025). Korean and international guidelines all avoid antidepressant monotherapy (Jeong et al., 2023). In a Swedish study of 3,240 people with bipolar disorder, the risk of mania was about 2.8 times higher with an antidepressant alone, but did not rise in the 3 months after starting one together with a mood stabiliser (Viktorin et al., 2014). In an analysis of 6 trials adding an antidepressant to a mood stabiliser or antipsychotic, depressive symptoms eased a little but recovery rates did not clearly differ, and using it for close to a year raised the risk of mania (McGirr et al., 2016). Whether to add an antidepressant is the doctor’s call. If you are taking medicine for depression now, do not stop it because of this article; tell the doctor who prescribed it about any past high periods. If you feel high or your sleep drops sharply after starting a medicine, contact the prescriber right away (WHO, 2016).

Psychological therapy is given in addition to medicine (WHO, 2023). In an analysis of 39 randomised trials (3,863 people), the 20 trials with usable data showed that adding a manual-based psychological therapy to medicine lowered the odds of relapse (odds ratio 0.56). Psychoeducation in which people practise illness-management skills with family or in a group, rather than alone, tended to reduce relapses further (Miklowitz et al., 2021). Psychoeducation teaches about the illness, early warning signs of relapse, medicines and stress management, and the Canadian and international (CANMAT and ISBD) guidelines recommend it as a first-line treatment to prevent relapse (Yatham et al., 2018). A review of psychoeducation trials in people whose symptoms were stable found one extra relapse prevented for every 5 to 7 people taught, but no clear effect on depressive relapse on its own, and the effect was clearer in groups (Bond & Anderson, 2015).

In a trial of 293 people with bipolar depression, those who received family-focused therapy, interpersonal and social rhythm therapy or cognitive behavioural therapy (up to 30 sessions over 9 months) alongside medicine were more likely to have recovered after a year (64.4%) than those who had a brief intervention of 3 sessions over 6 weeks (51.5%), with no clear difference between the three therapies (Miklowitz et al., 2007). Interpersonal and social rhythm therapy helps people keep daily rhythms steady, such as when they wake, eat, see people and go to bed. In a trial of 175 people, those who received it went longer without a new episode (Frank et al., 2005), but the Canadian and international guidelines rate it third-line because the evidence is more limited (Yatham et al., 2018). Depression treatment in general is covered in depression: what helps, but medicine for bipolar depression is different, so use it for reference only.

Bipolar disorder tends to improve and return over a long time, so learning to manage it yourself matters (NICE, 2014). In an analysis of studies that followed 734 people after a first manic episode, 84.2% recovered enough to no longer meet the criteria within a year, but 41.0% had another episode within a year and 59.7% within 4 years (Gignac et al., 2015). In a study that followed 858 people who had recovered with treatment for up to 2 years, 48.5% had another episode, more than twice as often depressive as manic, and relapse was more common when mild symptoms remained at recovery (Perlis et al., 2006). Remaining mild symptoms are worth raising with your doctor as a treatment goal.

After symptoms settle, mood stabilisers or antipsychotics are usually continued for at least six months, and treatment usually lasts longer after several episodes (WHO, 2026). Guidelines consider that almost everyone with bipolar disorder needs maintenance treatment to prevent new episodes (Yatham et al., 2018). Do not stop your medicine without talking to your doctor, even if you feel better (NHS, 2024). If you decide to stop, reduce it gradually with your doctor and keep watching for signs of relapse for 2 years after stopping (NICE, 2014).

At least 80% of people with a mood disorder could identify one or more early signs before an episode, and in bipolar disorder the most robust early sign of mania was sleep becoming shorter or disturbed (median 77%). Early signs of mania were reported to last more than 20 days on average (Jackson et al., 2003). A Cochrane review of programmes that help people recognise and act on their own early warning signs found a longer time to the next relapse (hazard ratio 0.57) and fewer hospital stays, but the studies were old and many lacked data on the main outcome (Morriss et al., 2007). Keep a mood diary of changes in mood, sleep and energy (NIMH, 2025), and while you are well, make a plan with your doctor listing your warning signs, what to do and whom to contact, and share it with your family (NICE, 2014).

When 3,140 UK adults with bipolar disorder were asked, 20% said that losing sleep had triggered mania or hypomania, and sleep loss was the most commonly reported of the triggers asked about (Lewis et al., 2017). Keep regular times for sleeping, waking, meals and exercise, and if you can, avoid shift work, very long working hours, night flights or travel across time zones, and lots of caffeinated drinks (NHS, 2024). For sleep problems, see insomnia: what helps, but sleep restriction, which cuts the time spent in bed, may not suit people prone to mania, so do it with a professional (Edinger et al., 2021).

In an analysis of general-population surveys, about a quarter (24%) of people with bipolar disorder had an alcohol use disorder (Hunt et al., 2016). Alcohol and drugs can worsen symptoms and are best avoided (WHO, 2016), and they can interfere with medicines and psychological therapy (NICE, 2014). Physical health matters too: people with bipolar disorder lived about 13 years less on average, and about half of that gap was due to natural causes such as physical illness (Chan et al., 2022). Have your blood pressure, blood sugar and weight checked regularly.

It helps when the people around someone understand the illness too. In a network meta-analysis comparing psychosocial treatments, education and support aimed at family members or carers reduced the risk of manic or depressive relapse (Chatterton et al., 2017). A 2007 Cochrane review, however, found little and mixed evidence on family interventions and could not draw firm conclusions (Justo et al., 2007). The WHO recommends considering psychoeducation and support groups for families caring for someone with bipolar disorder (WHO, 2023).

Offer understanding, patience and encouragement, and practical help such as going to appointments together or picking up prescriptions. Remind the person that getting better is possible with the right treatment (NIMH, 2025). If you notice changes in sleep, speech or spending, talk about them calmly (Santé.fr, 2026). During a high, encourage them to put off important decisions until they have recovered (NICE, 2014), and help them get advice from someone they trust before any big financial commitment (WHO, 2016). Do not blame the person or their family for the symptoms (WHO, 2016).

During a high, the person may not see a problem, so agreeing on warning signs and whom to contact in a crisis while they are well can help (NICE, 2014; National Mental Health Information Portal, 2020). If you are worried about suicidal thoughts, it is all right to ask about them directly (Santé.fr, 2026). How to ask and how to support someone are covered in depression: what helps. Carers should not have to cope alone either; look for help such as education and support groups for families (WHO, 2023).

If someone has gone days with little or no sleep yet feels full of energy, keeps doing risky things that are completely out of character such as spending money they cannot afford, hears things others cannot hear or firmly believes things that are not true, get help from a psychiatrist straight away. If mania or severe depression is suspected, or there is a risk of harm to themselves or others, an urgent specialist assessment is needed (NICE, 2014). A first manic episode is treated as a psychiatric emergency that may need a hospital stay (HAS, 2015), and some people need hospital care or support from a crisis team at home to stay safe (NHS, 2024). If mood changes last a long time or affect your everyday life, see a doctor even if it is not urgent (NHS, 2024).

Outside Korea, start with a family doctor or your local mental health services. In Korea, you can get help from a psychiatrist or your city, county or district mental health welfare centre, and the mental health crisis line 1577-0199 (24 hours) connects you to a nearby centre (Ministry of Health and Welfare, 2025). The conditions for the 2026 counselling voucher are in depression: what helps. mind.io does not offer a bipolar disorder test; the depression check-in (PHQ-9) looks at depressive symptoms but cannot identify bipolar disorder.

In a Danish study that followed more than 170,000 people for up to 36 years after their first contact with specialist mental health care, 7.8% of men and 4.8% of women with bipolar disorder died by suicide, far more than among people without a mental disorder (0.7% of men and 0.3% of women); seen the other way, most did not die by suicide (Nordentoft et al., 2011). There is also evidence that a mood stabiliser reduced deaths by suicide, so staying in treatment matters (Cipriani et al., 2013). The risk is especially high during depressive or mixed episodes (WHO, 2024). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Q. If my mood swings a lot, is it bipolar disorder? A. Not necessarily. Mood that goes up and down over a few hours or a day can happen to anyone. Bipolar disorder means high or low periods that are clearly different from your usual self and last days to weeks (National Mental Health Information Portal, 2020; WHO, 2024). If mood swings are making life hard, whatever the cause, it is worth talking to a professional. Things that can make mood swings worse, such as sleep, the menstrual cycle and menopause, are covered in Mood swings.

Q. Is there a bipolar disorder test? A. mind.io does not offer one. Diagnosis is made by a professional through an interview, and UK guidance advises against using questionnaires in primary care to identify bipolar disorder (NICE, 2014). Even when a screening questionnaire is used, it needs to be followed by an interview (Yatham et al., 2018). The depression check-in (PHQ-9) looks only at depressive symptoms and cannot identify bipolar disorder.

Q. Will I have to take medicine for life? A. It differs from person to person. Medicine is usually continued for at least six months after symptoms settle, and usually longer after several episodes (WHO, 2026), and guidelines consider that almost everyone with bipolar disorder needs maintenance treatment (Yatham et al., 2018). If you want to reduce or stop it, do not decide alone; reduce it gradually with your doctor (NICE, 2014).

Q. Is type II a mild form of bipolar disorder? A. No. Type II means hypomania instead of mania. Many people with type II spend long periods in a low-grade depressive state (NIMH, 2025), and as with type I, their suicide risk is clearly higher than in the general population. Up to 15% of people with type II later have a manic episode and are then diagnosed with type I (WHO, 2024).

Q. Are people with bipolar disorder dangerous? A. No. In a Swedish study, the higher risk of violent crime was mostly confined to people who also had alcohol or drug problems; without them, the increase was minimal, and compared with their own siblings there was almost no difference (Fazel et al., 2010). Many people with bipolar disorder face discrimination and stigma instead (WHO, 2026).

Q. I am taking medicine for depression, but I have had high periods lasting several days. A. Do not stop your medicine on your own; tell the doctor who prescribed it about those periods so that they can review the diagnosis and treatment (NICE, 2014). If you feel high or your sleep drops sharply after starting a medicine, contact them right away (WHO, 2016).

Q. It’s so hard I’m having thoughts of harming myself. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

References: World Health Organization (2024), Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR), https://www.who.int/publications/i/item/9789240077263; World Health Organization (2026), Bipolar disorder [Fact sheet], https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder; World Health Organization (2016), mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0, https://iris.who.int/handle/10665/250239; World Health Organization (2023), Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders, https://iris.who.int/handle/10665/374250; NHS (2024), Bipolar disorder, https://www.nhs.uk/mental-health/conditions/bipolar-disorder/; National Institute of Mental Health (2025), Bipolar disorder (NIH Publication No. 25-MH-8088), https://www.nimh.nih.gov/health/publications/bipolar-disorder; National Center for Mental Health (2020), Bipolar I disorder and Bipolar II disorder [National Mental Health Information Portal, in Korean], https://www.mentalhealth.go.kr/portal/disease/diseaseDetail.do?dissId=25 and https://www.mentalhealth.go.kr/portal/disease/diseaseDetail.do?dissId=24; National Center of Neurology and Psychiatry (n.d.), Bipolar disorder (manic depression) [Kokoro no Joho site, in Japanese], https://kokoro.ncnp.go.jp/disease.php?@uid=RM3UirqngPV6bFW0; Santé.fr (2026), Troubles bipolaires, by Psycom [in French], https://www.sante.fr/troubles-bipolaires-0; Haute Autorité de santé (2015), Patient avec un trouble bipolaire : repérage et prise en charge initiale en premier recours [Fiche mémo, in French], https://www.has-sante.fr/upload/docs/application/pdf/2015-10/fiche_memo_trouble_bipolaire_vd.pdf; National Institute for Health and Care Excellence (2014, updated 2025), Bipolar disorder: assessment and management (CG185), https://www.nice.org.uk/guidance/cg185; Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., et al. (2018), Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder, Bipolar Disorders 20(2), 97-170, https://doi.org/10.1111/bdi.12609; Health Insurance Review and Assessment Service (2026), Disease statistics: F31 bipolar affective disorder, 2010-2025 [in Korean], https://opendata.hira.or.kr; Rim, S. J., Hahm, B. J., Seong, S. J., Park, J. E., Chang, S. M., Kim, B. S., et al. (2023), Prevalence of mental disorders and associated factors in Korean adults: National Mental Health Survey of Korea 2021, Psychiatry Investigation 20(3), 262-272, https://doi.org/10.30773/pi.2022.0307; Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., et al. (2011), Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative, Archives of General Psychiatry 68(3), 241-251, https://doi.org/10.1001/archgenpsychiatry.2011.12; Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Maser, J., Solomon, D. A., et al. (2002), The long-term natural history of the weekly symptomatic status of bipolar I disorder, Archives of General Psychiatry 59(6), 530-537, https://doi.org/10.1001/archpsyc.59.6.530; Paris, J., & Black, D. W. (2015), Borderline personality disorder and bipolar disorder: what is the difference and why does it matter?, The Journal of Nervous and Mental Disease 203(1), 3-7, https://doi.org/10.1097/NMD.0000000000000225; Dagani, J., Signorini, G., Nielssen, O., Bani, M., Pastore, A., de Girolamo, G., & Large, M. (2017), Meta-analysis of the interval between the onset and management of bipolar disorder, Canadian Journal of Psychiatry 62(4), 247-258, https://doi.org/10.1177/0706743716656607; Ratheesh, A., Davey, C., Hetrick, S., Alvarez-Jimenez, M., Voutier, C., Bechdolf, A., et al. (2017), A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder, Acta Psychiatrica Scandinavica 135(4), 273-284, https://doi.org/10.1111/acps.12686; Kim, E. Y., Kim, N. W., Kim, M. J., Yang, B. R., Rhee, S. J., Park, C. H. K., et al. (2020), Rate of diagnostic conversion to bipolar disorder in adults with unipolar depression and psychopharmacological treatment in the republic of Korea: A nationwide register-based study, Journal of Affective Disorders 273, 240-246, https://doi.org/10.1016/j.jad.2020.03.159; Geddes, J. R., Burgess, S., Hawton, K., Jamison, K., & Goodwin, G. M. (2004), Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials, American Journal of Psychiatry 161(2), 217-222, https://doi.org/10.1176/appi.ajp.161.2.217; Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013), Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis, BMJ 346, f3646, https://doi.org/10.1136/bmj.f3646; Jeong, J. H., Bahk, W. M., Woo, Y. S., Yoon, B. H., Lee, J. G., Kim, W., et al. (2023), Korean Medication Algorithm Project for Bipolar Disorder 2022: comparisons with other treatment guidelines, Clinical Psychopharmacology and Neuroscience 21(1), 32-48, https://doi.org/10.9758/cpn.2023.21.1.32; Viktorin, A., Lichtenstein, P., Thase, M. E., Larsson, H., Lundholm, C., Magnusson, P. K., & Landén, M. (2014), The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer, American Journal of Psychiatry 171(10), 1067-1073, https://doi.org/10.1176/appi.ajp.2014.13111501; McGirr, A., Vöhringer, P. A., Ghaemi, S. N., Lam, R. W., & Yatham, L. N. (2016), Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials, The Lancet Psychiatry 3(12), 1138-1146, https://doi.org/10.1016/S2215-0366(16)30264-4; Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021), Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis, JAMA Psychiatry 78(2), 141-150, https://doi.org/10.1001/jamapsychiatry.2020.2993; Bond, K., & Anderson, I. M. (2015), Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials, Bipolar Disorders 17(4), 349-362, https://doi.org/10.1111/bdi.12287; Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Wisniewski, S. R., Kogan, J. N., et al. (2007), Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program, Archives of General Psychiatry 64(4), 419-426, https://doi.org/10.1001/archpsyc.64.4.419; Frank, E., Kupfer, D. J., Thase, M. E., Mallinger, A. G., Swartz, H. A., Fagiolini, A. M., et al. (2005), Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder, Archives of General Psychiatry 62(9), 996-1004, https://doi.org/10.1001/archpsyc.62.9.996; Gignac, A., McGirr, A., Lam, R. W., & Yatham, L. N. (2015), Recovery and recurrence following a first episode of mania: a systematic review and meta-analysis of prospectively characterized cohorts, Journal of Clinical Psychiatry 76(9), 1241-1248, https://doi.org/10.4088/JCP.14r09245; Perlis, R. H., Ostacher, M. J., Patel, J. K., Marangell, L. B., Zhang, H., Wisniewski, S. R., et al. (2006), Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), American Journal of Psychiatry 163(2), 217-224, https://doi.org/10.1176/appi.ajp.163.2.217; Jackson, A., Cavanagh, J., & Scott, J. (2003), A systematic review of manic and depressive prodromes, Journal of Affective Disorders 74(3), 209-217, https://doi.org/10.1016/S0165-0327(02)00266-5; Morriss, R. K., Faizal, M. A., Jones, A. P., Williamson, P. R., Bolton, C., & McCarthy, J. P. (2007), Interventions for helping people recognise early signs of recurrence in bipolar disorder, Cochrane Database of Systematic Reviews 2007(1), CD004854, https://doi.org/10.1002/14651858.CD004854.pub2; Lewis, K. S., Gordon-Smith, K., Forty, L., Di Florio, A., Craddock, N., Jones, L., & Jones, I. (2017), Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender, British Journal of Psychiatry 211(3), 169-174, https://doi.org/10.1192/bjp.bp.117.202259; Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., et al. (2021), Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline, Journal of Clinical Sleep Medicine 17(2), 255-262, https://doi.org/10.5664/jcsm.8986, and the accompanying systematic review, meta-analysis, and GRADE assessment, 17(2), 263-298, https://doi.org/10.5664/jcsm.8988; Hunt, G. E., Malhi, G. S., Cleary, M., Lai, H. M., & Sitharthan, T. (2016), Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: systematic review and meta-analysis, Journal of Affective Disorders 206, 321-330, https://doi.org/10.1016/j.jad.2016.06.051; Chan, J. K. N., Tong, C. H. Y., Wong, C. S. M., Chen, E. Y. H., & Chang, W. C. (2022), Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis, British Journal of Psychiatry 221(3), 567-576, https://doi.org/10.1192/bjp.2022.19; Chatterton, M. L., Stockings, E., Berk, M., Barendregt, J. J., Carter, R., & Mihalopoulos, C. (2017), Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis, British Journal of Psychiatry 210(5), 333-341, https://doi.org/10.1192/bjp.bp.116.195321; Justo, L. P., Soares, B. G., & Calil, H. M. (2007), Family interventions for bipolar disorder, Cochrane Database of Systematic Reviews 2007(4), CD005167, https://doi.org/10.1002/14651858.CD005167.pub2; Nordentoft, M., Mortensen, P. B., & Pedersen, C. B. (2011), Absolute risk of suicide after first hospital contact in mental disorder, Archives of General Psychiatry 68(10), 1058-1064, https://doi.org/10.1001/archgenpsychiatry.2011.113; Fazel, S., Lichtenstein, P., Grann, M., Goodwin, G. M., & Långström, N. (2010), Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review, Archives of General Psychiatry 67(9), 931-938, https://doi.org/10.1001/archgenpsychiatry.2010.97; Ministry of Health and Welfare (2025), Community mental health welfare centres and the mental health crisis line [in Korean], https://www.mohw.go.kr/menu.es?mid=a10706040100