Depressed mood accompanies manic activation. Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When 4 or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling . Bipolar disorder is often complicated by co-occurring alcohol or substance abuse. Severe depression or mania may be accompanied by symptoms of psychosis .
Psychotic symptoms associated with bipolar typically reflect the extreme mood state at the time.
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy, and psychoeducation. Lithium has long been used as a first-line treatment for bipolar disorder.