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Bipolar disorder in adults: Epidemiology and pathogenesis

Jeffrey Stovall, MD
Section Editor
Paul Keck, MD
Deputy Editor
David Solomon, MD


Bipolar disorder is common and disabling [1]. The hallmark of the disorder is mood elevation (mania or hypomania) [2]. Patients with bipolar I disorder have episodes of mania and nearly always experience major depressive episodes. Patients with bipolar II disorder suffer both hypomanic episodes and major depressive episodes.

This topic addresses the epidemiology and pathogenesis of bipolar disorder. The clinical features, diagnosis, and treatment of bipolar disorder in adults are discussed separately:

(See "Bipolar disorder in adults: Clinical features".)

(See "Bipolar disorder in adults: Assessment and diagnosis".)

(See "Bipolar disorder in adults: Choosing pharmacotherapy for acute mania and hypomania".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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  1. Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011; 68:241.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  3. Pedersen CB, Mors O, Bertelsen A, et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 2014; 71:573.
  4. Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011; 68:90.
  5. Seedat S, Scott KM, Angermeyer MC, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 2009; 66:785.
  6. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197.
  7. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007; 64:543.
  8. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310:591.
  9. Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in general primary care samples: a systematic review. Gen Hosp Psychiatry 2014; 36:19.
  10. Craddock N, Sklar P. Genetics of bipolar disorder. Lancet 2013; 381:1654.
  11. Barnett JH, Smoller JW. The genetics of bipolar disorder. Neuroscience 2009; 164:331.
  12. Nurnberger JI Jr, McInnis M, Reich W, et al. A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders. Arch Gen Psychiatry 2011; 68:1012.
  13. Lichtenstein P, Yip BH, Björk C, et al. Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 2009; 373:234.
  14. McGuffin P, Rijsdijk F, Andrew M, et al. The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Arch Gen Psychiatry 2003; 60:497.
  15. Finn CT, Smoller JW. Genetic counseling in psychiatry. Harv Rev Psychiatry 2006; 14:109.
  16. Nurnberger JI Jr, Koller DL, Jung J, et al. Identification of pathways for bipolar disorder: a meta-analysis. JAMA Psychiatry 2014; 71:657.
  17. Ferreira MA, O'Donovan MC, Meng YA, et al. Collaborative genome-wide association analysis supports a role for ANK3 and CACNA1C in bipolar disorder. Nat Genet 2008; 40:1056.
  18. Cross-Disorder Group of the Psychiatric Genomics Consortium. Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet 2013; 381:1371.
  19. Serretti A, Fabbri C. Shared genetics among major psychiatric disorders. Lancet 2013; 381:1339.
  20. Akula N, Barb J, Jiang X, et al. RNA-sequencing of the brain transcriptome implicates dysregulation of neuroplasticity, circadian rhythms and GTPase binding in bipolar disorder. Mol Psychiatry 2014; 19:1179.
  21. Cruceanu C, Tan PP, Rogic S, et al. Transcriptome sequencing of the anterior cingulate in bipolar disorder: dysregulation of G protein-coupled receptors. Am J Psychiatry 2015; 172:1131.
  22. Kato T. Searching for the molecular basis of bipolar disorder. Am J Psychiatry 2015; 172:1057.
  23. Ruzicka WB. Epigenetic mechanisms in the pathophysiology of psychotic disorders. Harv Rev Psychiatry 2015; 23:212.
  24. Ruzicka WB, Subburaju S, Benes FM. Circuit- and Diagnosis-Specific DNA Methylation Changes at γ-Aminobutyric Acid-Related Genes in Postmortem Human Hippocampus in Schizophrenia and Bipolar Disorder. JAMA Psychiatry 2015; 72:541.
  25. Schneider MR, DelBello MP, McNamara RK, et al. Neuroprogression in bipolar disorder. Bipolar Disord 2012; 14:356.
  26. Strakowski SM, Adler CM, Almeida J, et al. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012; 14:313.
  27. Gildengers AG, Chung KH, Huang SH, et al. Neuroprogressive effects of lifetime illness duration in older adults with bipolar disorder. Bipolar Disord 2014; 16:617.
  28. Modabbernia A, Taslimi S, Brietzke E, Ashrafi M. Cytokine alterations in bipolar disorder: a meta-analysis of 30 studies. Biol Psychiatry 2013; 74:15.
  29. Munkholm K, Braüner JV, Kessing LV, Vinberg M. Cytokines in bipolar disorder vs. healthy control subjects: a systematic review and meta-analysis. J Psychiatr Res 2013; 47:1119.
  30. Dargél AA, Godin O, Kapczinski F, et al. C-reactive protein alterations in bipolar disorder: a meta-analysis. J Clin Psychiatry 2015; 76:142.
  31. Konopaske GT, Lange N, Coyle JT, Benes FM. Prefrontal cortical dendritic spine pathology in schizophrenia and bipolar disorder. JAMA Psychiatry 2014; 71:1323.
  32. Goodkind M, Eickhoff SB, Oathes DJ, et al. Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry 2015; 72:305.
  33. Chudal R, Gissler M, Sucksdorff D, et al. Parental age and the risk of bipolar disorders. Bipolar Disord 2014; 16:624.
  34. D'Onofrio BM, Rickert ME, Frans E, et al. Paternal age at childbearing and offspring psychiatric and academic morbidity. JAMA Psychiatry 2014; 71:432.
  35. Janiri D, Sani G, Danese E, et al. Childhood traumatic experiences of patients with bipolar disorder type I and type II. J Affect Disord 2015; 175:92.
  36. Sugaya L, Hasin DS, Olfson M, et al. Child physical abuse and adult mental health: a national study. J Trauma Stress 2012; 25:384.
  37. Gilman SE, Ni MY, Dunn EC, et al. Contributions of the social environment to first-onset and recurrent mania. Mol Psychiatry 2015; 20:329.
  38. Etain B, Aas M, Andreassen OA, et al. Childhood trauma is associated with severe clinical characteristics of bipolar disorders. J Clin Psychiatry 2013; 74:991.
  39. Scott KM, Smith DR, Ellis PM. Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Arch Gen Psychiatry 2010; 67:712.