Evidence-Based Resources About Opioid Overdose

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SAMHSA’s Evidence-Based Practice Resource Center (EBPRC) contains a wide variety of downloadable resources available from SAMHSA and other federal partners about opioid overdose and other substance use and mental health topics to help communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.

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SAMHSA Resources

Medication-Assisted Treatment (MAT) – The use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Medications, Counseling, and Related Conditions – Medications approved to treat Alcohol and Opioid Use Disorders relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. Medications used for treatment are evidence-based treatment options

Opioid Overdose – Learn the warning signs of opioid overdose and how naloxone and medications for OUD treatment can help treat and prevent it.

Know the Risk of Using Drugs – All drug use comes with risk. Know the facts before letting drugs take their toll on you and your family.

Tips for Teens: The Truth About Opioids – This fact sheet for teens provides facts about opioids. It describes short- and long-term effects and lists signs of opioid use. The fact sheet helps to dispel common myths about opioids. Access sources cited in this fact sheet.

Opioid Overdose Prevention Toolkit -This toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families, and those recovering from opioid overdose.

Use of Medication-Assisted Treatment in Emergency Departments – This guide examines emerging and best practices for initiating medication-assisted treatment (MAT) in emergency departments.

Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings -This guide focuses on using medication-assisted treatment for opioid use disorder in jails and prisons and during the reentry process when justice-involved persons return to the community.

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders – This guide reviews ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders including opioid overdose among adults.

TIP 63: Medications for Opioid Use Disorder – This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine.

Advisory: Opioid Therapy in Patients With Chronic Noncancer Pain Who Are in Recovery From Substance Use Disorders – This advisory addresses screening and assessment tools, nonpharmacologic and nonopioid treatment for chronic pain, and the role of opioid therapy in people with chronic noncancer pain and SUDs.

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Other Federal Resources

Overdose Prevention & Naloxone Manual | HRC – This Harm Reduction Coalition (HRC) manual outlines the process of developing an Overdose Prevention and Education Program that may involve a take-home naloxone component.

Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States | CDC (PDF |  11.5 MB) – This CDC document reviews evidence-based strategies to reduce overdose. It explains why these strategies work, the research behind them, and examples of organizations that have put these strategies into practice.

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit | National Council of Behavioral Health – Developed by the National Council of Behavioral Health, this guide provides correctional administrators and healthcare providers tools for implementing MAT in correctional settings.

Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers | CDC (PDF | 785 KB) – This fact sheet helps employers understand the risk of opioid overdose and provides guidance about establishing a workplace naloxone program.

Opioids | HHS – Increased prescription of opioid medications like oxycodone and hydrocodone led to widespread misuse of both prescription and non- prescription opioids. Prevention, treatment, and recovery information is available here to help health professionals and families combat the epidemic.

Opioids | NIDA – Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Drug Overdose | CDC – Overdose Data to Action (OD2A) supports jurisdictions in collecting high quality, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to inform prevention and response efforts.

Rx Awareness | CDC – Prescription opioids can be addictive and dangerous. CDC’s Rx Awareness campaign tells the stories of people whose lives were impacted by prescription opioids.

Last Updated

Last Updated: 06/09/2023

Bipolar Help: Living with Bipolar Disorder

How to cope with bipolar disorder

No matter how down or out of control you feel, it’s important to remember that you’re not powerless when it comes to bipolar disorder. Beyond the treatment you get from your doctor or therapist, there are many things you can do for yourself to reduce your symptoms and stay on track.

Living well with bipolar disorder requires certain adjustments. Like diabetics who take insulin or recovering alcoholics who avoid drinking, if you have bipolar disorder, it’s important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.

Managing bipolar disorder starts with proper treatment, including medication and therapy. But there is so much more you can do to help yourself on a day-to-day basis. These tips can help you influence the course of your illness, enabling you to take greater control over your symptoms, to stay well longer, and to quickly rebound from any mood episode or relapse.

Living with bipolar disorder tip 1: Get involved in your treatment

Be a full and active participant in your own treatment. Learn everything you can about bipolar disorder. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available treatment options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself.

Using what you’ve learned about bipolar disorder, collaborate with your doctor or therapist in the treatment planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a treatment contract outlining the goals you and your provider have agreed upon.

Improve your treatment by:

Being patient. Don’t expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.

Communicating with your treatment provider. Your treatment program will change over time, so keep in close contact with your doctor or therapist. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.

Taking your medication as instructed. If you’re taking medication, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your doctor.

Getting therapy. While medication may be able to manage some of the symptoms of bipolar disorder, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.

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Tip 2: Monitor your symptoms and moods

In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.

Know your triggers and early warning signs

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:

• stress
• financial difficulties
• arguments with your loved ones
• problems at school or work
• seasonal changes
• lack of sleep

Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life.

Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, medications you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.

Tip 3: Act on warning signs

If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.”

Develop a wellness toolbox

The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many people with bipolar disorder have found the following tools to be helpful in reducing symptoms and maintaining wellness:

• Talk to a supportive person.
• Get a full eight hours of sleep.
• Cut back on your activities.
• Attend a support group.
• Call your doctor or therapist.
• Do something fun or creative, or write in your journal.

• Take time for yourself to relax and unwind.
• Increase your exposure to light.
• Exercise.
• Ask for extra help from loved ones.
• Cut back on sugar, alcohol, and caffeine.
• Increase or decrease the stimulation in your environment.

Create an emergency action plan

Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or doctor may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own treatment.

A plan of action typically includes:

A list of emergency contacts for your doctor, therapist, and close family members.

A list of all medications you are taking, including dosage information.

Symptoms that indicate you need others to take responsibility for your care, and information about any other health problems you have.

Treatment preferences such as who you want to care for you, what treatments and medications do and do not work, and who is authorized to make decisions on your behalf.

Tip 4: Reach out for face-to-face connection

Having a strong support system is essential to staying happy and healthy. Often, simply having someone to talk to face-to-face can be an enormous help in relieving bipolar depression and boosting your outlook and motivation. The people you turn to don’t have to be able to “fix” you; they just have to be good listeners. The more people that you can turn to who will be available and good listeners, the more likely you are to manage your moods.

Don’t isolate! Support for bipolar disorder starts close to home. It’s important to have people you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself. Reaching out to others is not a sign of weakness and it won’t make you a burden. Support for bipolar disorder starts close to home. Your loved ones care about you and want to help. In order to manage bipolar disorder, it’s essential that you have people you can count on to help you through rough times.

Join a bipolar disorder support group. Spending time with people who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members.

Build new relationships. Isolation and loneliness make bipolar disorder worse. If you don’t have a support network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.

10 tips for reaching out and building relationships

1. Talk to one person about your feelings.
2. Help someone else by volunteering.
3. Have lunch or coffee with a friend.
4. Ask a loved one to check in with you regularly.
5. Accompany someone to the movies, a concert, or a small get-together.
6. Call or email an old friend.
7. Go for a walk with a workout buddy.
8. Schedule a weekly dinner date.
9. Meet new people by taking a class or joining a club.
10. Confide in a counselor, therapist, or clergy member.

Tip 5: Develop an active daily routine

Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.

Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of bipolar disorder. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity even through emotional ups and downs.

Exercise frequently and avoid sitting for long periods of time. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise such as running, swimming dancing, climbing or drumming – all activities that keep both arms and legs active are especially effective at treating depression. Try to incorporate at least 30 minutes of activity into your daily routine. Ten minutes here and there is just as effective as exercising for longer periods of time. Walking is a good choice for people of all fitness levels.

Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some people, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a consistent sleep schedule.

Healthy sleep habits for managing bipolar disorder

• Go to bed and wake up at the same time each day.
• Avoid or minimize napping, especially if it interferes with your sleep at night.
• Instead of viewing screens or other stimulating activities before bed, try taking a bath, reading a book, or listening to relaxing music.
• Limit caffeine after lunch and alcohol at night as both interfere with sleep.

Tip 6: Keep stress to a minimum

Stress can trigger episodes of mania and depression in people with bipolar disorder, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.

Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. A daily relaxation practice can improve your mood and keep depression at bay.

Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.

Appeal to your senses. Stay calm and energized by appealing to your senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.

Tip 7: Watch what you put in your body

From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of bipolar disorder—for better or worse.

Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-damaging foods include chocolate, caffeine, and processed foods.

Get your omega-3s. Omega-3 fatty acids may decrease mood swings in bipolar disorder. You can increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts. Omega-3 is also available as a nutritional supplement.

Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your medications. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.

Be cautious when taking any medication. Certain prescription and over-the-counter medications can be problematic for people with bipolar disorder. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

Hotlines and support

• In the U.S.

  Call the NAMI HelpLine at 1-800-950-6264 or find DBSA Chapters/Support Groups in your area. (Depression and Bipolar Support Alliance)

• UK

  Call the peer support line at 0333 323 3880 and leave a message for a return call or Find a Support Group near you. (Bipolar UK)

• Australia

  Call the Sane Helpline at 1800 187 263 or find a local Support Group. (Bipolar Australia)

• Canada

  Visit Finding Help for links to provincial helplines and support groups. (Mood Disorders Society of Canada)

• India

  Call the Vandrevala Foundation Helpline (India) at 1860 2662 345 or 1800 2333 330

Last updated or reviewed on June 5, 2023

7 rules for a fulfilling life with bipolar disorder

Life

Column

June 18, 2020

Daily routine, proper nutrition and mindfulness will help to cope with mood swings.

Masha Pushkina

Founder of the Bipolar Association, author of the books Bipolar People: How Bipolar People Live and Dream About and Bipolar Disorder: A Survival Guide.

For three years I have been leading a community that brings together people with mood disorders and their loved ones. These are very different personalities – from schoolchildren to company leaders, but they all have a common problem: sharp and often unpredictable swings of emotions that affect all areas of life. Many understand that medication and psychotherapy can help curb mood swings. But not everyone is ready to admit that the results of treatment largely depend on themselves – their daily activities and lifestyle. Bad habits can trigger disease attacks and slow down treatment, while good habits help maintain balance.

1. More order, less chaos

I know very well how hard it is for a creative person to keep within limits. After all, you really want to ride on a wave of mood: either hang out all night long or work 20 hours in a row on an interesting project, or spend weeks watching TV shows without leaving your room. But a chaotic lifestyle is exactly what shatters an already unstable psyche.

The more order in the life of a bipolar person, the smoother his mood. In addition, if you are used to a certain regime, it will be much easier for you to maintain it even in depression – automatically, without gigantic volitional efforts.

The most important components of the daily routine:

• Quality sleep. At least 8 hours per night, at the same time. During periods of depression, it is normal to sleep more, but for a couple of hours, not twice.
• Stable operation. Even if you are a freelancer, try to work around the same time and the same number of hours in a row. Night shifts, and even more so their alternation with day shifts, are categorically contraindicated.
• No gadgets or activity before bed. The bipolar brain can be very difficult to calm down, thoughts are spinning in it without stopping. To fall asleep normally, you need to exclude external stimulation an hour or two before bedtime. A common culprit for insomnia is gadgets with bright screens.
• Regular walks or outdoor exercise. Even if you have to literally force yourself to get out of the house, the sun and fresh air improve your mood – it’s a fact!

2. The support of loved ones saves

When you either shock others with crazy ideas, or lie low, turning off your phone, it’s easy to lose friends. But the support of understanding loved ones is what can save you at the most difficult moment.

First, it is an outsider’s perspective: if a friend knows you well, he will notice suspicious changes and advise you to take action. Secondly, when you are understood and supported, it is easier to get through difficult times.

It is very important that during the days of deterioration there is a person who is aware of what is happening and does not blame you for it. Discuss with your loved one in advance what measures he can take if he notices something is amiss. And don’t forget to thank him when you feel better.

If your relatives do not recognize and do not understand your problems, look for support elsewhere. For example, in support groups that exist both in real life and online.

3. Mindfulness is important

Many associate mindfulness with yoga and Buddhist practices. But this is a universal skill, very useful for people who are constantly captured by a storm of emotions. It is needed to notice changes in mood in time, track what could have caused them, and separate emotions from facts.

One popular technique is to keep a mood chart. Every day, you rate your mood on a 10-point scale, enter information about medications and triggers (that is, events that provoke deterioration in you).

There are many smartphone apps for developing mindfulness and other self-control skills. I can recommend Brain.fm, Daylio, Mood Tracker, Woebot, DBT.

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4. Less stress

Strong stress is one of the main enemies. The psyche of a person with bipolar disorder is much less resistant to excessive stress. Stress can trigger another mania or depression. Just take it for granted and do not demand great feats from yourself. It is possible that trials and “coming out of the comfort zone” really harden someone, but this is definitely not about people with mood swings.

But that doesn’t mean that you don’t need to work on your stress resistance: it can be increased within reasonable limits if you take a feasible load and give yourself time to rest and recover as soon as you feel worse.

The key principle here is self-care. It is especially important during depressive periods, when energy is at zero and any little thing can bring you to tears. The best thing to do at a time like this is to take a break and relax, reducing things to the bare minimum. This is much better than heroically dragging them to a nervous breakdown.

In hypomania, it is important to be careful not to pile on projects that will simply crush you with their weight as soon as the wave of euphoria subsides.

5. Complete meals on schedule

Rapid fluctuations in blood sugar contribute to mood swings.

So it is important to eat a normal lunch on time, and not snack on sweets and fatty fast food on the go.

In addition, it is common for people with bipolar disorder and depression to eat mountains of goodies when they are in a bad mood, or to eat at night when they cannot sleep. Over the years, this habit leads to very unpleasant consequences, from excess weight to diabetes.

When taking medicines, you need to be especially attentive to the diet, because many of them increase appetite.

In addition to the quantity of food, its quality is also important. The Mediterranean diet is considered the most useful for nourishing the brain – more greens, fish and fruits, and less starchy, sweet and fatty. And if you do not live by the sea, nutritional supplements – omega-3 acids – can replace the lack of fish.

6. Exercise for the mind

Mental abilities are much less affected in bipolar disorder than in other mental illnesses. But people who are prone to prolonged depression almost always complain of a deterioration in attention, memory, and logical thinking.

During mood swings, the brain works “with a scratch”. I want to “stupid” all day and flip through social networks. But in order not to become irrevocably stupid, it is necessary to regularly give yourself mental tasks, even small ones.

Remember the expression “cognitive rehabilitation” – this is a specially designed training of cognitive functions. And to put it in very simple words, exercises that help restore and maintain mental abilities at a good level.

Here, for example, is one of the popular programs.

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7. No doping

Bipolar disorder is perhaps the only disease that can be enjoyed, albeit with health risks. After all, the bipolar brain often captures a feeling of euphoria without any external reasons. But this means that additional doping (strong alcohol, a lot of cigarettes in a row, all kinds of prohibited substances) is doubly dangerous. From it can literally “break the roof”: in people with a tendency to manic episodes, stimulant substances can cause a real psychosis. It can manifest itself in the form of hallucinations, panic attacks, memory lapses, suicidal thoughts, aggression, and a host of other unpleasant things. In addition, people with mood disorders are many times more prone to harmful addictions than healthy people.

It is important to remember that psychotropic substances are incompatible with drug treatment, their combination can be very dangerous.

Read also 🧐

• What is bipolar affective disorder and how to live with it
• How to recognize alcoholism, depression and other mental disorders
• 12 signs of an anxiety disorder

Bipolar disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. They may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.

• Bipolar disorder I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).
• Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
• Cyclothymic disorder. You have had at least two years – or one year in children and adolescents – many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol or due to health conditions such as Cushing’s disease, multiple sclerosis or stroke.

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.

Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time.

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally optimistic or nervous
• Increased activity, energy or excitement
• Exaggerated sense of well-being and self-confidence (euphoria)
• Reduced need for sleep
• Unusual talkativeness
• Distractibility
• Poor decision-making – such as in speculation, in sexual encounters, or in irrational investments

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. Episode includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may present as irritability)
• Marked loss of interest or feeling of displeasure in all (or nearly all) activities
• Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
• Either insomnia or sleeping too much
• Either anxiety or slow behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others.