Bipolar disorder — master index¶
Last curated: 2026-09-03 · status: audited (evidence-broadening pass independently re-audited by Claude on 2026-09-03)
Build at a glance: 18 curated wiki pages · 393 distinct PubMed records condition-wide (382 cited across wiki pages) · 33 directly live-verified ClinicalTrials.gov records · 6 audited landmark notes · 25 guideline/consensus entries · 143 statistics rows · 13 verified public organizations · 24 tiered open questions and 14 cross-domain junctions. All 393 PMIDs and 33 NCT IDs were live-resolved again during the 2026-09-03 independent audit.
The condition in five sentences. Bipolar disorder is a recurrent mood disorder defined by mania or hypomania, usually with a longitudinal burden dominated by depression and subsyndromal symptoms rather than continuous euthymia (Nierenberg 2023, PMID 37815563; Joffe 2004, PMID 14996142). World Mental Health surveys estimated lifetime prevalence of 0.6% for bipolar I, 0.4% for bipolar II and 1.4% for subthreshold bipolar disorder, while three-quarters of spectrum cases had another mental disorder (Merikangas 2011, PMID 21383262). It is highly polygenic: a GWAS of 41,917 cases identified 64 loci, but ancestry transfer and individual prediction remain weak (Mullins 2021, PMID 34002096; Li 2021, PMID 33263727). Treatment is phase-specific—antipsychotics, lithium and valproate anchor acute mania; several antipsychotics and combinations have modest short-term bipolar-depression effects; lithium, lamotrigine, valproate and antipsychotics differ in polarity-specific maintenance benefit and harm (Kishi 2022, PMID 34642461; Yildiz 2023, PMID 37595997; Miura 2014, PMID 26360999). The unresolved priorities are prospective polarity and relapse prediction, clinically meaningful treatment matching, safe reproductive decisions, and closing an all-cause mortality gap of about twofold without reducing the problem to suicide alone (Hayes 2015, PMID 25735195; Biazus 2023, PMID 37491460).
Start here: overview. Frontier: open questions. Growth history: curation log.
Reading paths¶
| Need | Recommended path |
|---|---|
| First orientation | Overview → Diagnosis and spectrum → Epidemiology and course |
| Acute treatment | Mania and mixed states → Bipolar depression → Guidelines |
| Long-term treatment | Maintenance → Lithium → Psychotherapy and self-management |
| Controversies | Antidepressants → Biomarkers and digital phenotyping → Open questions |
| Safety and special populations | Suicide, mortality and physical health → Pregnancy and reproductive health → Red flags |
| Human and service context | Comorbidity and differential diagnosis → Patient experience and advocacy → patient-voice layer |
| Research pipeline | Genetics and neurobiology → Biomarkers → Clinical trials |
Pages¶
The canonical page list for this condition. Every page was materially extended in the 2026-09-03 evidence-broadening pass (codex) and re-audited the same day by a different engine (Claude); all 18 are curated.
| File | Scope | Status |
|---|---|---|
| overview.md | Bipolar spectrum, burden, mechanisms and treatment map | curated |
| diagnosis-and-bipolar-spectrum.md | Mania, hypomania, bipolar I/II, cyclothymia, mixed features and mimics | curated |
| epidemiology-and-course.md | Prevalence, onset, recurrence, disability, diagnostic delay and polarity | curated |
| genetics-and-neurobiology.md | Heritability, GWAS, circuits, rhythms, signaling and neurobiology | curated |
| mania-and-mixed-states.md | Acute mania, agitation, psychosis, mixed presentations and evidence | curated |
| bipolar-depression.md | Depressive episodes, differentiation from MDD and evidence-based therapies | curated |
| maintenance-and-relapse-prevention.md | Lithium, anticonvulsants, antipsychotics and polarity-specific prevention | curated |
| lithium.md | Efficacy, suicide evidence, monitoring, renal/thyroid effects and toxicity | curated |
| antidepressant-controversy.md | Switch, cycle acceleration, efficacy, subgroups and disagreement | curated |
| psychotherapy-and-self-management.md | Psychoeducation, family therapy, cognitive therapy, rhythms and digital tools | curated |
| comorbidity-and-differential-diagnosis.md | ADHD, substance use, anxiety, personality and medical mimics | curated |
| suicide-mortality-and-physical-health.md | Suicide, cardiovascular/metabolic burden and mortality gap | curated |
| pregnancy-and-reproductive-health.md | Teratogenicity, postpartum risk, lactation and comparative risk | curated |
| guidelines.md | CANMAT/ISBD, NICE, VA/DoD and international disagreements | curated |
| biomarkers-and-digital-phenotyping.md | Omics, imaging, actigraphy, speech and relapse prediction | curated |
| clinical-trials-landscape.md | Acute, maintenance, neuromodulation and precision-treatment trials | curated |
| patient-experience-and-advocacy.md | Diagnosis journey, stigma, identity, family burden and organizations | curated |
| red-flags-and-safety-concerns.md | Mania, psychosis, suicidality, toxicity and unsafe withdrawal | curated |
Literature layer¶
| Artifact | Contents | Build state |
|---|---|---|
| BIBLIOGRAPHY.md | 393 unique PubMed records; tags and citing files | broadened and re-audited |
| Landmark notes | 6 structured notes: GWAS, STEP-BD, psychoeducation, maintenance, lithium/suicide and pregnancy recurrence | complete |
| Guideline registry | 25 international, national and special-purpose documents; superseded chains, disagreements and watch list | broadened and re-audited |
| Statistics | 143 source-locked rows across epidemiology, course, treatment, physical health and reproduction | broadened and re-audited |
| Patient voice | Ethics/method, 13-organization directory, themes and annotated sources | audited |
| Open questions | 24 stable tiered questions plus 14 “Dots not yet connected” junctions | sharpened and re-audited |
Curation state¶
All 18 pages were extended on 2026-09-03 by codex and independently re-audited the same day by Claude, which re-fetched every added record, corrected eight substantive or labelling defects, replaced a stale absence statement and promoted all 18 pages to curated. The pass added quantified trials and syntheses, guideline-grade disagreements, mechanistic depth and explicit two-sided uncertainties while widening the bibliography from 304 to 393 distinct records; wiki citation breadth rose from 16.5 to 21.2 distinct records per page (297→382), so the added lines carried genuinely new evidence rather than recycling the existing pool. The unipolar depression condition retains major depressive disorder generally; treatment and risk questions specific to bipolar depression remain here.