Symptoms of bipolar disorder can be confusing, even for professionals who have spent years learning to diagnose and treat various mental health conditions. People with bipolar disorder are often misdiagnosed as having depression before they get an accurate confirmation of their condition, delaying their treatment and possibly making their lives harder in the process. Between that and the rampant, undeserved stigma surrounding bipolar disorder, it’s important to understand the actual signs of the condition. Here’s what you need to know about the symptoms of bipolar disorder.
Bipolar disorder can cause drastic shifts in a person’s mood and behavior, fluctuating between highs (manic episodes) and lows (depressive episodes). It can also induce less severe manic periods (hypomanic episodes).
These episodes can typically last at least a week, but they can span months. Let’s walk through the typical symptoms you can expect in each kind of episode, according to the National Institute of Mental Health (NIMH).
Mania and hypomania
Medical providers generally look for an ongoing, overall unusual mood along with three or more of the following symptoms when diagnosing a manic or hypomanic episode:
- Feeling abnormally upbeat
- Feeling jumpy
- Feeling euphoric
- Increased energy or activity levels
- Inflated self-esteem
- Racing thoughts
- Being more talkative
- Being easily irritated
- Needing less sleep
- Taking more risks than usual
However, if a person experiences manic symptoms linked with psychosis resulting in hallucinations or delusions, or if their symptoms are severe enough to require hospitalization, that’s also a diagnosable manic episode.
To be clear, mania and hypomania share the same symptoms. They’re just more extreme in manic periods than hypomanic ones and, as such, may be easier to recognize, Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF. “Hypomanic episodes are highly adaptive,” he says. “A lot of people work 15 hours a day and have energy that’s much higher than average, but [their hypomania] is easily missed until there is a failure of some sort in their personal or professional life that results in an episode of depression.”
A bipolar depressive episode is defined as having five or more of the following symptoms for at least two weeks, with one of the symptoms being a depressed mood or reduced interest or pleasure in life:
- Feeling sad, empty, or hopeless
- Feeling slower than usual
- Feeling worried
- A loss of energy
- A loss of interest or enjoyment in activities
- Lower activity levels
- Sleeping too much or too little
- Appetite or weight changes
- Difficulty concentrating
- Memory problems
- Suicidal or death-related thoughts
Suicide is a big concern for people with bipolar disorder. “Bipolar disorder can be lethal,” Jed Magen, D.O., associate professor and chair in the department of psychiatry at Michigan State University, tells SELF. This is not only due to the depressive episodes, but because of what experts call “mixed episodes,” where people may experience features of mania and depression at the same time. This means that people with mixed episodes might have suicidal thoughts and also have a ton of energy to potentially act them out, Dr. Magen says.
As with mania, severe episodes of depression can also lead to psychosis.
Depending on the combination, length, and severity of symptoms, there are four main types of bipolar and related disorders that someone may be diagnosed with.
Here they are, per the NIMH:
Bipolar I disorder is defined as having manic episodes that last at least seven days or having such severe mania that someone needs to be hospitalized. People with bipolar I disorder usually have depressive episodes, too, or mixed episodes that feature characteristics of both depression and mania.
Bipolar II disorder includes depressive episodes along with hypomanic episodes rather than more severe mania.
Cyclothymic disorder involves periods of hypomanic symptoms and depressive symptoms lasting for at least two years in adults (and only one year in kids and teenagers). (The symptoms don’t last for two full years—as with the other diagnoses here, people with cyclothymic disorder have alternating periods without any symptoms.) Although the symptoms don’t meet the diagnostic requirements for hypomanic and depressive episodes, having cyclothymic disorder increases a person’s risk of developing bipolar disorder.
Other Specified and Unspecified Bipolar and Related Disorders describes having symptoms of bipolar disorder that don’t quite fit into any of the other categories.
Doctors aren’t entirely sure why people with bipolar or related disorders go through these mood changes. Major risk factors include structural brain changes and a family history of first-degree relatives with the condition, according to the Mayo Clinic.
If you think you have bipolar disorder, it’s important to consult a mental health professional and go over your symptoms in detail.
People with bipolar disorder are more likely to seek help when they’re dealing with the depressive symptoms than manic ones. If you’re dealing with mania, you might feel excellent and relish the amped up energy, and if you’re experiencing hypomania, it might not even seem like anything is different enough to warrant talking to an expert. So, if you do end up seeing a doctor about possibly having bipolar disorder, it’s important to explain the full range of your symptoms in order for them to give you a proper diagnosis, the NIMH says.
Landing on the right treatment for bipolar disorder often takes some effort, but trying is crucial. “People with bipolar disorder who go without treatment will relapse,” Dr. Galynker says.
Medication is a cornerstone of treatment, and many different types can be effective for bipolar disorder, according to the Mayo Clinic. These generally include mood stabilizers to reduce mania and hypomania, antipsychotics, antidepressants, antidepressant-antipsychotics, and anti-anxiety drugs. Since the symptoms of bipolar disorder can span such a wide range, your doctor may prescribe medications in various combinations to target them.
Therapy is another main aspect of treatment for bipolar disorder. According to the Mayo Clinic, one option is interpersonal and social rhythm therapy meant to help a person keep their mood stable by regulating their daily routine, like when they sleep and eat. Cognitive behavioral therapy, which aims to retrain a person’s thought patterns and resulting actions, can also be an asset.
Wading through all the potential treatments out there can be overwhelming, which is why seeing a professional is of the essence. As Dr. Galynker explains, with the right treatment, it’s much easier to lead a healthy life with bipolar disorder.