Bipolar Disorder: Signs, Symptoms, and Complications

Bipolar Disorder: Signs, Symptoms, and Complications Image

Symptoms of bipolar disorder include periods of extreme emotional highs (mania or hypomania) and extreme emotional lows (depression) Bipolar disorder, formerly known as manic depression, is a mental health disorder characterized by emotional extremes. People with bipolar disorder typically experience periods of abnormally elevated or irritable moods and increased energy (known as

Bipolar disorder, formerly known as manic depression, is a mental health disorder characterized by emotional extremes. People with bipolar disorder typically experience periods of abnormally elevated or irritable moods and increased energy (known as mania or the milder hypomania) and periods of depression. They may also experience mixed episodes that share features of both mania and depression.

These periods of being up and down are more extreme than normal mood swings. They represent a marked shift in a person's normal mood, energy, and behaviors, and endure for at least several days to weeks.

Bipolar symptoms can begin at any time throughout your lifetime, but they most often first appear between the ages of 15 and 24.

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Types

There are several different types of bipolar disorders, which vary in their severity. Their shared defining feature is the presence of mania or hypomania. Most of the time, people with bipolar disorder also experience periods of depression.

Bipolar 1 Disorder

The hallmark of bipolar 1 disorder is having one or more manic episodes.

During manic episodes, people have greatly increased energy and often a dramatically decreased need for sleep. They may feel elated, on top of the world, or extremely irritable and prone to hostile outbursts.    

Although many people with bipolar 1 disorder experience periods of depression (low mood, despair, loss of pleasure, and fatigue), a depressive episode is not required for diagnosis.

People with bipolar 1 sometimes also have periods of hypomania. And most experience stretches of normal or neutral (euthymic) mood between episodes.

Less often, people with bipolar swing repeatedly between mania and depression. This is known as "rapid cycling."

Bipolar 2 Disorder

To be diagnosed with bipolar 2 disorder, a person must have had at least one episode of major depression and one episode of hypomania. Between these episodes, many people with bipolar 2 disorder return to their regular functioning and mood. 

Hypomania can be pleasurable. It is a time of increased productivity and creativity that does not impair a person's relationships or ability to function at school or at work. Therefore, it's often hard for people with hypomania to recognize that their moods present a problem.

Most people with bipolar 2 disorder do not seek medical attention until they are depressed. This fact can make bipolar 2 disorder difficult to diagnose. 

In addition, people with bipolar 2 disorder often also have anxiety or substance use disorders. These co-occurring conditions may further complicate their diagnosis and treatment.

Cyclothymic Disorder

Cyclothymic disorder is a condition with less extreme mood swings than other bipolar disorders. People with cyclothymic disorder experience frequent mood swings characterized by depressive and hypomanic symptoms, but these mood swings:

  • Do not meet the full criteria (listed below) for either an episode of hypomania or depression

and

  • Occur during at least half of a two-year period, and cannot cease for more than a two-month stretch during that two-year period

Other Types

Bipolar disorder is sometimes triggered or exacerbated (worsened) by certain medications, such as steroids, interferon-based drugs, levodopa (a Parkinson's disease drug), and certain antidepressants and anti-seizure medications. Drug or alcohol use can also induce symptoms of mania or depression.

The relationship between drug and alcohol use and bipolar disorder is complex and frequently bidirectional, as patients sometimes use drugs and alcohol as a form of self-medication.

Symptoms of Mania/Hypomania

Hypomania and mania are periods of abnormally elevated, expansive, or irritable mood and increased energy.

While many people experience mood swings, mania and hypomania are more radical departures from a person's normal mood, sleep, and behavior and are more sustained than normal mood swings—lasting from days to weeks. These changes are present for much or all of the day and are pronounced enough that those around them take notice. 

Mania/Hypomania Symptoms

Diagnosis of mania or hypomania requires the presence and persistence of three or more of the following symptoms:

  • Expressing an inflated or grandiose self-image
  • Having a markedly decreased need for sleep (feels well rested after only a few hours of sleep)
  • Being more talkative than normal, being excessively loud, or speaking rapidly
  • Having racing thoughts and ideas
  • Being highly distractible, having scattered thoughts and conversations
  • Being extremely goal orientated (at school or work or sexually) or having physical agitation and restlessness
  • Practicing risky behaviors, pleasure-seeking without regard for negative consequences (such as going on spending sprees, having sexual indiscretions, gambling, or making risky financial decisions)

To be classified as hypomania, these mood symptoms must last for at least four days. To be classified as mania, symptoms must last at least a week, be sufficiently severe to cause marked impairment in functioning, or be severe enough to warrant hospitalization.

Although the symptoms of hypomania and mania overlap, they are distinct conditions. Mania is more severe than hypomania. Unlike hypomania, mania disrupts social relationships and a person's ability to function at school, at home, or at work.

Mania can also lead to psychosis—a break from reality that involves hallucinations (seeing, hearing or smelling things that are not there) or delusions (believing things that are not true).

Symptoms of Depression

Periods of mania or hypomania are the defining feature of bipolar disorders. Despite this fact, people with bipolar disorders generally spend more time depressed than manic or hypomanic. 

Common symptoms of depression include:

  • Depressed or low mood
  • Loss of interest or pleasure in once enjoyable activities
  • Rapid weight and appetite changes (weight gain or loss of more than 5% in a month)
  • Sleep problems (sleeping too much or too little, inability to fall asleep or stay asleep)
  • Tiredness, fatigue
  • Slowed thoughts or speech, or increased agitation and nervous energy
  • Inability to think, concentrate, or make decisions
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Thoughts of self-harm or suicide

Suicide Hotline

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

People with bipolar disorder are most likely to seek help while depressed, when they are not exhibiting manic or hypomanic symptoms. Their presenting symptoms often closely resemble those of people with major depressive disorder—a more common mental health disorder characterized by despair, exhaustion, sleep problems, and loss of pleasure.

People with bipolar disorder are often initially misdiagnosed with major depressive disorder. A careful and thorough history by a trained mental health professional is essential for people presenting with depressive symptoms.

Manic or Hypomanic Episode with Mixed Features

People with bipolar disorder sometimes experience periods with features of both a manic or hypomanic episode and depression. These periods are sometimes known as mixed episodes, mixed mania, or mixed states. For example, they may feel despondent and hopeless but full of restless energy. 

According to the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), a manic or hypomanic episode with mixed features meets the criteria for a manic or hypomanic episode, plus has at least three of the following features:

  • Depressed or low mood, feels sad or empty
  • Loss of pleasure or interest in activities
  • Slowed movement or speech
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Recurrent thoughts of death or suicide

Bipolar Disorder in Children

Bipolar disorder is less common in children and teens than in adults, but it has been diagnosed in children as young as 5.

Nearly all children and teens have emotional outbursts, mood swings, and exhibit challenging behaviors. The difference between normal behavior and bipolar disorder lies in the duration and degree of mood swings.

In bipolar disorder, extreme moods are sustained for several days and are accompanied by radical shifts in energy levels, the need for sleep, and a person's ability to focus and think clearly. The shift is severe enough that it impairs a child's or teen's ability to interact with others and to function normally at school and at home.

In addition, the symptoms of bipolar disorder in children and adolescents sometimes overlap with those of attention deficit hyperactive disorder (ADHD), anxiety disorders, other mood disorders, or conduct disorders. As is true for adults, a careful and thorough evaluation by a trained mental health professional is essential for proper diagnosis.  

Complications

There is no cure for bipolar disorder, but many of its symptoms and negative side effects can be mitigated or prevented with careful ongoing psychiatric treatment. Untreated, bipolar disorder can lead to severe problems, including:

  • Worsening of the disorder and debilitating symptoms
  • Psychosis (a break with reality, involving hallucinations or delusions)
  • Drug or alcohol abuse
  • Damaged relationships
  • Financial or legal troubles
  • Involvement in crime or violence
  • Failure at work or at school
  • Suicide or attempted suicide

Co-Occurring Conditions

People with bipolar disorder often have other physical and mental health ailments. These ailments can sometimes worsen symptoms or complicate your treatment. It’s important to get these other problems diagnosed and managed.

When to See Your Doctor

If you or a loved one are exhibiting signs of mania, hypomania, or depression, seek medical attention. With prompt and proper treatment, bipolar disorder can be managed and many of its harms avoided.

Mental Health Resources

If you or a loved one are struggling with bipolar disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

If you or a loved one is experiencing signs and symptoms of psychosis—a break with reality that involves believing things that are untrue or seeing or hearing things that are not there—this is a medical emergency requiring immediate medical care. Call 911 or head to the nearest emergency room.

A Word From Verywell

Bipolar disorder is a brain disorder that requires appropriate psychiatric treatment. Early and proper treatment improves long-term outcomes and can help manage and prevent the most severe consequences of this disease.

If you suspect you or a loved one has bipolar disorder, a full and careful medical and psychiatric history is required for diagnosis. People with bipolar disorder generally first seek medical care during a depressive episode, and many are misdiagnosed with major depressive disorder rather than bipolar disorder.  

A misdiagnosis not only delays proper care, but also can directly worsen a person's mental condition. Taken alone, the standard treatment for major depression, antidepressants such as serotonin reuptake inhibitors (SSRIs), can trigger a manic or hypomanic episode and may induce thoughts of suicide.

It is critical for the person and their loved ones to be forthcoming about previous periods of inflated self-esteem, self-importance, excess energy, or feeling high or elated, and any other signs of mania or hypomania when seeking help.

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