Symptoms

Symptoms of bipolar disorder tend to fluctuate dramatically between two extremes: mania and depression. Sometimes a patient may have an episode in which both symptoms of mania and depression are present at the same time. This is called a “mixed state."

Symptoms vary among patients. The types of symptoms experienced also depend on the type of bipolar disorder. Patients with bipolar I disorder typically have severe manic episodes that alternate with shorter bouts of depressive symptoms. Patients with bipolar II disorder, experience longer periods of depression that alternate with manic episodes that are shorter in duration and less severe (hypomania) than those associated with bipolar I disorder.

Symptoms of Mania

Symptoms associated with manic episodes include:

• Exaggerated euphoria. A feeling of great happiness or well-being
• Irritability. Can include aggressive behavior and agitation.
• Distractibility. Characterized by the inability to concentrate on or pay attention to any activity for very long.
• Insomnia. Having high energy and difficulty sleeping.
• Grandiosity. Patients with this symptom have an inflated sense of self-esteem, which, in severe cases, can be delusional. Patients may experience feelings of being all-powerful or feel that they are godlike or have celebrity status.
• Rapid speech and racing thoughts. The patient may talk quickly and excessively and move rapidly from one idea to another.
• Increased activity. The patient may show an increase in intensity in goal-directed activities related to social behavior, sexual activity, work or school.
• Poor judgment. Excessive involvement in high-risk activities may occur (such as unrestrained shopping, promiscuity). Impulsivity and poor judgment may be severe enough to damage workplace or social functioning or relationships with others. Some patients require hospitalization to prevent harm to themselves or to others.

Symptoms of Depression

The symptoms of depression experienced in bipolar disorder are almost identical to those of major depression, the primary form of unipolar depressive disorder. They include:

• Sad mood
• Fatigue or loss of energy
• Sleep problems such as insomnia, excessive sleeping, or shallow sleep with frequent awakenings
• Appetite changes
• Diminished ability to concentrate or to make decisions
• Agitation or markedly sedentary behavior
• Feelings of guilt, pessimism, helplessness, or low self-esteem
• Loss of interest or pleasure in life
• Thoughts of or attempts at suicide

Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)