Let's Talk About the Symptoms of Bipolar Disorder
We've got the doctor-vetted details on how to tell if you, or a loved one, is experiencing the mania or depression classic to bipolar.by Leslie Pepper
All of us have mood shifts: happy to sad, fearful to brave, confused to assured. That’s called “being a human.” The mood swings for people with bipolar disorder are very different. Bipolar is a serious mental condition that short-circuits the brain’s ability to think clearly and causes states of extreme ups and extreme downs, called mania and depression. If you’re on this page, you may worry you, or someone you love, has bipolar. We understand this can be scary, but know this: With the right treatment, most people with bipolar live rich, productive, meaningful lives. The key is to identify the symptoms and get a diagnosis so you can get the help you need. We’re here for you, too.
Our Pro Panel
We went to some of the nation’s top experts in bipolar disorder to bring you the most up-to-date information possible.
Po Wang, M.D.
Psychiatrist and Clinic Chief
Bipolar Disorders Clinic at Stanford University Department of Psychiatry
Amit Anand, M.D.
Professor and Vice-Chair for Research
Center for Behavioral Health at the Cleveland Clinic
Linda Hubbard, L.M.F.T.
Department of Behavioral Health, Psychiatry & Psychology at the Mayo Clinic
Bipolar looks the same in women and men in terms of the signs of mania and depression. The differences scientists have found are that women are more likely than men to…
- Go through rapid cycling—many mood ups and downs in a given year.
- Experience mixed episodes, when mania and depression happen at the same time or in quick succession without a stretch of time in between. - Have bipolar II.
The main difference is the intensity of the manic episodes. Mania for a person with bipolar I is indisputable: Not only is it noticeable to everyone around the person, it is often so debilitating that the person is unable to function, and it may even lead to psychosis, necessitating hospitalization. Mania for a person with bipolar II is less severe. It’s called hypomania, and though it can vary in intensity, it’s far less obvious than the mania in bipolar 1. In fact, it can sometimes be subtle enough that those around the bipolar person barely see anything unusual, and if you’re experiencing it, you may function relatively normally day to day.
Someone with bipolar might seem like a pinball machine, bouncing all over. They may exaggerate their accomplishments, may be distractible or irritated, and may engage in risky behaviors like having unsafe sex or taking drugs. Or, if they’re in a depressive phase instead of a manic one, they may seem exactly the opposite—appearing sad or lethargic, claiming they’re worthless, or eating too much or too little, and they may show little interest in activities they usually enjoy. The main thing to look out for with all of these behaviors is: Is this behavior out of the norm for this person?
Rapid cycling is when a person with bipolar disorder experiences four or more periods of mania and depression within one year. Rapid cycling can happen continually, or it can happen during one year, then never again. While anyone can experience rapid cycling, it’s more common in women than men, and more common in bipolar II than I.
What Does Bipolar Disorder Look Like, Generally?
We’re all unique, and so is the way bipolar manifests in each person. Bipolar causes intense mood changes and irregularities in behavior—and, depending on the intensity of the disorder, those can interfere with personal relationships, harm careers, and disrupt life’s day-to-day functioning. (But remember: Treatment improves things so much.)
The definition of bipolar disorder is that a person experiences episodes of depression and episodes of mania. In fact, one of the criteria for being diagnosed with bipolar is that you’ve experienced at least one manic episode or one of hypomania, a milder form of mania. Knowing that you’ve had at least one episode of mania, the doctor or psychiatrist will ask you further questions to decipher exactly which kind of bipolar you have. There are four possibilities:
Bipolar I: This is the most severe type of bipolar. People with Bipolar I typically experience severe cycles of mania and depression.
Bipolar II: Bipolar II comes with the milder mania—hypomania—as well as standard depressive episodes.
Cyclothymic Bipolar: This type of bipolar means that both the depression and mania are on the mild side.
Unspecified Bipolar: Symptoms are like bipolar, but do not have a frequency or length that warrants the diagnosis of one of the other types of bipolar.
Do I Have the Signs of Mania?
Despite how colloquial the word “manic” has become, it’s not appropriate to use—nor does it accurately describe—when, say, you’re freaking out that Whole Foods is out of your favorite cold brew, or you’re just super upset about something. A true manic state is very different, so let’s dispel the myths. With actual mania, you may display all or a mix of the following signs for at least seven days:
High levels of energy and exhilaration. You feel euphoric, with an intense feeling of joy, and appear extremely lively—in a manner that’s far beyond what the situation warrants. Think of it this way: It’s as if you’ve hit $10 million in the lottery when really, you’ve only won a buck on a scratch-off.
Supercharged creativity, no execution. You move from one activity to the next, constantly starting new projects. I’ll paint the house rainbow! Let’s go to Rome! I’m going to start a dog-grooming business! You may buy the paint, toss Italian brochures around the house, and order 10 books on dog care from Amazon, but the details of how to legitimately carry out any of the projects aren’t really registering with you, and nothing actually gets done.
Grandiosity and inflated self-esteem. You feel you can do anything and everything bigger and better than someone else can. Sometimes, these feelings become so severe that they turn into psychosis—a loss of contact with reality. (Estimates vary, but some experts think about two-thirds of people with bipolar I will have psychosis at some point.) When you’re manic, you might believe that everything you do will turn out to be a huge success; with psychosis, you might believe you have supernatural abilities.
Pressured speech. Those experiencing mania may talk at a frenetic pace, often in a jumbled fashion without proper pauses. They don’t have a natural, back-and-forth conversation. Instead, they talk over you, jump around to various topics, and generally don’t make a lot of sense.
Sleep problems. In a manic state, you can go for days without sleeping, or only snooze a few hours a night for days or even weeks. And yet, you still have abundant amounts of energy, say you feel great, and never complain of exhaustion. (Essentially: the opposite of what people typically do when they lack serious shuteye.)
Engaging in risky behaviors. When mania grabs hold, it can lead to impulse-control issues. Incessant gambling, using illegal drugs, or having unsafe sex are some telltale signs. Others include binge eating or spending money you don’t have (to the point of going bankrupt even).
Irritability. You might be restless, pace back and forth, and tap your fingers or feet. You just can’t sit still.
The tricky part about mania is that it can feel enjoyable—and it can be hard for you, if you’re the one experiencing it, to realize anything’s off. Why? You’ve got loads of energy, feel more creative and productive than ever, and are friendly and talkative. But mania can spiral out of control. People in a manic state can pick fights, lash out when friends won’t go along with their grand schemes, gamble all their money away, or cheat on their spouses. Or all of the above.
Okay, So Then What Is Hypomania?
As we mentioned, hypomania is a less extreme version of mania. To be diagnosed with hypomania, you must experience at least three of the following symptoms for at least four days but not to a degree that they lead to hospitalization or include psychotic symptoms (a break with reality):
decreased need for sleep
racing thoughts or ideas
agitation or increased activity
participating in risky behaviors (shopping sprees, gambling, risky sex)
Do I Have the Signs of Depression?
Everyone feels sad once in a while. But diagnosable depression is so much deeper. If you're in a depressed state, you may display any or all of the following signs at least once a day for a period of more than two weeks:
Feeling bleak. You can feel so low you don’t want to do anything, particularly things you used to love. For example: You may have been an avid runner, but now refuse to even put on a pair of sneakers. Or you’ve always loved trying new restaurants, yet now you have no interest in going out. You feel hopeless, empty, and worthless.
No energy. People in a depressed state are sometimes so exhausted, they don’t even get out of bed. Doesn't matter if they've had enough sleep: There’s simply no drive to do anything. The simplest tasks can seem too heavy to manage.
Sleep issues. You may be unable to fall asleep and/or toss and turn for hours. If you can drift off, you might wake up in the middle of the night or pre-dawn and not be able to get back to sleep. On the flip side, you may snooze too much—eight hours doesn’t feel like enough.
Difficulty concentrating. Basic questions like what to have for dinner seem overwhelming. Easy tasks like reading a book or even watching Netflix may be too much. When you're in a depressed state, you don’t have the focus to create a to-do list, let alone complete it.
Appetite changes. You eat either too much or too little. You may gain or lose a lot of weight in a short period of time.
Suicidal thoughts. Depression can get so bad, you may consider suicide.
What Triggers Bipolar Symptoms?
Sometimes it may feel like bipolar symptoms come out of nowhere, but certain things may provoke periods of mania or depression. They include:
Sleep disruptions. Sleep deprivation or jet lag can bring on mania. It’s important for a person with bipolar disorder to stay on a regular sleep schedule, meaning you go to sleep and wake up at the same time every day, including on weekends and vacations.
Stress overload. Too many deadlines, financial strains, or relationship stresses can cause moods to spiral. Dialectical behavior therapy and cognitive behavioral therapy both help teach ways of thinking and acting that can reduce reactive and unhelpful responses to stress. Another idea is to make a list of things that calm you and help you feel more at peace. Some possibilities include: a warm cup of hot chocolate, playing an instrument, or baking your favorite dessert.
Schedule changes. Vacations, a new job, or a new school schedule can trigger a bipolar episode. Shifting schedules also makes it more difficult to stay on a regular medication regimen. If you’re away from home, try to keep as many routines (time you shower, type of breakfast you eat, what kind of exercise you do, etc.) as consistent as possible.
Drugs and alcohol. Substance abuse is common in people with bipolar disorder and can be dangerous. Drugs and alcohol can trigger either mania or depression, and people with bipolar should avoid them.
Do Men and Women Have the Same or Different Bipolar Symptoms?
For the most part, the symptoms are similar for women and men, although there are some minor differences. Women experience depressive episodes, mixed mania, and rapid cycling more often than men. Bipolar II disorder appears to be more common in women. Substance use, which can sometimes look like mania but isn’t truly bipolar disorder, is more common in men.
How Frequently Do the Periods of Mania and Depression Occur?
Many people with bipolar have long periods of normal mood and functioning in between their highs and lows. Others have “rapid cycling” symptoms—defined as having episodes of mania or depression four or more times in one year. The majority of people with bipolar have one or two cycles a year, but there’s no typical duration for the cycles—they could last a few hours, days, weeks, or months.
Sometimes the manic and depressive symptoms occur at the same time (known as “mixed mania” or a “mixed episode”) or go from one to the other within a day. People who are experiencing a mixed episode can feel sad, empty, and hopeless as well as wired and full of energy, all at the same time.
When to Call a Doctor
Since people in a manic state often don’t realize anything’s off, it’s unlikely that they’ll call a doctor. It’s one reason that some data has found that people wait an average of almost six years after the first sign of bipolar disorder to get diagnosed and treated. Most people with bipolar disorder seek help themselves when they’re in a depressive state. But antidepressants can make bipolar disorder worse, so it’s important that a professional takes your full medical history to ensure a proper diagnosis.
If you have a friend with bipolar disorder, it's important to be aware of the signs and suggest they see their doctor. It’s tricky not offending someone when you tell them their behavior is erratic or their moods unhealthy. But if you discuss it in a non-judgmental way, you may be able to help them see they need to seek help. Make it clear that you care and are only looking out for their best interests. Explain that it’s not their fault, many people struggle with this condition, and it’s an issue that can be helped by medicine and therapy. Sharing the facts of how you see their moods impacting them, you, and others can be helpful, particularly if you do it in a solution-seeking manner instead of an accusatory one.
If a friend has been diagnosed with bipolar and stops taking their medicine, that’s another reason to speak up and suggest they call their doctor, or you may even have to call the doctor yourself. This is a tough one—sometimes it gets to a point where a loved one is so difficult to live with that you have to give them an ultimatum. Another suggestion: Talk to your loved one/friend when they’re in a good place and ask if they would sign a release so that the doctor can talk to you about their case in the future when/if things get bad.
Suicide is also a grave concern with bipolar disorder. If you, or someone you know, experiences any of the following signs, contact a professional immediately, or call the National Suicide Prevention Hotline at 1-800-273-8255:
Talking about death or self-harm
Talking about being a burden to others
Talking about being in unbearable pain
While this sounds dire, remember that not everyone has a version of bipolar disorder so severe they would contemplate or attempt suicide. For most people diagnosed with bipolar who get proper treatment, they can lead full and happy lives.