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Symptoms of Bipolar Disorder

Bipolar disorder causes dramatic mood swings—from overly high and/or irritable to sad and hopeless, and then back again to the high point. Often, there are periods of normal mood patterns in between these highs and lows. Severe changes in energy and behavior go along with these changes in mood. The periods of highs are called mania. The periods of low are called depression .

Bipolar disorder may cause:

  • Dramatic mood swings ranging from elated excitability to hopeless despondency
  • Periods of normal mood in between
  • Extreme changes in energy and behavior

Depressive Episode

Depressive episodes may cause:

  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy or a feeling of fatigue
  • Difficulty concentrating, remembering, or making decisions
  • Restlessness or irritability
  • Sleeping too much or not being able to sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
  • Thoughts of death or suicide, or suicide attempts

Manic Episode

Manic episodes may cause:

  • Increased energy, activity, and restlessness
  • Excessively high, overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, inability to concentrate
  • Little need for sleep
  • Unrealistic beliefs in one's abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different than usual
  • Increased sexual drive
  • Drug abuse , particularly cocaine , alcohol , and sleeping medicines
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it. It may even be associated with good functioning and enhanced productivity. Without proper treatment, hypomania can become severe mania or can switch to depression.

Other Symptoms

People with bipolar disorder may also experience:

Psychosis

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are:

  • Hallucinations—hearing, seeing, or sensing the presence of things not actually there
  • Delusions—false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts
  • Disorders of thought—loose associations between topics, "flight of ideas," or incomprehensible speech
  • Catatonia—abnormal motor behaviors or unresponsiveness (rarely occurs)

Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania. Delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression.

Suicidal Symptoms

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a doctor. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

  • Talking about feeling suicidal or wanting to die
  • Feeling hopeless, that nothing will ever change or get better
  • Feeling helpless, that nothing one does makes any difference
  • Feeling like a burden to family and friends
  • Abusing alcohol or drugs
  • Putting affairs in order (organizing finances or giving away possessions to prepare for one's death)
  • Writing a suicide note
  • Putting oneself in harm's way or in situations where there is a danger of being killed

Range of Symptoms

As the above list of symptoms illustrate, bipolar disorder can range from mild to severe. If you are feeling depressed, for example, you may have a low mood, feel moderately depressed, or suffer from major depression. The symptoms of mania can also range from experiencing more energy to being in an extremely euphoric mood.

The condition is even more complex because there is also a “mixed” state, where you may feel energized, but also sad, agitated, and suicidal. In between these changes in mood, you could have periods of normal mood.

Bipolar disorder is also broken down into four main types. These types, identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), have specific symptoms, such as:

  • Bipolar Disorder Type I:
    • Having manic or mixed episodes lasting for at least a week, or
    • Having severe manic symptoms that require emergency care
  • Bipolar Disorder Type II:
    • Having episodes of depression and then hypomania
    • Not having severe mania or mixed episodes
  • Bipolar Disorder Type III:
    • Having symptoms that do not meet types I or II
    • Having symptoms that are beyond your normal behavior
  • Mild Form (called cyclothymia):
    • Having episodes of hypomania and mild depression for at least two years
    • Not meeting the criteria for types I, II, or III

There is another type called rapid cycling. This is more likely to happen if you have severe bipolar disorder. Rapid cycling means that you experience four or more episodes of major depression, mania, hypomania, or mixed state in one year.

While these symptoms of bipolar disorder may seem straightforward, it is actually a difficult condition for doctors to diagnose. One reason is that most patients—60% to 80%—who have undiagnosed bipolar disorder seek help from their doctors because of the depressive symptoms. Patients may not share information about their episodes of elevated mood, and doctors may not ask questions about mood changes.

Some symptoms that may help doctors to identify bipolar disorder include:

  • Typically occurs before age 25
  • Life events may trigger episodes
  • Traits unique to bipolar disorder: has mood changes without a clear cause, gets hurt feelings easily, has ideas that disturb sleep, quickly moves from one activity to another, does not usually feel fatigued, works long hours, may not need sleep at all, experiences days full of energy, has racing thoughts and frequent daydreams

Major depression, on the other hand, includes symptoms like feelings of guilt, worthlessness, or helplessness, which last for at least two weeks. If you have depression, you may have one episode or many episodes. The main difference between a diagnosis of depression and bipolar disorder is that there are no episodes of mania or hypomania in people who have depression.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2013 -
  • Update Date: 09/30/2013 -
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  • Depression. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/depression/index.shtml . Accessed September 6, 2013.

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