Bipolar disorder is a complex mental health condition that can affect a person’s mood and energy levels. During a manic episode, a person may feel full of energy and as if they can do anything. But a depressive episode may follow.
When a person has bipolar disorder, their mood can range from elation and high energy to depression. The condition can also cause disruptions in sleep, changes in thinking patterns, and other behavioral symptoms.
Periods of very high and low moods in bipolar disorder are called manic episodes and depressive episodes, respectively. Hypomanic episodes involve less intense symptoms of a manic episode.
According to the American Psychiatric Association, on average, people begin to experience symptoms at age 25 years. However, symptoms can appear during the teenage years or, less commonly, during childhood.
There are several forms of bipolar disorder, each with slightly different symptoms.
To receive a diagnosis of bipolar I disorder, a person needs to experience only a manic episode. A person with bipolar I disorder may never have a major depressive episode.
When someone experiences mania, they do not just feel very happy — they feel euphoric.
A person experiencing mania may:
- have a lot of energy
- feel able to do and achieve anything
- have difficulty sleeping
- speak rapidly, jumping between topics and ideas
- feel agitated, jumpy, or “wired”
- engage in potentially harmful behavior, such as sex without condoms or other barrier methods, spending a lot of money, dangerous driving, or excessive consumption of alcohol and other substances
- believe that they are more important than others or have important connections
- show anger or aggression if others challenge their views or behavior
- have episodes of psychosis with hallucinations or delusions
A person in a manic state may not realize their behavior is atypical, but others may notice a change in their behavior. Some may see the person’s outlook as sociable and fun-loving, while others may find it unusual or bizarre.
The person may not realize they are acting inappropriately or be aware of the potential consequences of their behavior.
They may need help staying safe.
Not everyone with bipolar disorder will experience a severe manic episode. Less severe mania is known as hypomania. The symptoms are similar to those of mania but less extreme, and people can often function well in their daily life.
Signs of a depressive episode are the same as those of a major depressive episode.
They may include:
- feeling down or sad
- having very little energy
- having trouble sleeping or sleeping a lot more than usual
- thinking of death or suicide
- forgetting things
- feeling tired
- losing enjoyment in daily activities
- having a “flatness” of emotion that may show in the person’s facial expression
In severe cases, a person may experience psychosis or catatonic depression. With catatonic depression, they will not be able to move, talk, or take any action.
Psychosis is a collection of symptoms that cause people to experience a loss of contact with reality. During an episode of psychosis, a person may have trouble distinguishing between what is real and what is not.
People experiencing psychosis may have delusions and distorted thinking that cause them to believe that certain things are true when they are not.
For example, they may believe they have important friends, such as the president of the United States or a celebrity, or that they descend from royalty.
People experiencing psychosis may also have hallucinations, which involve seeing, hearing, or feeling things that are not there.
Read about types of bipolar disorder.
Bipolar disorder is a lifelong condition. It can be present in young children, but this is very uncommon. Bipolar disorder often does not emerge until a person’s late teens or early adulthood.
Any young person who is showing symptoms of bipolar disorder must see a mental health professional.
Learn more here about how bipolar disorder can affect teens.
Doctors do not know exactly what causes bipolar disorder, but the following factors play a role:
- Genetic factors: A person with bipolar disorder may have a parent with the condition. However, having a parent or even a twin with bipolar disorder does not mean a person will develop it.
- Brain structure and function: The brains of people with some mental health conditions, such as bipolar disorder,
may be differentfrom the brains of people without those conditions.
- Stressful triggers: If a person is already susceptible to developing bipolar disorder, stressful life events such as abuse, the end of an important relationship or job, or significant sleep disturbances may trigger the appearance of symptoms.
Engaging in potentially harmful behavior and thinking about suicide can pose serious concerns for a person with bipolar disorder.
Whenever there is a possibility of harm or suicide, it is important to address the concern quickly and directly.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
It is always a good idea to consult a doctor when there is concern about frequent changes in mood. It is especially important to speak with a doctor if these mood changes make it difficult to work or to complete other daily tasks.
Talking with a primary care doctor or family doctor may be a good place to start. However, they will likely refer someone with these symptoms to a psychiatrist or another specialist who cares for people with mental health conditions.
Someone who notices these symptoms in a friend or loved one can also speak with a doctor about their concerns. The doctor can help a person find local support groups or other mental health resources.
To diagnose bipolar disorder, a healthcare professional should begin with a complete medical interview and a physical exam to rule out a physical cause for the person’s behaviors.
There is currently no blood test or imaging to diagnose the condition, but a doctor may suggest tests to rule out other medical conditions with similar symptoms.
If no medical conditions or medications are causing the symptoms, the healthcare professional will consider bipolar disorder. They may refer the person to a mental health specialist.
The best person to diagnose bipolar disorder is a psychiatrist or psychiatric nurse practitioner specializing in caring for people with mental health conditions.
Bipolar disorder has several comorbidities. These are conditions that often occur alongside it.
Other mental health conditions that people might experience include:
These can complicate the diagnosis.
It can take time to receive a correct diagnosis of bipolar disorder. A doctor may diagnose one of bipolar disorder’s comorbidities or a personality disorder instead.
If a person experiences psychosis, this can sometimes lead to a misdiagnosis of schizophrenia, a mental health disorder involving persistent hallucinations and delusions.
Treating these conditions may make it more difficult to diagnose or treat bipolar disorder. Finding a suitable medication and the correct dose for the person can also take time.
However, once a person receives a correct diagnosis and appropriate treatment, medication can help manage the symptoms of bipolar disorder, and these related conditions usually improve as well.
Learn about the outlook for bipolar disorder.
Bipolar disorder is a complex but treatable mental health condition. The symptoms can vary depending on which form of the condition a person has, how old they are, and whether they have a family history of the condition or other risk factors.
If a person believes they may have bipolar disorder, they should consider talking with a primary care doctor or a mental health professional.