Bipolar disorder is a mental health condition characterized by extreme mood swings that include periods of mania, hypomania, and depression.

Bipolar disorder (BP), formerly known as manic depression, is where a person has extreme mood swings, which people often call episodes, including periods of mania, hypomania, and depression.

These mood swings can be severe and disruptive, affecting a person’s thoughts, emotions, behavior, and overall functioning.

This article looks at the stages of this condition in depth.

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People may experience BP differently, but in general, they will follow three stages:

  • Early, or prodromal, stage: This phase occurs before the beginning of a manic or depressive episode. During this time, a person may notice subtle shifts in mood, behavior, or functioning. Symptoms can include anxiety, depression, or disrupted sleep patterns.
  • Acute stage: The acute stage is when a person has a full mood episode, manifesting as mania, depression, or a mixed episode, depending on the person.
  • Maintenance stage: In the maintenance stage, the focus shifts toward effectively managing the disorder and sustaining stability through medication and therapy.

Mania is the most intense and extreme phase of BP. During a manic episode, people may experience:

  • elevated mood
  • feelings of grandiosity
  • heightened sense of self-esteem
  • increased energy
  • irritability

They may also engage in risky behaviors such as:

  • engaging in activities they normally would not
  • impulsive decision-making
  • reckless spending

Mania can interfere with daily functioning and impair judgment. It can also lead to psychosis in some cases, where the person loses touch with reality.

Read more about the symptoms of mania.

Hypomania is a less severe form of mania. It shares some characteristics with mania, such as:

  • decreased need for sleep
  • heightened creativity
  • increased energy

However, hypomania typically does not result in the severe impairment and psychotic symptoms that mania can cause.

People in a hypomanic state may feel more productive and outgoing, but they can still function reasonably well in their daily lives.

Hypomanic episodes often have an association with a more positive mood and can be enjoyable for the person experiencing them. However, they sometimes progress to full-blown manic episodes or lead to problematic behaviors.

Depression is the other aspect of BP. During depressive episodes, people may experience:

  • a lack of interest or pleasure in activities they once enjoyed
  • changes in appetite
  • hopelessness
  • persistent feelings of sadness
  • sleep pattern disturbances
  • thoughts of death or suicide
  • trouble concentrating

Depression can be debilitating and may last for weeks or even months.

A mixed episode is a distinct period during which a person experiences symptoms of both mania or hypomania and depression simultaneously.

During these episodes, the person experiences a complex and often intense emotional state, and they can be particularly challenging to manage.

Rapid cycling is having four or more mood episodes (either manic, hypomanic, depressive, or mixed) in a year. These episodes can occur in any combination and may involve abrupt shifts between different mood states.

Different things can trigger mood episodes, but some common triggers include:

  • Stress: Stress is a significant trigger for mood episodes in many individuals with BP. High stress levels that relate to work, relationships, financial issues, or other life events can contribute to depressive or manic/hypomanic episodes.
  • Sleep disruptions: Changes in sleep patterns, including sleep deprivation or irregular sleep schedules, can trigger manic or hypomanic episodes. Conversely, oversleeping or disrupted sleep can have an association with depressive episodes.
  • Substance use: Alcohol or recreational drugs can trigger mood episodes. Substance misuse may exacerbate symptoms and make it more challenging to manage BP effectively.
  • Medication nonadherence: Skipping or discontinuing prescribed medications can destabilize mood and increase the risk of mood episodes. People with BP should take their medications as their doctor prescribes and communicate with their healthcare team about any concerns or side effects.
  • Major life events: Significant life changes or events, such as the loss of a loved one, divorce, job loss, or a major transition, can trigger mood episodes, especially depressive episodes.
  • Seasonal changes: Some people with BP experience seasonal patterns in their mood episodes, known as seasonal affective disorder (SAD). They may be more prone to depressive episodes during the fall and winter and experience more elevated moods in the spring and summer.
  • Medical conditions: Physical illnesses or medical conditions can sometimes trigger mood episodes. For example, thyroid problems or other hormonal imbalances can affect mood stability.

In the early stages of BP, individuals may experience subtle changes in their mood, energy levels, and behavior. These changes can be relatively mild and intermittent, making them easy to overlook or dismiss as normal fluctuations in mood. Mood swings may not be constant, and people can return to a relatively stable mood between episodes.

A family history of BP or mood disorders can be an important clue to recognizing the early stages. Identifying patterns of mood swings and seeking professional help for a thorough evaluation are crucial steps in diagnosis and early intervention.

While BP usually emerges in young adulthood, it can also manifest during adolescence and childhood.

Read about the outlook for BP.

BP is a lifelong condition, but with proper treatment and support, many people can manage their symptoms and lead fulfilling lives.

Early diagnosis and intervention are crucial for improving outcomes and preventing severe mood episodes.