Everyone has days when they feel great and days when life gets them down. These swings are a normal part of life. But the swings of bipolar disorder (BPD) are different. In this mental health condition, a person cycles between very high “highs” and very low “lows.” The high and low moods of BPD are notably different from regular mood changes.1
BPD was once known as manic depression. Doctors used this term to describe the 2 extreme mood levels that people with the condition tend to cycle between. The name was changed to bipolar disorder to better show the ways people with the condition experience their moods.1
What symptoms look like
There are 3 main symptoms of BPD: mania, depression, and hypomania. People cycle between the highs of mania and the lows of depression depending on the type of BPD they have and the stresses in their life. Some people experience hypomania, which is a milder form of mania.2
The symptoms of mania, depression, and hypomania look different in different people.3
Mania
The extremely high mood of BPD is called mania. Mania often feels good and positive to the person experiencing it – at first. But it can become frightening, confusing, and frustrating as it strengthens. Signs of mania include:3
- More energy and more activity than usual
- Extreme talkativeness or inability to stop talking
- Unrealistic self-esteem, such as believing they can do something they’ve never done
- Living on little to no sleep
- Starting new, unrealistic projects such as opening a business or writing a book
- Spending money recklessly
- Getting distracted by minor things easily
- Risky behavior, such as having unprotected sex, gambling, or bingeing on drugs or alcohol
- Irritability or edginess
- Having hallucinations, delusions, or paranoia, such as believing they are a government spy or are connected to a famous person
A period of bipolar mania lasts at least 7 days for most of each day, or any amount of time if hospitalization is required. Nine out of 10 people who have one manic episode go on to have more. Six out of every 10 manic episodes lead to an episode of depression.3
Depression
Major depression is more than a case of the blues. It is a serious medical condition that affects a person’s ability to socialize, work, or go to school. Symptoms of bipolar depression include:3
- Low mood and loss of interest or pleasure in once-enjoyable activities
- Feeling sad, hopeless, empty, or tearful most of the day, nearly every day
- Significant weight loss or weight gain, or loss or increase in appetite
- Sleeping either too much (hypersomnia) or not enough (insomnia)
- Other people noticing that you seem either restless or “slowed down”
- Extreme tiredness (fatigue)
- Feelings of worthlessness or inappropriate guilt
- Problems concentrating or making decisions
- Recurring thoughts of death and dying
To be diagnosed with bipolar depression, 5 or more of these symptoms must last at least 2 weeks, all day every day or nearly every day.3
Hypomania
Hypomania is similar to full mania, but it never includes delusions or hallucinations (psychosis). A person with hypomania is more energetic, needs less sleep, and is more talkative than usual. They may be easily distracted and get involved in risky or unwise activities.3
The key difference between hypomania and mania is the degree to which the person’s life is affected and how long it lasts. Hypomania symptoms may not be severe enough to disturb social interactions, work, or school. They do not require hospitalization.3
Symptoms by type
There are 3 main types of BPD. Each type comes with symptoms of mania, depression, or hypomania. But these symptoms appear in different combinations and, sometimes, intensity.2
Bipolar 1
People with bipolar 1 disorder have mania with periods of hypomania or depression. These periods may come before or after the mania. Studies show that about half of people with bipolar 1 have more of one mood than another:1,3
- 1 in 3 have mostly mania
- 1 in 5 have mostly depression
- About half have a mix of mania and depression
Bipolar 2
People with bipolar 2 disorder have major depression followed by hypomania. Depression is by far their most consistent symptom. Their depressed cycles last longer than any hypomania or symptom-free periods. They have no episodes of mania.1,3
People with bipolar 2 tend to experience symptoms more often over their lifetimes than people with bipolar 1 do.3
Cyclothymic disorder
People with cyclothymic disorder move between episodes of hypomania and mild depression. They do not have major depression or mania.1
Mixed features
Some people with certain types of BPD cycle quickly between mania and depression. About 1 in 3 people with bipolar type 1 have a mix of mania and depression at the same time. This is known as having “mixed features.” Having mixed features is linked to poor response to treatment and increased suicide attempts.3
Rapid cycling
People with bipolar 1 who swing between mania and depression 4 or more times per year have what is called “rapid cycling.” People with bipolar 2 swing quickly between depression and hypomania.3
Bipolar symptoms and episodes vary greatly from person to person. Some people have few major manic or depressive episodes during their lifetime, while others cycle often. But treatment can help people manage their symptoms and live full lives.3
