Everyone has mood swings. But people with bipolar disorder (BPD) have such extreme mood swings that it impacts their ability to think clearly, work, go to school, or socialize with others.1
BPD is a common mental health condition. It was once known as manic depression or manic-depressive illness.2
There are 3 main types of BPD:1
- Bipolar 1 disorder (BD-I), in which a person swings between very high moods (mania) and very low moods (major depression)
- Bipolar 2 disorder (BD-II), in which a person has both mild highs (hypomania) and major depression
- Cyclothymic disorder, in which the person cycles between hypomania and mild depression
There also are types of BPD that do not fit any of the categories above. Doctors call these other specified or unspecified bipolar and related disorders. These conditions may be caused by prescription or illegal drugs, alcohol misuse, or a medical condition.1
Bipolar 1 disorder
To be diagnosed with bipolar type 1, a person must have had at least 1 manic episode that lasted at least 7 days. A period of hypomania or major depression may come before or follow the manic episode.3
During a manic episode, a person may have an unusually and consistently high mood. Or they be irritable most of the day. They also have unusually high energy compared to their typical energy levels. Most people with bipolar 1 also experience bouts of major depression in addition to mania. “Rapid cycling” is the term for having 4 or more episodes of mania or depression per year.1,3
Mania may look different depending on the person, but some examples include:3
- An inflated sense of self or grandiosity
- Feeling rested after very short bouts of sleep
- Loud, rapid talking, or inability to stop talking
- Hostile or angry tirades, especially if interrupted
- Speech that is disorganized or difficult to understand
- Racing thoughts
- Being easily distracted by unimportant things
- Starting multiple, unrealistic projects, often with no expertise in those areas
- Going for several days with little to no sleep
- Restlessness or pacing
- Increased sex drive, sociability, or religious activities
- Poor judgment that leads to reckless activities such as gambling, giving away possessions, unsafe sexual encounters, or unwise investments
People in a manic state often think they are fine and do not need treatment. They may cycle quickly between depression and anger. They may demonstrate strange behaviors including delusions or believing things that are not true, suicidal thoughts or actions, poor judgment, and other behaviors that are outside of their day to day. A hospital stay may be needed to treat the physical effects of their mania or to prevent self-harm.3
Bipolar 2 disorder
Bipolar 2 disorder was once thought to be a less serious form of bipolar 1. But doctors now believe it is an equally serious condition because it increases a person’s risk of attempting and completing suicide.3
To be diagnosed with bipolar 2 disorder, a person must have had at least 1 episode of major depression and at least 1 episode of hypomania (but not mania).3
Hypomania is a less severe form of mania. Here, a person may feel very good and be more active than usual. But they are not able to maintain their regular daily life. They may feel that nothing is wrong, but their loved ones may notice a difference.2
Cyclothymic disorder
Cyclothymic disorder is also known as cyclothymia. To be diagnosed with cyclothymic disorder, a person must cycle between hypomania and depression without ever having mania or major depression. The difference is how severe the symptoms are and how long they last. The cycles must last for at least 2 years in adults and 1 year in children.3
Other types of bipolar disorder
Some people have symptoms that do not fit the categories of bipolar 1, bipolar 2, or cyclothymia. These people may be diagnosed with other specified or unspecified bipolar or related disorders.3
Some prescribed drugs and medical conditions can cause symptoms that look like mania. In this case, a person may be diagnosed with substance-induced bipolar and related disorder. Misuse of alcohol or drugs is another possible cause of mania-like symptoms. In this case, the diagnosis may be bipolar and related disorder due to another medical condition.3
Often, people with bipolar 1 also have other mental health conditions. Some common examples are:3
- Anxiety
- Alcohol or other substance use disorder
- ADHD (attention-deficit/hyperactivity disorder)
It is very common for people with BP to have mental or physical conditions that can cause mania and depression or make it worse. For that reason, an accurate diagnosis is key to getting the right treatment.1