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Symptoms of Bipolar Disorder


Bipolar disorder can cause mood swings from "highs" and/or irritable to sad and hopeless, and back again, often with periods of normal moods in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Some of the signs and symptoms of mania or a manic episode:

  • Restlessness and increased activity and energy
  • Euphoric outlook or mood
  • Extreme irritability easily agitated
  • Talking fast and thoughts that seems to race
  • Difficulty in concentrating and easily distracted
  • Little sleep needed
  • Thoughts about one's abilities that may seem unrealistic
  • Poor judgment
  • Periods of spending a lot of money
  • A lasting period of behavior that is different from usual
  • Some people experience an increased sexual drive
  • Drug abuse such as cocaine, alcohol, or sleeping medications
  • Aggressive behaviors or intrusive behavior
  • Denial that something may be wrong with them

A manic episode is diagnosed when the elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for one week or more. If the mood is irritable, generally four additional symptoms must be present.

Signs and symptoms of depression or a depressive episode:

  • 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,
  • Decreased energy and/or feelings of fatigue
  • Difficulty concentrating, remembering and making decisions
  • Restlessness or irritability
  • Unable to sleep or sleeping too much
  • 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

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one has has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined or has committed some terrible crime, may appear during depression.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may feel full of energy and excitement while also experiencing a mood of sadness or hopelessness.

Diagnosis of Bipolar Disorder Bipolar disorder cannot yet be identified physiologically, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of family history, symptoms and the course of illness.

Some people with bipolar disorder may feel suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide seems 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 (e.g., 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

If you are feeling suicidal or know someone who is:
  • call a doctor, emergency room, or 911 right away to get immediate help
  • make sure you, or the suicidal person, are not left alone
  • make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.



Brain and Mental Health


References and Sources: Medline, Pubmed, National Institutes of Health


last update: February 2009


This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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