Bipolar disorder symptoms: mania, depression, types and treatment

What is bipolar disorder?

Bipolar disorder (also called bipolar affective disorder, and once known as manic depression) is a mental illness that causes marked shifts in mood, energy and activity levels. As the US National Institute of Mental Health (NIMH) explains, a person goes through episodes of elation and extreme activity or intense irritability, called mania or hypomania, and other episodes of sadness and hopelessness, called depression, with periods in between when mood often returns to normal.

The World Health Organization (WHO) estimates that about 36 million people worldwide were living with bipolar disorder in 2023, and stresses that recovery is possible with the right care. NIMH notes that symptoms most often begin in late adolescence or early adulthood.

Signs of a manic episode: what does it look like day to day?

A manic episode is not "being very happy". It is a sustained period in which the person changes in a way others notice, most of the day, nearly every day. These are its most common forms, as described by the UK's National Health Service (NHS) and NIMH:

• Little sleep without tiredness: sleeping a few hours and waking full of energy
• A very high mood or intense irritability: exaggerated happiness and excitement, or anger and outbursts over the smallest thing
• Fast, pressured speech that is hard to interrupt, and racing thoughts that jump from one topic to another
• Inflated self-confidence: seeing oneself as more capable than everyone and starting many big projects at once
• Impulsiveness and risk-taking: sudden large spending, reckless decisions, or inappropriate behavior that is unusual for them
• Severe distractibility and difficulty finishing anything
• In severe episodes: ideas detached from reality, suspicion and mistrust of people, or hearing or seeing things that are not there

Hypomania: the quieter form that is easy to miss

Hypomania is a less severe form of mania with much the same symptoms. NIMH explains that during it a person may feel at their best and most productive and see no problem at all, while family and friends notice the changes in mood and activity. That is why the family's observations are often the first thread that leads to a diagnosis.

Bipolar 1 vs bipolar 2, and how both differ from ordinary mood swings

A doctor determines the type from the episodes, how severe they are and how long they last:

• Bipolar I disorder: a full manic episode lasting at least a week, or severe enough to need hospital care, often with depressive episodes lasting at least two weeks.
• Bipolar II disorder: depressive episodes and hypomanic episodes without a full manic episode. Its highs are milder than full mania, but Cleveland Clinic points out that it can still seriously affect daily life, mainly because its depressive episodes tend to come more often or stay longer.
• Cyclothymic disorder: repeated swings between hypomanic symptoms and depressive symptoms too mild to count as full episodes, lasting two years or more in adults, or one year or more in children and teenagers.

Symptoms of mania and depression can occur in the same period, in what is called an episode with mixed features: energy and impulsiveness together with sadness and hopelessness. Many people find these episodes very hard, so tell the doctor promptly if they appear.

A depressive episode looks like ordinary depression (see depression symptoms). Because many people with bipolar II seek help only during depression, hypomania may go unnoticed and the condition may be diagnosed as depression alone. So always tell the doctor if you or your relative have had periods of unusual activity and little sleep.

The difference from ordinary mood swings is that bipolar mood changes are far more intense, may come without an obvious reason, last days or weeks, and come with changes in sleep, energy and clear thinking that disrupt work, study and relationships.

Sleep loss, overspending and high energy: symptoms of illness, not character

When your son stays up for days without tiring, or the family's savings are spent in a few days, the first thought is often "carelessness" or "irresponsibility". But the NHS and WHO count a reduced need for sleep, excessive spending and risk-taking among the symptoms of a manic episode itself.

A person in a manic episode does not control their behavior as they normally would. Blame does not stop an episode; treatment helps bring it under control. Sleep plays a double role: lack of sleep is a sign of an episode, and, as the NHS notes, it is also one of the things that can trigger one, along with stress and being too busy. That is why regular sleep is part of treatment, not a side detail. NIMH also advises avoiding alcohol and drugs, because some substances can mimic or worsen mood symptoms.

Because money decisions made during mania can leave lasting effects, the UK's National Institute for Health and Care Excellence (NICE) advises that important decisions wait until a manic or hypomanic episode has passed, and recommends offering help, with the family involved, with financial problems caused by episodes. The legal arrangements available for protecting money differ from country to country.

Early warning signs the family can learn

An episode is often preceded by small signs that repeat the same way in the same person. Learn them with your relative during a stable period, because acting early may prevent a full episode. Signs that may come before mania include:

• Less sleep than usual for several nights, with restless activity
• Faster speech and jumping between ideas
• New irritability or getting worked up over small things
• Sudden big plans, or unusual purchases and debts
• Skipping medication or saying they "don't need it any more"
• More late nights, more stimulants, or using any substance
• And before depression: withdrawing from people, sleeping a lot, and losing interest in things they used to enjoy

NIMH recommends keeping a mood journal or life chart to help recognize mood swings early, along with a regular routine for sleeping, eating and exercise. The UK guidelines recommend agreeing a written plan with the person, who is encouraged to share it with their family, that covers early warning signs and triggers, the person's own coping strategies, and who to contact when you are worried or in a crisis.

Bipolar disorder in teenagers

Symptoms often begin in adolescence, which makes them hard to tell apart from the ups and downs of that age. NIMH explains that bipolar mood changes in teenagers are more intense, often come without a reason, and come with changes in sleep, energy and clear thinking. Signs include long periods of exaggerated silliness or intense irritability, fast speech, little sleep without tiredness, and dangerous risk-taking, alternating with periods of sadness, withdrawal and sleeping a lot.

No blood test or scan diagnoses the illness; diagnosis needs a specialist assessment because symptoms overlap with ADHD, depression and anxiety. A teenager with bipolar disorder may also be more likely to misuse alcohol or drugs. NIMH also notes that some teenagers with bipolar disorder may try to hurt themselves or attempt suicide: take any sign of suicidal thinking seriously and get help straight away, using the warning signs and emergency numbers in the next section. At Oxygen Center, teenagers aged 15 and over can be seen at an appointment with a psychiatrist, with a parent or guardian's consent for anyone under 18.

When does an episode need a doctor or a hospital stay?

Book a psychiatric appointment if you notice in yourself or a relative repeated periods of mania, hypomania or depression that affect work, study, relationships or money, even if the person believes they are "fine".

An episode needs urgent intervention, and the doctor may decide on inpatient treatment, in situations such as:

• Thoughts or talk of death or self-harm
• A risk to the person's safety or the safety of others, or severe aggression
• Severe mania that cannot be managed at home
• Losing touch with reality: delusions, hallucinations or intense suspicion of people
• Refusing to eat, drink or take medication, or being unable to look after themselves

The NHS explains that a person may need to stay in hospital if doctors fear they may harm themselves or others. Admission here is not a punishment but a safe place where the episode can settle and treatment can be adjusted under continuous monitoring. Read more about when psychiatric hospital admission is needed, and voluntary versus involuntary care.

Act straight away if you notice warning signs of suicide, especially if they are new or getting worse. NIMH lists signs such as:

• Talking about wanting to die, about being a burden on others, or about deep guilt or shame
• Feeling hopeless, trapped or empty, saying there is no reason to live, or describing unbearable pain
• Making a plan or searching for ways to die
• Withdrawing from people, saying goodbye, or giving away valued belongings
• Taking dangerous risks, sudden sharp mood changes, or drinking or using drugs more

Bipolar disorder treatment: why does it continue between episodes?

NIMH explains that bipolar disorder does not fade away by itself and usually needs treatment for life. That does not mean life stops: regular treatment helps stabilize mood and reduce episodes. The doctor decides the right plan for each person, which may include:

• Mood stabilizers such as lithium and valproate. The UK guidelines consider lithium the first choice for long-term treatment, and it needs regular blood tests set by the doctor.
• Other medicines, such as some antipsychotics, chosen by the doctor according to the episode. Antidepressants are not usually given alone, because they can trigger a manic episode.
• Psychotherapy, such as cognitive behavioral therapy, family-focused therapy, and therapy that regulates daily rhythms, sleep and relationships.
• Involving the family early in understanding the illness and the treatment plan, as the UK guidelines recommend.
• Brain stimulation treatments, such as electroconvulsive therapy (ECT) for severe or treatment-resistant cases, decided by the doctor after careful assessment.

Why doesn't medication stop once things improve? Because the improvement itself is often the result of treatment, and the UK guidelines warn of the risk of relapse after reducing or stopping medication. So never start, stop or change what your doctor prescribed on your own, even if you feel better.

At Oxygen Center we start with an appointment with a psychiatrist to assess the condition and build a treatment plan, together with psychotherapy sessions and regular follow-up. When a severe episode needs it, inpatient psychiatric treatment is available at the center for males aged 15 and over; women are welcome for outpatient appointments and therapy sessions. Alcohol or drug use is common alongside bipolar disorder, so if it is part of the picture, tell the doctor so that the treatment plan covers both.

How can families support someone without arguing with the illness?

Sometimes the episode speaks in the voice of someone you love. These practical principles help:

• Don't argue with the episode: during mania you will not convince your relative that their huge plan is unrealistic, so calmly focus on what matters now: sleep, safety and getting to the doctor.
• Separate the person from the episode: hurtful words or reckless spending are symptoms, so don't take them personally or hold them harshly against the person once the episode is over.
• Agree during stable times on the warning signs, who calls the doctor, and how money will be protected in the next episode.
• Support treatment instead of policing: encourage appointments, medication and regular sleep without threats.
• Offer patience and hope: NIMH recommends emotional support, understanding and encouragement, and reminding the person that things can get better.
• Look after yourself: caring for someone with bipolar disorder is exhausting, and you have every right to ask for support for yourself too.

At Oxygen Center, the treating doctor and psychologist can also help the family understand the illness and agree on a clear plan for handling episodes. If you have a question about your relative, contact us at any time, day or night.