Signs and symptoms of bipolar disorder: What to do next

Identifying the symptoms of bipolar disorder can be challenging, as its fluctuating moods and behaviors often go unnoticed or misinterpreted. But recognizing the key signs can be crucial for getting the right support and treatment.

A person with bipolar disorder will have both major depressive episodes—periods of intense low mood—and manic or hypomanic episodes. Mania is an abnormally elevated mood, energy, or activity level. Hypomania is a milder form of mania. Let's look at the symptoms of each episode type, so that you potentially can identify them in yourself or a loved one with bipolar disorder.

Major depressive episode

The depressive part of bipolar disorder is a period of at least two weeks in which you have at least five of the following symptoms (including at least one of the first two symptoms):

• intense sadness or despair
• a loss of interest in activities you once enjoyed
• feelings of worthlessness or guilt
• increased or decreased appetite
• increased or decreased sleep
• slowed speech
• thoughts of death or suicide
• tiredness
• trouble concentrating

Mania

A manic episode is a period of abnormally high energy or mood, or irritability, that lasts for at least one week, disrupts your daily life, and is obvious to your friends and family. You will know that you are in a manic episode if you experience at least three of the following symptoms in addition to abnormally high mood and energy:

• distractibility
• less need for sleep
• more activity than usual (for example, doing several things at once)
• racing thoughts
• risky behaviors (spending money recklessly, gambling, having unprotected sex)
• very rapid speech
• grandiosity, a feeling of being superior to others.

Hypomania

This is a milder form of mania that lasts for a shorter period of time (four days or more) and has less of an impact on your day-to-day functioning.

Psychosis

Some episodes of mania or depression can become so severe that the person experiencing the mood disturbance loses contact with reality.

Signs of psychosis include delusions (a false belief or judgment that is held despite incontrovertible evidence to the contrary) and hallucinations (hearing voices, seeing visions, or experiencing something that is not real).

Bipolar disorder can manifest in different combinations of symptoms. A loved one with bipolar disorder might not recognize the signs to ask for help. If you have noticed changes in a loved one's behavior or your own behavior that have a real and noticeable effect on the daily life and relationships, it may be time to seek help. Talk to a psychiatrist or visit a reputable website like the American Psychiatric Association (www.psychiatry.org) or the National Alliance on Mental Illness (NAMI, www.nami.org).

For more information on how to cope with bipolar disorder in your daily life, check out Bipolar Disorder: Recognizing the signs, getting help, an Online Guide from Harvard Medical School.

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