Bipolar disorder

The pattern of symptoms helps doctors to decide whether someone has bipolar disorder or not. Symptoms also provide the basis on which treatments are selected.

To have bipolar disorder, both depressive symptoms and symptoms of mania or hypomania must have been present. Although some people may have mixed symptoms, usually one or the other is present at any one time. However, the most common symptom experienced by people with bipolar disorder is low mood, with shorter and less frequent episodes of mania or hypomania.

Episodes of mania and depression usually happen in cycles, and there's often a symptom-free period between episodes. However, up to one-third of people may have residual symptoms between episodes, while others have symptoms that don't go away despite treatment.

Occasionally, some people with bipolar disorder can experience a psychotic episode during an episode of depression or mania. Symptoms of psychosis include hallucinations and delusions.

Taking a careful note of symptoms over a period of time and monitoring how they change is a good way of managing them.

The depressive symptoms of bipolar disorder are similar to those of clinical depression and include:

• Feeling sad and hopeless.
• Lack of energy.
• Finding it difficult to concentrate and remember things.
• Loss of interest and enjoyment in everyday activities.
• Feelings of emptiness or worthlessness.
• Feelings of guilt and despair.
• Feeling pessimistic about everything.
• Self-doubt.
• Difficulty sleeping and waking up early.
• Suicidal thoughts.

The symptoms of mania include:

• Feeling extremely happy, elated or euphoric.
• Talking quickly.
• Feeling full of energy.
• Feeling self-important.
• Feeling full of great new ideas and having important plans.
• Being easily distracted.
• Being easily irritated or agitated.
• Not sleeping.
• Not eating.
• Doing pleasurable things with disastrous consequences, such as spending money you can't afford, or starting unwise sexual relationships.

Psychosis
Some people with bipolar disorder may have hallucinations. They may see, smell or hear things that aren't there. This may include hearing voices telling them what to do, or firmly believing things that other people find irrational (delusions). These are called psychotic episodes or psychoses.

Self-harm
Self-harm, as a distraction from mental pain and distress, is common in people with bipolar disorder.

There are two types of bipolar disorder, and they have slightly different symptoms.

Bipolar I disorder
Bipolar I disorder has the extreme high or mania that's usually (but not always) followed by a depression. There are also mixed types of bipolar I disorder in which both types of symptoms occur. So someone may feel depressed but simultaneously has the racing thoughts that are typical of a manic episode.

Bipolar II disorder
In bipolar II disorder, a milder ‘high’ known as hypomania occurs. People with bipolar disorder II who have hypomania may be able to function well, and may appear to simply have increased energy and be in a very good mood. However, there's more likely to be a severe depression after the hypomania.

Rapid-cycling bipolar disorder
If the episodes of depression and mania or hypomania occur quickly (over less than a month, although some people with bipolar disorder switch moods weekly or even daily), that's a sign of the rapid-cycling form of bipolar disorder. If an individual has more than four or more episodes of major depression, mania, mixed episodes or hypomania in a 12-month period, they have rapid-cycling bipolar disorder.