Bipolar Disorder Symptoms and Signs
Bipolar disorder is a mood condition defined by episodes of mania or hypomania, usually alongside episodes of depression, in which energy, sleep need, judgement and speed of thought all move together.
Also called: Manic depression, Bipolar affective disorder, Bipolar I disorder, Bipolar II disorder.
ICD-10 F31 · ICD-11 6A60
Not mood swings. Episodes.
Everyone has good days and bad days. Bipolar disorder is not a faster version of that. It is an illness of episodes. An episode of depression lasts weeks or months. Separate episodes of raised energy, called mania or hypomania, come at other times. In between there are long stretches of being well.
People picture the high. People live mostly with the low. Over the years, someone with bipolar I spends about three times as many weeks depressed as high.
It is a long-term condition, and it is very treatable. Most people who find the right plan spend much more of their life well.
FROM INSIDE
What it is actually like
In mania, sleep stops feeling necessary. Thoughts run faster than you can speak them. Ideas feel brilliant and urgent. Spending money and taking risks feel sensible. Other people seem slow. It can feel wonderful. It can also feel wired and angry.
In depression, the same person can barely get out of bed. Energy, interest and hope drain away. This often lasts longer than the high did.
Between episodes, many people are simply themselves. That is part of what makes it hard. When you feel well, it is easy to believe it will not happen again.
An air conditioner with a broken control
Most of the time it keeps the room comfortable. Every so often it blows cold at full power for weeks. Other times it switches off and lets the room get hot. The room is fine. The control is not.
WHAT IT DOES
Four shapes it takes
The name covers more than one pattern. Which pattern a person has changes the treatment.
Bipolar I
This means at least one full manic episode. It lasts a week or more, or it needs hospital care. Most of these people also have episodes of depression.
Bipolar II
This means episodes of hypomania, which is a milder high, plus at least one major depression. It is not a milder illness. The depression is often long and heavy.
Cyclothymia
This means two years or more of ups and downs that never reach a full episode. They still get in the way of daily life.
Mixed features
This means high energy and low mood at the same time. A person feels restless and racing, and hopeless with it. This is one of the most dangerous states.
2.4% — LIFETIME
40M — GLOBAL
32% — WEEKS LOW
9% — WEEKS HIGH
When it tends to begin
Peak age of onset: 20.
Median age of onset: 33.
It usually begins in the late teens or twenties. The first episode is often depression. So many people are told they have depression at first. The right diagnosis only comes later, after a high.
How it is actually diagnosed
There is no scan or blood test for this. The diagnosis rests on the history of episodes. A manic episode means a clearly raised or irritable mood, with more energy than usual, plus at least three of the following.
- Needing much less sleep, without feeling tired
- Talking more, or faster, than usual
- Racing thoughts, or jumping between ideas
- Inflated self-esteem, or feeling unusually important
- Being easily distracted
- A burst of activity, or restless movement
- Risky choices, like spending sprees or reckless plans
Mania lasts at least a week. It causes clear problems, or it needs hospital care. Hypomania is milder and lasts at least four days. Four or more episodes in one year is called rapid cycling. None of it should be caused by drugs, alcohol or another illness.
If it is worse than that right now
The risk of suicide in bipolar disorder is many times higher than average. It is highest during depression and during mixed states. Those thoughts can be treated, and they do pass.
If you are thinking about harming yourself, contact emergency services or a crisis line now.