Bipolar disorder
Explains what bipolar disorder is, as well as different diagnoses and treatments. Offers information on how you can support someone with bipolar and tips for self-management.
Bipolar moods and symptoms
We all have changes in our mood, but in bipolar disorder these changes can feel very distressing and have a big impact on your life.
You may feel that your high and low moods are extreme, and that swings in your mood are overwhelming. And you may feel and behave very differently, depending on your mood. This can be difficult and confusing.
These swings in mood are sometimes called mood episodes or mood states. Not everyone experiences mood episodes in the same way or for the same amount of time.
This page covers:
Manic and hypomanic episodes
Manic and hypomanic episodes – or mania and hypomania – both mean feeling high.
Manic and hypomanic episodes have similarities in how they may make you feel or act. But there are some key differences:
- Severity of symptoms. Severe mania is very serious and often requires hospital treatment. Hypomania can noticeably change your mood or behaviour, but it's less severe than mania.
- Impact on your life. Manic episodes can impact your ability to do your daily activities – often disrupting or completely stopping them. Hypomanic episodes can disrupt your life, but you may still feel able to work or socialise.
- Length of episode. For a mood episode to be classed as mania, it needs to last for a week or more. For hypomania, it needs to last for 4 days or more. But both manic and hypomanic episodes can last much longer than this.
- Types of symptoms. You may be more likely to experience severe symptoms with mania, such as more extreme risk-taking behaviours. Manic episodes can sometimes include psychotic symptoms, like hallucinations or delusions. Hypomanic episodes never include these.
Both mania and hypomania can be really tough to experience and manage. Whether you experience mania or hypomania, or if you're not sure what you're experiencing, it's always OK to seek support.
The hardest thing to explain is the racing thoughts when I'm manic. It's like I've got four brains and they're all on overdrive... it can be scary but also euphoric at the same time.
Feelings
During a manic or hypomanic episode, you might feel:
- Happy, joyful or a sense of wellbeing
- Very excited or uncontrollably excited
- Like you can't get your words out fast enough
- Irritable or agitated
- Increased sexual energy
- Easily distracted – like your thoughts are racing or you can't concentrate
- Confident or adventurous
- Like you’re untouchable or can't be harmed (more likely in mania)
- Like you can perform physical and mental tasks better than normal
- Like you need less sleep than usual
- Very focused or determined to complete certain tasks or projects
Behaviours
During a manic or hypomanic episode, you might:
- Be more active than usual
- Talk a lot, speak very quickly, or not make sense to other people
- Be very friendly to others
- Say or do things that are inappropriate and out of character
- Sleep very little or not at all
- Act rudely or aggressively
- Misuse drugs or alcohol
- Spend money excessively or in a way that is unusual for you
- Lose social inhibitions
- Take risks with your safety
On 'up' days I chatter nineteen to the dozen with anyone, to the point it annoys people, and I can't stay still.
What will I feel like afterwards?
After a manic or hypomanic episode you might:
- Feel very unhappy or ashamed about how you behaved
- Have made commitments or taken on responsibilities that now feel unmanageable
- Have only a few clear memories of what happened during your episode, or none at all
- Feel very tired and need a lot of sleep and rest
For more information, see our pages on hypomania and mania.
Depressive episodes
Depressive episodes are periods of feeling low. They last at least two weeks but can last much longer, sometimes for months. Like manic or hypomanic episodes, they can severely disrupt your everyday life. Severe depression may require medication or a stay in hospital.
Some people find that depressive episodes can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper.
Feelings
During a depressive episode, you might feel:
- Down, upset or tearful
- Tired or sluggish
- Uninterested in things you usually enjoy
- Low self-esteem and a lack of confidence
- Guilty, worthless or hopeless
- Agitated and tense
- Like you can't concentrate on anything
- Suicidal
Behaviours
During a depressive episode, you might:
- Not do things you normally enjoy
- Have trouble sleeping, or sleep too much
- Eat too little or too much
- Misuse drugs or alcohol
- Act withdrawn or avoid social situations
- Spend a lot of time thinking about upsetting or difficult things (also called rumination)
- Avoid contacting or responding to people
- Be less physically active than usual
- Try to self-harm or attempt suicide
For more information, see our pages on depression.
The lows can be flat and devoid of colour, or intense and torturous. Sometimes it's full of demons, and pain inside so bad that nothing physical could hurt you.
Mixed episodes
A mixed episode, sometimes called a mixed state, is when you feel both high and low.
You may experience symptoms of depression, plus mania or hypomania at the same time. For example, you may feel very energised and impulsive, while feeling upset or tearful. Or you may feel very agitated or irritable.
You may also experience highs and lows very quickly after the other, within the same day or hour.
A mixed episode can be particularly difficult to cope with, as:
- It can be harder to work out what you're feeling
- It can be harder to identify what help you need
- You might find managing your emotions harder and more exhausting
- Your friends, family or doctor might struggle to know how to best support you
- You may be more likely to act on suicidal thoughts and feelings
The mixed episodes are the worst. The most unpredictable and most dangerous ones, I find them difficult to explain.
Psychotic symptoms
Not everyone with a diagnosis of bipolar disorder experiences psychosis, but some people do. It's more common during manic episodes, but can also happen during depressive episodes.
These kinds of experiences can feel very real to you at the time, which may make it hard to understand other people's concerns about you.
Psychotic symptoms can include:
- Delusions, such as paranoia
- Hallucinations, such as hearing voices
For more information, see our pages on psychosis.
Then with mania comes the paranoia, the shadows, the voices, the thought someone is behind me following me everywhere I go, ready to get me.
Stable or neutral periods
It's common to have stable or neutral periods in between episodes. This doesn't mean that you have no emotions during this time. It means that you're not currently experiencing mania, hypomania or depression, or that you're managing your symptoms effectively.
You might find you feel stable for years in between episodes. Or your periods of stability might be much shorter.
Stable periods can feel like a relief. But they can also feel challenging in their own way. You may feel:
- Happy, calm or relieved
- Worried about becoming unwell again
- Embarrassed or guilty about things you did or said when you were unwell
- Like you have lots to sort out or catch up on
- Like you have to 'get back to normal life' straight away
- That you miss elements of your life or personality from when you were unwell
- Unsure about whether to continue with medication or other treatment
It's a lot harder coming to terms with being stable than I could have imagined. I've had to struggle with a 'new' identity and way of life after spending so many years thinking the ups and downs of bipolar are 'normal'.
How often do bipolar episodes occur?
Bipolar episodes happen at different times for different people. The frequency can depend on a lot of things, such as:
- Your exact bipolar disorder diagnosis.
- How well you're able to manage your symptoms.
- How you'd personally define an episode.
- Whether certain situations or experiences can trigger episodes. For example, you might find that sleeping very little or going through a stressful life event could trigger a manic episode.
The length of mood episodes can also vary. They can last for a few weeks or much longer. What's normal for you can also change over time.
This information was published in February 2022. We will revise it in 2025.
References and bibliography available on request.
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