Bipolar Disorder Symptoms: Mania, Hypomania, Depression and When to Seek Help

01Basics

What are bipolar mood episodes?

NIMH describes bipolar disorder as a mental illness, once called manic depression, in which the range of mood changes can be extreme. People can have manic episodes, depressive episodes or mixed episodes, which have manic and depressive symptoms at the same time. Some people have hypomanic episodes, which are like manic episodes but less severe.

These episodes last a week or two, or sometimes longer, according to NIMH. During an episode the symptoms are present every day for most of the day, and the intense feelings come with changes in behavior, energy or activity that are noticeable to others. Between episodes, mood usually returns to a healthy baseline, although without adequate treatment episodes often become more frequent over time. Mayo Clinic adds that episodes may occur rarely or several times a year, and that some people have long periods of emotional stability between them.

Symptoms most often start in late adolescence or early adulthood, and occasionally in children. Mayo Clinic notes it can start at any age but is usually diagnosed in the teenage years or early 20s.

02Mania

Signs of a manic episode

In a manic episode a person may feel very up, high, elated, or extremely irritable or touchy, with a marked increase in activity compared with their usual self. Symptoms listed by NIMH and Mayo Clinic include:

• feeling jumpy or wired, or being much more active, energetic or agitated than usual
• needing much less sleep than usual
• racing thoughts, or jumping quickly from one topic to another
• talking fast about many different things
• being easily distracted
• feeling unusually important, talented or powerful, or overly self-confident
• an excessive appetite for food, drinking, sex or other pleasurable activities
• poor decisions, such as buying sprees, sexual risks or foolish investments

Mania is more severe than hypomania. It causes more noticeable problems at work, school and in relationships, it may cause a break from reality (psychosis), and it may need hospital treatment.

03Hypomania

Hypomania: the milder high that is easy to miss

Mayo Clinic explains that mania and hypomania share the same symptoms, and that an episode involves three or more of them. Hypomania is less extreme and does not interfere as much with daily life.

That is why it is easy to overlook. NIMH notes that hypomanic episodes may make a person feel very good and productive, so they may not feel anything is wrong, while family and friends notice the mood swings and changes in activity as unusual behavior. People with bipolar II disorder may seek help only for their depressive episodes, so hypomanic episodes go unnoticed and the diagnosis can be delayed for years.

04Depression

Signs of a depressive episode

A major depressive episode is severe enough to make day-to-day activities, work, school or relationships difficult. Mayo Clinic says it includes five or more of these symptoms, and NIMH lists similar ones:

• depressed mood: feeling sad, empty, hopeless, anxious or tearful (children and teens may seem irritable, angry or hostile)
• marked loss of interest or pleasure in almost all activities
• weight loss without dieting, or overeating and weight gain
• sleeping too little, waking too early or sleeping too much
• feeling restless or slowed down, talking very slowly
• tiredness or loss of energy, being unable to do even simple things
• feeling worthless or excessively guilty
• trouble thinking, concentrating, remembering or making decisions
• thinking about death, or planning or attempting suicide

05Other features

Mixed episodes, rapid cycling and symptoms in young people

Mood episodes can include other features, according to Mayo Clinic: anxious distress (anxiety and fear of losing control), melancholy (very deep sadness and loss of pleasure) and psychosis. NIMH explains that psychotic symptoms such as hallucinations or delusions tend to match the extreme mood, for example believing one is ruined during depression or famous during mania.

Two patterns are described by timing. A mixed episode means symptoms of depression and mania or hypomania at the same time. Rapid cycling means four or more mood episodes within a year. Mayo Clinic adds that symptoms can change with the seasons or appear during pregnancy.

In children and teens, symptoms can be hard to identify, because it is often difficult to tell them apart from usual ups and downs, stress, trauma or another mental health problem. The most noticeable sign may be severe mood swings that are unlike their usual mood swings.

06Types

Types of bipolar disorder

• Bipolar I disorder: at least one manic episode. NIMH defines it by manic episodes lasting at least 7 days, or mania so severe that hospital care is needed; depressive episodes, typically lasting at least 2 weeks, usually occur as well.
• Bipolar II disorder: at least one major depressive episode and at least one hypomanic episode, but never a full manic episode. Many people spend long periods in a persistent, low-grade depressive state.
• Cyclothymia: for at least two years (one year in children and teens), repeated periods of hypomanic and depressive symptoms that are not intense or long enough to count as episodes.
• Other types: bipolar and related disorders caused by drugs or alcohol, or by a medical condition such as Cushing’s disease, multiple sclerosis or stroke, and symptoms that do not match the main types.

Mayo Clinic stresses that bipolar II is not a milder form of bipolar I but a separate diagnosis: the mania of bipolar I can be severe and dangerous, while people with bipolar II can be depressed for longer periods. The difference with borderline personality disorder is covered in our guide bipolar vs BPD.

07Diagnosis

How it is diagnosed and what can look similar

A health care provider may do a physical exam and tests to rule out other illnesses and refer the person for a mental health evaluation. NIMH says the diagnosis is based on the severity, length and frequency of symptoms over a lifetime, plus family history. An online checklist cannot replace this.

Other problems can look similar. Thyroid disease can cause symptoms like those of bipolar disorder, and some prescribed, recreational or illicit drugs can mimic or worsen mood symptoms. People with psychotic symptoms can be misdiagnosed with schizophrenia. Anxiety disorders, ADHD, eating disorders, PTSD, alcohol or drug misuse and borderline personality traits can overlap or occur at the same time. NIMH also warns that if bipolar disorder is missed and depression is treated with an antidepressant alone, a manic episode or rapid cycling may be triggered.

Because the course over days and weeks matters more than a single moment, NIMH recommends keeping a life chart or mood journal. Writing down dates, sleep, energy, activity, spending or risky behavior, and how work and relationships are going gives the professional a clearer picture than memory alone.

09Sources

Where the sources differ

Does a crash always follow a high? Mayo Clinic writes that an emotional crash always follows the euphoria. NIMH is more cautious: depressive episodes may follow hypomanic episodes, and between episodes mood usually returns to baseline. The course varies from person to person.

How long episodes last. NIMH says mood episodes last a week or two, or sometimes longer; Mayo Clinic says each bout usually lasts several days. NIMH’s 7-day threshold for mania in bipolar I also has an exception when hospital care is needed. None of these time frames is a reason to wait before seeking help.

Rapid cycling. NIMH speaks of four or more episodes within a year; Mayo Clinic of four mood episodes in the past year. The idea is the same, with slightly different wording.

10Summary

In summary

Bipolar disorder causes episodes of mania or hypomania and episodes of depression, sometimes mixed, that last days to weeks and are noticeable to others. Less need for sleep, racing thoughts, fast talking and risky decisions point to a high; sadness, loss of interest, exhaustion and hopelessness to a low.

There are several types, and bipolar II is not simply a milder bipolar I. Diagnosis needs a professional assessment of the course over time, and other conditions can look similar. Treatment with medicines and psychotherapy helps many people, and suicidal thoughts always need urgent help.