Can Bipolar People's Eyes Give You A Clue As To When They're Experiencing Mania?

Medically reviewed by Paige Henry
Updated March 6, 2024by BetterHelp Editorial Team

You may have heard that you can tell a lot by looking into someone's eyes, but scientists believe that the eyes of people with bipolar disorder may reveal something more than just emotion. Read on to learn about the relationship between the human eye and bipolar disorder.

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There are many signs of bipolar disorder

The human eye and bipolar disorder

From a scientific standpoint, our eyes are organs that react to light and pressure and, like every other part of the body, they are connected to our brains to offer signals about our environment for our brain to process. That said, it makes perfect sense that our eyes and eye movement are connected in some way to our emotions. But can our eyes give us physical clues as to whether someone has bipolar disorder? Some scientists seem to think so. For example, there is thought to be a link between impairments in color vision processing—our ability to perceive and discern colors—and bipolar I disorder. 

Another study, published in Biological Psychiatry, involved scientists using electroretinography (ERG) to get an up-close look at the retina and how well it was working. The retina is located at the back of the eyeball and is part of the central nervous system. It contains cells that are sensitive to light, and it activates nerves to send signals through the optic nerve to the brain, which ultimately form an image for the brain.

The retina is made up of two types of photoreceptors that process light: rods and cones. The rods process black and white light so that we can see in low-light conditions. The rods also give us our peripheral vision. On the other hand, the cones process color. ERG is a tool that measures the rods and cones in the retina.

In the reference study, scientists concluded that the retina of the eye plays a role in whether a child is at a high risk of developing a psychiatric disorder where mania is a symptom, including bipolar disorder and schizophrenia. That being said, while a specialized eye exam may help doctors identify mania symptoms, there are other ways to detect if someone is experiencing a manic episode. Often, it takes several sources of information for doctors and therapists to get a clear enough picture to make an accurate diagnosis.

Doctors may look for physical signs of a condition by tracking vergence eye movements, or how the eye tracks an object coming towards an individual. In addition, there is a link between saccadic or anti-saccadic eye movements to bipolar disorder and schizophrenia. By identifying irregular saccadic eye movements, doctors may help to paint a complete picture in identifying mental illness.

Retinal function and the risk of developing bipolar disorder

Your annual eye examination may be an early indicator of bipolar disorder if it includes an assessment of the retina. Researchers have known for some time that people who live with bipolar disorder and schizophrenia have abnormalities in their eyes’ retinas. Until recently, those findings were of little use because of the symptoms of the illnesses and the medications being used to treat them.

To gain a clearer picture of the role of the retina in mental and behavioral health, researchers enlisted the help of healthy young adults over the age of 20 who were at risk of developing bipolar disorder or schizophrenia. Specifically, they chose young adults with a family history mental illness having at least one parent living with bipolar disorder or schizophrenia. They then examined these young people’s retinas and compared the results with a control group of individuals whose families didn't have a history of the illnesses.

The results proved that the group that had the genetic risk for bipolar disorder and schizophrenia had a reduced ability to activate the rods in their eyes compared to the control group. Taking the study a step further, researchers repeated it using control groups for age, gender, and testing season and got the same results. In all studies, there was no difference in the responsiveness of the eyes’ cones.

What do these results mean for the eyes?

Getty/Vadym Pastukh

Researchers believe that the study results indicate that the rods in the retina may be an early warning sign for those who may experience symptoms of bipolar disorder or schizophrenia later in life. The study will likely be used as a basis of knowledge for other mental health studies in genetic testing and prevention research.

While researchers consider the study to be a success, they acknowledge that it's difficult to form an exact explanation as to why there is a higher risk in the offspring of people living with bipolar disorder and schizophrenia. Prior studies using animals suggest that the reason may be due to an abnormality of the brain chemicals serotonin and dopamine. They also believe the higher risk may be related to receptor sensitivity of serotonin and dopamine.

Researchers point out that it's possible that the brains of children who are born into a family that has a strong history of bipolar disorder or schizophrenia may have abnormal brain development.

The human eye and your brain

The retina is connected to the brain by the optic nerve, opening the door to the brain. Is it possible that the reduced response from the retina produces actual perceptual challenges in the eyes? Researchers aren't ruling out that possibility. They suspect that this could be why people living with bipolar disorder and schizophrenia have difficulty with how they perceive the world around them, which may be a contributing factor to functional impairment.

If we look at the larger picture, researchers have conducted other studies showing ERG anomalies in people living with other mental health illnesses like seasonal affective disorder, autism, major depression, and substance use disorders. This information supports the notion that the function of the retina may help properly diagnose certain mental health conditions.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Are there other ways to know if someone is experiencing mania or bipolar disorder?

To better understand mania, it helps to know more about the different categories of bipolar disorder. Doctors have classified bipolar disorder into four categories according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

  • Bipolar I – The person has had a manic episode lasting a week or longer or needed to enter a behavioral health hospital for treatment. The person may have had a depressive episode before or after manic episodes, or they may not have had a depressive episode at all.

  • Bipolar II – The individual has moderate symptoms of mania (also referred to as hypomania) that last for at least four days and where symptoms are present for most of the day on most days. Similar to bipolar I, the individual may have a major depressive episode before or after having manic symptoms or may not have depressive symptoms at all.

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There are many signs of bipolar disorder
  • Cyclothymic disorder – This category of bipolar disorder is characterized by periods of hypomania that alternate with periods of depression. Symptoms aren't usually severe enough to be classified as either hypomania or major depression.

  • Not Otherwise Specified (NOS) – There is a final category of bipolar disorder formerly called NOS. The term was seen as being too general and has instead been replaced by two different terms to help with diagnosis: "other specified" and "unspecified". Individuals who fall into this category may have symptoms of mania and depression that affect their daily lives; yet, their symptoms don't easily fall into any of the categories above.

Eye tests for distinguishing between unipolar and bipolar depression

Because depressive symptoms are present in both bipolar disorders and depressive disorders, knowing whether someone is exhibiting bipolar or unipolar depression can be important. Misdiagnosis can lead to ineffective treatment or the use of modalities that exacerbate symptoms. Recent research suggests that eye movement analyses may be used to determine whether someone is experiencing bipolar disorder or a form of unipolar depression. In one study, researchers found that reaction times and accuracy in certain visual tests can help distinguish between the two. 

Inside bipolar depression and mania

Everyone experiences occasional periods of feeling extra excited or slightly down in the dumps. Barring situations where individuals can point to a specific event that's causing extreme mood changes, these moods usually pass in short order and aren't considered mania or depression. In some cases, an individual may only experience unipolar depression, meaning they never feel an elevated mood or mood swings like individuals with bipolar disorder do.

The difference between unipolar and bipolar depression is that bipolar disorder causes extreme changes in mood, though. Mania, for example, is characterized by an unusually high level of energy and activity. It can be challenging to recognize mania, other manic symptoms may include:

  • Racing thoughts

  • Sleeplessness or insomnia and still feeling great

  • Difficulty concentrating

  • Higher energy

  • Failing to finish tasks they started

  • Irritability

  • Feelings of exhilaration

  • Inflated self-esteem

  • Risk-taking behavior

  • Impulsivity

  • Talking loudly and quickly

  • High energy level

There are different types of mania, including euphoric mania and dysphoric mania. Euphoric mania or a euphoric manic episode involves individuals feeling like they are in an energized good mood, they eyes may widen and they may appear to have sparkling eyes. 

How dysphoric mania differs is that it is a mixed mania bipolar episode and involves individuals experiencing both agitated depression and mania at the same time. This means a person may be in an energized bad mood. Each person’s own dysphoric mania presents a variety of symptoms, however, in some cases, dysphoric mania narrows the eyes for a long period of time and may include pupil dilation making the eyes appear black.

Reaching out for help: Bipolar disorder

For years, people with bipolar disorder, depression, or dysphoric mania turned to in-person therapy for treatment. However, while many people are interested in therapy, the idea of seeing a stranger can feel a bit intimidating. This is especially true for individuals who are experiencing symptoms of bipolar disorder like sudden and intense mood swings. There are other alternatives. For example, online therapy can be a more discreet way of connecting with a therapist or mental health provider.

Managing depression or mania sounds like a challenge, however, you do not have to manage alone, and online therapy can help. Studies support the idea that online therapy can improve mental health by alleviating certain symptoms of mental health conditions and illnesses. One such study evaluated the use of a specific treatment for bipolar disorder. Results showed that this treatment was indeed effective when delivered remotely. 

Therapist reviews: Bipolar disorder

“Lisa is a warm, wise, sound, and refreshing voice speaking into my otherwise chaotic life. She understands me, she guides with positivity and without judgment, and she offers resources which address my concerns straight-on.”

“Sabrina is amazing! I love knowing that she's there, when life feels crazy, I can reach out to her, and it's like she just knows what to say. On the tough days, on the crazy days, on the side days, and even when I'm doing good, she's that voice that instantly makes me feel calmer when I listen to her messages just because I know that she gets me, she understands me, and she's so helpful with her insight and her suggestions.”

Takeaway

It's not likely that we're at a point in scientific discovery where it makes sense to test the retinas of every person who may be living with bipolar disorder. Still, the more that researchers learn about the brain and how it works together with our other organs, the closer they will become to identifying effective treatments for bipolar disorder, schizophrenia, and other mental health disorders.

At BetterHelp, you can get the personal attention you need to address bipolar disorder symptoms in a safe environment. BetterHelp provides licensed, experienced, and accredited psychologists, marriage and family therapists, social workers, and board-licensed professional counselors who specialize in a wide range of mental health areas. Below are some reviews of BetterHelp counselors working with people like you.

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