Understanding Symptoms Of Bipolar Disorder

Medically reviewed by Paige Henry, LMSW, J.D.
Updated May 15, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Manic Depression, or bipolar disorder, affects roughly 4.4% of adults in the United States. It’s marked by periods of intense mood swings of mania and depression, and when untreated, it can have a seriously negative impact on the patient’s daily life. 

Understanding the symptoms of bipolar disorder begins with understanding its causes and types.

Symptoms of bipolar disorder can be difficult

Causes and risk factors of bipolar disorder

While the exact cause of bipolar disorder is unknown, experts believe it stems from a combination of biology and genetics marked by various risk factors. 

Biological Contributors- Bipolar disorder appears to be associated with an imbalance in the brain of dopamine, serotonin, and/or noradrenaline. 

Genetic Contributors- Although researchers are still looking for a “bipolar gene,” it appears more frequently when the patient has a biological first-degree relative with the disorder, like a sibling or parent.

Traumatic, Stressful Events- While not a cause, traumatic events like the death of a loved one, natural disaster, and incidents of abuse can initiate bipolar episodes. 

Drug/Alcohol Abuse- Frequent use of drugs and/or alcohol may also spark bipolar episodes if the individual is already predisposed to the condition. 

Symptoms of bipolar disorder

Bipolar disorder can occur at any age but is primarily diagnosed in the mid to late teens and early 20s. Like all mental health disorders, the symptoms of Bipolar disorder often change with time and circumstance and vary between individuals. 

Depressive episodes

Depressive episodes can last for weeks or even months, and their symptoms are often severe enough to significantly impact daily activities and relationships. Depressive episodes usually include five or more of the following symptoms:

  • Loss of energy, fatigue
  • Extreme sleep patterns (either sleeping too much or insomnia)
  • Restlessness or sluggishness
  • Drastic weight fluctuations without dieting
  • Low feelings of sadness, emptiness, and hopelessness
  • Feelings of excessive, inappropriate guilt, worthlessness
  • Trouble concentrating
  • Loss of interest in activities that ordinarily bring pleasure
  • Suicidal thoughts, plans, or attempting suicide.
Getty/Vadym Pastukh

Manic/hypomania episodes

Although they discuss symptoms, manic episodes are typically more severe than hypomania, causing more dramatic problems in daily life. In its most intense form, a manic episode can initiate delusions and hallucinations severe enough that it requires in-patient intervention. 

Manic and hypomanic episodes usually feature three or more of the following symptoms: 

  • Extreme increase in energy and activity
  • Racing thoughts, distractibility
  • Abnormally agitated or upbeat
  • Insomnia
  • Excessively talkative, disorganized communication
  • Intense euphoria, exaggerated feelings of self-confidence
  • Unusually impulsive, risky behaviors 

Mixed episodes

While people without bipolar disorder can experience depressive and manic episodes, mixed episodes are unique to bipolar disorders. During a mixed episode, the individual may experience the symptoms of depression and mania at the same time or in rapid succession. 

Types of bipolar disorder 

While there are Bipolar disorders associated with medical conditions like Multiple Sclerosis, stroke, Cushing’s disease, and the physiological effects of certain drugs or alcohol- there are three primary types of Bipolar:

Bipolar I

Episodes of mania associated with Bipolar I are usually more intense and more likely to include instances of psychosis. This type of bipolar disorder includes at least one manic episode interspersed among episodes of hypomania and/or major depression. 

Bipolar II 

Bipolar II includes at least one episode of major depression and a hypomanic episode. The diagnosis for Bipolar II excludes manic episodes. 

Cyclothymic disorder

Patients with Cyclothymic disorder experience at least two years of depressive symptoms (less severe than major depression) and several periods of hypomania. Children and teens are diagnosed after one year of symptoms. 

Diagnosing bipolar disorder 

If left unaddressed, the symptoms of Bipolar disorder can worsen and increase the likelihood of comorbidity with conditions such as anxiety and conduct disorders. Substance Use Disorder (SUD) is the most common, affecting 61% of patients with Bipolar I and 48% with Bipolar II. 

If you are experiencing symptoms of Bipolar disorder, it’s essential to contact your doctor so they may determine if you have it and begin a treatment plan. Your doctor will probably start with a physical exam, lab tests, and a thorough review of your family and medical history. 

If your doctor determines that your symptoms aren’t caused by another physical issue, they’ll likely refer you to a psychiatrist for an evaluation. The psychiatrist will probably request a psychological self-assessment and ask you about your mental health status, including your behavior patterns, thoughts, and feelings. They may also ask you to keep a daily journal of your mood, behavior patterns, sleep patterns, etc. With your permission, they may request an interview with close friends and loved ones to gather information about your symptoms. 

Once your psychiatrist is confident in a diagnosis of Bipolar disorder, they will cross-reference your symptoms with the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published by the APA. From here, they will determine the best treatment for your unique situation.

Symptoms of bipolar disorder can be difficult


Bipolar Disorder is usually treated with a combination of psychotherapy and medication. In addition to the below treatments, your therapist will likely provide educational guidance about the disorder to help you and your loved ones understand the causes, symptoms, and treatment options. Becoming educated about the condition will also help you devise strategies for potential relapses and disruptions of therapy. 


Psychotherapy techniques for Bipolar disorder include Cognitive Behavioral Therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and family therapy. 

Even though psychotherapy is one of the most vital parts of treatment, the nature of its symptoms can sometimes create barriers to treatment for people with Bipolar disorder. For example, commuting to and from an office during a potentially dangerous manic episode. Or feelings of deep depression that make it difficult to get out of bed, much less travel to an office and interact with other people in person. Online therapy is an excellent solution to such barriers for people with a wide range of mental health issues, including Bipolar disorder. Platforms like BetterHelp match patients with licensed mental health professionals from various backgrounds and expertise. 

Several studies have shown that online therapy is as effective as in-person therapy. Research shows that online therapy is also effective for treating bipolar depression


Antipsychotics, antidepressants, and mood stabilizers are commonly prescribed to help the patient manage symptoms. Your doctor will review the side effects, risks, and benefits associated with the medications. Remember that it often takes time to determine which medications are best for your unique physiology, and you may have to try different combinations before you find what works for you. Don’t start or stop taking your medications without directions from your doctor. 

Long-term, continuous treatment

While there may be times between episodes when a person feels fine, a long-term, ongoing treatment plan can reduce the severity and frequency of mood swings.

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is sometimes prescribed for patients who aren’t responsive to medications or can’t take them. 

Managing symptoms of bipolar disorder in daily life

It’s important to understand that Bipolar disorder doesn’t go away with time or get better on its own. Treatment is symptom-centric and is usually ongoing and lifelong.

But in addition to medical treatment, there are lifestyle habits that can help better manage the symptoms:

Establish healthy habits

Keep a regular sleep schedule, follow a nutritious diet, and get regular exercise approved by your doctor. Keeping your doctor in the loop about your diet before beginning a new exercise program or if you have sleep problems is essential. Also, always consult your doctor before taking other medications or over-the-counter supplements. 

Quit drinking/recreational drug use

Substance use disorder is one of the most frequent comorbidities of Bipolar disorder and one of the biggest concerns because of its strong association with risky behaviors. If you have trouble quitting, speak to your doctor. 

Cultivate a support group

Keep close relationships with people who can provide positive, compassionate support and help you recognize when Bipolar symptoms arise. 


Bipolar disorder is often complex, with symptoms that can change quickly or even go temporarily dormant. If it goes unaddressed by a mental health professional, symptoms will almost always worsen, leading to other potentially more severe problems. But Bipolar is highly treatable, and with the correct combination of medications, psychotherapy, and daily management, you can keep the symptoms in check and out of your everyday life. If you suspect you have symptoms of Bipolar disorder or any other mental health disorder, it’s important to seek the appropriate help.
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