Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again to the high point. Often, there are periods of normal mood patterns in between these highs and lows. Severe changes in energy and behavior go along with these changes in mood. The periods of highs are called mania, and those of the lows are called depression.

Symptoms of bipolar disorder include:

  • Dramatic mood swings ranging from elated excitability to hopeless despondency
  • Periods of normal mood in between
  • Extreme changes in energy and behavior

Mania (Manic Episode)

Periods of highs are called mania. Signs and symptoms of mania include:

  • Increased energy, activity, and restlessness
  • Excessively high, overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, inability to concentrate
  • Little need for sleep
  • Unrealistic beliefs in one's abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs , particularly cocaine , alcohol , and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

Depression (Depressive Episode)

Periods of lows are called depression . Signs and symptoms of depression include:

  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, a feeling of fatigue or of being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleeping too much or not being able to sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
  • Thoughts of death or suicide, or suicide attempts

Variations of Symptoms

Someone with bipolar disorder may also experience the following:

Hypomania

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Without proper treatment, however, hypomania can become severe mania or can switch over into depression.

Psychosis

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are:

  • Hallucinations—hearing, seeing, or otherwise sensing the presence of things not actually there)
  • Delusions—false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts
  • Disorders of thought—loose associations between topics, "flight of ideas," or incomprehensible speech
  • Catatonia—abnormal motor behaviors or unresponsiveness (rarely occurs)

Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania. Delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression.

Suicidal Symptoms

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a doctor. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

  • Talking about feeling suicidal or wanting to die
  • Feeling hopeless, that nothing will ever change or get better
  • Feeling helpless, that nothing one does makes any difference
  • Feeling like a burden to family and friends
  • Abusing alcohol or drugs
  • Putting affairs in order (eg, organizing finances or giving away possessions to prepare for one's death)
  • Writing a suicide note
  • Putting oneself in harm's way, or in situations where there is a danger of being killed

Unipolar and Bipolar Depression

As many as 35% to 60% of patients with bipolar disorder will have an episode of major depression before having a manic episode. Until an episode of mania occurs, these patients generally have a diagnosis of major depressive disorder and will be treated for that, rather than bipolar disorder.

Clues that you may be suffering from bipolar disorder instead of major depression include:

  • Onset of symptoms before the age of 25
  • Atypical depressive symptoms, such as oversleeping, overeating, weight gain, and slowing of thoughts and actions
  • Psychotic symptoms
  • Drug abuse
  • Short-term response to antidepressants, then wearing off of the response
  • More than three episodes of depression that are of brief duration (less than three months)
  • For women, postpartum depression without a history of depression