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Symptoms of Bipolar disorder

Symptoms of Bipolar disorder: Introduction

The severity and types of symptoms of bipolar disorder vary from person to person but generally affect mood, energy and functioning. Bipolar disorder is characterized by periods of intense mania or euphoria that alternates with episodes of depression. Symptoms of bipolar disorder can seriously interfere with a person's ability to function normally in relationships and activities of everyday life, such work, school, social activities, and self-care.

Bipolar disorder is characterized by severe mood swings that also manifest in extremes in energy and activity. Bipolar disorder includes periods of intense mania, in which a person's mood is extremely elevated. The emotion can be euphoric or it can be intensely irritable and angry. Symptoms of this period also include having a very high level of energy, alertness and excitability. People in the manic phase of bipolar disorder can experience extremely high levels of self esteem and ambition, act impulsivity, and take serious risks. Impulsive and risky behaviors commonly include excessive sexual behaviors, gambling, and alcohol and drug use.

People in the manic phase of bipolar disorder may also experience erratic behavior, racing thoughts, talk very rapidly, and feel little need for sleep. Complications of this phase of bipolar disorder include the development of delirium, (mental confusion) or paranoia.

These periods of mania alternate with episodes of depression. Typical symptoms of depression include feelings of sadness, anxiety, and/or despair that do not go away. Other feelings may include hopelessness, guilt, worthlessness, helplessness, and anger and irritability.

People with depression may also experience a loss in interest in activities they once enjoyed, chronic fatigue, trouble focusing, and difficulties with memory or in making decisions. Sleep abnormalities may also occur, such as insomnia or a desire to sleep all the time. Suicidal thoughts, self-harm, such as cutting or burning oneself, or attempts at committing suicide may also occur. People with depression may also experience physical symptoms, typically pain and chronic pain.

Some people with bipolar disorder may experience a mixed state, which is a combination of symptoms of mania and depression at the same time. In addition, some people with bipolar disorder can experience a rapid shifting from symptoms of mania to symptoms of depression. This is called rapid cycling. Rapid cycling occurs when periods of mania and depression occur four or more times a year.

In some cases symptoms of bipolar disorder may be so serious that people with the disorder are unable to safely care for their basic needs and/or may be a danger to themselves because of extremely risky behaviors, self-harm, or suicidal thoughts....more about Bipolar disorder »

Symptoms of Bipolar disorder

The list of signs and symptoms mentioned in various sources for Bipolar disorder includes the 57 symptoms listed below:

Research symptoms & diagnosis of Bipolar disorder:

Bipolar disorder: Symptom Checkers

Review the available symptom checkers for these symptoms of Bipolar disorder:

Bipolar disorder: Symptom Assessment Questionnaires

Review the available Assessment Questionnaires for the symptoms of Bipolar disorder:

Bipolar disorder: Complications

Review medical complications possibly associated with Bipolar disorder:

Research More About Bipolar disorder

Do I have Bipolar disorder?

Bipolar disorder: Medical Mistakes

Bipolar disorder: Undiagnosed Conditions

Diseases that may be commonly undiagnosed in related medical areas:

Home Diagnostic Testing

Home medical tests related to Bipolar disorder:

Wrongly Diagnosed with Bipolar disorder?

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Bipolar disorder includes:

Bipolar disorder: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

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More information about symptoms of Bipolar disorder and related conditions:

Other Possible Causes of these Symptoms

Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.

Article Excerpts About Symptoms of Bipolar disorder:

Going to Extremes Bipolar Disorder: NIMH (Excerpt)

Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.

Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.

Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; and excessive involvement in risky behaviors or activities.

"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.

Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When 4 or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse. 4

Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar typically reflect the extreme mood state at the time. (Source: excerpt from Going to Extremes Bipolar Disorder: NIMH)

Let's Talk About Depression: NIMH (Excerpt)

When You're Depressed...

  • You feel sad or cry a lot and it doesn't go away.
  • You feel guilty for no reason; you feel like you're no good; you've lost your confidence.
  • Life seems meaningless or like nothing good is ever going to happen again. You have a negative attitude a lot of the time, or it seems like you have no feelings.
  • You don't feel like doing a lot of the things you used to like - like music, sports, being with friends, going out - and you want to be left alone most of the time.
  • It's hard to make up your mind. You forget lots of things, and it's hard to concentrate.
  • You get irritated often. Little things make you lose your temper; you over-react.
  • Your sleep pattern changes; you start sleeping a lot more or you have trouble falling asleep at night. Or you wake up really early most mornings and can't get back to sleep.
  • Your eating pattern changes; you've lost your appetite or you eat a lot more.
  • You feel restless and tired most of the time.
  • You think about death, or feel like you're dying, or have thoughts about committing suicide.

When You're Manic...

  • You feel high as a you're "on top of the world."
  • You get unreal ideas about the great things you can do...things that you really can't do.
  • Thoughts go racing through your head, you jump from one subject to another, and you talk a lot.
  • You're a non-stop party, constantly running around.
  • You do too many wild or risky things: with driving, with spending money, with sex, etc.
  • You're so "up" that you don't need much sleep.
  • You're rebellious or irritable and can't get along at home or school, or with your friends.
(Source: excerpt from Let's Talk About Depression: NIMH)

Bipolar Disorder: NIMH (Excerpt)

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

Signs and symptoms of mania (or a manic episode) 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, can't concentrate well
  • Little sleep needed
  • 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

A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) 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 can't 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

A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

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. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

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) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). 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. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized. (Source: excerpt from Bipolar Disorder: NIMH)

Bipolar Disorder: NIMH (Excerpt)

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania:At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped. (Source: excerpt from Bipolar Disorder: NIMH)

Bipolar Disorder Research at the National Institute of Mental Health: NIMH (Excerpt)

When the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state that may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or may have features of these disorders as initial symptoms. In contrast, later adolescent- or adult-onset bipolar disorder tends to begin suddenly, often with a classic manic episode, and to have a more episodic pattern with relatively stable periods between episodes. There is also less co-occurring ADHD or CD among those with later onset illness. (Source: excerpt from Bipolar Disorder Research at the National Institute of Mental Health: NIMH)

Depression Research: NIMH (Excerpt)

Bipolar disorder (or manic-depressive illness) is characterized by episodes of major depression as well as episodes of mania – periods of abnormally and persistently elevated mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity or physical agitation; and excessive involvement in pleasurable activities that have a high potential for painful consequences. While sharing some of the features of major depression, bipolar disorder is a different illness that is discussed in detail in a separate NIMH publication. (Source: excerpt from Depression Research: NIMH)

Medications: NIMH (Excerpt)

When people are in a manic "high," they may be overactive, overly talkative, have a great deal of energy, and have much less need for sleep than normal. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. Their attention span is often short, and they can be easily distracted. Sometimes people who are "high" are irritable or angry and have false or inflated ideas about their position or importance in the world. They may be very elated, and full of grand schemes that might range from business deals to romantic sprees. Often, they show poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state. (Source: excerpt from Medications: NIMH)

Bipolar disorder as a Cause of Symptoms or Medical Conditions

When considering symptoms of Bipolar disorder, it is also important to consider Bipolar disorder as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Bipolar disorder may cause:

- (Source - Diseases Database)

Bipolar disorder: Onset and Incubation

Onset of Bipolar disorder: Most people are in their late teens or early 20s when symptoms first start. Nearly everyone with bipolar II disorder develops it before age 50

Medical articles and books on symptoms:

These general reference articles may be of interest in relation to medical signs and symptoms of disease in general:

About signs and symptoms of Bipolar disorder:

The symptom information on this page attempts to provide a list of some possible signs and symptoms of Bipolar disorder. This signs and symptoms information for Bipolar disorder has been gathered from various sources, may not be fully accurate, and may not be the full list of Bipolar disorder signs or Bipolar disorder symptoms. Furthermore, signs and symptoms of Bipolar disorder may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Bipolar disorder symptoms.


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