People with bipolar disorder often experience irritability and restlessness, which some people may think is anger. Medication side effects can also contribute to perceptions of anger.

Bipolar disorder is a brain disorder that causes unexpected and often dramatic shifts in mood.

During what’s known as a manic period, these moods can be intense and euphoric. During a depressive period, they may leave you feeling sad and despairing. That’s why bipolar disorder is also sometimes called manic-depressive disorder.

The mood changes associated with bipolar disorder can cause changes in energy, too. These shifts can cause someone to feel more irritable or restless than usual, which may look like anger to someone else.

Here’s a closer look at anger’s role in bipolar disorder.

Anger isn’t a symptom of bipolar disorder. Others may perceive symptoms of mania and hypomania as anger.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, text revision (DSM-5-TR), symptoms of manic or hypomanic episodes typically present with a persistently elevated or irritable mood.

Other symptoms include:

  • increased distractability
  • decreased need for sleep
  • excessive involvement in high risk activities, like spending sprees or business investments
  • being more talkative than usual or compulsions to talk more
  • psychomotor agitation, such as racing thoughts or fidgeting

Studies from 2012 and 2014 by some members of the same research team suggest that people with bipolar disorder show greater episodes of aggression than those without bipolar disorder.

A 2017 analysis of two clinical trials suggests nearly 62% of participants with bipolar disorder experienced irritability before starting treatment. In addition, they experienced agitation.

Prescription medication is one of the primary treatments for bipolar disorder.

Some people take mood stabilizers such as lithium (Lithobid). While anger isn’t a side effect of mood stabilizers, these medications can cause restlessness and agitation, which some people might interpret as anger.

Mood stabilizers can cause some uncomfortable symptoms, like constipation and dry mouth, which may contribute to irritability.

These effects are often the result of your body learning to adjust to the new chemicals. That’s why it’s important you continue taking your medication exactly as your doctor prescribes.

Even if new side effects occur, don’t stop taking your medication without first discussing it with your doctor. They may recommend adjusting your dose or suggest ways to manage side effects.

Everyone gets upset from time to time. Anger is a typical reaction to a stressful or challenging event in a person’s life.

However, anger that’s uncontrollable or prevents you from interacting with another person can cause distress.

Here are some signs that irritability or anger may be affecting your life:

  • Your friends avoid you: Too many angry run-ins with friends may discourage them from inviting you to future events.
  • Your family and loved ones back down: Arguments are common, even within the most secure relationships. However, if you find your loved ones aren’t willing to engage in intense conversations with you, it may be because they do not understand your behavior and don’t know how to manage the conversation.
  • You’re reprimanded at work: If your behavior has led to a reprimand or counseling, it might be because your colleagues or manager do not understand how your condition affects your emotions and mood and misinterpret them as anger. However, it is important to learn how to effectively manage your emotions.

If you think a strong emotion is preventing you from having a good relationship with friends, loved ones, and colleagues, talking with a mental health professional can help

If you’re experiencing anger or irritability, learning to manage your emotions can help improve your relationships with others and your overall quality of life.

The following steps may help you manage any shifts in emotions.

Identify your triggers

Some events, people, or requests can be upsetting and turn a good day into a bad one.

Try making a list of the triggers as they occur. This will help you understand what triggers your anger or upsets you most and help you recognize and manage them.

Take your medications

Well-managed bipolar disorder may cause fewer severe emotional shifts. Once you and your doctor decide on a treatment plan, stick to it. It can help you maintain even emotional states.

Talk with a therapist

In addition to medications, doctors often suggest people with bipolar disorder take part in cognitive behavioral therapy (CBT).

CBT is a type of therapy that can help people with bipolar disorder express their thoughts, feelings, and concerns.

The goal is for you to learn to be productive despite the disorder and to find ways to cope with any lingering side effects or complications, whether from medication or the condition itself.

Harness the energy

When you sense yourself getting upset or frustrated, look for creative outlets that can help you harness the energy while avoiding an adverse interaction with another person.

This could include exercise, meditation, reading, or any other activity that helps you manage emotions more productively.

Lean into your support team

When you’re having a bad day or week, you need people you can turn to. Explain to your friends and family members that you’re working through the symptoms of bipolar disorder and need accountability.

Together, you can learn to manage this mood disorder.

When a person has bipolar disorder, their emotional shifts may seem very unexpected to you. The highs and lows may take a toll.

Learning to anticipate and react to these changes can help people with bipolar disorder, as well as their loved ones, cope with the emotional changes.

Here are a few strategies to keep in mind.

Don’t back down

If you’ve been dealing with your loved one’s bursts of anger and irritability over a long period, you may be tired and unwilling to put up a fight.

Instead, ask your loved one to visit a therapist with you so the two of you can learn ways to communicate more clearly when emotions are high.

Remember, they’re not necessarily angry at you

It can be easy to feel that the anger attack is about something you did or said. If you can’t pinpoint a reason for their anger, take a step back. Ask them what they’re upset about, and go from there.

Engage positively

Ask your loved one about their experiences. Be willing to listen and be open.

Sometimes, explaining what they’re experiencing can help them cope better with their mood shifts and allow them to communicate through them.

Look for a community of support

Ask your loved one’s doctor or therapist for recommendations for groups you could join or professionals you could see. You need support, too.

Help them stick to treatment

The key to treatment for bipolar disorder is consistency.

Help ensure that your loved one is taking their medication and following through with other treatments when and how they’re supposed to. If they’re not, encourage them to talk with their doctor about finding a treatment that works better for them.

Bipolar disorder can cause a range of symptoms that resemble anger, especially during manic or hypomanic episodes. Restlessness caused by excess energy may come off as aggression or irritability to others.

Keep in mind that medication side effects can also cause restlessness and other uncomfortable symptoms that might contribute to anger.