Severe bipolar may involve intense or prolonged mood episodes, psychotic symptoms, or hospitalization.

Bipolar disorder is a complex psychiatric condition that causes extreme shifts in energy and mood.

When bipolar is severe, it may involve intense and prolonged episodes of mania and sometimes depression. These episodes may also be accompanied by symptoms of psychosis, which can lead to significant impairment in your daily functioning.

Bipolar disorder is a psychiatric condition characterized by severe shifts in mood and energy levels, as well as impaired thinking.

The mood states in bipolar may include:

The severity and duration of these mood episodes vary from person to person. If you have severe bipolar, you might have longer or more intense mood episodes that require hospitalization or intensive treatment to manage your symptoms.

Manic episodes

Mania involves extremely heightened energy levels, an abnormally elevated mood, and intense goal-directed behavior. When you’re manic, your behavior is a distinct change from your typical self, and it’s noticeable to others.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a manic episode in bipolar must last at least 1 week and be present most of the day, nearly every day (or any amount of time, if hospitalization is necessary).

Symptoms of mania may include:

  • having abnormally high energy
  • feeling extreme happiness
  • having grand ideas and plans
  • feeling self-important
  • having little desire to eat or sleep
  • talking rapidly
  • having illogical reasoning or delusions
  • being highly distracted
  • making high risk or out-of-character decisions
  • experiencing psychotic features (e.g., hearing voices or having a delusion that a famous person is in love with you)

Depressive episodes

Bipolar depressive episodes involve a low mood or loss of pleasure in life. Research suggests that depressive episodes in bipolar tend to last longer than manic or hypomanic episodes. The episodes last at least 2 weeks, but in some cases, they can last for months.

Symptoms of a depressive episode may include:

  • feeling extremely sad
  • having unusually low energy levels
  • having memory and concentration difficulties
  • losing interest in activities you previously enjoyed
  • lacking appetite
  • having trouble sleeping
  • feeling guilty
  • feeling hopeless or worthless
  • experiencing psychotic features (e.g., hearing voices or having delusions that you’re being persecuted for a perceived past wrongdoing or that you’re not worthy of happiness)

Mixed features

When mania and depression happen at the same time, it’s called “mixed features.” These symptoms may look like:

  • feeling irritable or agitated
  • feeling aggressive
  • showing unprovoked rage
  • having racing thoughts
  • crying
  • having difficulty falling asleep
  • feeling strong emotions

Psychotic features

Some people with bipolar disorder experience symptoms of psychosis, such as hallucinations or delusions, during a severe manic or depressive episode.

Delusions in bipolar disorder are often “mood-congruent,” meaning they mirror your mood. Examples of mood-congruent delusions in depression might include those involving guilt, illness, or inferiority.

During mania, you might believe that you have extraordinary abilities or powers. For instance, you might suddenly decide to run for president or believe that you have an endless amount of money.

While there’s a general assumption among clinicians that psychosis in bipolar means it’s a more severe case overall, the research on this is mixed.

One 2018 study compared 213 bipolar participants with a history of psychosis to 168 bipolar participants without a history of psychosis.

The findings showed that bipolar participants without psychosis experienced a longer duration of mood symptoms and a greater degree of rapid cycling than those with a history of psychosis.

While psychosis in itself is severe, the researchers conclude that the presence of psychosis in bipolar does not appear to be linked to a worse overall outcome nor neuropsychological impairment.

Signs your bipolar disorder symptoms are getting worse

Some signs that bipolar disorder may be getting worse include:

  • having more frequent or more severe manic or depressive episodes
  • having difficulty managing symptoms
  • experiencing rapid cycling (having four or more mood episodes in a year)
  • having trouble with daily functioning
  • experiencing more suicidal thoughts or behaviors

Different types of bipolar disorder can be severe in different ways.

Bipolar disorder can be divided into the following types:

  • Bipolar I disorder: A bipolar I diagnosis requires at least one manic episode. Although many people with bipolar I have depressive episodes, they’re not required for a diagnosis. Bipolar I carries a risk for the most severe manic episodes.
  • Bipolar II disorder: A bipolar II diagnosis requires at least one hypomanic episode and one depressive episode. There cannot have been a full manic episode. Research suggests that depression is often more severe — more frequent, longer-lasting, and debilitating — in bipolar II than in bipolar I.
  • Cyclothymic disorder: Cyclothymia involves multiple episodes of hypomanic and depressive symptoms lasting for at least 2 years, but these symptoms don’t quite meet the criteria for a hypomanic or depressive episode. This type is less severe than bipolar I and II.

There are several situations in which hospitalization for bipolar disorder may be necessary in order to stabilize you and keep you safe.

These include periods when you:

  • have acute manic or depressive episodes
  • experience suicidal thoughts or behaviors
  • experience psychotic symptoms
  • are unable to care for yourself
  • are unable or unwilling to follow treatment
  • have severe symptoms that are treatment resistant

There are several things you can do to help you manage bipolar disorder symptoms:

  • Stick to a treatment plan: It’s important to work closely with a mental health professional to develop an individualized treatment plan, including medication and therapy, and to stay consistent with it.
  • Learn to recognize triggers: Knowing what triggers your mood episodes can help you prevent them or at least manage them more effectively.
  • Build a support network: Connecting with friends, family, and support groups can provide valuable social support and help reduce any feelings of isolation.
  • Keep a regular schedule: Establishing a regular schedule for sleeping, eating, and activities can help stabilize moods.
  • Practice self-care: Taking care of yourself physically and emotionally is important for managing your symptoms. This includes eating a nutritious diet, getting enough sleep, and engaging in regular physical activity.
  • Practice stress-reduction techniques: Techniques such as mindfulness or yoga can help to reduce stress and improve your overall well-being.

Severe bipolar disorder involves intense and prolonged mood episodes and may require hospitalization and intensive treatment.

If you live with severe bipolar, it’s important that you work closely with a mental health professional to develop an individualized treatment plan. A strong support system is also very beneficial, as it can help provide emotional support and reduce feelings of isolation.