Bipolar disorder is a mental health condition that involves significantly high and low moods. Highs are periods of mania or hypomania, while lows are periods of depression. The changes in mood may also become mixed, so you might feel elated and depressed at the same time.

The National Institute of Mental Health estimates that around 4.4 percent of adults in the United States experience bipolar disorder at some time. The symptoms usually appear between the ages of 18 to 29 years, but they can occur at any age, including childhood and the teenage years.

Bipolar disorder can be hard to diagnose, but there are signs or symptoms that you can look for.

The signs and symptoms of bipolar disorder are varied. Many of these symptoms can also be caused by other conditions, making this condition hard to diagnose. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lays out the criteria for diagnosing bipolar disorder.

Types and symptoms

There are four common types of bipolar disorder. Bipolar I and II are the most common types.

Bipolar I

To have bipolar I, a person must experience manic episodes. In order for an event to be considered a manic episode, it must:

  • include shifts in mood or behaviors that are unlike the person’s usual behavior
  • be present most of the day, nearly every day during the episode
  • last at least 1 week, or be so extreme that the person needs immediate hospital care

People with bipolar I typically have depressive episodes as well, but a depressive episode isn’t required to make the bipolar I diagnosis. For a diagnosis of bipolar I, the person should not have another condition that could explain the symptoms.

Bipolar II

Bipolar II also involves high and low moods, but depressive symptoms are more likely to dominate, and its manic symptoms are less severe. This less severe type of mania is known as hypomania.

For a diagnosis of bipolar II disorder, a person must:

  • have experienced at least one episode of major depression
  • have had at least one episode of hypomania
  • not have another condition that could explain the symptoms

Cyclothymic disorder

Cyclothymic disorder involves changes in mood and shifts similar to bipolar I and II, but the shifts may be less dramatic. A person with cyclothymic disorder will have had symptoms of hypomania and episodes of depression for at least 2 years, or 1 year for children and teens.

Bipolar disorder not otherwise specified

Bipolar disorder not otherwise specified is a general category for a person who only has symptoms of bipolar disorder that don’t match the three other categories. The symptoms are not enough to make a diagnosis of one of the other three types.

The signs of bipolar disorder can generally be divided into those for mania, and those for depression.

10 signs of mania

Mania can cause other symptoms as well, but seven of the key signs of this phase of bipolar disorder are:

  1. feeling overly happy or “high” for long periods of time
  2. feeling jumpy or “wired”
  3. having a reduced need for sleep
  4. talking very fast, often with racing thoughts and rapid changes of topic
  5. feeling extremely restless or impulsive
  6. becoming easily distracted
  7. feelings of grandiosity, which is when you feel you’re very important or have important connections
  8. feeling as if you can do anything
  9. engaging in risky behavior, like having impulsive sex, gambling with life savings, or going on big spending sprees
  10. having a low appetite

10 signs of depression

Like mania, depression can cause other symptoms as well, but here are 10 of the key signs of depression from bipolar disorder:

  1. feeling sad or hopeless for long periods of time
  2. withdrawing from friends and family
  3. losing interest in activities that you once enjoyed
  4. having a significant change in appetite
  5. feeling severe fatigue or lack of energy
  6. feeling slowed down and unable to carry out simple tasks
  7. talking slowly
  8. sleeping too much or too little
  9. having problems with memory, concentration, and decision making
  10. thinking about death or suicide or attempting suicide

An extremely high or low mood can sometimes involve hallucinations or delusions, known as psychosis. During a manic period, for example, the person may have delusions of grandeur. For example, they may believe they’re very important or have special powers.

A person with depressive psychosis might believe they’ve committed a crime or are financially ruined. The person may also see, hear, or smell things that are not there.

Substance use

Substance use disorder involves the use of substances like drugs or alcohol in a way that’s harmful for the person’s mental and physical health.

Studies suggest that substance use disorder may be three to six times higher among people with bipolar disorder than in the general population.

Having bipolar disorder alongside a substance use disorder can make it harder to treat either condition, and it can also affect the outcome of each disorder. People with both disorders are more likely to have a lower quality of life, a less stable progression through treatment, and are more likely to consider suicide.

Having a substance use disorder can also make it harder to get an accurate diagnosis, as a doctor may have difficulty identifying which symptoms are due to bipolar disorder and which stem from substance use.

Learn about the link between bipolar disorder and alcohol use disorder.

Bipolar disorder or depression?

Doctors sometimes find it hard to distinguish between bipolar disorder and depression, and this can lead to misdiagnosis. People with bipolar disorder are more likely to seek help during a low mood because depression is more likely to have a negative impact on their health and wellbeing. During a high mood, they may feel exceptionally well.

Factors that increase the chance of this happening include the following:

  • Depression is the dominant mood.
  • Depression is the first episode you have.
  • You have experienced mania or hypomania but not realized it could be significant.

It’s essential to get an accurate diagnosis in order to work out a treatment plan. Antidepressants may not be effective in treating bipolar disorder.

In addition, some antidepressant medications can trigger a first manic or hypomanic episode if you’re susceptible to them, and this could complicate both treatment and the outcome.

If you go to see your doctor with depression, be sure to tell them about any of the following, as these can help get an accurate diagnosis:

  • a family history of bipolar disorder or other mental health conditions
  • any other conditions that affect your mental or physical wellbeing
  • any medications, drugs, or other substances you’re taking or have used in the past
  • if you’ve already tried antidepressants and they did not help

Learn how bipolar disorder is diagnosed.

Symptoms in children and teens

Symptoms of bipolar disorder usually emerge in early adulthood, though they can occur at any age. Sometimes, they can appear in children.

Signs that a child may have bipolar disorder include the following:

  • getting much more excited or irritable than other children
  • having high and low moods that seem extreme compared with other children
  • having mood changes that affect their behavior at school or home

Children or teens who are experiencing a high mood may:

  • appear excessively happy or silly for long periods
  • have a short temper
  • talk rapidly about many different things
  • have difficulty sleeping but not be sleepy
  • have difficulty focusing on an activity
  • have racing thoughts
  • seem excessively interested in risky activities or take unusual risks

Those with a low mood may:

  • often feel sad for no apparent reason
  • have a short temper or show hostility or anger
  • complain about aches and pains
  • sleep more than usual
  • eat more or less than usual
  • have difficulty focusing
  • feel hopeless or worthless
  • have difficulty maintaining relationships
  • have little energy
  • lose interests in things they used to enjoy
  • think about death or suicide

There are many reasons why children and teens can experience mood changes or moods that seem extreme. The hormonal changes in puberty can lead to fluctuations in mood, and the symptoms of ADHD and other conditions can resemble those of bipolar disorder.

If you’re concerned about yourself or a young person, seek medical help early. Whatever the reason for mood changes in a young person, getting a correct diagnosis can help manage the symptoms and prevent long-term complications.

Suicide prevention

If you or someone you know is considering suicide or self-harm, please seek support:

While you wait for help to arrive, stay with someone and remove any weapons or substances that can cause harm. You are not alone.

Healthline connected with people living with bipolar disorder to hear a little bit about their experiences and feelings. Here’s what they shared:

Bipolar disorder can affect many different aspects of day-to-day life, including energy levels and sleep.

Intense feelings – from feeling like you can do anything to feeling hopeless – are among the most common experiences shared by many people living with bipolar disorder.

If you think that you or a loved one has signs or symptoms of bipolar disorder, your first step should be to talk with your doctor. Only a trained medical professional can diagnose this disorder, and diagnosis is key to getting proper treatment.

Medication, therapy, or other treatment options can help you or your loved one manage symptoms and maximize quality of life.

Learn more about treatments for bipolar disorder.

Bipolar disorder is a mental health condition that involves high and low moods.

Bipolar I disorder involves at least one episode of mania, which is a very high mood. This can alternate with times of depression. During a manic phase, you may feel “wired” or jumpy and full of energy. During a depressive phase, you may feel you have no energy and are unable to carry out daily tasks.

If you have bipolar II disorder, you’re more likely to experience depression, but there may also be times of hypomania, a less severe form of high mood. It’s also possible to feel both high and low at the same time or within a short space of time.

Symptoms of bipolar disorder can be similar to those of depression, substance use disorder, ADHD, and other conditions. Getting a correct diagnosis can be challenging but is essential for getting the right treatment.