What is bipolar disorder?

Bipolar disorder is a mental health problem that mainly affects your mood. If you have bipolar disorder, you are likely to have times where you experience:

  • Manic or hypomanic episodes (feeling high)
  • Depressive episodes (feeling low)
  • Potentially some psychotic symptoms during manic or depressed episodes

You might hear these different experiences being referred to as bipolar mood states. Everyone has variations in their mood, but in bipolar disorder these changes can be very distressing and have a big impact on your life. You may feel that your high and low moods are extreme, and that swings in your mood are overwhelming.

Depending on the way you experience these mood states, and how severely they affect you, your doctor may diagnose you with a particular type of bipolar disorder (see ‘What types of bipolar disorder are there?’).

“It’s an emotional amplifier: when my mood is high I feel far quicker, funnier, smarter and livelier than anyone; when my mood is low I take on the suffering of the whole world”

Bipolar disorder or manic depression?

The term ‘bipolar’ refers to the way your mood can change between two very different states – mania and depression. In the past, bipolar disorder was referred to as manic depression, so you might still hear people use this term. Some health care professionals may also use the term ‘bipolar affective disorder’ (affective means the disorder relates to mood or emotions).

Manic episodes

Having a manic episode can sometimes feel exciting and fun, but it can also feel distressing, disorientating or unpleasant. Here are some things you might experience during a manic episode:

How you might feel? How you might behave?
  • Happy, euphoric or a sense of wellbeing
  • Uncontrollably excited, like you cannot get your words out fast enough
  • Irritable and agitated
  • Increased sexual energy
  • Easily distracted, like your thoughts are racing, or you cannot concentrate
  • Very confident or adventurous like you are special or understand things other people do not
  • Like you are untouchable or cannot be harmed
  • Like you can perform physical and mental tasks better than normal
  • More active than usual
  • Talking a lot, speaking very quickly, or not making sense
  • Being very friendly
  • Saying or doing things that are inappropriate and out of character
  • Sleeping very little or not at all
  • Being rude or aggressive
  • Misusing drugs or alcohol
  • Spending money excessively and inappropriately
  • Losing social inhibitions
  • Taking serious risks with your safety

After a manic episode, you might:

  • Feel very unhappy or ashamed about how you behaved
  • Have made commitments or taken on responsibilities that now feel unmanageable
  • Have only a few clear memories of what happened while you were manic, or none at all

“The hardest thing to explain is the racing thoughts when I’m manic. It’s like I’ve got four brains and they’re all on overdrive… it can be scary but also euphoric at the same time.” 

Hypomanic episodes

How you might feel? How you might behave?
  • Happy, euphoric or a sense of wellbeing
  • Very excited, like you cannot get your words out fast enough
  • Irritable and agitated
  • Increased sexual energy
  • Easily distracted, like your thoughts are racing, or you cannot concentrate
  • Confident or adventurous
  • More active than usual
  • Talking a lot or speaking very quickly
  • Being very friendly
  • Sleeping very little
  • Spending money excessively
  • Losing social inhibitions or taking risks

Compared with mania, hypomanic symptoms are likely to:

  • Feel more manageable – for example, you might feel able to go to work and socialise without any major problems (although people might still notice your change in mood)
  • Last for a shorter time
  • Not include any psychotic symptoms

On the surface, this description might make it seem like hypomania is less serious than mania, but in reality that is often not the case. A hypomanic episode can still have a significant impact on your life and can be very difficult to cope with.

“On ‘up’ days I chatter 19 to the dozen with anyone to the point it annoys people, and I can’t stay still”

Depressive episodes

Here are some things you might experience during a depressive episode: 

How you might feel? How you might behave?
  • Down, upset or tearful
  • Tired or sluggish
  • Not finding enjoyment in things
  • Low self-esteem and lacking in confidence
  • Guilty, worthless or hopeless
  • Agitated and tense
  • Suicidal
  • Not doing things you normally enjoy
  • Having trouble sleeping or sleeping too much
  • Eating too little or too much
  • Misusing drugs or alcohol
  • Being withdrawn or avoiding people
  • Being less physically active than usual
  • Self-harming or attempting suicide

Many people find that a depressive episode can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper. 

Psychotic symptoms

Psychotic symptoms can include delusions, such as paranoia, and hallucinations, such as hearing voices.

Not everyone with a diagnosis of bipolar disorder experiences psychosis, but some people do. It is more common during manic episodes, but can happen during depressive episodes too. These kinds of experiences can feel very real to you at the time, which may make it hard to understand other people’s concerns about you.

“Then [with mania] comes the paranoia, the shadows, the voices, the thought someone is behind me following me everywhere I go, ready to get me.”

Mixed episodes

Mixed episodes (also called ‘mixed states’) are when you experience symptoms of depression and mania or hypomania at the same time. This can be particularly difficult to cope with, as:

  • It can be harder to work out what you are feeling
  • It can be harder to identify what help you want
  • It might feel even more challenging and exhausting to manage your emotions
  • You may be more likely to act on suicidal thoughts and feelings
  • Your friends, family or doctor might struggle to know how they can support you best

“The mixed episodes are the worst. The most unpredictable and most dangerous ones, I find them difficult to explain.”

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