What it is
Bipolar disorder involves shifts between mood “highs” and lows:
- Mania or hypomania: periods of unusually elevated or irritable mood with increased energy and activity.
- Depression: periods of low mood, low energy, and loss of interest.
Bipolar I includes at least one manic episode. Bipolar II includes hypomanic episodes (a milder, shorter “up” period) and depressive episodes. Cyclothymic disorder involves chronic, fluctuating milder highs and lows. Bipolar is treatable, and many people live full, stable lives with care.
Signs and symptoms
- Mania (several days to weeks):
- Elevated/irritable mood, decreased need for sleep, rapid speech, racing thoughts
- Increased goal-directed activity, impulsive or risky choices (spending, sex, travel, substances)
- Inflated confidence or grandiosity; distractibility
- Severe mania can include psychosis (hallucinations or delusions)
- Hypomania (days): similar to mania but less severe; may feel productive or creative, but still disruptive for some
- Depression (2+ weeks): low mood, low energy, sleep/appetite changes, poor focus, hopelessness, thoughts of self-harm
Note: ADHD, anxiety, and substance use can overlap and complicate diagnosis. Evaluation by a clinician is important, especially before starting antidepressants.
Why it happens
- Biology: strong genetic contribution; brain circuit differences in mood regulation and sleep/circadian systems
- Triggers: sleep loss, jet lag, substances, major stressors, some medications
- Life patterns: irregular routines can destabilize mood
What helps
- Daily stability skills:
- Keep a regular sleep–wake schedule; protect sleep consistency
- Monitor early warning signs (reduced sleep need, racing ideas, overspending)
- Limit alcohol/recreational drugs; be careful with caffeine/energy drinks
- Use a mood/sleep tracker to spot patterns early
- Therapies:
- Psychoeducation and relapse prevention planning
- CBT and Interpersonal and Social Rhythm Therapy (IPSRT) to stabilize routines
- Family-focused therapy to improve communication and support
- Medications (cornerstone of treatment):
- Mood stabilizers: lithium, lamotrigine, valproate, and certain atypical antipsychotics
- Antidepressants are used cautiously and typically alongside a mood stabilizer
- Discuss benefits/risks, lab monitoring (e.g., lithium levels, thyroid, kidneys), and pregnancy considerations
- Crisis planning:
- Identify supporters, early-warning signs, and when to call your clinician
- Consider safety steps for finances (spending limits, alerts) during highs
When to seek help now
- New or worsening manic/hypomanic symptoms
- Depression with thoughts of self-harm or suicide (seek urgent help)
- Severe changes in behavior, psychosis, or inability to sleep for days
How to talk to a clinician
- “I have periods of high energy, little sleep, fast speech, and risky spending followed by crashes. I’d like an evaluation for bipolar disorder and to discuss mood-stabilizing treatments.”
Outlook
With the right plan—medication, therapy, sleep routines, and support—most people reduce episode frequency and severity and regain stability.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline (call/text 988); Crisis Text Line (text HOME to 741741); Veterans: 988 then 1; The Trevor Project (LGBTQ+ youth): 1-866-488-7386 or text START to 678678
- Find care: FindTreatment.gov; Psychology Today directory; NAMI HelpLine (nami.org/help); Depression and Bipolar Support Alliance: dbsalliance.org
- Low-cost/community: Open Path Collective; Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Verify in-network mental health benefits, deductible, copay/coinsurance, telehealth coverage, prior authorization, out-of-network reimbursement, out-of-pocket max; note rep name/date/reference number
- Work/school supports: FMLA, ADA accommodations (e.g., flexible scheduling), EAP; campus counseling
- Urgent options besides ER: Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.