Symptoms

How does it feel when you are up?
When you are at the high end of the mood spectrum, it is called "mania".
During an episode of mania, you have an abnormally high or irritable mood, which lasts for one week or longer.

If you are having a manic episode you might have any of these feelings:

• Grand ideas about yourself and your own self importance.

• ‘Flight of ideas’ – your mind is racing and you can't focus on any one idea. 

• Full of ideas and plans. 

• Irritation or agitation, especially when people don't understand your great ideas or plans.

• Increased energy and less need for sleep without feeling tired. 

• Talking very rapidly – other people have trouble keeping up with you. 

• Easily distracted - you can't concentrate and your attention is drawn to irrelevant things.

• Wanting to do fun or exciting things without thinking about the consequences. Some examples:

1. Driving recklessly
2. Drinking a lot of alcohol or taking illicit drugs
3. Spending too much money
4. Being less inhibited sexually
5. Making rash decisions, which can affect relationships, work and your health.

Hypomania
Hypomania is mania, but not as pronounced. Hypomania will not cause you problems that stop you doing your daily activities. But hypomania can easily lead to mania.

How does it feel when you are down?
Depression is not simply feeling sad or fed up with life. It's very difficult to explain to someone who has not suffered from it.  Each depressive episode for someone with bipolar disorder will last at least two weeks.

If you are having a depressive episode you might have any of these feelings:

• Low mood, feeling empty or sad, crying about things that you normally would not cry about

• Less interest or pleasure from the things you used to enjoy

• Changes in weight and appetite – losing or gaining weight

• Having no energy and always feeling tired

• Changes in your sleeping pattern – waking up during the night and finding it difficult to go back to sleep, or sleeping too much

• Feeling worthless and guilty

• Having trouble thinking, concentrating and making decisions

• Feeling unexplained aches and pains

Like in manic episodes, these feelings are so strong that they stop you from doing your day-to-day activities.

Mixed episodes
Some people have symptoms of both mania and depression at the same time.  This is called a mixed episode.  People may be agitated or excitable but may also feel irritable and depressed. 

Mixed episodes carry the greatest risk of suicide for people with bipolar disorder.  If you are having symptoms of a mixed episode, you need to make sure you discuss it with your doctor.

Psychosis
Psychosis means that you lose contact with the real world: the way you think and see things is impaired.  Sometimes it is so serious that the person loses contact with family or friends.

Psychosis can happen when you are having an episode of mania or depression. You might experience hallucinations, delusions, changes in personality or behaviour, disorganised thinking, or thoughts of death or suicide.

Psychosis can happen suddenly, or it can come on gradually.  Psychotic illnesses seem to affect women at a later age than men. Treatments tend to work better on women than on men. However, women have times when the risk of relapse tends to be greater: when they are due to get their period, after giving birth and around the time of the menopause.

What are the different types of bipolar disorder?
There are three common patterns of symptoms in people with bipolar disorder.  Each "type" is simply a name we use to describe a particular pattern of symptoms.

Bipolar I

• The patient has mixed or manic episodes 

• and almost always has depression as well.

Bipolar II

• The patient has hypomanic and depressive episodes,

• not full manic or mixed episodes.

Rapid–cycling bipolar disorder

• The patient has at least four episodes each year,

• in any combination of manic, hypomanic, mixed or depressive episodes.

• Can be difficult to treat.

• About 13-20% of people with bipolar disorder are rapid-cycling.