In bipolar disorder, episodes of symptoms alternate with virtually symptom-free periods (remissions).
Episodes last anywhere from a few weeks to three (3) to six (6) months.
Cycles – time from onset of one episode to that of the next – vary in length. Some individuals have infrequent episodes, perhaps only a few over a lifetime, whereas others have four or more episodes each year (called rapid cycling). Despite this large variation, the cycle time for each individual is relatively consistent.
Episodes consist of depression, mania, or less severe mania (hypomania). Only a minority of individuals alternate back and forth between mania and depression during each cycle. In most, one or the other predominates to some extent.
Individuals with bipolar disorder may attempt or commit suicide. Over their lifetime, they are at least 15 times more likely to commit suicide than the general population.
Depression in bipolar disorder resembles depression that occurs alone.
Individuals feel excessively sad and lose interest in their activities.
- They think and move slowly and may sleep more than usual.
- Their appetite may be increased or decreased, and they may gain or lose weight.
- They may be overwhelmed with feelings of hopelessness and guilt.
- They may be unable to concentrate or to make decisions.
Psychotic symptoms (such as hallucinations and delusions) are more common in depression that occurs in bipolar disorder than in depression that occurs alone.
Episodes of mania end more abruptly than those of depression and are typically shorter, lasting a week or longer.
Individuals feel exuberant, energetic, and elated or irritable. They may also feel overly confident, act or dress extravagantly, sleep little, and talk more than usual. Their thoughts race.
They are easily distracted and constantly shift from one theme or endeavour to another. They pursue one activity (such as risky business endeavours, gambling, or dangerous sexual behaviour) after another, without thinking about the consequences (such as loss of money or injury).
However, individuals often think that they are in their best mental state.
Individuals lack insight into their condition. This lack plus their huge capacity for activity can make them impatient, intrusive, meddlesome, and aggressively irritable when crossed. As a result, they may have problems with social relationships and may feel that they are being treated unjustly or are being persecuted.
Some individuals have hallucinations, hearing and seeing things that are not there.
Manic psychosis is an extreme form of mania. Individuals have psychotic symptoms that resemble schizophrenia. They may have extremely grandiose delusions, such as of being Jesus. Others may feel persecuted, such as being pursued by the police/authorities.
Activity level increases markedly. Individuals may race about and scream, swear, or sing. Mental and physical activity may be so frenzied that there is a complete loss of coherent thinking and behaviour (delirious mania), causing extreme exhaustion.
Individuals so affected require immediate treatment.
Hypomania is not as severe as mania.
Individuals feel cheerful, need little sleep, and are mentally and physically active.
For some individuals, hypomania is a productive time. They have a lot of energy, feel creative and confident, and often function well in social situations. They may not wish to leave this pleasurable state.
However, other individuals with hypomania are easily distracted and easily irritated, sometimes resulting in angry outbursts. They often make commitments that they cannot keep or start projects that they do not finish. They rapidly change moods.
They may recognise such effects and be bothered by them, as are the people around them.
When depression and mania or hypomania occur in one episode, individuals may momentarily become tearful in the middle of elation, or their thoughts may start racing in the middle of depression.
Often, individuals go to bed depressed and wake early in the morning and feel elated and energetic.
The risk of suicide during mixed episodes is particularly high.