Bipolar disorder, also known as manic-depressive illness, is a mental illness characterized by extreme moods that include mania, or extremely ‘high’ moods, and major depression, or extremely ‘low’ moods. The person’s mood usually swings from overly ‘high’ and irritable, to sad and hopeless and then back again with periods of normal mood in between. Episodes can last days, weeks, months or in some cases, even years.

Over the course of bipolar disorder, four different kinds of mood episodes can occur:

Symptoms of mania (manic episode) include:

  • Increased energy, activity, restlessness, racing thoughts, and rapid talking
  • Excessive ‘high’ or euphoric feelings
  • Extreme irritability and distractibility
  • Decreased need for sleep
  • Unrealistic beliefs in one’s abilities and powers
  • Uncharacteristically poor judgment
  • A sustained period of behaviour that is different than usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behaviour
  • Denial that anything is wrong
  • Hypomania (hypomanic episode) is a milder form of mania with similar but less severe symptoms. Hypomania is often followed by a worsening of symptoms to mania, or a crash to depression.

Symptoms of depression (depressive episode) include:

  • Persistent sad, anxious or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness or helplessness
  • Loss of interest or pleasure in ordinary activities, including sex
  • Decreased energy, a feeling of fatigue or of being ‘slowed down’
  • Difficulty concentrating, remembering and making decisions
  • Restlessness or irritability
  • Sleep disturbances
  • Loss of appetite, weight loss or weight gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical disease
  • Suicidal thoughts or suicide attempts

In a mixed episode, symptoms of mania and depression are present at the same time. People may be agitated or excitable but may also feel irritable and depressed. Mixed episodes carry the greatest risk of suicide.

People vary in the types and number of episodes they have. Some people have equal numbers of manic and depressive episodes while others have mostly one type or the other. Women are more likely to start with a manic episode, men with a depressive episode.

The following terms are used to describe common patterns of symptoms of Bipolar Disorder:

  • Bipolar I: a person has mixed or manic episodes and almost always has depression as well.
  • Bipolar II: a person has only hypomanic and depressive episodes, not full manic or mixed episodes.
  • Rapid–cycling bipolar disorder: a person has at least four episodes each year, in any combination of manic, hypomanic, mixed or depressive episodes. Rapid–cycling bipolar disorder can be difficult to treat and affects approximately 13-20% of people with bipolar disorder