The Ups and Downs of Bipolar

Bipolar disorder manic and depressive symptoms

/ Author:  / Reviewed by: Robert Carlson, M.D

Bipolar disorder, characterized by a tricky combination of extreme highs and extreme lows, can be a difficult and confusing disorder to manage. Symptoms can seem contradictory and may be difficult to identify as part of one larger problem or condition. And according to the University of Maryland Medical Center (UMMC), "Although chemical imbalances in the brain are a key component of bipolar disorder, it is a complex condition that involves genetic, environmental, and other factors."

Understanding the nature of the extremes that make up bipolar disorder and how they can show up in patients is an important step in coping. Knowing the ins and outs of both "up" and "down" symptoms can help patients with this condition and their loved ones better manage daily life.  

Mood Episodes

According to the National Institute of Mental Health (NIMH), bipolar disorder is characterized by distinct, intense periods of different emotional states called mood episodes.

On the one hand are "up" states, or mania, during which patients may be overly excited, euphoric or irritable.

The "down", or depressive, states consist of feelings of intense sadness and hopelessness.

Mixed episodes which contain symptoms of both are also possible.  

Regardless of what type of episode is at play at a given moment, "People with bipolar disorder also may be explosive and irritable during a mood episode," reports NIMH. 

These mood episodes are not always completely cut and dried.  In some patients there may not be clear cut periods of highs and clear cut periods of lows, but rather long periods consisting of highly unstable moods.  

Manic Highs

According to UMMC, the manic phase is largely characterized by feelings of "exaggerated euphoria" mixed with irritability. However, there are also other, perhaps less obvious symptoms of a manic mood episode.

One such symptom is distractibility.  Patients coping with a manic episode may have difficulties focusing on one thing for an extended period of time, and may jump quickly from one thing to another.

This distractibility can express itself in a more physical sense, such as jumping between different actions or activities. It can also manifest in terms of thought or speech patterns, as racing thoughts is another symptom of mania. Patients may talk excessively and speak very quickly.

Bipolar patients experiencing a manic episode might also display the symptom of grandiosity, in which they may have an extremely inflated and even delusional sense of self.  

According to UMMC, "Close to 60% of all manic patients experience feelings of being all-powerful. Sometimes they feel that they are godlike or have celebrity status."

Patients often become more interested and intensely focused on goal-oriented activities.  This symptom can show itself in many different ways.  Some patients may take on too many projects at work, others may become intensely focused on school, while others express intense goal orientation through sexuality or social situations.

Patients in a manic phase often also become more risky and impulsive.  This symptom can include "Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex and impulsive business investments," reports NIMH.

Insomnia is another symptom of mania, but UMMC takes care to note that insomnia can also be a symptom of a depressive mood episode, depending on the nature of the inability to sleep.

"Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep)," explains UMMC.

Depressive Lows

When bipolar patients enter a depressive mood episode, the symptoms can be very similar to those common in non-bipolar patients suffering from major depression.

Patients may feel excessively sad, in a way that measures beyond normal sensations of occasionally feeling down.  Often feelings of sadness are accompanied by feelings of pessimism about the future, guilt, hopelessness or low self-esteem, reports UMMC. 

Depressive episodes are also often characterized by fatigue and tiredness, and patients may experience sleeping changes.  As mentioned before, this can include insomnia, difficulties staying asleep or problems sleeping too much.

Patients often display a loss of interest in activities they typically enjoy, including sex or taking part in social situations.

Some patients are unable to concentrate or focus, and decisions may seem incredibly difficult to make.

Some may even think about or attempt suicide during a depressive mood episode.  

While symptoms of a bipolar depressive episode are similar to other cases of depression, there are some differences.  

For one, UMMC reports that "Bipolar depression typically lasts 2-3 months – not as long as in major depression (although left untreated, some bipolar disorder episodes can last 6-12 months or longer)."  

These episodes may also develop more slowly over time than is the case in non-bipolar depression.

Finding a Middle Ground

Though the extreme highs and lows of bipolar disorder can be dizzying, understanding the nature of the distinct symptoms is an important step in coping with the condition.  

"Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices," reports NIMH, "Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments."

As patients, loved ones and their doctors all work together to understand and identify the ups and downs of these symptoms, progress can be made to help each individual patient manage a healthy life in the middle ground.

Reviewed by: 
Review Date: 
February 23, 2013
Last Updated:
October 25, 2013