Understanding Bipolar Disorder: Signs, Symptoms, and Treatment

Bipolar disorder is a mental health condition that affects a person's mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that usually fall into two categories: manic (high) episodes and depressive (low) episodes. These mood swings are very different from the typical ups and downs most people feel, and they can severely affect a person’s life if left untreated.

Although bipolar disorder is a long-term condition, effective treatment and support can help people manage symptoms and lead fulfilling lives.

Bipolar disorder is sometimes called “manic depression” because it involves episodes of mania and depression. These mood episodes can last for days, weeks, or even months and often cause serious disruptions in work, relationships, and daily life.

There are different types of bipolar disorder:

• Bipolar I disorder involves at least one episode of mania, often followed by periods of depression.
   
• Bipolar II disorder involves at least one episode of hypomania (a milder form of mania) and one or more episodes of major depression.
   
• Cyclothymic disorder involves frequent mood swings that don’t meet the full criteria for mania or depression but still cause disruption.
   
• Other specified or unspecified bipolar disorders may be diagnosed when symptoms don’t fit neatly into the above categories but still cause significant impairment.
   

Bipolar disorder affects about 1 in 50 Australians at some point in their lives. It affects people of all backgrounds and genders and often begins in the late teens to early adulthood.

While anyone can develop bipolar disorder, some risk factors include:

• A family history of bipolar or other mood disorders
   
• A history of early-life trauma or abuse
   
• Sleep disruption or irregular sleep patterns
   
• Substance use, particularly stimulants or cannabis
   
• Periods of high stress or major life changes
   

During a manic episode, a person may feel unusually energetic, elated, or irritable. They may have an inflated sense of self-confidence or grandiosity, thinking they are invincible or destined for greatness. Common signs include:

• Elevated mood: Feeling euphoric, overly happy, or “high”
   
• Increased energy: Needing less sleep but feeling very alert
   
• Fast speech and racing thoughts: Talking quickly or jumping between topics
   
• Impulsivity: Spending sprees, reckless driving, or risky sexual behaviour
   
• Distractibility: Easily sidetracked by minor things
   
• Unrealistic plans: Taking on big projects or goals with little preparation
   
• Poor judgment: Making decisions without considering the consequences
   

In more severe cases, mania can lead to psychosis, where a person loses touch with reality. They may experience delusions (false beliefs) or hallucinations (seeing or hearing things that aren’t there).

Hypomania is a milder version of mania. It shares many of the same features—like elevated mood, increased energy, and reduced need for sleep—but is less extreme. People with hypomania can often still function in daily life, though their behaviour may be unusual or out of character.

Hypomania can be harder to recognise, especially because it can feel pleasant or productive. However, it often precedes or alternates with depressive episodes, which makes it important to treat.

A depressive episode in bipolar disorder can feel very similar to major depression. Symptoms include:

• Feeling sad, hopeless, or empty
   
• Loss of interest in activities
   
• Fatigue or low energy
   
• Trouble concentrating
   
• Sleep problems (too much or too little)
   
• Changes in appetite or weight
   
• Thoughts of death or suicide
   

For some people, depression is the more prominent symptom of bipolar disorder. These episodes can be severe and last weeks or months, especially without treatment.

Bipolar disorder is not just about having “highs and lows.” People can spend long periods in a stable mood between episodes, or they may experience rapid cycling, where four or more mood episodes occur in a year.

Some people also experience mixed features, where symptoms of depression and mania happen at the same time. For example, someone may feel very sad but also restless and agitated, with racing thoughts and little need for sleep. These mixed states can be particularly distressing and increase the risk of suicide.

Diagnosing bipolar disorder is not straightforward. There’s no single test or brain scan that can confirm it. Instead, a psychiatrist will assess a person’s symptoms, history, and mood patterns over time.

To diagnose bipolar I disorder, there must be at least one manic episode lasting at least a week (or requiring hospitalisation), with or without depressive episodes. For bipolar II disorder, there must be at least one hypomanic and one depressive episode, but no full manic episode.

Diagnosing bipolar disorder can take time. Sometimes, people seek help during a depressive episode and are misdiagnosed with unipolar depression. Only later—when they have a manic or hypomanic episode—is the full picture understood.

Because symptoms of bipolar disorder can overlap with other conditions, it’s important for clinicians to rule out:

• Unipolar depression
   
• Borderline personality disorder
   
• Substance-induced mood changes
   
• ADHD (especially in children and adolescents)
   
• Medical conditions like thyroid problems or neurological disorders
   

A thorough psychiatric assessment, along with input from family or close contacts, helps clarify the diagnosis.

Bipolar disorder is a long-term condition, but with the right treatment, many people recover well. The goal of treatment is to reduce the frequency and severity of mood episodes, improve functioning, and prevent relapse.

Treatment usually involves a combination of:

Medication is central to managing bipolar disorder. Common types include:

• Mood stabilisers: such as lithium, which helps prevent both mania and depression.
   
• Antipsychotics: especially in acute mania or when psychosis is present.
   
• Anticonvulsants: like valproate or lamotrigine, used to stabilise mood.
   
• Antidepressants: may be used cautiously, usually in combination with a mood stabiliser, due to the risk of triggering mania.
   

Choosing the right medication depends on the individual’s symptoms, history, and side effect profile. Treatment is often long-term, and stopping medication suddenly can lead to relapse.

Talking therapies can help people understand their condition, recognise warning signs of mood changes, and develop coping strategies. Helpful therapies include:

• Cognitive Behavioural Therapy (CBT)
   
• Psychoeducation: learning about bipolar disorder and how to manage it
   
• Interpersonal and Social Rhythm Therapy: focuses on improving daily routines and sleep patterns
   
• Family therapy: involving loved ones in support and planning
   

Therapy is often most effective when combined with medication.

Certain lifestyle habits can help reduce mood episodes:

• Maintaining a regular sleep schedule is crucial—sleep disruption is a common trigger for mania.
   
• Avoiding drugs and alcohol, which can worsen symptoms or interfere with medication.
   
• Reducing stress through mindfulness, exercise, or support groups.
   
• Routine: Having a daily structure can help stabilise mood.
   

Many people also benefit from mood tracking, using journals or apps to identify early signs of mood shifts and act early.

Living with bipolar disorder can be challenging, but many people live stable, fulfilling lives with the right support. The key is early diagnosis, ongoing treatment, and supportive relationships.

It’s important to treat bipolar disorder like any other chronic health condition—there may be setbacks, but with consistency and care, people can recover and thrive.

Support from family, friends, clinicians, and peer networks plays a vital role. Many people also find it helpful to connect with others who live with bipolar disorder, through online forums or peer-led groups.

Bipolar disorder carries a higher risk of suicide, especially during depressive or mixed episodes. 

Warning signs include:

• Talking about death or suicide
   
• Withdrawing from loved ones
   
• Sudden mood changes
   
• Feelings of hopelessness
   

For further support please, see the emergency contacts section of this website.

Bipolar disorder is a serious but treatable mental health condition. It involves changes in mood, energy, and thinking that can significantly impact a person’s life. But with accurate diagnosis, personalised treatment, and strong support systems, people with bipolar disorder can manage their condition and live well.