What are the Stages of Bipolar Disorder? I Psych Central

People with bipolar disorder experience mood swings, and these changes can come at different stages.

We all experience changing moods and have days that we think are better than others.

But if you live with bipolar disorder, those fleeting moments of good and bad days can be intense enough that they can lead to problems at work, at home, and in relationships.

Bipolar disorder can look different from person to person. Symptoms vary depending on the stage of bipolar disorder you are in.

Some people with bipolar disorder are more prone to extreme highs (mania or hypomania) or extreme lows (depression). Others might be more likely to alternate between these two extreme mood swings.

Each stage of the disease has its own unique symptoms. Treatment for bipolar disorder begins with knowing more about, and recognizing, your symptoms and triggers.

During the mania phase – also known as the manic episode – people experience periods of inflated or “high” mood. It is not uncommon to have an increased sense of creativity, energy, and happiness.

When you find yourself in a mania phase, you may find that you speak so quickly that it is difficult for people to keep up. You might also feel like you are invincible and can do anything.

Other characteristics during mania are:

  • Decreased need for sleep. Up to 99% of people with bipolar disorder sleep less during the mania phase.
  • An exaggerated sense of self-worth. Often times during manic episodes, people feel unusually gifted, important, or powerful. You may have terrific beliefs about your talents.
  • Flight of ideas. This is described as jumping from one topic to another quickly. In some cases language becomes fast and connections between ideas seem illogical.
  • Excessive energy level. Mania can cause your energy levels to rise suddenly beyond what is normal for you. This can manifest itself in the simultaneous participation in several projects.
  • Elevated mood. In the mania phase, people with bipolar disorder alternate between intense joy and irritable mood.
  • Bad judgment. Some people exhibit unusual or potentially harmful behaviors.
  • Extreme anger, irritability, and aggressiveness. Some people start arguing or beating up when others don’t agree with them.

During a mania phase, you can start multiple activities at the same time and believe that you can finish them all.

All of that energy and heightened mood can be exhausting – not just for someone with bipolar disorder, but also for their family, friends, and colleagues who are going through these phases together.

There are no laboratory tests to diagnose bipolar disorder, but three or more of these mania symptoms may be sufficient for a diagnosis, according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Mania and hypomania are two different phases of bipolar disorder with similar symptoms. However, the hypomania phase is less intense than the mania phase.

In other words, people in the hypomanic phase may experience the same symptoms of high energy and euphoria, but they are still able to work and continue their daily lives without major disruption.

Other differences are:

  • Mania is defined as lasting at least 7 days in a row while hypomania lasts for at least 4 days in a row.
  • A manic episode may require hospitalization while hypomanic episodes do not.
  • Mania can cause major problems at home and at work, while hypomania causes fewer problems with daily work.
  • Mania can trigger psychosis – an inability to distinguish reality from unreality. Not hypomania.

Hypomania involves behavioral changes such as:

  • being too talkative
  • extreme friendliness
  • Substance use
  • Loss of social inhibitions

Similar to mania, people often feel bad or ashamed of their behavior after an episode of hypomania. You may also find that the episode is followed by a period of depression.

The symptoms of the depressive phase are similar to the symptoms of major depression. This makes it difficult to diagnose bipolar disorder at this stage.

Common symptoms for both are feelings of:

  • sadness
  • worthlessness
  • hopelessness
  • blame

You may also have the following in both:

  • Trouble sleeping (too much or not enough)
  • inertia
  • Loss of interest in previously enjoyable activities
  • Suicidal thoughts
  • Weight changes
  • Difficulty concentrating

Despite the similarities between the two, there are some symptoms that are unique to the depression phase of bipolar disorder. For example, people with bipolar disorder may experience feelings of restlessness and unpredictable mood swings during the period of depression. You can also be more prone to irritability.

Because it is so difficult to tell the difference between depression and bipolar disorder, it is important to discuss both the mania and hypomania symptoms that you are suffering from and the depression.

Proper diagnosis is important in finding the right treatment plan.

Corresponding 2017 research, Mixed episodes refer to the simultaneous or sequential occurrence of symptoms of mania, hypomania, and depression.

For example, quick moments of happiness can quickly be followed by sadness or tears.

Mixed episodes (also known as mixed features) are difficult to diagnose and tend to last longer. Symptoms include:

  • Engage in enjoyable activities but feel depressed
  • agitation
  • irritability
  • Despondency with quick speech
  • increased mood, characterized by an increase in suicidal thoughts

Not all mixed episodes have these symptoms. Some present with other symptoms such as regret or low energy levels.

Typically, mood episodes occur once or twice a year. However, rapid cycling refers to someone who experiences four or more distinct stages of mania, hypomania, depression, and mixed episodes over a period of 12 months.

Fast cycling is not an uncommon phenomenon. In people with bipolar disorder approx 12-24% can experience it sometime.

Episodes are random and can last from days to weeks. They also vary in the duration and severity of symptoms.

Researchers are unsure of the exact cause of fast cycling, but experts believe it could be linked to:

If you notice you are experiencing periods of fast cycling, try to keep an eye on these episodes. You can use a journal, journal, or symptom tracking app to keep track of your symptoms and medications.

There are a few ways to track them:

  • Document moods of the day
  • Tracking of drug usage
  • Monitoring sleep patterns
  • Noting life events and stressors
  • watch out for symptoms

Keep these notes handy and prepare to discuss them with your health team the next time you visit, be it in person or online.

If you think you may have bipolar disorder, the first thing you should do is speak to a psychologist or even your family doctor. You can also start with our short quiz on bipolar disorder.

Living with bipolar disorder can be challenging and frustrating, but you are not alone.

It can be helpful to connect with others who have faced similar experiences and challenges. You can do this by:

  • Check out blogs devoted to people with bipolar disorder
  • Find a personal or online support group through the Depression and Bipolar Support Alliance
  • Contact a healthcare professional for a referral to a local group

If you know someone with bipolar disorder, here are ways to help them: How to help a loved one with bipolar disorder.

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