Bipolar Disorder Symptoms and the Treatment Process

What are the symptoms of bipolar disorder, and how does it differ from mood swings? Learn about manic and depressive episodes, warning signs and treatment.

"I'm so happy today, so unhappy tomorrow; I must be bipolar." This sentence, which we hear more and more on social media and in everyday conversation, can overshadow what bipolar disorder actually is. Moods that change during the day are something we all experience. Bipolar disorder, on the other hand, is a serious but treatable mental health condition that runs with mood episodes lasting days, weeks or even months, markedly changing a person's energy, sleep, thoughts and behaviour. With the right diagnosis and regular treatment, many people who receive this diagnosis can keep working, maintain their relationships and carry on with their life plans. In this article we explain the symptoms of bipolar disorder, what manic and depressive episodes look like, the causes, the treatment process and the place of psychotherapy in it.

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder in which a person's mood changes between two extremes in distinct episodes. One of these extremes is mania, or its milder form hypomania; the other is depression. It used to be called "manic-depressive disorder" as well.

Between episodes, the person's mood often returns to its usual level. In other words, the person is not ill all the time; symptoms appear in certain periods, and with appropriate treatment these episodes can be brought under control and their frequency and severity reduced.

Main Types

• Bipolar I disorder: At least one full manic episode has occurred. Depressive episodes often accompany it too.
• Bipolar II disorder: There are hypomanic episodes and marked depressive episodes, but no full manic episode. Depressive episodes are usually longer and more wearing.
• Cyclothymia: Ongoing mood fluctuations lasting at least two years that do not fully meet the criteria for hypomania and depression.

Determining which type is involved requires a detailed psychiatric assessment. The distinction between types also guides how the treatment plan is shaped.

How It Differs From Ordinary Mood Swings

Getting irritated and then calming down within a day, being elated after good news or sad after bad news are ordinary emotional reactions. In this disorder, however, the change:

• is experienced in episodes lasting days or weeks,
• affects not only mood but also sleep, energy, speed of thought and behaviour,
• is clearly different from the person's usual self and is noticed by those around them too,
• can have serious consequences for work, school, relationships or finances.

What Are the Symptoms of Bipolar Disorder?

Symptoms of Manic and Hypomanic Episodes

During a manic episode, the person experiences an unusually elevated, euphoric or extremely irritable mood. The following symptoms may accompany this:

• A marked decrease in the need for sleep: Feeling energetic on a few hours of sleep. This is one of the most important early warning signs.
• Excessive energy and activity: Rushing non-stop from one job to another, starting many projects at once.
• Racing thoughts: Jumping quickly from one subject to another, thoughts flowing too fast to keep up with.
• Fast, unstoppable speech: Not allowing interruption, talking a great deal.
• Grandiose thoughts: Believing you have special abilities, powers or missions.
• Risky behaviour: Making large purchases without thinking, taking on debt, sudden career decisions, dangerous driving.
• Distractibility and impatience.

When mania becomes severe, the person may lose touch with reality and hospital treatment may be needed. Hypomania is a milder form of similar symptoms; the person often continues to function and may even feel more productive and creative than ever. For this reason hypomanic episodes often go unnoticed or are remembered as "a really good period".

Symptoms of Depressive Episodes

• Low mood, emptiness or hopelessness lasting most days
• Loss of the capacity to enjoy things
• Low energy, fatigue, slowing down of movement
• Insomnia or sleeping too much, changes in appetite
• Feelings of worthlessness and guilt
• Difficulty concentrating and making decisions
• Thoughts of death or ending your life

For more information about the depressive episode, you can look at our article on symptoms of depression.

Episodes With Mixed Features

In some people, symptoms of mania and depression can appear together in the same period: for example, deep hopelessness together with intense restlessness, racing thoughts and insomnia. These mixed episodes can be particularly difficult and risky, so they need to be monitored closely.

Causes and Risk Factors

This mood disorder has no single cause. Research shows that several factors play a part together.

• Genetic predisposition: Bipolar disorder is known as one of the mental health conditions with strong family transmission. However, having this diagnosis in the family does not mean a person will necessarily experience it.
• Brain function: Differences in the brain systems that regulate mood, energy and sleep play a role.
• Biological rhythms: Disruptions to the sleep-wake cycle can trigger episodes. For this reason sleep routine is one of the most critical parts of treatment.
• Stressful life events: Major life events such as losses, breakups, job changes and childbirth can start an episode in people who are predisposed.
• Substance and alcohol use: It can trigger and worsen symptoms and make treatment harder.

Delays in Diagnosis and Stigma in Daily Life

Bipolar disorder often begins in late adolescence or young adulthood. But the diagnosis may be made only years later. An important reason for this is that people usually seek help during a depressive episode, while hypomanic episodes are not seen as a problem. In this case the person may receive only a diagnosis of depression, and their treatment may not cover the whole picture. For this reason, it is important during assessment to ask whether there were periods in the past that were "very energetic, with little sleep and a lot of spending".

In Turkey, stigma towards mental illness can delay people living with this diagnosis, and their families, in seeking help. Fear of stigmatising labels such as "mad" can lead a person to hide their diagnosis or stop treatment. Yet bipolar disorder is a health condition that needs regular follow-up, like diabetes or hypertension.

Present-day conditions can also increase some risks. Online shopping and one-click credit, and apps such as cryptocurrency and online betting, can worsen the consequences of impulsive spending during a manic episode. Debts that arise in a high cost-of-living environment can make the depressive episode that follows even heavier. Screen use late into the night, shift work and long working hours can disrupt the sleep routine and trigger episodes.

Practical Steps for Living With Mood Swings

The suggestions below are no substitute for treatment; when applied together with the treatment planned by your psychiatrist, they help support balance.

1. Protect Your Sleep Routine

Going to bed and getting up at similar times every day is one of the most powerful protective habits. Avoid long night shifts, all-night parties and sleepless journeys as far as possible. Noticing that your need for sleep has suddenly dropped can be an early warning sign.

2. Keep a Mood Diary

Briefly note down your mood, hours of sleep, energy level and important events each day. This record lets you see under what conditions episodes begin and share clearer information with your doctor. A simple method is to rate each day from minus five to plus five: zero is your usual state, positive values show elevation and negative values show low mood. After a few months, these scores map out your own fluctuations.

3. Identify Your Personal Early Warning Signs

Everyone's signs before an episode are different: for some it is talking a lot, for some cleaning at night, for some a sudden urge to shop or withdrawal. Write these signs down as a list and share it with a relative you trust.

4. Prepare a Crisis Plan

During a calm period, prepare a plan covering what to do when symptoms start: who will be told, how your doctor can be reached, who will temporarily keep your credit cards, and so on. This plan makes decisions easier once an episode begins.

5. Don't Stop Treatment on Your Own

It is common to think treatment is unnecessary when you feel well. But any change to treatment must be made only after talking to your doctor.

6. Stay Away From Alcohol and Substances

Alcohol and substances can upset mood balance, trigger episodes by disrupting the sleep routine and reduce the effect of treatment. Preparing a short sentence in advance for when you face the "one drink won't hurt" pressure in social settings makes things easier.

7. Make an Early Warning Agreement With Your Loved Ones

At the start of an episode, the person often does not notice the change themselves; hypomanic episodes in particular can make a person feel very good. For this reason it helps to make an agreement with one or two people you trust during a calm period. Say your partner notices that for the last few nights you haven't slept until three, that you've spoken of three new business ideas at once and that you've been looking at expensive equipment online. Thanks to an agreement made beforehand, they can remind you in a non-blaming way, for example by saying "I'm seeing some of the signs we talked about, shall we call your doctor?" An agreement like this works not like criticism but like a safety net built together, and lets the person feel they have a say in their own treatment.

The strongest protection against mood episodes is recognising the symptoms early and having a plan prepared before an episode begins.

When Should You Seek Professional Support?

In the following situations it is recommended that you see a psychiatrist without delay:

• If you don't feel tired despite sleeping little for days, and your thoughts and speech are speeding up,
• If you notice unusually large purchases, risky decisions or behaviour,
• If you have had deep depressive episodes after "very energetic" periods in the past,
• If, while receiving treatment for depression, you or those around you notice unusual speeding up, restlessness or overexcitement.

Diagnosis and medication for bipolar disorder are the domain of a psychiatrist. We explained the roles of a psychologist and a psychiatrist in our article on the difference between a psychologist and a psychiatrist.

Emergencies: If there is a risk that the person may harm themselves or others, if thoughts of ending their life have intensified or if their contact with reality is markedly disturbed, call 112 (Turkey's emergency services) without any delay or go to the nearest emergency department.

The Place of Psychotherapy in Treatment

The main treatment in bipolar disorder is medication led by a psychiatrist. Psychotherapy is an important support that complements this treatment and helps reduce the recurrence of episodes and improve quality of life. Psychotherapy work in the area of depression and mood is carried out in cooperation with the doctor.

Psychoeducation

The person and their family understanding the illness, its symptoms, triggers and the treatment process is the cornerstone of therapy. Knowledge both reduces the feeling of stigma and makes early intervention easier.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is used especially for coping with depressive episodes, recognising early warning signs and developing skills that slow down impulsive decisions. The person's thoughts about the diagnosis, such as the belief "Nothing will ever be the same again", are also addressed.

Rhythm and Routine Work

Regularising the times of sleep, meals, work and social activity supports biological rhythms. This approach is based on the knowledge that disruptions in daily routines can trigger episodes.

Family and Couple Work

This condition affects not only the person but also their family and partner. Family members recognising the symptoms, adjusting the way they communicate and being included in the crisis plan make the process more manageable for everyone. Our article on supporting a loved one with depression may also offer ideas here.

Frequently Asked Questions

Does bipolar disorder go away completely?

It is generally a condition that requires long-term follow-up. But with regular treatment, psychotherapy and healthy routines, many people can stay balanced for long periods and carry on with their lives.

My mood changes often. Am I bipolar?

Moods that change during the day or in response to events do not on their own mean bipolar disorder. In this disorder, the changes are experienced in episodes lasting days, and markedly affect sleep, energy and behaviour. For a definite assessment, you need to see a professional.

Is bipolar disorder hereditary?

Family predisposition plays an important role. But having this diagnosis in the family does not mean a person will necessarily experience it; environmental factors and lifestyle matter too.

Can someone with this diagnosis get married and have children?

Yes, many people carry on with married life and parenthood with this diagnosis. Especially if a pregnancy is being planned, it is important to plan the treatment process in advance with the psychiatrist.

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• #mania
• #mood
• #depression

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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