One cliched image of bipolar disorder shows the two Greek theater masks: one making the joyful grin beside the other with a sorrowful frown. The two masks serve to show the clear-cut extreme moods that define bipolar disorder.
“Bipolar disorder is a mental illness that involves both having had experience of a manic episode, as well as experience of depressive episodes,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
But contrary to the opposing mask symbolism, bipolar disorder might be more nuanced in real life. Manic episodes may be few and far between, and states of hypomania may fly under the radar. But catching manic symptoms is crucial because it’s arguably the most vital piece for diagnosing someone with bipolar disorder.
How to Spot a Manic Episode in Bipolar Disorder
Symptoms of bipolar disorder typically appear first during late adolescence and early adulthood, according to Dr. Samuels. This mood disorder may last a lifetime, but treatment for bipolar disorder may lessen symptoms.
The signature symptom of bipolar disorder is the presence of manic or hypomanic episodes. A true manic episodes lasts at least one week and may be severe enough to result in hospitalization, according to the National Alliance for Mental Illness.
During a manic episode, you might notice the following symptoms, according to Ben Michaelis, PhD, psychologist in New York City.
Feeling special and grandiose
Needing less sleep
Having racing thoughts
Talking more than usual
Engaging in risky behaviors, such as gambling, impulsive spending, reckless sex, or misusing drugs and alcohol
If someone has bipolar I disorder, their manic episodes may include psychosis, meaning they hear and see things that aren’t there. Someone with bipolar II disorder may not have true mania, but will often experience a more subtle form: hypomania. Learn more about the difference between bipolar I and bipolar II here.
Symptoms of a Depressive Episode in Bipolar Disorder
Although manic episodes distinguish bipolar disorder from other mental health problems, most patients tend to notice depressive symptoms first. Sometimes, people with bipolar disorder may have a hypomanic episode but not realize it—or not care because it actually feels great.
“Depression in bipolar disorder looks like major depression,” says Gail Saltz, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Just like with unipolar depression, a depressive episode of bipolar disorder may exhibit these symptoms:
Sleeping more or less than usual
Eating more or less than usual
Extended feelings of sadness, hopelessness, and worthlessness
Losing interest in things you once loved
Thinking about self-harm, death, or suicide
When Depression Becomes Bipolar Disorder
Here’s the truth: Most people with bipolar disorder feel depressed more than they feel manic. The feelings of sadness and worthlessness may seem constant and acute. For many days, their symptoms are indistinguishable from someone with major depressive disorder.
“To qualify for the diagnosis [of bipolar disorder], you only need to have ever had one manic episode in your entire life,” says Dr. Samuels. That’s important because bipolar disorder is treated differently than depression, since medications for depression may actually trigger a manic episode.
It might seem like manic episodes don’t need treatment, but severe mania can have serious consequences and be exhausting to deal with. Even hypomania, which is sometimes considered a “high-functioning” form of mania, needs treatment.
“The problem is that untreated hypomania doesn’t stay that way,” says Dr. Saltz. “It dips quickly into either severe depression or mania with psychosis—both of which are dangerous states.” Learn more about how bipolar disorder is treated.
If you’re having thoughts of self-harm or suicide, call 911, go to the nearest emergency room, or call the National Suicide Prevention Lifeline: 1-800-273-8255.
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