Bipolar Disorder: Mood Episodes, Diagnosis and Long-Term Care
Bipolar disorder affects mood, energy, activity and functioning. It is more than ordinary changes in mood during a difficult day. Episodes can include mania, hypomania and depression, with patterns that differ between people.
Treatment can help people manage symptoms and live fulfilling lives. The earlier version of this article incorrectly promised that all symptoms could be cured and described bipolar II as simply a milder illness. Bipolar disorder usually needs ongoing care, and bipolar II can cause substantial difficulties.
Mania, hypomania and depression
Mania
A manic episode involves an unusually elevated or irritable mood and increased energy or activity that represents a marked change from the person’s usual state. Signs can include needing much less sleep, racing thoughts, speaking rapidly, feeling unusually powerful or important, and making impulsive or risky decisions.
Mania can severely disrupt work, relationships or safety and may require hospital care. A person may feel exceptionally well and not recognize that they need help. This does not make the episode harmless.
Hypomania
Hypomania involves similar changes but is less severe than mania and does not cause the same degree of impairment. It can still matter clinically and may be overlooked, especially when someone seeks help mainly during depression. Feeling productive for a day is not enough to establish hypomania.
Depressive episodes
Depression can involve low mood or loss of interest, fatigue, changes in sleep or appetite, difficulty concentrating, hopelessness and thoughts of death or suicide. Some episodes have mixed features, meaning symptoms associated with elevated mood and depression occur together.
Severe manic or depressive episodes can include psychosis, such as hallucinations or delusions. Psychosis is not a feature of every episode or every person with bipolar disorder.
How the main diagnoses differ
- Bipolar I: defined by at least one manic episode. Depressive episodes commonly occur too, but a prior depressive episode is not required for this diagnosis.
- Bipolar II: involves hypomanic and major depressive episodes without a history of mania. “II” does not mean that its effects on someone’s life are minor.
- Cyclothymic disorder: a persistent pattern of fluctuating hypomanic and depressive symptoms that do not meet the full requirements for those episodes.
- Other specified or unspecified bipolar and related disorders: terms used for clinically important presentations that do not fit the main categories.
A qualified clinician assesses duration, severity and the course over time. Do not use this list to diagnose yourself or label someone else.
What causes bipolar disorder?
The exact cause is not fully understood. Research points to genetic influences and differences in brain structure and function, with stressful experiences potentially contributing in people who are susceptible. Having a close relative with bipolar disorder increases risk but does not determine that someone will develop it.
Some medical conditions and substances can mimic or worsen mood symptoms. They need to be considered during assessment rather than assuming that every change in energy is bipolar disorder. A simple “chemical imbalance” explanation cannot describe an individual’s illness.
What an assessment looks at
A clinician may ask about earlier periods of unusually high energy, reduced need for sleep, depression, family history, medicines and substance use. Medical assessment can help rule out other causes. With your agreement, observations from someone who knows you well may add useful context.
Bring a short timeline, especially if earlier high-energy periods felt positive and you had not thought to mention them. For children and teenagers, specialist assessment is particularly important; irritability or tantrums alone do not establish bipolar disorder.
Treatment and follow-up
Medication and psychological therapies are central treatment options. Mood stabilizers and some antipsychotic medicines may be used, with the choice depending on the episode, medical history and longer-term plan. Some medicines require blood tests or other monitoring.
Antidepressants should not be used alone to treat bipolar disorder because they can trigger mania or rapid cycling in some people. If you are already taking one and have concerns, contact the prescriber rather than stopping abruptly. Discuss side effects and any pregnancy plans before changing medication.
Therapy can help with understanding episodes, relationships, routines and coping strategies. More intensive treatments may be considered for severe episodes. Ask what the plan is for an acute episode and what will help prevent recurrence.
Make an early-warning plan
With your care team, identify changes that have preceded episodes, such as reduced sleep or rising activity. A brief mood and sleep record may help. Agree on whom to contact, how quickly and what support trusted people can offer.
Regular sleep and daily routines, taking treatment as directed and avoiding alcohol or recreational drugs can support care. They do not replace prescribed treatment. Review the plan when you are relatively well, when it may be easier to discuss preferences.
When to seek urgent help
Contact the care team urgently for a marked change in sleep, energy, judgment or behavior, especially if symptoms are escalating. New psychotic symptoms, inability to care for basic needs or behavior that puts someone at risk require urgent assessment.
Need urgent support? If you may harm yourself or cannot stay safe, get immediate help. In the US, call or text 988; call emergency services for immediate danger. Outside the US, use your local crisis or emergency service. You do not need to wait for a routine appointment.
Source: National Institute of Mental Health: bipolar disorder. Related reading: understanding depression and seeking treatment.
Editorial update: October 1, 2026. General information, not a diagnosis or individual treatment plan. This article has not been presented as clinically reviewed. Send corrections through our Contact Us page.