The symptoms of bipolar disorder can be varied, due to the different mood states that are experienced during the course of the illness. The mood swings themselves, and their duration, are the defining symptoms of bipolar disorder. As with all mental disorders, there must be a marked impairment in social or occupational functioning as a consequence of the condition, which cannot be otherwise attributed to the effects of substance use or abuse, medications or physical illness.

The three types of mood episode in bipolar disorder are:

• major depressive episode;
• manic episode; and
• mixed episode.

The first episode of bipolar disorder could be any one of these mood episodes.

Major depressive episode

Depression is a mood state that involves a significant and persistent lowering of mood associated with great sadness. Depression, however, does not simply involve feeling a little low, having a bad day, or feeling blue. In depression, the low mood does not go away after a day or two, but persists, often causing major difficulties in coping with everyday life. Depression is also associated with a number of physical symptoms not usually seen when a person is simply sad.

A depressive episode involves five or more of the following symptoms that last most of the day, every day, for a period of two weeks or longer. The symptoms may be:

• lasting sadness or empty mood;
• feelings of hopelessness, pessimism or guilt;
• increased feelings of anxiety;
• loss of self-confidence;
• loss of interest in life and decreased ability to enjoy yourself;
• decreased sex-drive or libido;
• lack of motivation and decreased energy;
• difficulty concentrating, remembering, or making decisions;
• increased restlessness or irritability;
• sleeping too much or unable to sleep;
• change in appetite and/or unintended weight loss or gain;
• thoughts of death or suicide, or suicide attempts; and
• slowness and procrastination.

Manic episode

Mania is the name given to a mood state that is the opposite of depression. A manic person may have excessively or abnormally happy or irritable moods (usually for no obvious reason) that occur with other features such as racing thoughts, very rapid speech, increased energy levels and very ambitious plans for various projects. On occasions, a person with mania will experience psychotic symptoms, such as losing their sense of reality.

An episode of mania is diagnosed if the symptoms listed below last for longer than a week, or if they are serious enough to require hospitalization. It is not considered mania if symptoms are caused exclusively by drugs or physical illness. The symptoms include:

• feeling very happy, excited and energetic;
• being full of new and exciting ideas;
• being distracted and unable to concentrate;
• irritability;
• poor sleep, needing only 2-4 or less hours sleep per night;
• feeling more important/rich/intelligent or powerful than usual; and
• having an increased desire to go shopping, invest money in businesses, eat and drink, or have sex.
  

Hypomanic episode

When the symptoms of mania aren't so extreme, doctors may describe the episode as 'hypomania'. Hypomania is not severe enough to cause significant disruption to employment or social life, and does not require hospitalization. Also, there are no psychotic features with hypomania. It can, however, be quite disruptive and cause problems for the person.

Mixed episode

People with bipolar disorder will sometimes experience a mixed episode, that is, there will be features of mania and depression occurring at the same time, or the mood may alternate from depressed to manic extremely rapidly (i.e. within minutes or hours). To be diagnosed with a mixed episode, the criteria for both a manic episode and a major depressive episode must be met every day for a minimum of a week.

Psychosis

The most severe symptoms of depression and mania are those experienced when a person is psychotic, or has a psychosis. This is an extreme case when a person loses contact with reality and has problems with thinking and reasoning. This state is usually associated with the development of delusions (i.e. false, irrational and illogical thoughts or beliefs) and hallucinations (e.g. hearing, seeing, or sensing things that, in reality, are not there).

The symptoms of psychosis experienced by someone with a bipolar disorder usually involve themes that are consistent with the mood state at the time. These are referred to as being 'mood congruent'. For someone with mania, this may include delusions of being a king or president, or being someone with special powers. Such are called grandiose delusions and are common in severe mania. For someone with depression, such themes may include ideas of great personal inadequacy, overwhelming negativity, or of deserving punishment, such as being persecuted, having a terrible disease or having committed a serious crime. Such delusions, typical of severe depression, are called depressive delusions. Voices (hallucinations) might be derogatory or abusive. A psychosis is very a serious state and requires immediate treatment from a doctor or mental health professional.

Suicidal thoughts

Some people with bipolar disorder become extremely sad, consumed with feelings of misery, hopelessness and despair. The effort of making it through one day to the next, or even from the morning to the afternoon, can seem like an unbearable and impossible task. In this negative and irrational frame of mind, thoughts of suicide are common.

Unfortunately, there is a real risk of a person with bipolar disorder committing suicide; up to 25% of people with the condition will make a suicide attempt at some time in their lives. Tragically, approximately 10% will die by suicide. The risk of suicide can be minimized by early diagnosis and treatment of bipolar disorder. Talk of suicide should be taken very seriously. Those experiencing suicidal thoughts need immediate attention from a doctor or mental health professional.