Bipolar Disorder

The defining feature of bipolar disorder is mania. There is great variability in manic symptoms, but features may include:

• increased energy, activity, and restlessness
• euphoric mood and extreme optimism
• extreme irritability
• racing thoughts, pressured speech, thoughts that jump from one idea to another
• distractibility and lack of concentration
• decreased need for sleep
• unrealistic beliefs in one’s abilities and powers and ideas
• poor judgment
• spending sprees
• increased sexual drive
• reckless behavior including fast driving
• provocative, intrusive, or aggressive behavior
• denial that anything is wrong

While there is great variability in degree and duration of depressive symptoms, features generally include:

• Lasting sad, anxious, or empty mood
• feelings of hopelessness or pessimism
• feelings of guilt, worthlessness, or helplessness
• loss of interest or pleasure in activities once enjoyed, including sex
• decreased energy, feelings of fatigue or of being “slowed down”
• difficulty concentrating, remembering, or making decisions
• restlessness or irritability
• sleeping too much or inability to sleep or stay asleep
• change in appetite and/or unintended weight loss or gain
• chronic pain or other persistent physical symptoms not accounted for by illness or injury
• thoughts of death or suicide, or suicide attempts

Not infrequently, the symptoms of mania and depression can occur together in “mixed” episodes. Symptoms of a mixed state can include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person can feel sad in mood yet highly energized.