Bipolar Disorder: Symptoms, Types and Treatment

For the past few weeks, Andriy slept for only three to four hours and woke up feeling like he finally saw everything clearly. In one night, he came up with a plan for a new business, the next day ordered equipment he couldn't afford, and the day after that convinced his wife that it was time to sell their apartment. He spoke quickly, got angry when interrupted, and genuinely wondered at the anxiety of his loved ones: for the first time in a long time, he didn't feel bad, but rather incredibly good. A month later, the same man barely got out of bed and called all his ideas proof of his own worthlessness.

This is a composite scene, not a description of a specific person or a way to diagnose someone based on their behavior. It illustrates one reason bipolar disorder can remain unnoticed for a long time: a period of elevation may feel like the return of energy, productivity, and confidence, while a depressive episode is more readily perceived as an obvious problem. To see the full picture, a clinician needs more than isolated emotions; changes in sleep, energy, thinking pace, activity, risk-taking, functioning, and consequences over time all matter.

In everyday language, "bipolar disorder" is sometimes used to describe a changeable mood: a person might be joking in the morning and angry in the evening. The clinical definition means something else. Bipolar disorder (BD) is associated with episodes of distinct changes in mood and activity — manic, hypomanic, and depressive — that last for a period of time and are noticeably different from a person's usual state.

One argument, an energetic week before a deadline, or sadness after a loss are not, in themselves, evidence of a disorder. A psychiatrist diagnoses BD after a conversation about the course of symptoms, previous episodes, sleep, medications and substances, physical health, family history, and changes in work and relationships. Information from a close person is often helpful, if the patient agrees to involve them.

During a manic or hypomanic episode, a person may sleep less and not feel tired, speak faster, jump between thoughts, take on many tasks, become unusually sociable, irritable, or overconfident. Sometimes, spending, sexual activity, substance use, risky driving, or the number of decisions made without considering consequences increase.

Hypomania is usually shorter and does not cause such severe disruption to functioning as mania. A person may even enjoy this state: they feel faster, bolder, and more productive. However, for diagnosis, it's important that the change is noticeable to others and is not a typical work boost.

Mania significantly disrupts life, may require hospitalization, and sometimes involves psychotic symptoms—for example, delusions or hallucinations. This is not about a "bright personality," but a state where the ability to assess risk can significantly decrease.

A depressive episode can include a persistent low mood or loss of interest, exhaustion, difficulty concentrating, changes in sleep and appetite, feelings of guilt or hopelessness, slowed down movements or inner agitation. Some people find it hard to shower, respond to messages, or even cook a meal, though this is mistakenly labeled as laziness.

Due to the symptoms, such depression can be similar to unipolar depressive disorder. That's why a doctor asks not only about the current downturn but also about past periods of unusual elevation, decreased need for sleep, impulsive spending, or excessive confidence. Without this part of the history, treatment may be chosen inaccurately.

Episodes don't always fit the simple picture of "first euphoria, then sadness." A person may simultaneously experience high energy, racing thoughts, insomnia, irritability, and severe hopelessness. This state can be especially draining: there's plenty of energy for action, but the thoughts are painful and gloomy.

The combination of agitation, near-total lack of sleep, impulsivity, psychotic symptoms, or thoughts of suicide requires prompt professional evaluation. This is not a case where it's advisable to wait for the person to "pull themselves together."

According to current classifications, Bipolar I involves at least one manic episode; depressive episodes occur frequently, but for the diagnosis of Bipolar I, mania alone is sufficient. Bipolar II includes hypomanic and major depressive episodes without a history of full-blown mania. The second type is not a "mild version": depressive periods can be prolonged and severe.

Cyclothymic disorder describes prolonged fluctuations with numerous hypomanic and depressive symptoms that do not always meet the full criteria for an episode. The term "rapid cycling" refers to four or more episodes within a year; this is a characteristic of the course, not a separate personality type.

People often seek help during a depressive episode. They might remember hypomania as the best period: working late, making new friends easily, finally feeling "like themselves." If the chronology isn't reconstructed during the consultation, the period of elevation may remain outside the narrative.

In another scenario, irritability, anxiety, sleep problems, or substance use become noticeable, and the mood changes get lost in them. A map of several months or years helps: when sleep changed, what happened with decisions and spending, how loved ones reacted, and how the elevated period ended.

Fluctuations in energy and mood can arise from various causes. A doctor must consider disorders of the thyroid gland, neurological conditions, the influence of stimulants, alcohol, and other substances, side effects of medications, sleep deprivation, traumatic experiences, anxiety and personality disorders, ADHD, and unipolar depression.

This does not mean that all these conditions are the same. On the contrary, the similarity of certain symptoms makes self-diagnosis unreliable. An online questionnaire can suggest a topic for discussion with a specialist, but it does not replace an assessment of the course of the illness and a medical examination.

Bipolar disorder (BD) cannot be explained by a "lack of serotonin" or "excess dopamine." Research points to an interaction of genetic predisposition, characteristics of brain system regulation, circadian rhythms, sleep, stress, and environment. Heredity plays a role, but it doesn't determine destiny: having a disorder in the family increases the risk, but it doesn't allow for predicting the future of a specific person.

A stressful event or several sleepless nights can precede an episode, but they are not a universal "first cause." This perspective is important for accountability: a person is not to blame for having a disorder, but together with a treatment team, they can learn to notice their own triggers and early warning signs.

What helps during a manic episode differs from treatment for bipolar depression and maintenance therapy between episodes. Therefore, general advice like "take antidepressants" or "just relax and rest" is dangerous in its inaccuracy.

A psychiatrist creates a plan, considering the type and phase of the disorder, previous response to treatment, co-occurring illnesses, pregnancy or planning for pregnancy, other medications, and personal priorities. The goal is not to erase all emotions, but to reduce the risk of episodes, restore sleep and functioning, and help the person maintain their life between exacerbations.

In treatment, mood stabilizers and atypical antipsychotics may be used; the specific choice depends on the phase and individual risks. Some medications require blood tests, monitoring of kidney and thyroid function, weight, or metabolic indicators. Valproic acid has serious reproductive risks and requires especially careful safety discussions.

Antidepressants are not used as a simple copy of treatment for unipolar depression in bipolar disorder. According to clinical guidelines, antidepressant monotherapy can increase the risk of a switch into mania or mood instability. The decision therefore belongs in a psychiatric treatment plan rather than self-treatment. Prescribed medication should not be stopped abruptly either; changes to the regimen are made under medical supervision.

Psychotherapy does not replace medication when it is necessary, but it helps a person live with the diagnosis. Treatment may include psychoeducation, cognitive-behavioral approaches, family-focused therapy, and interpersonal and social rhythm therapy. A person learns to recognize early signals, plan actions for elevation or depression, discuss the boundaries of help, and address the consequences of episodes without total self-blame.

Psychotherapeutic conversation is important even after stabilization. Mania can leave debts, conflicts, shame, or gaps in memory; depression — a loss of trust in one's own abilities. This experience needs to be worked with carefully, without reducing the person to a diagnosis.

For many people, changes in sleep needs precede other symptoms. This isn't just about insomnia: during hypomania or mania, a person may sleep very little and not feel tired. During depression, sleep may sometimes lengthen, become fragmented, or fail to restore.

Regular sleep and wake times, caution with overnight shifts, alcohol, and stimulants can be part of prevention. However, a routine is not a measure of willpower and is not a substitute for treatment. If someone is barely sleeping for several nights, becomes increasingly active, or rapidly loses insight and judgment, contact with a doctor is needed, not just advice to put away the phone.

A helpful plan is created during a more stable period with a professional and, with the person's consent, with loved ones. It may include:

Such a document does not take away autonomy. It gives a person the opportunity to pre-define what kind of help they consider acceptable while their ability to assess risk has not changed.

The phrase "you're acting crazy again" will almost certainly worsen shame and conflict. It's more helpful to talk about what you observe: "You've been sleeping only two hours for the third night in a row, you ordered expensive equipment today, and you're speaking much faster. According to our plan, this is an early sign. Let's call the doctor right now."

Support doesn't mean agreeing to dangerous decisions or becoming a therapist on your own. Loved ones also need boundaries, information, and rest. The MriyaRun material on personal boundaries at home and at work can help distinguish between care and taking complete control of someone else's life.

Immediate assessment is needed if someone talks about suicide or has a plan, cannot meet basic needs, has barely slept for several nights and is rapidly losing insight and judgment, hears voices or has beliefs that push them toward dangerous actions, or poses a threat to themselves or others. In Ukraine, if someone is in immediate danger, call 112 or 103, stay nearby if it is safe, and remove access to weapons, large quantities of medication, and other obvious means of self-harm.

Don't argue with psychotic beliefs and don't try to physically restrain the person alone. Speak briefly, calmly, and focus on safety and professional help.

Entries are helpful not because you need to label yourself "manic" or "depressive" every day. They help reveal patterns over time. It is enough to spend a few minutes noting sleep duration, energy, mood, irritability, medication use, alcohol or stimulants, important events, and unusual decisions.

During an appointment, this chronology provides more than trying to remember the last three months in one word. If keeping records intensifies anxiety or obsessive control, simplify the format and discuss it with a therapist.

The CBT SHIFT Workbook can be helpful for monitoring thoughts and behavioral cycles. It does not diagnose a disorder, replace a psychiatrist, or suggest dosage changes. Its role is more modest: to help bring facts about sleep, events, reactions, and consequences to a consultation.

If you recognize yourself in this article, don't start with a label. Begin with a timeline and a professional evaluation. Bipolar disorder is treatable, and a precise plan is often developed gradually — taking into account specific episodes, the body, relationships, work, and the life a person wants to preserve.