by EBSCO Medical Review Board

Bipolar disorder causes mood swings. A person with it may feel very high or low and without hope. Often, there are times of steady moods in between these highs and lows. There may also be a change in energy and actions. The highs are called manic episodes. The lows are called depressive episodes.

Depressive Episode

Low moods may cause:

  • Lasting sad, worried, or empty mood
  • Negativity or lack of hope
  • Feelings of guilt, worthlessness, or helplessness
  • Not wanting to do things that were once enjoyed
  • Low energy
  • Problems with focus, recall, or making choices
  • Restlessness or irritability
  • Sleeping too much or not being able to sleep
  • Changes in hunger and weight loss or gain
  • Pain or other health symptoms that do not have a cause
  • Thoughts of death or self-harm or trying to kill oneself

Manic Episode

High moods may cause:

  • Raised energy, activity, and restlessness
  • Very high, overly good mood
  • Irritability
  • Racing thoughts and talking quickly, jumping from 1 point to the next
  • Lack of focus
  • Little need for sleep
  • Odd beliefs in one's abilities and powers
  • Problems making choices
  • Spending sprees
  • Changes in behavior
  • A higher sex drive
  • Drug abuse, such as cocaine, alcohol, and sleeping pills
  • Aggressive actions
  • Denying that something is wrong

A mild to medium level of mania is called hypomania. It may feel good to the person who has it. A person be able to get more things done. It can become mania or can switch to depression if it is not treated.

Other Symptoms

A person may also have:


Sometimes, mania, or depression turns into symptoms of psychosis, such as:

  • Hallucinations—hearing, seeing, or feeling that things are there that are not
  • Delusions—false, strongly held thoughts that are not based in reality
  • Disorders of thought—loose links between topics, flight of topics, or speech that others can't make sense of
Suicidal Symptoms

Some people are in danger of self-harm. A person who is thinking or talking about self-harm needs help right away.

Signs may be:

  • Talking about feeling like killing oneself or wanting to die
  • Feeling hopeless, that nothing will ever change or get better
  • Feeling helpless, that nothing one does makes any change
  • Feeling like a weight to family and friends
  • Using alcohol or drugs
  • Putting affairs in order (organizing finances or giving away items to get ready for one's death)
  • Writing a suicide note
  • Putting oneself in harm's way or places where there is a danger of dying


Bipolar disorder. EBSCO DynaMed website. Available at: . Updated September 9, 2019. Accessed October 10, 2019.

Bipolar disorder in adults. National Institute of Mental Health website. Available at: Updated October 2018. Accessed October 10, 2019.

Yatham LN, Kennedy SH, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018 Mar;20(2):97-170 Bipolar Disord 2018 Mar;20(2):97.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 09/2019