Bipolar disorder can unfold in stages over time. Here’s what it might look like.
Bipolar disorder is a mental health disorder characterized by severe shifts in mood and energy levels.
Similar to other mental disorders, bipolar can come in stages. These stages aren’t always clearly defined, and they don’t necessarily occur in any particular order. But here’s how the condition may play out.
Bipolar disorder varies widely from person to person, but it’s generally described with the following stages:
- Early or prodromal stage: Years before the onset of a manic or depressive episode, you might begin to notice changes in your mood, behavior, or ability to function. These symptoms might include anxiety, depression, or difficulty sleeping.
- Acute stage: During the acute stage, you experience a full-on mood episode (mania, depression, or a mixed episode).
- Maintenance stage: In the maintenance stage, you aim to manage your disorder and maintain stability via medication and therapy.
The mood episodes in bipolar vary as well.
They include the following:
- mania
- hypomania (a less severe form of mania)
- depression
- mixed features (depression and mania together)
The severity and duration of these episodes also vary from person to person. They primarily differ according to the type of bipolar disorder you have.
Bipolar disorder can be divided into the following types:
- Bipolar I disorder: A diagnosis of bipolar I requires the presence of at least one manic episode. Although depressive episodes are common, they’re not required for a bipolar I diagnosis. Mixed episodes may also occur in bipolar I.
- Bipolar II disorder: A diagnosis of bipolar II involves at least one hypomanic episode and one depressive episode. There cannot have been a full manic episode.
Research shows that depressive episodes tend to be more severe (more frequent, longer-lasting, and disabling) in bipolar II than in bipolar I. - Cyclothymic disorder: Cyclothymic disorder is characterized by multiple episodes of hypomanic and depressive symptoms lasting at least 2 years. But symptoms don’t quite meet the criteria for a hypomanic or depressive episode.
Mania
Mania involves an abnormally elevated mood, an increase in energy, and intense goal-directed behavior. The level of energy and behavior is a distinct change from your typical self and tends to be noticeable to others.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a manic episode in bipolar I must last at least 1 week and be present most of the day, nearly every day.
Symptoms of mania may include the following:
- unusually high energy
- extreme feelings of happiness
- grand ideas and plans
- feelings of self-importance
- little desire for eating or sleeping
- fast talking
- illogical reasoning or delusions
- distraction
- high risk or out-of-character decisions
- psychotic features (delusions or hallucinations)
Hypomania
Hypomania, which is a major feature of bipolar II, is a less severe form of mania that doesn’t significantly interfere with daily functioning. In fact, it may feel less like a disorder and more like natural excitement.
Symptoms of hypomania are the same as mania but to a lesser degree.
According to the DSM-5-TR, hypomania must last at least 4 consecutive days and be present most of the day, nearly every day.
Depression
Depressive episodes in bipolar disorder result in a low mood or loss of pleasure in life. Research shows that depressive episodes in bipolar disorder tend to last longer than mania or hypomania episodes. The episodes last at least 2 weeks, but in some cases, they can last for months.
During a depressive episode, you might have the following symptoms:
- extreme sadness
- feelings of hopelessness or worthlessness
- very low energy levels
- memory and concentration difficulties
- loss of interest in previously enjoyed activities
- feelings of guilt
- low appetite
- insomnia
Mixed episodes
A mixed episode occurs when depressive and manic symptoms happen together. It’s essentially like having a low mood with high levels of energy.
Mixed episodes are relatively common. A
Symptoms include:
- inner tension
- racing thoughts
- irritability
- agitation
- rage
- weeping spells
- difficulty falling asleep
- intense emotions
Rapid cycling is characterized by four or more mood episodes of mania, hypomania, or depression within a year. It can occur in all types of bipolar. For many individuals, rapid cycling is a temporary occurrence.
Rapid cycling can be quite challenging and may require more intensive treatment and management.
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- younger age at onset
- higher persistence
- more severe depressive symptoms
- greater impairment from depressive symptoms
- more anxiety disorders
- increased likelihood of using health services
Though bipolar disorder typically surfaces in young adulthood, the disorder may also appear in adolescence and childhood.
A long-term study of 279 high risk children revealed how childhood sleep and anxiety disorders may be important predictors of bipolar disorder.
The symptoms of those who developed bipolar (24.5%) typically unfolded in the following order:
- nonspecific symptoms such as sleep and anxiety symptoms
- minor mood problems
- adolescent depression
- full-on bipolar disorder
- anxiety disorders
- mood shifts
- cyclothymia
- subthreshold manic and hypomanic symptoms
- subsyndromal depression
- psychotic features in depression
- early age of onset of depressive episodes
Bipolar disorder is highly individualized, and its symptoms vary significantly from person to person.
The disorder can occur in various stages, but similar to the disorder’s mood episodes, the stages aren’t always clearly defined, and they don’t necessarily occur in any particular order.
If you’re experiencing any of these symptoms, consider reaching out to a mental health professional to get an accurate diagnosis.