DISORDER GUIDES · GUIDE 02
Bipolar disorder
Bipolar disorder is a condition of mood episodes: periods of depression and periods of mania or hypomania — elevated, expansive, or irritable mood with unusually high energy. Between episodes, many people return to their usual selves. The pattern, not any single day, is what defines it.
These guides describe patterns clinicians look for — not a diagnosis of any reader. A label is a map, not the person: two people with the same diagnosis can look very different, and only a clinician who knows your history can say what a pattern means. If you recognize yourself in one of these guides, treat that as a reason to start a conversation with a professional, not as a conclusion.
EVIDENCE REVIEW
OCTOBER 18, 2026
Common signs
- Manic or hypomanic episodes: unusually elevated or irritable mood, decreased need for sleep, racing thoughts, pressured speech, inflated confidence, distractibility, and risky decisions about money, sex, or business
- Depressive episodes: the same signs as major depression — low mood, loss of interest, fatigue, poor concentration, and sometimes suicidal thinking
- Episodes last days to weeks — at least a week for mania, four days for hypomania — and mark a clear change from the person's baseline
- Psychotic symptoms — delusions or hallucinations — can occur in severe manic or depressive episodes
How it's diagnosed
Diagnosis rests on history: a clinician reconstructs past episodes, often with help from family, because people frequently seek help only during depression. That history matters enormously — bipolar depression treated as ordinary depression, with an antidepressant alone, can worsen cycling. Medical causes, substances (including steroids and stimulants), and sleep disorders are ruled out, and the pattern is tracked over time, sometimes with mood charting.
How it's treated
Mood-stabilizing medication is the foundation — lithium and certain anticonvulsant and antipsychotic medicines, chosen and monitored by a prescriber (see the medication guides). Psychotherapy adds relapse prevention: recognizing early warning signs, protecting sleep, and steadying daily rhythms. Antidepressants are used cautiously, if at all, and generally not without a mood stabilizer. With consistent treatment, many people achieve long, stable stretches.
When to seek help promptly
Seek urgent help during mania or hypomania if someone has gone days with little sleep, is spending or risk-taking out of control, or shows psychotic symptoms — and during depressive episodes if suicidal thoughts appear. In the US, call or text 988 any time. Families often notice an episode before the person does; saying something early is an act of care, not betrayal.
