Symptoms of bipolar disorder that are unique to this condition include mania and hypomania, however depression is the most common symptom experienced. 

Mania

In the DSM-5-TR, mania is defined by the presence of a period of at least 1 week or more and includes symptoms such as:

1. Elevated, expansive, or irritable mood (eg feeling on top of the world, high or excited)

2. Inflated self-esteem 

3. Decreased need for sleep (eg only getting 4 hours of sleeping but feeling ok)

4. Racing thoughts

5. More talkative than usual 

6. Increase in goal-directed activity 

7. Risky or impulsive behaviour (eg excessive spending)

A lifetime episode of mania is required for the diagnosis of Bipolar I disorder. Psychosis can be common in mania, and many people report symptoms such as delusions that can occur with increasing severity when manic.  

Many people find that they are first diagnosed after a manic episode that led to hospitalisation.  Hospitalisation can be required to treat a severe manic episode as medication is needed to manage these symptoms.  

Hypomania

Hypomania is defined as a period of 4 days in a row that have similar symptoms to mania, but are not severe enough to cause impairment or the need for hospitalisation.

People living with Bipolar II disorder are diagnosed on the basis of both depression and a hypomanic epsiode, however people living with bipolar I disorder may also have periods of hypomania.  

Hypomania can sometimes be difficult to detect and diagnose which can mean that many people living with Bipolar II disorder can experience delays in diagnosis and treatment.  

Depression 

Depression is usually the most common symptom experienced for people living with bipolar disorder.  A major depression episode lasts at least 2 weeks or more and includes symptoms such as:

1. Feeling sad, or low

2. Excessive feelings of worthlessness or guilt.

3. Increased sleep

4. Decreased or increased appetite or weight loss/gain

5. Difficulty concentrating

6. Thoughts of death or dying or suicide.

Depression symptoms can sometimes be ongoing and difficult to treat.

Mixed episodes or features

Mixed episodes are when symptoms of both depression and hypo/mania are experienced at the same time, within the same episode.  This can look like having racing thoughts (symptoms of hypo/mania) and negative thoughts (symptom of depression) at the same time.  Research has indicated that the prevalence of having mixed symptoms in a period of depression is around 12% and in hypo/mania around 27% (Na et al., 2021).  Mixed symptoms in a major depression episode without a full episode of mania may also be a risk factor for the development of bipolar I or II disorder.

Rapid cycling

It is not uncommon for people living with bipolar disorder to experience multiple episodes known as 'rapid cycling'.  In the DSM-5-TR, rapid cycling is defined as 4 or more episodes of depression or hypo/mania in the previous 12 months.  

However many people living with bipolar disorder experience subsyndromal symptoms of hypo/mania or depression (those that do not meet full diagnostic criteria) often. 

Other specifiers

There are several other specifiers that are stated in the DSM that may be important in the management and treatment bipolar disorder.  eg Atypical features, melancholic features.  

Please note that the Bipolar Hub does not provide crisis support.   If you are in crisis please call 000 for assistance.

GPs will have a list of local psychiatrists that they will be able to refer to for a diagnosis and assessment.  However some people prefer to contact psychiatrists directly before seeing a GP to ensure that they have places available and to consider the waiting list length of the psychiatrist.

See the Resources section for links on how to locate a psychiatrist and other support and resources that can help.

For assistance in locating state-based government funded support, please visit:

https://www.healthdirect.gov.au/mental-health-crisis-support

https://www.medicarementalhealth.gov.au/