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learn: bipolar basics

Types of Bipolar

Bipolar disorder was once called “manic depression.” As the old name suggests, it involves extreme mood swings. While everyone experiences emotional ups and downs from time to time, people with bipolar disorder can reach much higher highs or lower lows than usual, affecting daily life and wellbeing.

Bipolar disorder is a long-term mental health condition that primarily affects your mood. It can cause significant shifts in how you feel, with your emotions swinging much higher or lower than usual.

Bipolar disorder is a long-term mental health condition that primarily affects your mood. It can cause significant shifts in how you feel, with your emotions swinging much higher or lower than usual.

People with bipolar disorder can experience episodes of mania and depression, which often last weeks or months and go well beyond typical mood changes. During mania, you may feel extremely energetic or excited, while depressive episodes can leave you feeling very low. These mood shifts usually affect your energy, behaviour, and daily functioning, though you may feel stable in between episodes.

Symptoms of bipolar disorder can be intense and may affect many areas of life, including work, school, and relationships.

Bipolar disorder usually develops before the age of 20, though it can appear later in life. It is rare for it to first emerge after age 40.

It can take time to receive a diagnosis. Early symptoms may be mistaken for depression or another mental health condition, because diagnosing bipolar disorder is often challenging—there are no blood tests or scans that can confirm it.

Bipolar I Disorder

This involves manic episodes that last at least 7 days straight.

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Bipolar Type I

Bipolar I disorder is characterised by at least one manic episode lasting seven days or more. During mania, you may feel extremely energetic, euphoric, or irritable, and these changes can significantly impact daily life—sometimes requiring hospital care for safety or support.

Many people with Bipolar I also experience periods of depression, though a major depressive episode isn’t always part of the picture. Without treatment, manic episodes can last 3–6 months, while depressive episodes may last 6–12 months. With proper support and management, however, people can reduce the intensity and duration of episodes and improve their quality of life.

Bipolar II Disorder

Involving less severe episodes of mania known as Hypomania.

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Bipolar Type II

Bipolar II disorder is characterised by at least one major depressive episode lasting two weeks or more, along with at least one hypomanic episode. Hypomania is a milder form of mania—people may feel unusually energetic, productive, or euphoric—but it usually isn’t severe enough to require hospitalisation.

Depressive episodes are often the most prominent feature, and a person with Bipolar II may spend more time feeling low than elevated. Because of this, Bipolar II is sometimes misdiagnosed as depression, particularly if the hypomanic episodes are subtle or overlooked.

A diagnosis of Bipolar II means you will have experienced at least one period of major depression and at least one period of hypomania, helping doctors distinguish it from other mood disorders. With the right treatment and support, symptoms can be managed, and people can maintain stability and a fulfilling life.

Cyclothymic Disorder

Chronic mood instability without extreme mood episodes.

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Cyclothymia

Despite common misconceptions, cyclothymia is not classified as a type of bipolar disorder. People with cyclothymia do experience both elevated and low moods, but these are usually less severe than the episodes seen in bipolar disorder.

A diagnosis of cyclothymic disorder means you have had regular periods of hypomanic and depressive symptoms for at least two years. However, these symptoms do not meet the full criteria for a major depressive or full hypomanic episode.

While cyclothymia is generally milder, it can still affect daily life and relationships. In some cases, cyclothymia may develop into bipolar disorder over time, so monitoring mood patterns and seeking support early can help with management and long-term wellbeing.

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Other Variants

Understandably, this can make treatment and management more challenging. Everyone experiences bipolar disorder differently, and finding a single category to classify your condition for treatment purposes is rarely straightforward. Individualised care and support are key.

Just when things start to make sense, there are even more variations of bipolar disorder. In addition to a base diagnosis of Type I or Type II, you may also receive a more specific diagnosis that falls into one of these variants:

Now this is getting very complicated...

Bipolar I or II with Mixed Features

In this variant, symptoms of mania or hypomania and depression occur at the same time. This is sometimes called a “mixed bipolar state.” You might feel very sad or hopeless while also experiencing restlessness, heightened energy, or overactivity. Mixed episodes can be particularly challenging because opposite emotions occur simultaneously.

Bipolar I or II with Rapid Cycling

Rapid cycling means having four or more episodes of depression, mania, or hypomania within a 12-month period. People with rapid cycling may notice mood changes happen more quickly and frequently than usual, which can make managing symptoms more complex.

Bipolar I or II with Seasonal Pattern

A seasonal pattern means that your depressive, manic, or hypomanic episodes follow a predictable pattern linked to the seasons. For example, you may regularly experience depressive episodes each winter. Mania may not follow a seasonal pattern. This variant can sometimes resemble seasonal affective disorder (SAD), but the mood changes in bipolar disorder are more extreme and involve episodes of elevated mood as well as depression.

Type I & Type II Differences?

Bipolar I disorder involves full manic episodes and may also include periods of depression. Bipolar II disorder is dominated by depressive episodes, but also includes periods of hypomania, which are milder than full mania.

All symptoms of bipolar disorder, regardless of type, can make daily life challenging. They can affect your relationships, work, and overall wellbeing.

Which is More Serious?

Bipolar I is often seen as more severe because manic episodes can be intense and sometimes require hospitalisation, making treatment more challenging.

However, research shows that depressive episodes in bipolar II may be more frequent, longer-lasting, and persist throughout life, meaning both types can have a serious impact on daily living.

What is Mania?

A manic episode is more than just feeling elated, energetic, or distracted—it can interfere with daily life and decision-making. During mania, people may make impulsive or risky choices, such as spending beyond their means or engaging in behaviours that could have harmful consequences.

An episode is not considered manic if caused by external factors like alcohol, drugs, or another health condition. Symptoms of mania can include:

  • Feeling unusually happy or excited, even when circumstances aren’t positive
  • Having a flood of new and exciting ideas
  • Jumping quickly from one idea to another
  • Racing thoughts
  • Talking very rapidly
  • Hearing voices or perceiving things others do not
  • Being more irritable than usual
  • Feeling excessively confident or self-important
  • Difficulty focusing or being easily distracted
  • Reduced need for sleep or feeling you don’t want to sleep
  • Overestimating your abilities or taking on too much

Mania can lead to unusual or risky behaviours, including:

  • Spending large amounts of money impulsively
  • Engaging in casual sex with multiple partners
  • Using drugs or alcohol
  • Gambling
  • Making other unwise or unsafe decisions

What About Hypomania?

A hypomanic episode is a milder form of mania. While less intense than a full manic episode, your thoughts, feelings, and behaviours will still be noticeably different from your usual state—enough that those around you may see the change.

An episode is not considered hypomania if it is caused by external factors such as drugs or alcohol.

What is Depression?

Depressive episodes in bipolar disorder are similar to those seen in major depressive disorder. They often involve prolonged feelings of sadness, hopelessness, or emptiness.

You may also lose interest in people, activities, or hobbies you once enjoyed.

Other common symptoms include:

Why do people keep asking me if I feel ok?
...I don't 'feel' anything!
Why do people keep asking me if I feel ok?
...I don't 'feel' anything!
  • Low mood, fatigue, or feeling tired
  • Hopelessness or persistent negative thoughts
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest in activities you usually enjoy
  • Difficulty concentrating, remembering, or making decisions
  • Restlessness or irritability
  • Sleeping too much or having trouble sleeping
  • Changes in appetite, eating too little or too much
  • Unintentional weight loss or gain
  • Thoughts of death or suicide, or suicide attempts

What is Psychosis?

Sometimes, psychotic symptoms can occur during severe episodes of mania or depression.

Common symptoms include:

  • Hallucinations: hearing, seeing, or feeling things that aren’t real
  • Delusions: believing things that aren’t true

Others will usually notice these beliefs as unusual. In bipolar disorder, psychotic symptoms often reflect your mood:

  • During mania, you might believe you have special powers or are being monitored by others.
  • During depression, you might feel extreme guilt, feel worse than everyone else, or feel as if you don’t exist.
Walking takes far too long, I'll just fly there!
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Bipolar Statistics

How common is bipolar?

  • Approximately 40 million adults worldwide live with bipolar disorder, about 0.53% of the global population. (WHO, 2023)
  • The lifetime prevalence of bipolar disorder is estimated at 2.4% globally. (PMC, 2023)
  • In the United States, around 5.7 million adults are affected, roughly 2.6% of the adult population. (DBSA, 2023)
  • Bipolar disorder often goes undiagnosed or misdiagnosed for several years; on average, it takes 6–10 years from the first symptoms to receive a correct diagnosis. (NIMH, 2023)
  • About 70% of people with bipolar disorder are initially diagnosed with depression before mania or hypomania is recognised. (NIMH, 2023)

Bipolar statistics by age

  • The average age of onset is 25 years. (WHO, 2023)
  • People aged 18–29 have the highest rates of bipolar disorder (4.7%). (WHO, 2023)
  • Rates are lowest among those 60 and older (0.7%). (WHO, 2023)

Bipolar and overall health

  • People with bipolar disorder have a life expectancy 12–13 years shorter than the general population. (Treatment Advocacy Center, 2023)
  • The risk of suicide is high, with 15–20% of people with bipolar disorder dying by suicide. (The Lancet, 2024)
  • Up to 60% of people with bipolar disorder may develop substance use disorders. (WHO, 2023)
  • Common co-occurring health conditions include migraine, asthma, high cholesterol, high blood pressure, thyroid disease, and osteoarthritis. (WHO, 2023)
  • Bipolar disorder is one of the leading causes of disability among young adults aged 18–44. (WHO, 2023)
  • Approximately 50% of people with bipolar disorder experience difficulties maintaining steady employment. (NIMH, 2023)
  • Relationship strain is common due to mood fluctuations, affecting family, friendships, and intimate relationships. (NIMH, 2023)

Treatment and management

  • Medication adherence reduces the risk of relapse and hospitalisation by up to 50%. (WHO, 2023)
  • Psychoeducation and therapy improve coping skills and reduce the severity and frequency of episodes. (WHO, 2023)
  • Early intervention and structured support can allow people to lead productive, fulfilling lives. (WHO, 2023)

Global perspective

  • Bipolar disorder occurs across all countries and cultures, affecting men and women equally. (WHO, 2023)