Manic and hypomanic episodes

Manic and hypomanic episodes – or mania and hypomania – both mean feeling high.

Manic and hypomanic episodes have similarities in how they may make you feel or act. But there are some key differences:

• Severity of symptoms. Severe mania is very serious and often requires hospital treatment. Hypomania can noticeably change your mood or behaviour, but it’s less severe than mania.
• Impact on your life. Manic episodes can impact your ability to do your daily activities – often disrupting or completely stopping them. Hypomanic episodes can disrupt your life, but you may still feel able to work or socialise.
• Length of episode. For a mood episode to be classed as mania, it needs to last for a week or more. For hypomania, it needs to last for 4 days or more. But both manic and hypomanic episodes can last much longer than this.
• Types of symptoms. You may be more likely to experience severe symptoms with mania, such as more extreme risk-taking behaviours. Manic episodes can sometimes include psychotic symptoms, like hallucinations or delusions. Hypomanic episodes never include these.

Both mania and hypomania can be really tough to experience and manage. Whether you experience mania or hypomania, or if you’re not sure what you’re experiencing, it’s always OK to seek support.

“The hardest thing to explain is the racing thoughts when I’m manic. It’s like I’ve got four brains and they’re all on overdrive… it can be scary but also euphoric at the same time.”

Feelings

During a manic or hypomanic episode, you might feel:

• Happy, joyful or a sense of wellbeing
• Very excited or uncontrollably excited
• Like you can’t get your words out fast enough
• Irritable or agitated
• Increased sexual energy
• Easily distracted – like your thoughts are racing or you can’t concentrate
• Confident or adventurous
• Like you’re untouchable or can’t be harmed (more likely in mania)
• Like you can perform physical and mental tasks better than normal
• Like you need less sleep than usual
• Very focused or determined to complete certain tasks or projects

Behaviours

During a manic or hypomanic episode, you might:

• Be more active than usual
• Talk a lot, speak very quickly, or not make sense to other people
• Be very friendly to others
• Say or do things that are inappropriate and out of character
• Sleep very little or not at all
• Act rudely or aggressively
• Misuse drugs or alcohol
• Spend money excessively or in a way that is unusual for you
• Lose social inhibitions
• Take risks with your safety

“On ‘up’ days I chatter nineteen to the dozen with anyone, to the point it annoys people, and I can’t stay still.”

What will I feel like afterwards?

After a manic or hypomanic episode you might:

• Feel very unhappy or ashamed about how you behaved
• Have made commitments or taken on responsibilities that now feel unmanageable
• Have only a few clear memories of what happened during your episode, or none at all
• Feel very tired and need a lot of sleep and rest

For more information, see our pages on hypomania and mania.

Depressive episodes

Depressive episodes are periods of feeling low. They last at least two weeks but can last much longer, sometimes for months. Like manic or hypomanic episodes, they can severely disrupt your everyday life. Severe depression may require medication or a stay in hospital.

Some people find that depressive episodes can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper.

Feelings

During a depressive episode, you might feel:

• Down, upset or tearful
• Tired or sluggish
• Uninterested in things you usually enjoy
• Low self-esteem and a lack of confidence
• Guilty, worthless or hopeless
• Agitated and tense
• Like you can’t concentrate on anything
• Suicidal

Behaviours

During a depressive episode, you might:

• Not do things you normally enjoy
• Have trouble sleeping, or sleep too much
• Eat too little or too much
• Misuse drugs or alcohol
• Act withdrawn or avoid social situations
• Spend a lot of time thinking about upsetting or difficult things (also called rumination)
• Avoid contacting or responding to people
• Be less physically active than usual
• Try to self-harm or attempt suicide

For more information, see our pages on depression.

“The lows can be flat and devoid of colour, or intense and torturous. Sometimes it’s full of demons, and pain inside so bad that nothing physical could hurt you.”

Mixed episodes

A mixed episode, sometimes called a mixed state, is when you feel both high and low.

You may experience symptoms of depression, plus mania or hypomania at the same time. For example, you may feel very energised and impulsive, while feeling upset or tearful. Or you may feel very agitated or irritable.

You may also experience highs and lows very quickly after the other, within the same day or hour.

A mixed episode can be particularly difficult to cope with, as:

• It can be harder to work out what you’re feeling
• It can be harder to identify what help you need
• You might find managing your emotions harder and more exhausting
• Your friends, family or doctor might struggle to know how to best support you
• You may be more likely to act on suicidal thoughts and feelings

“The mixed episodes are the worst. The most unpredictable and most dangerous ones, I find them difficult to explain.”

Psychotic symptoms

Not everyone with a diagnosis of bipolar disorder experiences psychosis, but some people do. It’s more common during manic episodes, but can also happen during depressive episodes.

These kinds of experiences can feel very real to you at the time, which may make it hard to understand other people’s concerns about you.

Psychotic symptoms can include:

• Delusions, such as paranoia
• Hallucinations, such as hearing voices

For more information, see our pages on psychosis.

“Then with mania comes the paranoia, the shadows, the voices, the thought someone is behind me following me everywhere I go, ready to get me.”

Stable or neutral periods

It’s common to have stable or neutral periods in between episodes. This doesn’t mean that you have no emotions during this time. It means that you’re not currently experiencing mania, hypomania or depression, or that you’re managing your symptoms effectively.

You might find you feel stable for years in between episodes. Or your periods of stability might be much shorter.

Stable periods can feel like a relief. But they can also feel challenging in their own way. You may feel:

• Happy, calm or relieved
• Worried about becoming unwell again
• Embarrassed or guilty about things you did or said when you were unwell
• Like you have lots to sort out or catch up on
• Like you have to ‘get back to normal life’ straight away
• That you miss elements of your life or personality from when you were unwell
• Unsure about whether to continue with medication or other treatment

“It’s a lot harder coming to terms with being stable than I could have imagined. I’ve had to struggle with a ‘new’ identity and way of life after spending so many years thinking the ups and downs of bipolar are ‘normal’.”

How often do bipolar episodes occur?

Bipolar episodes happen at different times for different people. The frequency can depend on a lot of things, such as:

• Your exact bipolar disorder diagnosis.
• How well you’re able to manage your symptoms.
• How you’d personally define an episode.
• Whether certain situations or experiences can trigger episodes. For example, you might find that sleeping very little or going through a stressful life event could trigger a manic episode.

The length of mood episodes can also vary. They can last for a few weeks or much longer. What’s normal for you can also change over time.

This page covers:

• Bipolar 1
• Bipolar 2
• Cyclothymia
• Rapid cycling bipolar
• Bipolar with mixed features
• Bipolar with seasonal pattern
• Unspecified bipolar

Bipolar 1

You may get a diagnosis of bipolar 1 if you have experienced:

• At least one episode of mania which has lasted longer than a week.
• Some depressive episodes too, although not everyone does.

Bipolar 2

You may get a diagnosis of bipolar 2 if you have experienced both of the following:

• At least one depressive episode.
• Symptoms of hypomania that have lasted at least four days.

Cyclothymia

You may get a diagnosis of cyclothymia if:

• You’ve experienced both hypomanic and depressive mood episodes over the course of two years or more.
• Your symptoms aren’t severe enough to meet the diagnostic criteria of bipolar 1 or bipolar 2.

Cyclothymia can sometimes develop into bipolar 1 or bipolar 2.

Cyclothymia can be a difficult diagnosis to receive. You may feel as though someone is saying your symptoms are ‘not serious enough’, but this isn’t the case. Cyclothymia can seriously impact your life. And mental health is a spectrum that covers lots of different experiences.

“I have cyclothymia. It can make you feel more like it must be all in your head as the symptoms are often not as extreme as bipolar.”

Rapid cycling bipolar

You may be told you have bipolar 1 or 2 ‘with rapid cycling’ if you’ve experienced 4 or more depressive, manic or hypomanic or mixed episodes within a year.

This might mean:

• You experience episodes of mania or hypomania, followed by episodes of depression.
• You feel stable for a few weeks between episodes. For example, you may cycle between manic episodes and stable periods.
• You experience episodes that last months, weeks or days.

If you have bipolar disorder, you may experience rapid cycling at certain times in your life and not others.

Currently, rapid cycling is not officially considered a separate type of bipolar disorder. More research is needed about rapid cycling and how best to treat it.

For more information on rapid cycling, see the Bipolar UK website.

Bipolar with mixed features

You may be told that you have bipolar 1 or 2 ‘with mixed features’ if you experience mixed episodes. This is when you experience depression and mania or hypomania at the same time, or very quickly after each other.

This is sometimes called mixed bipolar state or mixed affective bipolar.

Bipolar with seasonal pattern

You may be told that you have bipolar 1 or 2 ‘with seasonal pattern’. This means that the time of year or seasons regularly affect your mood episodes.

Unspecified bipolar

You may hear this if your symptoms don’t quite fit into the diagnostic categories for other types of bipolar disorder.

But this doesn’t mean that:

• Your symptoms are any less difficult
• You don’t need treatment or support

How is bipolar disorder diagnosed?

This page covers:

• What will my doctor ask me?
• How long will diagnosis take?
• Challenges with getting a diagnosis

What will my doctor ask me?

To make a diagnosis of bipolar disorder, your doctor will ask you about:

• How many symptoms you experience
• Which types of mood episodes you experience
• How long your mood episodes last for
• How many mood episodes you’ve had
• How often your mood episodes occur
• How your symptoms impact your life
• Your family history

They may also:

• Ask you to keep a diary of your moods to help you both identify patterns and triggers.
• Check up on your physical health. For example, some conditions like thyroid problems can cause mania-like symptoms.

“Doing too much, or going to extremes, in any aspect of my life, is a recipe for a mood episode.”

Brain chemistry

Evidence shows that you can treat bipolar symptoms with certain psychiatric medications which act on the neurotransmitters. These are the ‘messenger chemicals’ in your brain.

This suggests that bipolar disorder may relate to functional problems of the neurotransmitters. While some research supports this, no one knows for sure how these neurotransmitters work. And we don’t know whether problems with these are a cause of bipolar disorder, or a result of it.

Family links

If you experience bipolar disorder, you’re more likely to have a family member who also experiences bipolar moods and symptoms. But they might not have a formal diagnosis. This suggests that bipolar disorder can be passed on genetically through families.

But this doesn’t strictly mean that there is one ‘bipolar gene’. Family links are likely to be much more complex.

For example, researchers think that social factors can also trigger experiences of bipolar disorder symptoms. And family members can be an influential part of your environment as you grow up.

Medication, drugs and alcohol

Medication, drugs and alcohol may cause you to experience some bipolar moods and symptoms. For example:

• Medication. Some medications can cause hypomania or mania as a side effect. This can happen when you’re taking them, or as a withdrawal symptom when you stop taking them. This includes medications for physical conditions and psychiatric medications – including some antidepressants. Depression can also be a side effect of a lot of different medications. It’s important to discuss any concerns about medication side effects with your doctor.
• Alcohol or recreational drugs. Using these can cause you to experience symptoms similar to mania, hypomania or depression. It can often be difficult to distinguish the effects of alcohol and drugs from mental health symptoms.

Some studies suggest that using certain recreational drugs can increase your risk of developing bipolar disorder. But the evidence is very limited.

If you’re worried about the effects of medication, alcohol or recreational drugs on your mental health, it’s important to discuss it with your doctor.

For more information, see our pages on antidepressants and the mental health effects of alcohol and recreational drugs.