"My Mood Goes Up and Down – Does That Mean I Have Bipolar?" Understanding Bipolar Disorder

One of the questions people sometimes ask me is whether having frequent changes in mood means they might have bipolar disorder.

They may describe feeling very positive and energetic one day but low or irritable the next. Others tell me that friends or family have described them as "a bit bipolar" because their mood can change quickly.

This reflects one of the most common misunderstandings about bipolar disorder.

We all experience fluctuations in our mood. We can wake up feeling positive, have a difficult afternoon and feel completely different by the evening. Our mood naturally responds to sleep, stress, relationships, hormones, physical health and what is happening around us.

Bipolar disorder is different.

It involves distinct episodes in which someone's mood, energy, activity and behaviour change significantly from their usual level of functioning. These episodes generally persist over a period of time rather than simply representing the ordinary ups and downs of everyday life.

What Is Bipolar Disorder?

Bipolar disorder is a mental health condition characterised by episodes of significant changes in mood.

People can experience periods of depression as well as periods of unusually elevated or irritable mood known as mania or hypomania.

Importantly, bipolar disorder doesn't necessarily mean somebody is constantly moving between these two states.

Many people have substantial periods when their mood is relatively stable.

The pattern, frequency and severity of episodes can also vary considerably between individuals.

What Does Mania Look Like?

People sometimes imagine mania as simply feeling extremely happy. It is much more than that.

During a manic episode, someone's mood may become unusually elevated, but they may also become significantly more irritable or agitated.

Energy and activity levels often increase considerably. The person may sleep very little but still feel full of energy. They might speak much more quickly than usual, move rapidly between ideas or feel that their thoughts are racing.

Confidence can become unusually high. Someone may develop ambitious plans or believe they have abilities that are significantly beyond their usual experience.

Decision-making can also change.

They may spend unusually large amounts of money, make impulsive decisions, take significant risks or behave in ways that are completely out of character.

When mania becomes severe, people can lose touch with reality and develop psychotic symptoms such as delusional beliefs or hallucinations.

At that point, urgent psychiatric treatment is often required.

What About Hypomania?

Hypomania involves similar changes but is less severe than mania.

Someone may become noticeably more energetic, confident, talkative or productive and require less sleep than usual.

In fact, some people initially enjoy these periods.

They may feel exceptionally creative or productive and wonder why anyone would consider this a problem.

The important question is whether this represents a clear and sustained change from the person's usual self.

Hypomania is also important because it can form part of a broader pattern of bipolar disorder, particularly when someone has also experienced significant depressive episodes.

The Depressive Side Can Be Easier to Recognise

For many people with bipolar disorder, depression is what initially brings them into contact with mental health services.

During depressive episodes, they may experience persistent low mood, loss of enjoyment, reduced motivation, poor concentration, changes in sleep or appetite and feelings of hopelessness or worthlessness.

Some people experience thoughts of self-harm or suicide.

Because depression is much easier to recognise as something being wrong, previous periods of unusually elevated mood may not initially be mentioned.

Someone might simply remember a period when they were "doing really well" or had unusually high levels of energy.

Understanding someone's mood over a longer period of time is therefore an important part of psychiatric assessment.

Rapid Mood Changes Don't Automatically Mean Bipolar Disorder

This distinction is particularly important.

Someone whose emotions change several times during the same day does not necessarily have bipolar disorder.

Rapid emotional changes can occur for many reasons, including anxiety, stress, ADHD, emotional dysregulation, personality difficulties, trauma-related conditions and ordinary responses to challenging circumstances.

With bipolar disorder, we are usually interested in identifiable episodes involving a broader change in mood, energy, sleep, thinking and behaviour.

This is one reason why diagnosing bipolar disorder requires much more than simply asking whether somebody experiences "mood swings".

Why Does Getting the Diagnosis Right Matter?

Accurate diagnosis is particularly important because treatment for bipolar disorder can differ from treatment for other mental health conditions.

Medication is often an important part of treatment and may include mood stabilising medication or certain antipsychotic medications. Psychological therapy, recognising early warning signs, maintaining regular sleep and understanding personal triggers can also be important parts of staying well.

Treatment needs to be individualised.

It is also important for clinicians to understand whether somebody with depression has previously experienced mania or hypomania, as this can influence decisions about medication.

A detailed history is therefore essential.

Sometimes information from a partner or family member can be particularly helpful because changes in behaviour may have been more obvious to those around the person than they were to the individual themselves.

Learning Your Early Warning Signs

For somebody who has experienced episodes of mania, hypomania or depression, understanding their own early warning signs can be extremely valuable.

Sleep is often particularly important.

A noticeable reduction in the need for sleep, increasing energy, becoming unusually talkative, starting numerous projects or feeling increasingly confident may sometimes indicate that mood is beginning to become elevated.

Equally, withdrawing from other people, losing interest in usual activities or noticing persistent changes in sleep and motivation may indicate that depression is developing.

Recognising these changes early can provide an opportunity to seek help before an episode becomes more severe.

A Final Thought

Bipolar disorder is much more complex than simply having moods that go "up and down".

It is a condition involving significant episodes that can affect someone's mood, energy, sleep, thinking, judgement and behaviour.

For people living with bipolar disorder, receiving the right diagnosis can be enormously important. It provides an explanation for experiences that may previously have seemed confusing and allows treatment to focus not only on becoming well but also on remaining well.

At the same time, we should be careful not to medicalise every change in emotion.

Human beings are supposed to experience different moods.

The important questions are how significant the change has been, how long it has lasted, whether it represents a clear difference from the person's usual self and what effect it has had on their life.

Understanding that distinction helps us move beyond the popular idea of bipolar disorder as simply "mood swings" and towards a much more accurate understanding of what the condition actually involves.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry