Individuals with bipolar disorder (also known as manic depressive illness) may experience rapid mood changes, and during severe episodes may experience hallucinations (perceptions, such as sounds, visions, etc.) that do not exist  and delusions (fixed false beliefs). This illness is characterized by alternating  cycles (episodes) of depression and mania. These cycles may be frequent (daily) or infrequent (years apart).  In young people, manic cycles often contain substantial irritability as well as, or even instead of the grandiosity and euphoria symptoms seen in adults. 

A diagnosis of bipolar requires at least one depressive episode and one manic episode. The usual first episode in a person who develops a bipolar illness is depression.  Occasionally, a person can have two or more episodes of depression prior to the first manic episode occurring.  For most people with bipolar illness, the first episode of the disorder begins in the teenage years.


How is Mania Different From Feeling Extremely Happy?

• Mood is mostly elevated (high, euphoric, grandiose) or irritable
• The person is excessively active, restless, agitated - but activity is poorly focused

• Mood may often not reflect the reality of the environment (e.g.: euphoric at a funeral)
• Grandiose thoughts (i.e. i am the worlds greatest entrepreneur so i will purchase this business, with no afterthought to the implications)
• Racing thoughts  and rapid speech (can’t grab on to thoughts or focus on them, describes "pressure of thoughts in their head")
• Distractibility (can start a conversation about cars and end up talking about ice cream, less continuity between topics)
• Participation in risk taking behaviours (no limits, often with severe but unrecognized negative consequences)
• Much less sleep (often 2 - 4 hrs per night) with no discernable decrease in energy
• Behavioural, physical and thinking problems
• Significant problems in daily life because of mood (engages in behaviors that later cause embarrassment)
• It is not caused by a life problem or life event

What Causes Bipolar?

Bipolar has a genetic component to it. It is a disorder of mood control in the brain.  Instead of a person's mood moving up and down within a "usual" or "normal" range, the mood "thermostat" fails to provide the kind of mood leveling feedback we expect.  As a result, a person's mood "goes out of control".

How Do You Know if Someone You Love Has Bipolar?

The symptoms of bipolar can be extreme or subtle. Here are some items to take note of:
• History of at least one depressive episode and at least one manic episode
• Rapid mood changes including irritability and anger outbursts
• Self-destructive or self-harmful behaviours – including: spending sprees, violence towards others; sexual indiscretions, etc.
• Drug or alcohol overuse, misuse or abuse (as a result of the mood, not a causal of the mood)
• Psychotic symptoms including: hallucination and delusions

How is Bipolar different in Girls and Boys?

• Bipolar disorder occurs with similar frequency in boys and girls.  Differences in symptom expression may reflect different gender roles in our society.

What Are the Criteria for Diagnosis of Bipolar?

Bipolar disorder may begin as early as 10 years old, but usually begins in mid to late adolescence ( 15 -20  years old).  Mild bipolar symptoms may sometimes be  confused with ‘being a teenager’.  It is important to remember that "being a teenager" does not cause bipolar illness. 

Symptoms of bipolar illness may vary in severity.  Sometimes people with bipolar illness may have depressions and only mild manic episodes (these are know as hypomanic states).  This is a recognized variant of bipolar illness called bipolar type II disorder.  During depressive states in a bipolar illness, symptoms  of bipolar depression are similar to depression that happens without manic states, and can include:
• Feelings of  depression, despondence, living in a dark world with no joy
• Not enjoying things you used to do (lack of pleasure)
• Hopelessness and negative thoughts about the past, present and future
• Prefer to sleep rather than facing the day, fatigue and listlessness
• Poor concentration
• Changes in appetite and weight
• Suicidal thoughts

During episodes of mania, symptoms are opposite to those experienced during depression, and can include:
• Feeling on top of the world (euphoria)
• Continuously expressing emotions such as silly, giddy and goofy
• Act like they have special knowledge or are superior to others (grandiosity)
• Have too many thoughts at once, feeling a pressure of thoughts in their head
• Need to continue talking - rapid and sometimes confused speech
• Distracted, unable to focus
• Need for little sleep
• Strong sexual feelings (hypersexual very intense feelings), act on them when not appropriate
• Often have no insight into their behavior and may act in a way very different from their usual norms and values
These symptoms are much more severe,  last longer than regular ups and downs of life., are not easily controlled by the person and cause substantial impairment in their functioning.

Some individuals will experience a ‘mixed state’ mania and depression simultaneously.

For many people with bipolar illness, there may be periods of time (lasting from days to years) where the mood is under better control and more likely to stay within "usual" limits.  This is especially true if the person is being successfully treated for the illness.

Is There A Connection Between Self-Injury, Cutting and Bipolar?

The exact relationship between deliberate self-injury such as cutting and bipolar illness is not well understood.  Some people with bipolar illness will self-injure and others will not.  Individuals cut themselves for many reasons.  One reason may be to as a way to numb emotional pain. For some people, the act of cutting releases a chemical that can temporarily help them to feel better. However, over time, just like an addiction it may require more and more self injury to produce the same affect. Cutting and self-injury happens more often in girls than in boys. 

Someone in Your Life is Diagnosed with Bipolar, Now What?

It is really important for you and your loved on to be well informed about what bipolar illness is and what treatments are available.  There are many places on this site where you can get more information.  One important resource can help you in your discussions about what kinds of  things you need to know to ask your health provider about . Make sure you spend enough time discussing any concerns that you have with your treatment team.  Work together with them to create a holistic treatment plan that includes medication but not just medication.  Remember that treatment for bipolar illness includes everything that is important for getting well and staying well.  Here are a few other things that may help.

  • After the diagnosis and during the treatment,  it is important to track moods and other symptoms. You can help your loved one track their moods using a calendar, journal or something you design together with the treatment team that works best for your loved one.
  • The journal can include: how they feel, if there are changes throughout the day and how strong the feelings are. Sharing this information with the mental health team can improve and help modify treatments.
  • Help the young person identify things such as risky behaviour that they are taking while under the treatment of a professional. If their moods aren’t leveling out, it is important to share this information so that the treatment program can be adjusted accordingly.
  • Taking drugs or drinking alcohol are highly toxic to the brain of someone with bipolar illness.  They can make it harder to treat the illness or even cause it to come back when it has been treated.  So not taking drugs or alcohol is a good idea if you have bipolar. 
  • Sleep is restorative and lack of sleep can trigger an episode of mania. It is very important to get the proper amount of sleep every night ( 8 - 9 hours).

Suicide rates are high in people with bipolar mood disorder. It is important to  understand that the risk is higher and to note warning signs (see our suicide page for more information).

What Treatment Options Exist?

• Medications
• School supports
• Community supports

Treatment is different for everyone, so often trials of various combinations will be used until the right combination is found for you. This may also change over time if new symptoms develop or if symptoms are not responding as well as expected.


Other Disorders  and Outcomes That May Commonly Occur Alongside Bipolar Include:

• Eating Disorders

Resources for Teens and Families

Evidence Based Medicine

Other Helpful Resources

Bipolar Kids 
National Institute of Mental Health
Centre for Addiction and Mental Health
BlackDog Institute Bipolar Resources

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