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Most of us have ups and downs in our mood. But if you have bipolar disorder, you get extreme mood swings. This makes it hard to lead a normal life. In between the big highs and big lows, your mood may be normal and steady for weeks, months or even years.

If your doctor tells you that you have bipolar disorder, it means you have had at least one bout of very high mood. That is called mania. These bouts are also known as manic episodes.

Most people with bipolar disorder also have at least one bout of very low mood, called major depression. Because it happens as part of bipolar disorder, doctors refer to it as bipolar depression.

In bipolar disorder, you have low mood much more of the time than you have mania.¹

At first, you may like the way mania feels. You may:

• Feel extra creative
• Be very excited about new ideas
• Start several new interests or hobbies
• Find you can work long hours without getting tired
• Have loads of energy
• Feel high or intensely happy
• Have a stronger sex drive than usual.

And your friends and family may see you as good company early on. You may be charming and full of life.

But this high mood often gets out of control. You may turn aggressive or selfish. And you may do harmful things. You may behave in a way that could hurt you or other people.

As well as making you feel energetic and happy, mania can make you:²

• Feel very restless
• Feel very irritable
• Have racing thoughts
• Be easily distracted
• Find it hard to concentrate.

These feelings can affect the way you behave. You may:

• Speak very fast, jumping from one idea to another
• Need less sleep
• Think you have special abilities or powers
• Make bad decisions
• Go on spending sprees
• Act in a way that's unusual for you
• Abuse alcohol and drugs, especially cocaine and sleeping pills
• Be aggressive, flirt with people or behave in a way that is not appropriate.

Even though mania can make people do all these things, they often say that nothing is wrong.

If you have a bad bout of mania, your family and friends may think you are totally out of control, even if you think you are fine. You might make snap decisions about money and work. Then later on, you wish you had not. And you may act in a reckless way. For example, you may spend far more money than you can afford, drive in a dangerous way or have sex with lots of people.

But your mania may not be this bad. You may get the mild kind. This is called hypomania. With this kind, you may still speak quickly and be restless.³ And you may jump from one activity to another, without finishing anything properly. But you won't be seriously out of control.

A bout of mania may start suddenly. How long it lasts depends on what kind you get. If you get full-blown mania and you don't have treatment, it can last for between two weeks and five months.² If you get the mild kind of mania (hypomania), it will last for at least four days.⁴

At the end of a bout of mania, you may be run down. You may not have eaten or washed for a while. You may look scruffy. Also, you may have lots of regret and shame for the way you behaved.

Having a bout of mania can put a lot of strain on your relationships with friends, family and partner. It can be hard to keep up with your studies or hold down your job. This can happen even if you are normally quite capable of doing these things.

When depression happens in people with bipolar disorder, doctors call it bipolar depression. The symptoms are a lot like the ones of depression in people who don't get mania. (That kind is called unipolar depression.)

A bout of bipolar depression lasts longer than a bout of mania. You will have it for at least two weeks. But it usually goes on for about six months.

If you have bipolar depression, you may:²

• Feel sad, anxious or empty
• Feel hopeless or negative about the future
• Feel guilty, worthless or helpless
• Lose interest or pleasure in things you normally enjoy, including sex
• Have no energy or feel tired all the time or slowed down
• Find it hard to concentrate, remember things or make decisions
• Be restless or irritable
• Sleep too much or have trouble sleeping
• Feel hungry all the time or not at all
• Put on weight or lose weight, without meaning to
• Think about death or think about killing yourself, or try to kill yourself.

Bipolar disorder can cause other symptoms and follow other patterns too. Here are some to watch for.

• Psychosis. With psychosis, you get symptoms called hallucinations or delusions. They make you lose touch with reality. Psychosis can happen as part of a bout of mania or bipolar depression. But only a few people with bipolar disorder get psychosis. For more information, see Psychotic symptoms.
• Cyclothymia. This is a period when your mood swings between mild depression and mild mania. It lasts for at least two years.
• Mixed episode. This is when you get symptoms of depression and mania mixed together at the same time. For example, you might feel very sad and hopeless, but you also have racing thoughts and lots of energy. You may also hear this called mixed affective state.
• Rapid cycling. This is when you have four or more bouts of mania or depression within a year. You may switch in and out of a normal mood. Or you may switch from one extreme mood to the other, without any period of normal mood in between. Rapid cycling is more common in women than in men.

Bipolar disorder tends to be a long-term illness. More than 9 in 10 people who have one bout of this disorder have at least one more.⁴

The symptoms of bipolar disorder differ between people. You may be interested to read the stories of some people who have it. Here are some websites that you may find helpful:

• A Patient's Journey, by Suzanne G. Johnstone
• The MDF BiPolar Organisation
• Pendulum
• Massachusetts General Hospital Bipolar Clinic and Research Program
• Depression and Bipolar Support Alliance.

You may also find it helpful to read the book An Unquiet Mind (Picador, 1995). It was written by Kay Redfield Jamison. She is a psychologist and expert on treating mania. But she also has bipolar disorder. In the book, she talks about treatment for her own bipolar disorder.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.