What is a Bipolar Episode?

Summary: A bipolar episode is an extended mental health event that involves symptoms of mania associated with bipolar disorder, symptoms of depression associated with bipolar disorder, or a combination of both manic and depressive episodes associated with bipolar disorder.

Key Points:

• Bipolar disorder, formerly called manic depression, is characterized by a combination of manic episodes, depressive episodes, or a mix of both.
• Bipolar episodes can disrupt daily life, affect relationships, and impair vocational and academic performance and achievement.
• Extreme depressive episodes can create problems by severely decreasing motivation and ability to engage in essential activities.
• Extreme manic episodes can create problems associated with overconfidence, risky behavior, and an unrealistic sense of self and personal capabilities.

What is Bipolar Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies three primary types of bipolar disorder. These include:

• Bipolar I
• Bipolar II
• Cyclothymic disorder

We’ll discuss the differences in these three types of bipolar disorder in a moment. Before we explore the differences – and talk about how to identify a bipolar episode – we’ll offer with this definition from the American Psychiatric Association :

“Bipolar disorders are mental health conditions characterized by periodic, intense emotional states affecting a person’s mood, energy, and ability to function. These periods, lasting from days to weeks, are called mood episodes. Mood episodes are categorized as manic/hypomanic episodes when the predominant mood is intensely happy or irritable, or depressive episodes, when there is an intensely sad mood or the ability to experience joy or pleasure disappears.”

That gives us a solid basic understanding of what bipolar disorder is. The three types involve some combination of manic, hypomanic (manic episodes less intense than typical BD-associated mania), and depressive episodes.

Let’s look at the specific symptoms associated with these three types of bipolar disorder:

Bipolar I (BD-I):

Symptoms include:

• Manic episodes
• Depressive episodes
  • Depressive episodes appear in many, but not all, people with BD-I
• Mixed manic/depressive episodes
  • Episodes last a week or more
  • Disrupt sleep
  • Impair daily function

Bipolar II (BD-II):

Symptoms include:

• Depressive episodes
• Hypomanic episodes
• Mixed depressive/hypomanic episodes
• Manic and depressive episodes are most often less severe and disruptive than in BD-I.
• Manic episodes of diminished intensity in BD-II are called hypomanic episodes.

Cyclothymic disorder:

Symptoms include:

• Depressive episodes
• Hypomanic episodes
• Episodes are neither intense enough or long enough to meet criteria for BD-I or BD-II

The National Institutes of Health (NIH) report the prevalence of bipolar disorder among adults in the U.S. as follows:

• Total, ever diagnosed, age 18+: 4.4%
• Total, past 12-month diagnosis, age 18+: 2.8%
• Past 12-month diagnosis, by gender, age 18+:
  • Females: 2.8%
  • Males: 2.9%

The World Health Organization (WHO) reports a worldwide prevalence of bipolar disorder of roughly 37 million people.

How to Recognize a Bipolar Episode

According to the 2025 publication “Bipolar Disorder” from the peer-reviewed medical journal The Lancet, a bipolar episode is a distinct period of time during which the mood and behavior of an individual changes drastically from the mood and behavior typical for that individual.

In general, manic episodes are characterized by high energy and unpredictable behavior, depressive episodes are characterized by low energy, low mood, and lack of motivation, and mixed episodes involve a combination of both.

Let’s learn about what a manic episode might look like.

Manic Episodes: What to Watch For

A person experiencing a manic episode may display some or all the following behaviors/moods:

• Extremely high energy
• Excess activity/business
• Agitation
• Overconfidence
• Distorted sense of self/unrealistic concept of self
• Extreme euphoria
• Excess agitation/irritability
• Poor sleep habits/perceived decreased need for sleep
• Disorganized/racing thoughts
• Excess talking/fast talking
• Impaired rational decision-making
• Risky behavior

When a person is in a manic phase – especially if they have BD but are undiagnosed – they may be difficult to communicate with, reason with, and interact with. They may not recognize the fact they’re in a manic phase and have difficulty understanding why others think something is wrong. From their perspective, things are great, and they may feel better than ever. That’s one of the dangers of undiagnosed BD. The excess – but ungrounded – positivity and confidence associated with the manic phase of bipolar can result in risky behavior and or behavior that alienates friends, family, and loved ones.

In contrast, a person who knows they have BD may be able to recognize their atypical behavior when reminded they may be in a manic phase. In most cases, a return of mania in bipolar coincides with the individual voluntarily discontinuing medication, and symptoms can be regulated with a return to medication and psychotherapy as needed.

Depressive Episodes in Bipolar Disorder/Mixed Episodes in Bipolar Disorder

While depressive episodes in bipolar disorder aren’t as dramatic and obvious as manic episodes, they can still be incredibly disruptive. A depressive episode in bipolar disorder is akin to experiencing severe major depressive disorder (MDD) for two weeks or more.

Let’s learn about what a depressive episode might look like.

Depressive Episodes: What to Watch For

A person experiencing a depressive episode may display some or all the following behaviors/moods:

• Extreme sadness/hopelessness
• Persistent sense of worthlessness
• Feelings of guilt/shame
• Withdrawal from friends, family, loved ones
• Decreased interest in favorite activities, hobbies, pursuits
• Rapid loss or gain of weight/change in eating habits
• Problems with sleep: too much or too little
• Decreased energy
• Persistent, daily fatigue
• Decreased interest in or attention to basic personal hygiene

Depressive phases of bipolar disorder, both in people with and without a diagnosis, may be more difficult to identify than manic phases because of their nature. A person experiencing a manic episode often draws attention to themselves, whereas a person experiencing often does the opposite, and diverts attention from themselves.

During a depressive episode, a person with bipolar disorder experiences distressing, uncomfortable levels of sadness, low mood, and low self-regard, often resulting in severe disruption in daily life and basic activities. Depressive episodes can have a negative impact on relationships, work, and school. The dangers of untreated depression in people with bipolar disorder include worsening symptoms and increased risk of suicidality.

That last sentence is important: while the depressive episodes in bipolar disorder may not be as apparent or visible as the manic episodes in bipolar disorder, the risks and possible negative consequences can be both serious and severe.

Next, we’ll take a closer look at mixed episodes.

Mixed Episodes: What to Watch For

A person experiencing a mixed episode may display the following:

• Some or all the symptoms of manic and depressive episodes listed above, grouped closely in time
• Rapid changes from depressive to manic states and vice versa
• Excessive energy/high mood accompanied by excessive sadness/low mood

Mixed episodes carry the same risks and negative consequences as manic and depressive episodes. They may be easier to identify than depressive episodes due to the presence of mania, and easier to distinguish from manic episodes due to the presence of depressive symptoms.

How to Help Someone Who Experiences a Bipolar Episode

When a bipolar episode is extreme and/or severe, it may be necessary to seek crisis support. If the individual has a diagnosis and a treatment team, that’s the place to start. If they don’t, or their providers are temporarily unreachable, then it may be necessary to call the following number:

The National Help Line: Dial 988

If an individual is experiencing a suicide crisis, call 911 or go to the emergency room right away if risk of harm is imminent. If not, call the crisis line. Do not ignore or downplay any talk of suicide: the consequences of being wrong far outweigh any inconvenience caused by addressing the problem or crisis right away.

Similarly, if a person is in a manic phase and displays behavior that puts them, a family member, or loved one at risk, call the national help line at 988.

When a bipolar episode does not rise to the level of a mental health emergency, the best way to help someone with a diagnosis is to help connect them to their treatment team: they’ll know the individual and know how to help. If you suspect the individual is having a bipolar episode and they don’t have a diagnosis of bipolar disorder, you can help them arrange for a full psychiatric evaluation.

If an evaluation indicates the presence of bipolar disorder, treatment may include a mix of medication, psychotherapy, and lifestyle changes:

• Medications for bipolar disorder may include antidepressants, mood stabilizers, or antipsychotics
• Psychotherapy for bipolar disorder may include:
  • Cognitive behavioral therapy (CBT)
  • Diagnostic behavior therapy (DBT)
  • Acceptance & commitment therapy (ACT)
  • Solution-focused brief therapy (SFBT)
• Lifestyle changes for bipolar disorder may include:
  • Improved diet
  • Increased exercise/activity
  • Improved sleep habits
  • Improved distress tolerance/stress management techniques

In addition, treatment centers may offer a range of new, emerging, or supportive treatments. New brain stimulation techniques may include electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). Emerging medications may include ketamine or Spravato, while supporting modalities may include approaches like mindfulness, meditation, yoga, acupuncture, or expressive therapies such as writing, visual art, or music.