Bipolar disorder strikes men and women equally and affects about 3 percent of American adults at some point in their lives. A person with bipolar disorder typically has alternating periods of major depression and mania. In rare cases, mania can occur on its own.

Manic episodes are characterized by distinct periods of abnormally and persistently elevated, expansive, or irritable mood. These episodes, with their restless energy and volatile mood swings, are severe enough to cause trouble at work, home, or both. Episodes of milder manic symptoms are termed hypomania. Men with bipolar disorder tend to have more manic episodes; women are more likely to experience depressive episodes. The time between cycles can vary greatly.

Bipolar disorder can begin with an episode of either depression or mania, but about two thirds of all cases start with a manic episode, and mania tends to predominate. A manic episode is accompanied by at least three of the following seven symptoms:

  • feelings of grandiosity or inflated self-esteem
  • diminished need for sleep
  • being extremely talkative
  • the sense that thoughts and ideas are racing
  • being easily distracted
  • increased productivity and/or activity at work, at school, or in social situations
  • excessive involvement in high-risk activities that are likely to have serious consequences.

Because manic episodes can cause impaired judgment, people must be protected from engaging in self-destructive actions, such as making unwise investments, going on large spending or gambling sprees, driving recklessly, or impulsively starting intense and unwise romantic or sexual relationships.

Certain medications and health conditions can cause significant mood swings that mimic the symptoms of bipolar disorder. These include corticosteroids, antidepressant or antianxiety drugs, drugs for Parkinson's disease such as tolcapone (Tasmar), abuse of alcohol or other drugs, an underactive or overactive thyroid gland, a neurological or adrenal disorder, vitamin B12 deficiency, and other mental health conditions such as schizophrenia. These potential causes of mood swings should be taken into account when a person is suspected of having bipolar disorder or is not responding to treatment.

Publication Review By: Karen L. Swartz, M.D.

Published: 03 Mar 2011

Last Modified: 19 May 2014