The manic phase may last from days to months and can include the following symptoms:

• Agitation or irritation
• Elevated mood
  • Hyperactivity
  • Increased energy
  • Lack of self-control
  • Racing thoughts
• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
• Little need for sleep
• Over-involvement in activities
• Poor temper control
• Reckless behavior
  • Binge eating, drinking, and/or drug use
  • Impaired judgment
  • Sexual promiscuity
  • Spending sprees
• Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

• Difficulty concentrating, remembering, or making decisions
• Eating disturbances
  • Loss of appetite and weight loss
  • Overeating and weight gain
• Fatigue or listlessness
• Feelings of worthlessness, hopelessness and/or guilt
• Loss of self-esteem
• Persistent sadness
• Persistent thoughts of death
• Sleep disturbances
  • Excessive sleepiness
  • Inability to sleep
• Suicidal thoughts
• Withdrawal from activities that were once enjoyed
• Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

• Ask about your family medical history, particularly whether anyone has or had bipolar disorder
• Ask about your recent mood swings and for how long you've experienced them
• Observe your behavior and mood
• Perform a thorough examination to identify or rule out physical causes for the symptoms
• Request laboratory tests to check for thyroid problems or drug levels
• Speak with your family members to discuss their observations about your behavior
• Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.