Episodes of hypomania, or mild mania, include symptoms such as increased energy, elevated mood, irritability, and intrusiveness, which may cause little impairment in functioning but are noticeable to others. Sometimes, severe depression or mania is accompanied by periods of psychosis. Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time. Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking.
Depressed mood accompanies manic activation.
Episodes of mania, depression, or mixed state typically recur and become more frequent across the life span. These episodes, especially early in the course of illness, are separated by periods of wellness during which a person suffers few to no symptoms. When four or more episodes of illness occur within a 12 month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse. A variety of medications are used to treat bipolar disorder.