Avatar photo

By Dr Dulcy Rakumakoe

Chief Executive Officer

The highs and the lows of bipolar disorder

If you have any symptoms of depression or mania, see your doctor or mental health professional.

Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

People with bipolar tend to fluctuate between being depressed and manic or hypomanic, and may feel euphoric, full of energy or unusually irritable.

These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year.

While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan that may include medications and counselling.

Although bipolar disorder can occur at any age, typically it’s diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Despite the mood extremes, people with bipolar disorder often don’t recognise how much their emotional instability disrupts their lives and the lives of their loved ones and don’t get the treatment they need.

If you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive.

However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Getting treatment from a
mental health professional can help you get your symptoms under control.

Suicidal thoughts and behavior are common among people with bipolar disorder.

If you have thoughts of hurting yourself, call the helpline of SADAG on 0800 12 13 14 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend.

Or call the suicide hotline number 0800 567 567.


There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behaviour.

Bipolar I disorder

You’ve had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger an episode of psychosis.

Bipolar II disorder.

You’ve had at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Cyclothymic disorder

You’ve had at least two years – or one year in children and teenagers – of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Mania and hypomania

Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties.

Mania may also trigger a break from reality (psychosis) and require hospitalization. Both a manic and a hypomanic episode include three or more of these symptoms:

  • Abnormally upbeat, jumpy or wired
  • Increased activity, energy or agitation
  • Exaggerated sense of well-being and self-confidence (euphoria)
  • Decreased need for sleep
  • Unusual talkativeness
  • Racing thoughts
  • Distractibility
  • Poor decision-making.

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

  • Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability).
  • Marked loss of interest or feeling no pleasure in all – or almost all – activities.
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite.
  • Either insomnia or sleeping too much.
  • Either restlessness or slowed behaviour.
  • Fatigue or loss of energy

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

For more news your way, download The Citizen’s app for iOS and Android.

Read more on these topics

depression Health