Bipolar Disorder Warning Signs

Medically Reviewed by Zilpah Sheikh, MD on March 13, 2024
4 min read

People with bipolar disorder often have mood swings that can be both high and low. When you show these classic mood patterns, diagnosing bipolar disorder is relatively straightforward.

But bipolar disorder can be sneaky. Symptoms may not always follow the typical high-low cycle. You could have occasional episodes of mild mania or hypomania that fly under the radar. Depression can overshadow other parts of the illness. Sometimes, symptoms of depression and mania can happen at the same time. And substance misuse can complicate your diagnosis even more.

These complexities make bipolar disorder challenging to diagnose, especially when symptoms aren't clear-cut. Here are some lesser-known facts about bipolar disorder:

  • As many as 20% of people who report depression to their doctor actually have bipolar disorder.
  • About half of people with bipolar disorder see three professionals before getting the correct diagnosis.
  • It typically takes around 10 years for people to seek treatment for bipolar disorder after symptoms start, often because of delays in diagnosis.
  • Most people with bipolar disorder also have other mental health conditions like substance abuse or anxiety , making diagnosis even more complex.

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Doctors often mistakenly diagnose people with bipolar disorder with depression alone. In bipolar 2 disorder, which is a milder form, manic episodes are subtle and can pass by unnoticed. People with bipolar 2 disorder typically spend much more time having depressive symptoms compared to hypomanic symptoms, with a ratio of about 35-to-1.

Similarly, in bipolar 1 disorder, where mania is more pronounced, time spent in depressive states usually exceeds time spent in manic states by about 3-to-1, although the severe nature of mania in bipolar 1 makes it easier to spot.

It's important to distinguish major depressive disorder, commonly known as unipolar depression, from bipolar disorder 2 because unipolar depression lacks episodes of hypomania present in bipolar 2.

Anyone being assessed for depression should also be evaluated for a lifetime history of manic or hypomanic episodes to accurately diagnose bipolar disorder.

Substance abuse makes diagnosing and treating bipolar disorder more complex. Research suggests that up to 60% of people with bipolar disorder also struggle with drug or alcohol misuse. When substance abuse goes untreated alongside bipolar disorder, managing mood symptoms of bipolar disorder becomes extremely challenging. It can also be hard to make a confident diagnosis of bipolar disorder when someone is actively using substances that cause mood swings.

Substances like alcohol and cocaine can further complicate the situation. For example, people high on cocaine can appear manic when they're actually intoxicated, or have a depression "crash" when the drug wears off. Some people with bipolar disorder use drugs and alcohol impulsively during manic episodes, while others may have a separate substance use disorder requiring its own treatment. Substance abuse may make bipolar episodes (mania and depression) more frequent or severe, and medicines typically used to manage bipolar disorder may not work as well when you use alcohol or drugs.




Bipolar disorder often emerges during the late teenage years and can be especially severe during this period, putting adolescents at a high risk for suicide.

Unfortunately, bipolar disorder in teens often goes undiagnosed and untreated. This is partly because although symptoms may start during adolescence, they may not fully meet the diagnostic criteria for bipolar disorder. Some experts think that bipolar disorder may be over diagnosed in younger people, especially when symptoms involve mood swings or disruptive behaviors rather than changes in energy or sleep patterns. This has led to the use of the diagnosis "disruptive mood dysregulation disorder" for teens who are constantly cranky and have severe temper outbursts or mood swings. Plus, teens may also have other conditions like ADHD, anxiety disorders, and substance abuse, making a diagnosis even more complex.

Some signs that a teenager might have bipolar disorder include:

Signs and symptoms of mania

  • Extremely happy or silly
  • Easily angered 
  • Highly agitated
  • Talking very fast
  • Racing thoughts
  • Exaggerated confidence in their abilities, knowledge, and power
  • Reckless behavior

Signs and symptoms of depression

  • Feeling very sad or hopeless
  • Loneliness
  • Isolation
  • Overeating or eating too little
  • A lack of energy
  • Loss of interest in usual activities
  • Sleeping too much

It's important to note that while some of these symptoms can happen in healthy teens and adults, they become concerning when they don't go away and get in the way of daily life. A psychiatrist or psychologist with expertise in mood disorders should evaluate teens showing symptoms that suggest bipolar disorder.

In addition to bipolar disorder, doctors should consider other possible diagnoses, including unipolar (major) depression, anxiety disorders, substance use disorders, adjustment disorders, attention deficit hyperactivity disorder, and personality disorders such as borderline personality disorder.



Bipolar disorder is an illness defined by cycles of elevated and depressed mood. Diagnosing it can be challenging due to its varied symptoms and possible overlap with substance abuse. Studies suggest up to 60% of people with bipolar disorder also abuse drugs or alcohol, complicating treatment and diagnosis. The condition often appears in your late teenage years and can be particularly severe during this time. A psychiatrist or psychologist with expertise in mood disorders can help make a proper diagnosis.