Bipolar disorder is a complex condition, and beneath the surface of stigmas is a host of truths you may not know about.

Bipolar disorder is a mental health condition that can cause significant shifts in your disposition, moods, energy and activity levels, and concentration.

It’s not about self-control — and it’s more than just mood changes.

We spoke to our very own Psych Central podcast host, Gabe Howard, who lives with bipolar disorder. He shared some of his lived experiences in hopes of helping you or someone you’re close with navigate living with bipolar disorder.

People who don’t live with bipolar disorder might not realize just how much work it takes to manage this condition behind the scenes.

Howard says, “I was learning the difference between depression and sadness. I was learning the difference between excitement and mania and, most of all, I was trying to figure out what my life was going to look like ‘on the other side.’”

Everyone will manage bipolar disorder differently. It will depend on what works for you personally, your family dynamics, and finances, to name a few.

For some potential strategies, Howard shares how he manages bipolar disorder and some of the effort it takes to cope with the condition.

1. Trying hard to keep the manic energy in check

Folks living with bipolar disorder can experience intense changes in mood, energy, and activity levels that can range from “up” periods of energetic agitation (mania) to “down” periods of hopelessness or low mood.

It all depends on the type of bipolar disorder that’s diagnosed:

What’s feltWhat it’s calledHow it’s defined
Like being thrown in a human catapult of max energy (good or bad feeling) that could launch you beyond control. Episodes can last a full week to months.

Social, legal, work, or academic consequences of mood episodes are legitimate enough to alarm you or those close to you.
Bipolar IManic episodes last at least 1 week. May or may not include depressive episodes.
Like being on a merry-go-round of unprompted agitation or energy and lows. Episodes can last as short as a week to months.

It’s noticeable to those close to you but doesn’t often lead to social, legal, work, or academic consequences.
Bipolar IIHypomanic (less severe mania
in intensity, not duration) lasting 4–7 days and major depressive episodes of varying lengths.
Depressive and manic moods feel less like a merry-go-round of episodes, and more like a biennial event.

These experiences last upwards of 2 years.
A chronic yet milder form of bipolar disorder. Symptoms of hypomania and depression last for at least 2 years, but don’t qualify as full mood episodes.

To the layperson, experiencing an “up” period may not sound so bad. But people living with bipolar disorder often try very hard to keep periods of mania in check, especially since manic episodes can interfere with everyday responsibilities by producing:

  • surging energy despite an inability to sleep well
  • racing thoughts
  • jumpiness
  • a loss of appetite
  • impulsive or harmful behaviors such as
    overspending or excessive drinking

Howard says during his periods of mania, “I spent thousands of dollars, lied to my friends, abused drugs and alcohol. I looked and felt productive, but the work was garbage. When the mania would subside, I would look back and just see nonsense and devastation.”

2. Sometimes it’s easier to pretend everything’s alright

Most of us have hidden behind a smile at some point. For those with bipolar disorder, pretending everything’s OK even when it’s not is one way of coping.

Howard says, “I’d try to ‘fake it until you make it.’”

Some people do this by pretending their treatments are working, even when they aren’t feeling any different. “Sometimes I would hide my symptoms because I just couldn’t stand the idea of switching medications again,” he says.

“Fake it until you make it is not as cut and dry as some people think it is,” Howard stresses.

“It’s not magic; it’s more of a suggested mindset that means trying new things, stepping outside of my comfort zone, giving the world a chance. Could I fail? Yes. But I kept facing the world as if I was going to succeed, even though I hadn’t yet. That made a big difference. It shifted my thinking from ‘if I reach recovery’ to ‘when I reach recovery.’”

3. Simply saying, “I’m sick” to excuse myself

“I say ‘I am not feeling well’ and just let the person on the other end of the line assume it’s a physical illness,” Howard says. “I don’t have to disclose. We have to get away from thinking that we have to prove our illness to someone. Simply being sick — without explanation — is enough.”

Not disclosing more information helps Howard preserve some of his mental energy and avoid the stigma associated with mental health.

“I choose to let people believe the sickness is physical because I simply don’t have the energy to fight back,” he says. “Stigma and discrimination is hard enough to endure when you’re well.”

Want to learn more about what to say if someone does disclose their mental illness? You can find tips here.

It’s not just the effort of managing bipolar disorder that’s not well-known. There are several hidden signs of bipolar disorder you may not be aware of:

4. Altogether fidgety? It’s actually a symptom of bipolar disorder

Up to 15% of people living with bipolar disorder may experience a period of psychomotor agitation each year.

Psychomotor agitation means uncontrollable movements due to inner restlessness and anxious tension, and can occur in several physical or mental health conditions. If you or someone you know experiences this, you might notice aimless:

  • pacing
  • tapping
  • picking at skin
  • inability to sit still
  • fidgeting
  • hand wringing
  • adjusting clothing
  • moving objects randomly

These symptoms can also indicate other mental health conditions, so a doctor may not always recognize these as symptoms of bipolar disorder. They may mistake it for ADHD, anxiety, depression, schizophrenia, or a side effect of substance use.

5. Operating “full-steam” on little sleep for days to weeks
is “a thing”

During an episode of bipolar disorder mania, folks may experience boundless energy on almost no sleep.

In fact, though this isn’t talked about as widely as other symptoms of bipolar disorder, as many as 69–99% of people with bipolar disorder have said they need less sleep or have trouble falling or staying asleep during a period of mania.

“Every time I was manic I felt amazing,” Howard says. “I was awesome and unstoppable.”

During mania, the decreased need for sleep may be a byproduct of the overall unstoppable feelings that Howard describes. However, in some cases, a lack of sleep may actually trigger mania.

6. If mania turns into psychosis, hallucinations and delusions are possible

A person living with bipolar disorder may experience psychosis, including hallucinations and delusions. Of people diagnosed with bipolar disorder, about half will experience psychosis at some point.

It’s hard to recognize when you’re in the midst of an episode of psychosis. You may:

  • hear voices
  • see or feel things that aren’t there
  • believe you’re invincible or have special abilities
  • have paranoid thoughts like believing someone wants to harm you

A loved one or close friend can help a person during a period of psychosis by reaching out to their treatment team (with prior permission) or by helping them get checked in to the hospital when they may hurt themselves or others.

Worth noting

Only use the advice above if the person you know with bipolar disorder has previously opened up about their condition.

Unsolicited interventions can violate their personal boundaries, heighten a manic episode, and spoil your sincere intentions to help.

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7. Yes there’s mania and depression, but we also have periods of calm

There are other experiences somewhere in between the highs of mania and the lows of depression.

Euthymia (you-thigh-me-uh) is a period of calm without mood disturbances or very mild mood fluctuations.

Bipolar disorder symptoms may change or lessen as you age, according to 2009 research.

Euthymia duration is more or less unpredictable, but may increase in frequency and duration following longer periods of successful treatment.

Howard says that at this age and stage in his condition management, he’s more euthymic than before. “After almost 20 years of managing bipolar disorder with the help of medications, I am excellent at recognizing symptoms and I have excellent coping skills that I have honed with years of practice.”

“These days, mood swings don’t last very long,” he adds. “If they last more than a week, I’m on the phone with my medical team to make adjustments and corrections.”

However, he points out that he’s in recovery and doing well with the same medications and treatment plan he has been using for years.

“I only point that out because my method of managing bipolar disorder today is vastly different from my method of managing bipolar disorder 1 year, 2 year, or even 5 years after diagnosis. It’s been an evolution. Knowing to ask for help after a week and being aware that my mood has shifted for a week are all advanced skills that took a lot of time to learn,” Howard clarifies.

Bipolar disorder isn’t as cut and dry as many would believe. If you live with bipolar disorder, you might find yourself spending a lot of unseen effort managing your mental health.

Just know we see you.

For anyone who knows someone who lives with bipolar disorder, realizing that the condition can be more nuanced than just changes in mood can help you support and validate the person in your life as they learn to cope with their condition.