Bipolar Disorder Symptoms and Causes: Mania vs Hypomania, Types and Indian Data
A side-by-side look at mania, hypomania and an ordinary good mood, the three main types, what the National Mental Health Survey found in India, and the warning signs that need urgent help.
Quick answer: Bipolar disorder is a long-term mental illness in which a person's mood, energy and activity swing between highs (mania, or a milder form called hypomania) and lows (depression), usually with stretches of normal mood in between. The NHS says episodes typically last days or weeks. The exact cause is unknown. According to WHO and the NHS, genes (it runs in families), stressful life events and alcohol or drug use all play a part.
It is treatable, but it is easy to miss. Many people only see a doctor during a low phase, so the highs can go unnoticed and they may be treated for depression alone. In India, the National Mental Health Survey found that about 7 in 10 people with bipolar disorder were not getting any treatment. If you or someone close to you is in crisis, call Tele-MANAS on 14416 (free, 24x7) or 112 in an emergency.
Mania, hypomania or just a good mood?
Feeling happy, confident or busy is not a symptom. A doctor is looking for a clear change from the person's usual self that lasts most of the day, nearly every day, and that other people notice. The signs listed by the NHS and Mayo Clinic include:
needing far less sleep (for example 2–3 hours) and still not feeling tired
talking very fast, jumping from one idea to the next, racing thoughts
unusual overconfidence or grand plans ("I'll start three businesses this month")
impulsive or risky behaviour: spending sprees, taking loans, reckless driving, risky sex
in severe mania, losing touch with reality: hearing voices, or holding false beliefs about special powers or importance
Ordinary good mood | Hypomania | Mania | |
Linked to a reason | Usually (good news, a holiday) | May follow a trigger such as stress or lost sleep, or come without a clear reason | May follow a trigger such as stress or lost sleep, or come without a clear reason |
Sleep | Normal | Needs much less, without tiredness | May barely sleep for days |
How long | Hours to a day or two | At least 4 days in a row | At least 7 days, or any length if hospital care is needed |
Effect on life | None | Noticeable to others, but the person can usually work | Seriously disrupts work, family and money; may need hospital |
Loss of touch with reality | No | No | Can happen |
The hypomania and mania durations come from the DSM-5, the diagnostic manual psychiatrists use. Many people enjoy hypomania, so they rarely report it.
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Symptoms of the depressive phase
The low phase looks like ordinary depression: low mood or loss of interest for most of the day, nearly every day, for at least two weeks (WHO), with poor sleep or oversleeping, tiredness, guilt, poor concentration, changes in appetite, withdrawal from people and sometimes thoughts of death. Our guide to depression symptoms and causes covers these signs; anxiety often overlaps too (see anxiety symptoms and causes).
Some people have mixed features, with high energy and racing thoughts at the same time as feeling hopeless. Mayo Clinic lists these mixed episodes as one form the illness can take, and they should be reported to a doctor promptly.
Types: bipolar I, bipolar II and cyclothymia
Based on the DSM-5 criteria and Mayo Clinic's descriptions:
Type | What has happened | Key point |
Bipolar I | At least one manic episode (7+ days, or needing hospital) | Depressive episodes are common but not required for the diagnosis; psychosis can occur during mania |
Bipolar II | At least one hypomanic episode (4+ days) and at least one major depressive episode (2+ weeks), but never full mania | Not a "mild" version: the depressions can be long and disabling |
Cyclothymia | At least 2 years (1 year in children and teens) of frequent ups and downs that are milder than hypomania or major depression | Often dismissed as "moodiness" |
Mayo Clinic notes that drugs, alcohol or a medical condition such as a stroke can also cause bipolar-like symptoms, so a doctor will rule these out first.
What causes bipolar disorder?
WHO says plainly that the exact cause is unknown. What sources agree on:
Family history. The NHS and Mayo Clinic both say the risk is higher if a parent, brother or sister has bipolar disorder. That is a raised risk, not a certainty: most relatives of a person with bipolar disorder never develop it.
Stress and trauma. The NHS lists childhood trauma or abuse and stressful events such as a death in the family, relationship breakdown or money problems. WHO adds violence and bereavement as possible triggers.
Alcohol and drugs. The NHS names cannabis and cocaine, and WHO says alcohol and drug use can trigger or worsen episodes.
Lost sleep. The NHS lists not getting enough sleep among the triggers of mood episodes.
Bipolar disorder is not caused by weak willpower, bad parenting or "too much thinking", and it is not a personality flaw.
Why it is often mistaken for depression
People rarely feel ill during a high, so the first visit to a doctor is usually during a low. Unless someone mentions the earlier highs, the doctor sees only half the picture.
This matters because treatment differs. A 2007 US national study described by NIMH found that many people with bipolar disorder had been given an antidepressant without a mood-stabilising medicine. The lead researcher warned that this "may actually worsen the condition". The Indian Psychiatric Society's 2017 clinical practice guidelines for bipolar disorder warn that treating it as depression alone can risk triggering mania or hypomania. Only a psychiatrist can decide which medicines are right for a particular person.
If you are being assessed for depression, tell the doctor about any past spells of very little sleep, unusual energy or reckless spending, and about any relative with bipolar disorder; a family member who has seen these phases can help. Never stop or change a prescribed medicine on your own.
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How common is bipolar disorder in India?
An analysis of the National Mental Health Survey 2015–16 (NIMHANS, covering 34,802 adults in 12 states), published in the Indian Journal of Psychiatry in 2023, found:
Measure | Finding |
Have bipolar disorder at present | 0.3% of adults |
Have had it at some point in life | 0.5% of adults |
People with current bipolar disorder not getting treatment | 70.4% |
Reporting difficulty at work | 63% |
Reporting difficulty in family life | 63% |
Also had tobacco use disorder | 33.3% |
The survey linked higher odds of having had bipolar disorder at some point in life with being male and with living in metro cities. Worldwide, the WHO bipolar disorder fact sheet estimates that about 36 million people (roughly 1 in 226) live with bipolar disorder. WHO also notes that people with the condition die, on average, 13 years earlier than the general population.
Severe mania can include psychosis, but bipolar disorder is a different illness from schizophrenia.
When to see a doctor, and when it's an emergency
See a doctor, ideally a psychiatrist, if mood changes are extreme, last more than a few days, or are affecting work, studies, money or relationships. In India, you can start at a government hospital's psychiatry department, a District Mental Health Programme clinic, or by calling Tele-MANAS. Under the Mental Healthcare Act, 2017, every person has a right to access mental healthcare from government-run or government-funded services.
Get urgent help (call 112, or go to the nearest hospital emergency department) if someone:
talks about wanting to die, or has harmed themselves
has barely slept for several days and is becoming more agitated
hears voices or holds strange beliefs that others can't talk them out of
is doing something that puts themselves or others in danger, such as reckless driving or aggression
WHO notes that bipolar disorder raises the risk of suicide. For support at any hour, Tele-MANAS (14416 or 1-800-891-4416) is the Ministry of Health's free mental health helpline. It can connect you to a counsellor and, if needed, a psychiatrist.
This article is general health information, not a diagnosis. Only a qualified doctor can diagnose bipolar disorder.
Frequently asked questions
Is bipolar disorder the same as mood swings?
No. Everyday mood swings come and go within hours or a day or two and usually have a reason. Bipolar episodes last days to weeks, bring clear changes in sleep, energy and behaviour, and affect daily life.
Can bipolar disorder be cured?
It is usually a long-term condition, but it can be managed well. With treatment from a psychiatrist and steady routines, many people have long stable periods and work and live normally.
Is bipolar disorder hereditary?
It tends to run in families, and the NHS says having a parent or sibling with it raises your risk. Most relatives never develop it, because life events and other factors also play a part.
Can a blood test diagnose bipolar disorder?
No. A psychiatrist diagnoses it from a detailed history of mood episodes, often with input from family. Tests may be done to rule out other medical causes of mood changes.
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