When speaking of symptoms of bipolar disorder, the symptoms of concern are those of mania, specifically because bipolar disorder can be diagnosed only after a manic episode has occurred.

Signs and symptoms of mania include:

• Extremely happy, euphoric, or irritable mood
• Engagement in risk-taking behaviors
• High energy levels
• Difficulty concentrating, high distractibility
• Decreased need for sleep
• Racing thoughts or increased rate of speech
• Increased sex drive
• Inflated self-esteem or grandiose ideas
• Auditory or visual hallucinations

If the symptoms noted here persist for at least one week, a manic episode may be present.  The greater the number of symptoms present, particularly if associated with euphoria, the more likely mania is present.  Hypomania has the same symptoms, but they are judged to be less severe, need only last for four days, and are not associated with psychotic symptoms.  It is also possible to have symptoms noted above in addition to such depressive symptoms as suicidal thinking, which may occur in a mixed episode, which is a combination of symptoms of mania and symptoms of major depression.  Suicidal ideation warrants an immediate evaluation, as manic individuals can be extremely impulsive.  Although mania is typically characterised by euphoria, severe anger and rageful mood are common as well.  The decreased need for sleep is exactly a decreased need, which differs from insomnia, a condition of not being able to sleep when it is needed.

Signs and symptoms of depression occurring in a bipolar person are the same as that for major (or unipolar) depression and include:

• Sadness or irritability
• Loss of enjoyment of once-pleasurable activities
• Loss of energy
• Difficulty concentrating
• Insomnia or excessive sleep
• Fatigue
• Unexplained physical complaints (e.g., headache, backache, stomach upset)
• Decreased sex drive
• Change in appetite (increased or reduced)
• Feelings of hopelessness, helplessness, and/or worthlessness
• Suicidal thoughts or attempts

If the symptoms noted here persist for more than two weeks, a major depressive episode may be present, and it is more likely the greater the number of symptoms present, particularly if associated with sadness or irritability.  Again, suicidal thinking warrants an immediate evaluation, especially if associated with hopelessness.  Because of the multitude of physical symptoms of depression, many patients seen by a primary care health provider for certain physical complaints actually have depression.  Certainly a physical complaints actually have depression.  Certainly a physical evaluation to rule out any other medical conditions is warranted, but depression needs to be considered as a possible condition.  If there is a history of mania or hypomania, a diagnosis of bipolar depression should be considered in the presence of such symptoms.