If you’re living with bipolar disorder (formerly known as manic depression), you’ve likely experienced mood changes between mania (elevated mood) and depression (low mood). But bipolar disorder can come with other symptoms, including psychosis — periods when it’s difficult to tell what’s real and what’s not.

Experiencing bipolar psychosis can be overwhelming, both for you and your loved ones. “One thing that scares me is not having control over these episodes,” shared one member of MyDepressionTeam.

Although bipolar psychosis can be scary, learning more about it can help you identify the symptoms and treat them. Keep reading to find out more about bipolar psychosis, including what it feels like, how long it lasts, and the steps you can take to manage it.

What Is Bipolar Psychosis?

According to the National Institute of Mental Health (NIMH), the term “psychosis” refers to times when a person can’t tell the difference between what’s real and what’s not. Psychosis may include delusions (false beliefs), hallucinations, or paranoia and unwarranted suspicion. Psychosis can happen during specific mood episodes caused by bipolar disorder.

Bipolar psychosis is more common in bipolar 1 disorder. Around 63 percent of people with bipolar 1 disorder have experienced bipolar psychosis.

Around 63 percent of people with bipolar 1 disorder have experienced bipolar psychosis.

Does Bipolar Psychosis Occur During Manic Episodes?

People with a diagnosis of bipolar disorder may experience episodes of:

• Mania
• Hypomania
• Depression
• Mixed symptoms

Manic periods are when your mood or energy level is extremely heightened. Symptoms of mania may include feeling euphoric (extremely happy) or irritable for many days at a time accompanied by other symptoms such as impulsivity (a tendency to act quickly without thinking), a decreased need for sleep, distractibility, and racing thoughts.

Episodes of hypomania are similar to mania but are milder in severity and shorter in duration.

Episodes of depression are when you feel extremely sad or have difficulty feeling joy or pleasure accompanied by other symptoms such as changes in appetite, sleep, energy, hopelessness, worthlessness, or suicidal thinking.

Mixed episodes can include symptoms of depression and mania or hypomania occurring at the same time.

Depressive, manic, and mixed episodes can cause psychosis. However, bipolar psychosis is more common during manic periods. It’s also possible to have mania or depression without psychosis.

How Long Does Bipolar Psychosis Last?

Psychosis in bipolar disorder doesn’t have a fixed timeline. Instead, psychosis typically occurs during bipolar mood episodes — such as mania or major depression — and lasts for the duration of that episode. Episodes of mania can typically last anywhere from seven days to a few months, while episodes of depression can typically last anywhere from two weeks to several months.

The length of a mood episode can vary depending on the person and whether they receive treatment. As a result, bipolar psychosis generally improves as the underlying mood episode stabilizes.

Timely and effective treatment may help improve symptoms of psychosis and reduce their duration.

What Are the Symptoms of Bipolar Psychosis?

The range of symptoms a person experiences during psychosis is often influenced by the person’s mood at the time.

Symptoms of bipolar psychosis vary, but they commonly include:

• Delusions — False beliefs
• Hallucinations — Perception (seeing or hearing) of things that aren’t there
• Paranoia — Sensation that everyone is “out to get you” or that you’re being watched
• Disorganized thinking or speech — Inability to put words together in a way that makes sense or loss of train of thought
• Catatonia — Inability to move normally or repetitive movements

Psychosis is linked to a high risk of self-harm and suicidal thoughts. The vast majority of people who experience psychosis aren’t dangerous to others. A systematic review showed that the greatest risk of violence in people with psychosis is a history of criminal activity or ongoing substance misuse. Antipsychotic treatment is associated with a lower risk of violence and suicide, so it’s important to seek treatment.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

You may need to act quickly if you suspect your loved one is experiencing psychosis. The best way to manage psychosis is to recognize the early signs and get help. Here are some of the early signs of psychosis to watch for:

• Isolating oneself from others
• Having trouble thinking clearly
• Experiencing problems at school or work
• Feeling paranoid or suspicious
• Experiencing changes in emotional state
• Paying less attention to self-care (for example, changes in sleep, showering, or brushing teeth)

The best way to manage psychosis is to recognize the early signs and get help.

If you notice these signs in yourself or a loved one, consult with a psychiatric provider or healthcare professional right away. Safety should be top of mind if you or a person you love is experiencing psychosis.

If a loved one is experiencing psychosis:

• Try to stay calm.
• Don’t confront them or challenge their beliefs directly.
• Acknowledge their feelings, even if you don’t agree with their beliefs.
• Stay grounded and in the moment, offering reassuring support and stability.
• If possible, seek urgent help from a healthcare provider.

After the episode, make sure they follow up with their healthcare provider or therapist to help prevent future episodes.

4 Facts About Bipolar Psychosis

Here are a few facts about bipolar psychosis. It’s important to remember that psychosis is not the same for everyone with bipolar disorder, and its symptoms can vary.

1. Psychosis Is a Common Symptom of Bipolar Disorder

Psychosis is a fairly common symptom for people with bipolar disorder. Psychosis is more common in people who have bipolar disorder plus other comorbidities (health conditions that happen at the same time). One review of studies indicated that psychosis might be a sign of a more severe type of bipolar disorder that can be harder to treat.

2. Your Doctor May Rule Out Other Causes

Bipolar disorder can be the cause of psychosis, along with other medical and psychiatric conditions like schizophrenia, depression, and Alzheimer’s disease. For this reason, your doctor will consider your history and symptoms to diagnose bipolar psychosis. They may ask you questions such as:

• How often do you experience symptoms of psychosis?
• How do you feel when you experience psychosis?
• Have you experienced any recent mood changes?
• Does anyone in your family have a history of psychotic episodes?

People who don’t have these health conditions may also experience psychosis. This may be caused by:

• Medication side effects
• Alcohol or substance use
• Sleep deprivation
• Stress or trauma
• Certain infections

Because there are different causes of psychosis, your healthcare provider will narrow down the cause by excluding other factors before diagnosing you with a mental health condition.

The diagnostic process will help your doctor decide whether your psychosis is a symptom of bipolar disorder, another related psychiatric disorder, a medical condition or some other factor.

3. Tracking Your Symptoms Can Help With Management

Keeping a record of when you experience psychosis can help you manage your symptoms. Write down what you were doing, how you felt, and how you managed your symptoms during and after the episode. If you can’t remember what happened, ask someone who was with you to help you record it.

Keeping a record of when you experience psychosis can help you manage your symptoms.

Recording this information will help you:

• Identify what triggers your psychosis
• Recognize the early signs of psychosis
• Find which strategies help manage how you feel during an episode
• Help your healthcare provider understand your symptoms and find the right treatment plan for you

4. Treatment May Include Medication, Therapy, and Lifestyle Changes

Although you can’t prevent bipolar psychosis, there are a variety of effective treatments to improve your symptoms and decrease the risk of future episodes. Untreated psychosis can lead to agitation and aggression, so seeking treatment is important.

As with many mental health conditions, treatment for bipolar psychosis usually involves a comprehensive plan that includes therapy, medication, and other interventions.

Treatment options for bipolar psychosis can include therapy, medication, case management, family support programs, and services to assist with school and work.

Medication and Therapy

Coordinated specialty care is a treatment approach for psychosis that includes:

• Case management — Provides an opportunity to work with a case manager to address practical problems, like gaining access to care.
• Family support and education programs — Help family members understand psychosis and learn how to cope, talk with their loved one, and solve problems.
• Individual or group psychotherapy — Talk therapy with a mental health professional can help manage symptoms and prevent relapse. This could include support groups or cognitive behavioral therapy (CBT), which can help you manage your symptoms and achieve your goals.
• Medication — Antipsychotic medication is often prescribed to help manage psychosis. Your healthcare provider will tailor your medication plan to your specific symptoms and condition.
• Services to assist with employment and school — A coach can help you balance school and work tasks and find suitable employment.

Make sure to work with a healthcare provider who has experience with psychosis. They will work with you to create a treatment plan that works for you.

Lifestyle Changes

Managing bipolar psychosis can be difficult, but there are several lifestyle changes that can help improve your overall well-being and quality of life. These include:

• Getting regular exercise
• Maintaining a healthy diet
• Avoiding alcohol and substance use (other than drugs prescribed by your doctor)
• Leaning on loved ones for support
• Getting enough sleep

Your Healthcare Professionals Are Your Best Resource

Be sure to talk with your doctor or a mental health professional if you have experienced symptoms of bipolar disorder, including bipolar psychosis. If you or a loved one is actively experiencing symptoms of bipolar psychosis and is at risk for harmful behavior toward themselves or others, it’s important to seek help right away. Call emergency services for immediate help.

Bipolar psychosis can feel overwhelming, but learning about it is the first step toward getting help. With effective health services and care, it’s possible to feel better and enjoy family, school, work, and hobbies again. If you or someone you know is showing signs of psychosis, don’t wait. Reach out for help right away.

Join the Conversation

On MyDepressionTeam, people share their experiences with depression and other mental health conditions, get advice, and find support from others who understand.

Have you ever experienced psychosis during an episode of mania or depression? Let others know in the comments below.