Understanding Bipolar in Men: Symptoms, Diagnosis & Treatment

Bipolar disorder is a mental health condition marked by a pattern of recurring significant shifts in mood, energy, and activity levels.

People with bipolar experience chronically occurring episodes of:

Depression: feeling very low, fatigued, and hopeless among other symptoms common in men
And one of:
- Hypomania: noticeable boost in energy, mood, or productivity that might even feel positive (more social, confident, creative) but can still cause strain.
- Mania: more extreme elevation of mood that is characterized by unusually high energy, impulsivity, and euphoria, and is associated with risky behaviours, impaired judgment, and/or delusions

The changes in mood are more severe and persistent than typical mood swings and can significantly affect work, relationships, and overall functioning.

Hypomania can look like:

Taking on multiple projects at once (fixing the car, starting renovations, launching a side business).
Needing only a few hours of sleep but still feeling full of energy.

While mania may look like:

Spending huge amounts of money impulsively (cars, investments, gambling).
Grandiose ideas, like believing you have special powers, connections, or destiny.
Needing almost no sleep for days without feeling tired.

Types of Bipolar Disorder

There are two main types of bipolar disorder, distinguished by the intensity of manic symptoms.

Bipolar I involves at least one full manic episode, often requiring hospitalization.
Bipolar II involves hypomania alongside major depressive episodes.

How Common is Bipolar Disorder?

Globally, about 1–2% of the population experiences bipolar disorder at some point in life.^[1,2]
Men and women are diagnosed at roughly similar rates, but men are more likely to experience earlier onset and more severe manic episodes.^[3,4]
- Recognition, diagnosis, and expression of bipolar disorder can differ for men, often influencing when and how treatment is sought.
Bipolar II is generally considered more common, though men are more often diagnosed with Bipolar I.

Bipolar Disorder vs. Major Depressive Disorder

Bipolar disorder is often misdiagnosed as major depression, especially if manic or hypomanic episodes are subtle or overlooked. Here’s how they differ:

Depressive episodes

Yes.

Mania/Hypomania

No.

Yes (mania in Bipolar I, hypomania in Bipolar II).

Energy Levels

Low during depressive episodes.

Can alternate between low (during depressive episodes) and excessively high (during manic/hypomanic episodes).

Onset

Often later adolescence or adulthood.

Often adolescence or early adulthood; men may present with symptoms earlier.

Treatment Focus

Talk therapy, antidepressants.

Mood stabilizers, antipsychotics, talk therapy, antidepressants.

Bipolar Disorder in Men

Bipolar disorder can look different in men compared to women:

Mania/Hypomania: Men are more likely to present with mania or mixed episodes, often leading to disruptive behaviour, financial or legal difficulties.
Higher risk-taking: Impulsivity during manic episodes may show up as substance use, aggression, or risky sexual behaviour.
Stigma and help-seeking: Men may delay seeking help due to cultural expectations around toughness or self-reliance. This increases the risk of untreated symptoms and complications.
Suicide risk: Men with bipolar disorder have a significantly higher suicide risk compared to the general population, especially during depressive or mixed episodes.^[5]

Bipolar I and Bipolar II: In Depth

Mania

At least one manic episode lasting 7 days or longer (or any duration if hospitalization is needed).

Full mania not present, only hypomania lasting 4 or more days.

Depression

Common, but not required for diagnosis.

At least one major depressive episode required for diagnosis.

Psychosis

Losing contact with reality, often via hallucinations or delusions, may require hospitalization.

Not present.

Course & Impact

Usually more severe overall with highly disruptive mania.

Often misdiagnosed as depression as hypomania is less disruptive, but can be more chronic due to depressive episodes.

Treatment

Mood stabilizers, antipsychotics, psychotherapy.

Mood stabilizers, antipsychotics, psychotherapy; focus often on depressive episode management & preventing mood swings.

Diagnosis

Bipolar disorder is diagnosed through a comprehensive clinical assessment rather than a single test or scan. Mental health professionals (psychiatrists, psychologists, or other properly trained clinicians) rely on structured interviews, symptom history, and standardized diagnostic criteria.

A key part of diagnosis is identifying the presence of manic or hypomanic episodes, which distinguish bipolar disorder from major depressive disorder. Because depression is often the first or most noticeable symptom, many people are initially misdiagnosed with major depressive disorder. Careful exploration of past highs or lows in mood, including periods of unusually high energy, reduced need for sleep, impulsivity, or elevated mood, is essential to making the correct diagnosis.

Clinicians also assess age of onset, family history, and comorbid conditions (such as anxiety, substance use, or ADHD), as these can influence both presentation and treatment planning.

Early recognition and accurate diagnosis are critical, as they allow people to begin appropriate treatment sooner, which improves long-term outcomes and reduces risks such as relapse or suicide.

Validated screening tools, such as the Mood Disorder Questionnaire (MDQ), may be used to support an initial assessment for bipolar disorder. Our Bipolar Assessment tool uses the MDQ and can help provide an indication of whether further assessment is warranted.

Take Bipolar Assessment

Treatments for Bipolar Disorder

Treatment for bipolar disorder is highly effective when followed consistently, and typically requires long-term management.

1. Medications

Mood stabilizers such as lithium, valproate, lamotrigine can reduce relapse risk by ~60%.^[6]
Antipsychotics such as quetiapine, olanzapine, lurasidone can be effective for mania and bipolar depression.
Antidepressants may be used in conjunction with the medication listed above, as they may trigger mania if not paired with a mood stabilizer.

2. Psychotherapy

Psychoeducation (structured learning about bipolar disorder) improves treatment adherence and relapse prevention.
Cognitive Behavioural Therapy is often used to help recognize and manage mood triggers.
Interpersonal and Social Rhythm Therapy is a therapy designed specifically for bipolar disorder, and focuses on stabilizing daily routines around sleep, eating, work and social interactions, reducing relapse and managing long-term stability.

Find a therapist near you

Effectiveness

With consistent treatment, ~70–80% of people with bipolar can achieve significant symptom improvement and reduced relapse risk.^[7,8]
However, bipolar is a very challenging illness, and about 30–50% struggle to stick to their prescribed treatments. It can also be really difficult just to keep up with the consistency and routine required to minimize symptoms.^[9] This is often due to:
- Side effects from medication
- Stigma around mental illness
- Not recognizing symptoms as part of an illness
- Complicated treatment plans or routines
- Forgetting doses or losing consistency
- Substance use interfering with treatment
- Cost or limited access to care
Having strong peer and family support greatly improves outcomes and provides a safety net that can help prevent relapse.^[10]
Maintaining regular sleep, exercise, and substance-use reduction are protective factors.

References

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572. https://doi.org/10.1016/S0140-6736(15)00241-X
Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J., Vos, T., & Whiteford, H. A. (2013). Burden of depressive disorders by country, sex, age, and year: Findings from the Global Burden of Disease Study 2010. The Lancet, 381(9875), 158–171. https://doi.org/10.1016/S0140-6736(12)61282-2
Diflorio, A., & Jones, I. (2010). Is sex important? Gender differences in bipolar disorder. International Review of Psychiatry, 22(5), 437–452. https://doi.org/10.3109/09540261.2010.514601
Kawa, I., Carter, J. D., Joyce, P. R., Doughty, C. J., Frampton, C. M. A., Wells, J. E., Walsh, A. E. S., & Olds, R. J. (2005). Gender differences in bipolar disorder: Age of onset, course, comorbidity, and symptom presentation. Journal of Affective Disorders, 87(2–3), 221–229. https://doi.org/10.1016/j.jad.2005.03.012
Schaffer, A., Isometsä, E. T., Tondo, L., Moreno, D. H., Turecki, G., Reis, C., Cassidy, F., Sinyor, M., Azorin, J. M., Kessing, L. V., Ha, K., Goldstein, T., Weizman, A., Beautrais, A., Chou, Y. H., Hirschfeld, R. M. A., & Rihmer, Z. (2015). International Society for Bipolar Disorders Task Force report on suicide in bipolar disorder. Bipolar Disorders, 17(1), 1–16. https://doi.org/10.1111/bdi.12271
Miura, T., Noma, H., Furukawa, T. A., Leucht, S., Cipriani, A., Kanba, S., & Geddes, J. R. (2014). Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 351–359. https://doi.org/10.1016/S2215-0366(14)70314-1
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672–1682. https://doi.org/10.1016/S0140-6736(13)60857-0
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198–217. https://doi.org/10.1038/s41380-018-0044-2
Levin, J. B., Krivenko, A., Howland, M., Schlachet, R., & Sajatovic, M. (2016). Medication adherence in patients with bipolar disorder: A comprehensive review. CNS Drugs, 30(9), 819–835. https://doi.org/10.1007/s40263-016-0368-x
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141–150. https://doi.org/10.1001/jamapsychiatry.2020.2993

Understanding Bipolar Disorder in Men