What happens after a manic episode?

Experts say that much of the suffering of bipolar disorder often comes from the swing “down” into a depressive phase, in which the person can feel sad, disinterested and hopeless about everything. Someone in a depressive state can sleep for “12, even 16 hours” at a time, Hirschfeld said. Experts say cases of bipolar disorder are most often diagnosed when a person is in this depressive state because that is when people tend to seek treatment. “The mania can cause huge messes and destroy people’s lives and families in a short period of time,” Hirschfeld said. “But, it’s the depression that can cause the most harm in the long term.”

Can bipolar disorder make you do strange things?

West’s erratic behavior has prompted a wide discussion on social media about whether bipolar disorder can cause people to make racist statements or behave in ways that many others find offensive. After disclosing his diagnosis, West later backtracked, attributing some behaviors to lack of sleep. But in a 2019 interview with David Letterman, he spoke more openly. “I ramp up, and I go high,” West said. “If you don’t take medication every day to keep you at a certain state, you have the potential to ramp up, and it can even take you to a point where you can even end up in the hospital. And you start acting erratic, as TMZ would put it.” Most experts agree that during a manic phase, people with bipolar disorder may say or do things they later regret. An otherwise loyal partner may have an affair while in a manic state, for instance, or a person may engage in more risk-taking, use drugs or gamble, or spend money well beyond their means. Research shows that even arrest and incarceration are “potential complications” of bipolar disorder. “What I will say, without getting into anything about a specific person, is that it is not unusual for people to do things that they would never, ever do,” Hirschfeld said. “I’ve had so many cases of people who are married happily who have never even thought about cheating on their spouse, and then they become manic, and they become hypersexual, and they go out and start picking people up off the street. They’re unbelievably remorseful.” Over time, it can become difficult to distinguish between a person’s action and the illness. “The question for any specific act or behavior, as to whether ‘my brain made me do it,' is it me or my illness, is usually just too entangled and difficult,” said Steve Hyman, a professor at Harvard and the director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT. “Courts struggle with this all the time. Often it is impossible to find a neat separation between a person as they would have been if not ill, and the influence of a mental illness.” Metzger, the professor at University of Georgia, who runs a lab dedicated to mental health research and education, said that “racism itself is not a mental health disorder” and that a mental health disorder does not excuse racism. “Those beliefs are not a symptom of having a bipolar disorder,” Metzger said. “Certainly, the lack of a filter might cause them to spill out.”

What happens in the brain during a manic episode?

Bipolar disorder seems to be linked to both genetics and environmental factors, and it can run in families. The condition is not fully understood, but it appears to be, at least in part, because of chemical imbalances in the brain. During a manic state, a person living with the disorder appears to have a higher level of “excitatory neurotransmitters” — such as dopamine — in the brain, said Chase Anderson, a professor in child and adolescent psychiatry at the University of California at San Francisco. “We’re still studying how this exactly works,” Anderson said. The University of Georgia’s Metzger said people describe a manic phase as “a natural high” in which they have higher self-esteem and racing thoughts, a state that often leads to greater productivity. “People often do report enjoying their manic states despite that some of that mania can lead to risky decisions being made,” Metzger said. Scientists at the Massachusetts Institute of Technology and Harvard recently found a gene that puts a person at higher risk of both bipolar disorder and schizophrenia. And scientists have discovered other genes that all have a “small effect” on whether someone is predisposed to bipolar disorder, Hyman said.

What’s the link between bipolar disorder and sleep?

Anderson said psychiatrists see bipolar disorder “as a disorder of sleep” because disrupted sleep often is one of the first symptoms clinicians recognize in patients. For the most severe type of bipolar disorder, people often will stay up for days on end, Anderson said. “If you don’t get your usual amount of sleep, you’re tired,” Hirschfeld said. “But, when someone is manic, they get two, three hours of sleep and they’re not vaguely tired.” Lack of sleep or a sleep disruption such as a transatlantic flight can also trigger a manic episode. “Lots of people have their first episode after transatlantic flight,” Hirschfeld said. “The disruption of normal circadian rhythms can absolutely precipitate a manic episode.”

How is bipolar disorder diagnosed?

Two decades ago, Hirschfeld created a 13-part questionnaire that is widely used by physicians to screen patients for the disorder. Among its questions, the assessment asks whether a person has felt so hyper that they got into trouble, whether they felt more self-confident than usual, if they had done things viewed by others as foolish or risky, were unusually interested in sex or had engaged in overspending that caused problems. If you score high on the questionnaire, Hirschfeld said, it doesn’t mean you have bipolar disorder. Instead, it just means you should be evaluated by a mental health professional who treats the condition. The trouble is that bipolar disorder can sometimes be misdiagnosed because the condition is “a bit of a chameleon” that can look similar to personality disorder, depression and other illnesses, Hyman said.

What is the treatment?

Psychiatrists will prescribe medication, often called mood stabilizers such as lithium, depakote and lamotrigine. Sometimes, clinicians will prescribe a combination of drugs, including an antipsychotic, depending on the symptoms during a person’s manic state, Anderson said. If untreated, experts say, a person’s manic episodes can become more frequent or severe over time. There is no cure for the disorder, but treatment can regulate the abnormal activity in the brain, allowing people with the condition to live productive and fulfilling lives. Hirschfeld said the condition should be viewed like other chronic medical conditions, including diabetes and hypertension, which require lifelong medication to control. Patients who have bipolar disorder are often in denial, and it takes “two to three bad episodes” for them to realize that they need to seek treatment, Hirschfeld said. “In my experience, people lose a whole decade of their lives before they recognize they have an illness,” he said.

What does bipolar disorder feel like? Can it explain Kanye’s behavior?

Erratic behavior by the musician formerly known as Kanye West has spurred widespread discussion on social media about the condition

By Teddy Amenabar

October 11, 2022 at 12:00 p.m. EDT

Bipolar disorder can include periods of depression and periods of mania at irregular times in a person’s life. (Photo illustration by The Washington Post: Sphere by Jonathan Knowles/Getty Images; Explosion by Jose A. Bernat Bacete/Getty Images)

The rapper Ye, formerly known as Kanye West, has a history of commenting on mental illness through his art. On a 2018 album cover, West included a telling quote: “I hate being Bi-Polar it’s awesome.” In the song “Yikes,” he called bipolar disorder his “superpower.”

More recently, West has been in the news for erratic behavior including antisemitic posts on Instagram and Twitter. The comments, as well as other displays — including a rambling appearance with conservative talk-show host Tucker Carlson and sporting a “White Lives Matter” T-shirt during Paris Fashion Week — have spurred a number of social media discussions about whether the behavior could be explained by mental illness.

While there is no way to know whether West’s behavior or comments are related to his mental health, most experts agree that people with bipolar disorder can behave erratically and may at times lose their “filter” and say or do socially inappropriate things.

The Washington Post spoke to psychiatrists, therapists and people diagnosed with bipolar disorder and asked them what it feels like to live with the condition, how it is treated and how much it can affect a person’s behavior. Here’s what they said.

What does bipolar disorder feel like? Can it explain Kanye’s behavior?

Erratic behavior by the musician formerly known as Kanye West has spurred widespread discussion on social media about the condition

Read more from Well+Being