In simple terms, euthymia is the state of living without mood disturbances. It’s commonly associated with bipolar disorder.
While in a euthymic state, one typically experiences feelings of cheerfulness and tranquility. A person in this state may also display an increased level of resiliency to stress.
One way of understanding a euthymic mood is to think of it in terms of the severity of the symptoms. If depression is on one end of the bipolar disorder continuum and mania is at the other end, euthymia lies somewhere in the middle. That’s why you can think of euthymic as living in a state of “normal” or “stable” moods.
People with dysthymia [persistent depressive disorder], or other types of mood disorders, may also experience periods of euthymia.
Being able to identify a euthymic mood is important when trying to distinguish between states of mania or depression, and states of calm and steady moods. When you’re in a euthymic mood, you’ll likely experience periods of calmness and happiness.
Euthymia is dramatically different from the periods of sadness and hopelessness that you feel when experiencing depression, or the extreme peaks of energy you experience when in a state of mania.
While the experience of euthymia varies from person to person, some of the more common signs that you’re in a euthymic mood include feeling:
- happy
- calm
- content
- congruent
- enthusiastic [this is typically a moderate enthusiasm]
Another area to consider when talking about the role euthymia plays in bipolar disorder is the presence of anxiety disorders. A 2016 study found that anxiety disorders are quite common with bipolar disorder.
Researchers found that anxiety is prevalent even when moods are adequately controlled. In other words, you may still experience symptoms of an anxiety disorder when in a euthymic state or mood. This points to the need for treatment that also focuses on anxiety disorders.
While a euthymic mood is considered a relatively normal or steady state, there are a few ways that you can experience euthymia.
- Euthymia with reactive affect. A reactive affect in a euthymic state means that you respond appropriately to the subject of a conversation.
- Euthymia with congruent affect. Congruent euthymia is evident when your emotions match the situation. In other words, the emotional reaction you have is congruent or in agreement with the situation you’re experiencing.
Bipolar disorder is a chronic mental illness, which means there’s no cure. Because of this, you’ll often need to work with your doctor and therapist to manage your symptoms. Treating bipolar disorder includes assessing euthymic moods.
Since the moods associated with bipolar disorder range from depression to mania, with euthymia in the middle, it’s essential to include this middle or steady state in an overall treatment plan for bipolar disorder. Documenting the amount of time spent in a normal state — not just in depression or mania — can help direct your type of treatment.
Standard treatment options for bipolar disorder include medication, psychotherapy [talk therapy], and lifestyle changes.
Medications
There are several medications available for treating bipolar disorder including mood stabilizers, antipsychotics, antidepressants, and in some cases, benzodiazepines.
Psychotherapy
Psychotherapy, or talk therapy, can help you understand bipolar disorder and come up with ways to manage the moods. Popular forms of therapy for bipolar disorder include cognitive-behavioral therapy, psychoeducation, and interpersonal and social rhythm therapy.
Additionally, a clinical trial found that a particular type of therapy [well-being therapy] is an effective intervention during euthymic states.
Lifestyle changes
Lifestyle changes are part of an overall treatment plan for bipolar disorder. Some of the more common modifications include eating a healthy and balanced diet of regularly timed meals, seeking out family and friends for support, taking the time to learn about and understand your mood swings, and making time to talk to a professional.
If you’re part of the population living with bipolar disorder, you know all too well how the full range of moods can affect your daily life. From the low periods of depression to the high states of mania, managing these ups and downs can feel like a never-ending battle.
With that said, taking the time to assess, understand, and manage the “middle” or euthymic mood that many people with bipolar disorder spend half of their time in, may help with developing coping strategies to manage the symptoms of bipolar disorder.
bipolar disorder
Is it bipolar disorder? Here’s how to recognize the signs and symptoms and get help for mania, hypomania, and bipolar depression.
What is bipolar disorder?
We all have our ups and downs, but with bipolar disorder [once known as manic depression or manic-depressive disorder] these peaks and valleys are more severe. Bipolar disorder causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they can interfere with your job or school performance, damage your relationships, and disrupt your ability to function in daily life.
During a manic episode, you might impulsively quit your job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.
The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting in unnecessary suffering. Since bipolar disorder tends to worsen without treatment, it’s important to learn what the symptoms look like. Recognizing the problem is the first step to feeling better and getting your life back on track.
| Myths and facts about bipolar disorder |
| Myth: People with bipolar disorder can't get better or lead a normal life. Fact: Many people with bipolar disorder have successful careers, happy family lives, and satisfying relationships. Living with bipolar disorder is challenging, but with treatment, healthy coping skills, and a solid support system, you can live fully while managing your symptoms. |
| Myth: People with bipolar disorder swing back and forth between mania and depression. Fact: Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms. |
| Myth: Bipolar disorder only affects mood. Fact: Bipolar disorder also affects your energy level, judgment, memory, concentration, appetite, sleep patterns, sex drive, and self-esteem. Additionally, bipolar disorder has been linked to anxiety, substance abuse, and health problems such as diabetes, heart disease, migraines, and high blood pressure. |
| Myth: Aside from taking medication, there is nothing you can do to control bipolar disorder. Fact: While medication is the foundation of bipolar disorder treatment, therapy and self-help strategies also play important roles. You can help control your symptoms by exercising regularly, getting enough sleep, eating right, monitoring your moods, keeping stress to a minimum, and surrounding yourself with supportive people. |
Signs and symptoms of bipolar disorder
Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.
There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.
Mania symptoms
In the manic phase of bipolar disorder, it's common to experience feelings of heightened energy, creativity, and euphoria. If you're experiencing a manic episode, you may talk a mile a minute, sleep very little, and be hyperactive. You may also feel like you're all-powerful, invincible, or destined for greatness.
But while mania feels good at first, it has a tendency to spiral out of control. You may behave recklessly during a manic episode: gambling away your savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. You may also become angry, irritable, and aggressive—picking fights, lashing out when others don't go along with your plans, and blaming anyone who criticizes your behavior. Some people even become delusional or start hearing voices.
Common signs and symptoms of mania include:
- Feeling unusually “high” and optimistic OR extremely irritable.
- Unrealistic, grandiose beliefs about one's abilities or powers.
- Sleeping very little, but feeling extremely energetic.
- Talking so rapidly that others can't keep up.
- Racing thoughts; jumping quickly from one idea to the next.
- Highly distractible, unable to concentrate.
- Impaired judgment and impulsiveness.
- Acting recklessly without thinking about the consequences.
- Delusions and hallucinations [in severe cases].
Hypomania symptoms
Hypomania is a less severe form of mania. In a hypomanic state, you'll likely feel euphoric, energetic, and productive, but will still be able to carry on with your day-to-day life without losing touch with reality. To others, it may seem as if you're merely in an unusually good mood. However, hypomania can result in bad decisions that harm your relationships, career, and reputation. In addition, hypomania often escalates to full-blown mania or is followed by a major depressive episode.
Bipolar depression symptoms
In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments.
Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse—triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.
Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. With bipolar depression, you may move and speak slowly, sleep a lot, and gain weight. In addition, you're more likely to develop psychotic depression—a condition in which you lose contact with reality—and to experience major problems in work and social functioning.
Common symptoms of bipolar depression include:
- Feeling hopeless, sad, or empty
- Irritability
- Inability to experience pleasure
- Fatigue or loss of energy
- Physical and mental sluggishness
- Appetite or weight changes
- Sleep problems
- Concentration and memory problems
- Feelings of worthlessness or guilt
- Thoughts of death or suicide
Symptoms of a mixed episode
A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.
What is rapid cycling?
Some people with bipolar disorder develop “rapid cycling” where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.
The different faces of bipolar disorder
Bipolar I Disorder [mania or a mixed episode] – This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.
Bipolar II Disorder [hypomania and depression] – In Bipolar II disorder, you don't experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.
Cyclothymia [hypomania and mild depression] – Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.
Treatment for bipolar disorder
If you spot the symptoms of bipolar disorder in yourself or someone else, don't wait to get help. Ignoring the problem won't make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. But bipolar disorder is highly treatable, so diagnosing the problem and starting treatment as early as possible can help prevent these complications.
If you're reluctant to seek treatment because you like the way you feel when you're manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.
Treatment basics
Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it's important to continue treatment even when you're feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.
There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.
With over 25,000 licensed counselors, BetterHelp has a therapist that fits your needs. Sign up today and get matched.
Affordable private online therapy. Get instant help, on any device, wherever you are in the world. Start feeling better today!
Get professional online counseling for relationship or marital issues. It’s confidential and convenient to get started.
Self-help for bipolar disorder
While dealing with bipolar disorder isn't always easy, it doesn't have to run your life. But in order to successfully manage bipolar disorder, you have to make smart choices. Your lifestyle and daily habits can have a significant impact on your moods and may even lessen your need for medication..
The keys to bipolar disorder self-help
Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you'll be at assisting your own recovery.
Get moving. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise that activates arm and leg movement such as running, walking, swimming, dancing, climbing or drumming may be especially beneficial to your brain and nervous system.
Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
Seek support. It's important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend. Reaching out is not a sign of weakness and it won't mean you're a burden to others. In fact, most friends will be flattered that you trust them enough to confide in them, and it will only strengthen your relationship.
Stay closely connected to friends and family. Nothing is as calming to the nervous system as face-to-face contact with caring supportive people who can just listen to you talk about what you're experiencing.
Make healthy choices. Healthy sleeping and eating habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.
Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.
Reduce Stress, Enhance Your Health and Achieve Balance in Your Life
Learn how Mindfulness-Based Stress Reduction [MBSR] can help you to experience less anxiety, less stress, and less physical and emotional pain and illness with this online program from Sounds True.
SIGN UP TODAY
Bipolar disorder and suicide
The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.
The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.
Suicide warning signs include:
- Talking about death, self-harm, or suicide.
- Feeling hopeless or helpless.
- Feeling worthless or like a burden to others.
- Acting recklessly, as if one has a “death wish”.
- Putting affairs in order or saying goodbye.
- Seeking out weapons or pills that could be used to commit suicide.
Take any thoughts or talk of suicide seriously
If you or someone you care about is suicidal, call the 988 Suicide and Crisis Lifeline in the U.S. at 988 or visit IASP or Suicide.org to find a helpline in your country. You can also read Suicide Prevention.
Causes and triggers
Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.
External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.
Stress. Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes—either good or bad—such as getting married, going away to college, losing a loved one, getting fired, or moving.
Substance Abuse. While substance abuse doesn't cause bipolar disorder, it can bring on an episode or worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
Medication. Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
Seasonal Changes. Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
Sleep Deprivation. Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.
Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D.
- References
Bipolar and Related Disorders. [2013] In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. //doi.org/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders
“NIMH » Bipolar Disorder.” Accessed October 20, 2021. //www.nimh.nih.gov/health/topics/bipolar-disorder
Butler, Mary, Snezana Urosevic, Priyanka Desai, Scott R. Sponheim, Jonah Popp, Victoria A. Nelson, Viengneesee Thao, and Benjamin Sunderlin. “Treatment for Bipolar Disorder in Adults: A Systematic Review.” Agency for Healthcare Research and Quality [AHRQ], August 7, 2018. //doi.org/10.23970/AHRQEPCCER208
Tondo, Leonardo, Gustavo H. Vázquez, and Ross J. Baldessarini. “Depression and Mania in Bipolar Disorder.” Current Neuropharmacology 15, no. 3 [April 2017]: 353–58. //doi.org/10.2174/1570159X14666160606210811
Solé, Brisa, Esther Jiménez, Carla Torrent, Maria Reinares, Caterina Del Mar Bonnin, Imma Torres, Cristina Varo, et al. “Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies.” The International Journal of Neuropsychopharmacology 20, no. 8 [August 1, 2017]: 670–80. //doi.org/10.1093/ijnp/pyx032
Vieta, Eduard, Estela Salagre, Iria Grande, André F. Carvalho, Brisa S. Fernandes, Michael Berk, Boris Birmaher, Mauricio Tohen, and Trisha Suppes. “Early Intervention in Bipolar Disorder.” The American Journal of Psychiatry 175, no. 5 [May 1, 2018]: 411–26. //doi.org/10.1176/appi.ajp.2017.17090972
Bobo, William V. “The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update.” Mayo Clinic Proceedings 92, no. 10 [October 2017]: 1532–51. //doi.org/10.1016/j.mayocp.2017.06.022
Bonnín, Caterina Del Mar, María Reinares, Anabel Martínez-Arán, Esther Jiménez, Jose Sánchez-Moreno, Brisa Solé, Laura Montejo, and Eduard Vieta. “Improving Functioning, Quality of Life, and Well-Being in Patients With Bipolar Disorder.” The International Journal of Neuropsychopharmacology 22, no. 8 [August 1, 2019]: 467–77. //doi.org/10.1093/ijnp/pyz018
Rolin, Donna, Jessica Whelan, and Charles B. Montano. “Is It Depression or Is It Bipolar Depression?” Journal of the American Association of Nurse Practitioners 32, no. 10 [October 2020]: 703–13. //doi.org/10.1097/JXX.0000000000000499
Hearing, CM, WC Chang, KL Szuhany, T Deckersbach, AA Nierenberg, and LG Sylvia. “Physical Exercise for Treatment of Mood Disorders: A Critical Review.” Current Behavioral Neuroscience Reports 3, no. 4 [December 2016]: 350–59. //doi.org/10.1007/s40473-016-0089-y
Melo, Matias Carvalho Aguiar, Elizabeth De Francesco Daher, Saulo Giovanni Castor Albuquerque, and Veralice Meireles Sales de Bruin. “Exercise in Bipolar Patients: A Systematic Review.” Journal of Affective Disorders 198 [July 2016]: 32–38. //doi.org/10.1016/j.jad.2016.03.004
Bipolar Disorder – Symptoms, causes, and treatment. [National Institute of Mental Health]
Rapid Cycling – Signs, symptoms, and causes of rapid cycling in bipolar disorder. [Depression and Bipolar Support Alliance]
Bipolar – Workbook and other self-help resources. [Centre for Clinical Interventions]
Last updated: November 1, 2022